People who suffer from chronic back pain may find some relief in yoga or intensive stretching, but neither form of exercise appears to be more effective than the other, a new study suggests.

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By Amanda MacMillan

MONDAY, October 24, 2011 ( — People who suffer from chronic back pain may find some relief in yoga or intensive stretching, but neither form of exercise appears to be more effective than the other, a new study suggests.

Roughly 80% of adults experience low back pain at some point in their lives, and as many as 8% will experience chronic symptoms that last three months or longer. Primary care physicians regularly prescribe painkillers and muscle relaxants to these patients with varying degrees of success, or refer patients to physical therapists, chiropractors, or other specialists. Many doctors also recommend exercise and stretching, but few studies have explored whether certain physical activities are especially effective for back-pain patients.

The new study, which appears this week in the Archives of Internal Medicine, is a follow-up to a small 2005 trial that found that yoga was slightly better for back pain than a comprehensive exercise program that included strength training, aerobics, and stretching. The researchers suspected this might have been due to the meditation-like "mental component" of yoga, and they expected to get a similar result this time around.

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The study included 228 mentally healthy adults with moderate chronic back pain, most of whom were fairly active in spite of their pain. The researchers randomly assigned them to one of three groups: One group took weekly 75-minute yoga classes, another took weekly stretching and strength classes, and a control group received a book on coping with back pain. The yoga and stretching groups also received instructional videos and were encouraged to practice at home for 20 minutes a day between classes.

Three months later, the stretching and yoga participants were far more likely than the people in the control group to report improvement in their back pain. Twice as many participants in these two groups (about 40%, versus 20% in the control group) said they'd decreased their medication use, a trend that persisted three months after the yoga and stretching classes ended.

Yoga was no more effective than stretching, however. This finding, which surprised the researchers, suggests that the back-pain benefits of yoga are mostly due to its physical (rather than mental or spiritual) aspects, the study notes. And in fact, the stretching class was not unlike a yoga class, says Karen Sherman, PhD, the lead author of the study and a senior investigator at the Group Health Research Institute, the research arm of a Seattle-based nonprofit health plan.

The stretching classes comprised "52 minutes [of] focusing on all the major groups in the back and the legs," Sherman says. "In that sense it was more like a yoga class with specific poses than what you'd think of as regular stretching."

Scott Duke, a sports chiropractor in New York City who was not involved in the study, says he's not surprised by the results. "I recommend flexibility exercises to every single lower back pain patient I have," he says. "Therapeutic stretching combined with relaxation and deep breathing absolutely helps low back pain."

The study should encourage physicians to incorporate stretching into their standard treatment protocol for back pain, Duke says. "Doctors today are looking for ways patients can be more proactive and take care of their own back pain, versus having to go to somebody to get treated," he adds.

But not just any yoga or stretching class will do the trick. The type of yoga used in the study focused on the back and legs, and was adapted for each individual's physical limitations. Sherman stresses that back-pain patients should avoid vinyasa, or "power yoga," classes, and should seek out therapeutic and restorative styles instead.

Without proper guidance and limits, patients may find themselves worse off than when they started. Even in the study, about 15% of the yoga and stretching participants exacerbated their back pain, a rate Duke says is close to real-world averages. (One patient in the control group also reported injuries from attempting exercises described in the self-care book.)

"Find a class geared toward beginners, and an instructor who has experience working with and making adjustments for people with chronic pain," Sherman says. "Go to class, practice at home, and see if it works. And if not, try another class."