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Regular practice of yoga can reduce lower-back pain, improve sleep and lessen reliance on pain medication, according to a <a href="https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2825746">study</a> conducted by Cleveland Clinic researchers.

The randomized clinical trial studied 140 Cleveland Clinic employees who had disclosed moderate amounts of pain for at least three months. Participants who engaged in a 12-week virtual yoga program reported feeling less pain and better sleep when compared with those who did not have access to the program.

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The study shows yoga can be effective when considered as part of a patient’s usual care, the way medications or referrals to physical therapy can be, said <a href="https://my.clevelandclinic.org/staff/27896-robert-saper">Robert Saper</a>, chair of the department of wellness and preventive medicine at the Cleveland Clinic and the senior author of the study. But unlike those interventions, the holistic approach to well-being common in yoga practices can address how pain affects a person overall.

“An anti-inflammatory medication can address that physical component, but perhaps the yoga may affect the emotional piece, the social piece, and even that area around meaning and purpose,” he said.

<a href="https://sleep.hms.harvard.edu/faculty-staff/sat-bir-singh-khalsa">Sat Bir Singh Khalsa</a>, an associate professor of medicine at Harvard Medical School who was not involved in the research, said the study was “encouraging” in part because a virtual class lacks an in-person instructor to ensure people are doing the postures correctly. Remote classes also remove some of the barriers to yoga, such as finding child care or paying for a class.

“The fact that you can get a positive benefit from a virtual class has enormous implications for the general public,” Khalsa said.

The average age of the participants was 48. Eighty percent were female, and 73.5 percent were college-educated. The cohort was split into a practicing “yoga now” group and a “yoga later” group, which was offered the program after the study’s conclusion but was not assessed.

The “yoga now” group attended a 60-minute live-streamed class each week and were encouraged to practice at least 30 minutes a day. They were given a mat and a supplemental packet explaining the postures and access to videos to encourage yoga practice on their own.

The study specifically centered around Hatha yoga, a style which emphasizes more static holds and breathing techniques compared with speedier Vinyasa practices. It included postures such as sphinx pose, bridge pose and shoulder openers.

About 36.6 percent of participants took part in the classes at least 50 percent of the time. The median days of practice outside the class was three to six, and the average amount of time spent practicing on those days was 28.1 minutes.

Before starting the trial, participants rated their lower-back pain, on average, as at least a 4 on an 11-point scale. After 12 weeks, the group which took part in yoga reported an average reduction in pain intensity of 1.5 points, and after 24 weeks, a mean reduction in pain intensity of 2.3 points.

Participants were also asked to rate their sleep quality on a scale of 0 to 4, with the rating on average being fair to poor. The “yoga now” group reported on average a 0.4 percentage point improvement after the 12 weeks compared with the “yoga later” group.

Use of pain medication was also tracked during the study. The “yoga now” group reported 34 percent fewer members using pain medication at the end of the 12 weeks of yoga compared with “yoga later” participants.

The study was published in JAMA Network Open on Friday.

Lower-back pain is extremely prevalent, affecting over 619 million people worldwide in 2020 and the leading cause of years lived with disability, according to a <a href="https://www.thelancet.com/journals/lanrhe/article/PIIS2665-9913(23)00098-X/fulltext">2021 study</a> in Lancet Rheumatology. Causes can include a <a href="https://www.niams.nih.gov/health-topics/back-pain/basics/symptoms-causes">lack of physical activity, injury or workplace stresses</a>.

Treating lower-back pain with yoga or physical therapy is recommended by the <a href="https://www.hhs.gov/sites/default/files/pain-mgmt-best-practices-draft-final-report-05062019.pdf">Department of Health and Human Services</a> and the <a href="https://www.acpjournals.org/doi/10.7326/M16-2367">American College of Physicians</a> as noninvasive methods before exploring more pharmacological interventions such as surgery.

Yoga is a good option for back pain because of its focus on static poses and its variations for those who may need a chair or another mobility aid to perform the moves, Saper said.

“We wanted to create a sequence of doable yoga poses for the individual who perhaps has never done yoga before, or who has multiple chronic conditions, or who is large,” he said.

Movement is crucial for pain management because it helps<b> </b>retrain the brain to understand which movements are safe to make, and it prevents muscle atrophy, said <a href="https://www.brighamandwomens.org/foxborough-health-care-center/foxborough-services/rehabilitation-staff">Marissa Lizotte</a>, a senior physical therapist with Mass General Brigham.

Yoga’s specific focus on moving gradually into positions as well as its focus on balance and stability makes it well-suited to help with injury recovery, Lizotte said. The postures can also trigger the parasympathetic nervous system, encouraging people to relax.

“The more our body can be in a parasympathetic response, the lower our pain will be, and if in that state regularly, strengthens the brain in the areas that modulate pain,” she said.

Why doctors may not recommend yoga for pain relief

Doctors rarely prescribe yoga as treatment, Saper said. Yoga is rarely covered by insurance, so doctors might hesitate to recommend it. Other times people are not aware of its potential benefits. Sometimes doctors do not have the time to talk with their patients about alternative treatments.

“One issue is that it’s easier to write a prescription for a pill or to refer a patient to a specialist who may do more pharmacologic procedures. You know, it takes less time to do that than to counsel the patient on yoga,” Saper said.

One limitation was that people self-reported their participation and feelings after the treatment. Another limitation was the “low rate of class attendance,” the study authors said.

Busy schedules may have been a factor in why the “yoga now”<b> </b>saw only an average 36 percent attendance rate, Khalsa said. But, he said, having videos for people to practice at their leisure shows results are possible even if they are not doing the prescribed amount of yoga.

“You may have a perfect intervention that works perfectly if people do it 100 percent, but you’re working in the real world, and people just don’t comply,” he said. “That’s part of human nature in clinical trials.”

Cleveland Clinic does not offer the Hatha yoga course used in the study, but has an <a href="https://clevelandclinic.ungerboeck.com/prod/app85.cshtml?AppCode=COE&CC=2&OrgCode=20">introductory yoga course</a> available online free.

For those looking to explore yoga virtually, there are several instructors available on YouTube. Your gym or recreational center may offer in-person classes.

Lizotte encouraged people to approach any exercise with a careful mind set. Keeping yourself safe can result in less pain, she said.

“Usually the rule I go by is slowly increasing your activity level and progressing your exercise from where you currently are to help avoid injury, and then slowly building up to your desired level of fitness as tolerated,” she said.

A previous version of this article incorrectly said that the “yoga now” group reported on average a 0.4 percent improvement in sleep quality after the 12 weeks compared with the “yoga later” group. The difference was 0.4 percentage points. The article has been corrected.

Caitlin Andrews

Yoga may help reduce lower back pain, study says

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Yoga instructor teaching online class from studio.

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