Improve Function in People with Back Pain

Years ago, treating low back pain revolved around bed rest. These days, we know better: Getting up and moving around is one of the best ways to improve back pain of unknown cause. Yoga, particularly, has been shown in studies to benefit people with mild to moderate chronic low back pain that lasts three months or longer.

The benefit of yoga is borne out again in a U.K. study published in the Annals of Internal Medicine. Researchers compared yoga therapy's effectiveness to that of traditional medical care for chronic or recurrent low back pain. They found that yoga relieved pain no better than routine care did. But, people with low back pain who took yoga classes reported being able to function better than those who didn't attend classes. Their mobility improved when walking and performing everyday household tasks, and they could stand for longer than usual periods despite pain.

Most of the 313 study participants were middle-aged women who suffered from moderate chronic or recurrent back pain for an average of 10 years. Half the participants took weekly 75-minute yoga classes for three months. The other half continued their usual routine care. Although the findings didn’t specify the types of routine care used, typical back pain treatment includes physical activity, pain medicine, muscle relaxants or spinal manipulation.

Yoga classes were specially designed for beginners to improve back function. Attendees were asked to practice yoga poses at least twice a week at home in addition to their weekly classes. At three, six and 12 months, the yoga group saw a bigger improvement in back function than the routine care group did. They also felt more confident in their abilities to perform normal activities despite pain at three and six months.

At least 65 percent continued to practice yoga after the study, which may be why the benefits continued, not because the earlier yoga classes were still having an effect. Stretching helps, too If yoga's not your thing, stretching may work just as well. That's according to a separate study sponsored by the National Center for Complementary and Alternative Medicine and published in the Archives of Internal Medicine.

Unlike the U.K. findings, this study reported a slight improvement in back pain among people who took yoga or stretching classes. However, the U.S. study did not compare yoga or stretching with routine care. Instead, researchers compared the effectiveness of yoga, stretching and self-care.

The 228 study participants all suffered from moderate nonspecific low back pain—pain that can't be explained. Persons who attended weekly 75-minute yoga or stretching classes for 12 weeks reported less pain and better back function than those assigned self-care with the help of a book about managing back pain.

The yoga classes were designed for beginners with chronic low back pain, based on the principles of Viniyoga, a modified version of yoga configured to each student’s particular needs. Stretching classes included some aerobic and strengthening exercises. All students were asked to practice yoga or stretching at home between classes.

As the study progressed, class attendees were twice as likely as those in the self-care group to cut back on their pain medication. At 12 and 26 weeks, all groups reported some improved back function and less pain, but the most substantial benefits were among the yoga and stretching groups.

Getting started

If you want to try yoga or stretching, you may have better success by taking a class than practicing at home. The people in both studies who benefited the most attended structured classes. This suggests that attending classes may improve the likelihood of sticking with a program.

Yoga. Look for a gentle beginner's class. Yoga classes vary widely, so make sure the program you choose is safe for someone with back ailments:

  • Seek classes with licensed instructors trained in modifying poses for persons with physical limitations.
  • Start with gentle and slow-paced forms such as Hatha or Viniyoga. Iyengar yoga—a form of Hatha—is a good choice for older adults and focuses on balance and alignment.
  • Stay away from vigorous classes like Bikram ("hot”"yoga), Ashtanga, Vinyasa and "power yoga."

Stretching. Intensive stretching classes aren't as readily available as yoga classes. The stretches in the study were held for at least 30 seconds—longer than stretches held during conventional exercise classes.

Your doctor may recommend a physical therapist who can tailor exercises to your condition. Stretches should focus on the major muscle groups, emphasizing the trunk and core.

Doctor's Viewpoint

Lee Hunter Riley, M.D., Associate Professor, Orthopaedic Surgery & Neurological Surgery Johns Hopkins Medicine

Just like other therapies for back ailments, yoga or stretching isn't effective for everyone. Yet, if you're willing to engage in physical activity, both therapies can be moderately beneficial.

They’re relatively safe, inexpensive and accessible. However, it's always a good idea to work with a qualified instructor who can help you modify and correct any poses for maximum benefit and safety.

Source: Prepared by the Editors of The Johns Hopkins Medical Letter: Health After 50

Publication Review By: the Editorial Staff at

Published: 17 Jul 2013

Last Modified: 02 Sep 2015