Role of Yoga Therapy in Chronic Low Back Ache – A Randomized Controlled Trial

Research Article

Ann Yoga Phys Ther. 2016; 1(2): 1008.

Role of Yoga Therapy in Chronic Low Back Ache – A Randomized Controlled Trial

Bali Y¹*, Ebnezar J² and John R³

¹Chief Ayurveda & Yoga Consultant, AAYUSH-An Integrated Ayurveda Multispeciality Hospital & Research Centre, India

²Consulting Orthopedic and Spine Surgeon, Parimala Health Care Services, India

3Senior Resident, Parimala Health Care Services, India

*Corresponding author: Yogitha Bali, AAYUSH-An Integrated Ayurveda Multispeciality Hospital, #120, 5th cross, Omkarnagar, Near Reliance Mart, Arakere, Bannerghatta Road, Bangalore-560076, India

Received: July 01, 2016; Accepted: September 02, 2016; Published: September 07, 2016


Objective: The aim of this study was to evaluate the efficacy of Integrated Approach of Yoga Therapy (IAYT) as an add-on treatment for pain, tenderness, back disability, and spinal flexibility in patients undergoing conventional treatment for chronic low back ache.

Design: 120 patients suffering from Chronic Low Back Pain (CLBP), aged 18–75 years (yoga group = 41.29±15.87, control group = 41.63±13.48) from Ebnezar orthopedic center, Bengaluru were randomly assigned into2 groups-a yoga group and a control group-to receive IAYT or therapeutic exercises after intermittent lumbar traction and ultrasound (20 minutes per day). Both groups practiced supervised interventions for three weeks at the center and later, for 12 weeks, at their residences after the completion of treatment.

Outcome Measures: Both groups were assessed for pain, tenderness, back disability, and spinal flexibility on the 1st day in the pre-test and on the 21st day in the post-test. Data were analyzed using repeated measures analysis of variance (RMANOVA).

Results: There were significant differences within (RMANOVA, p<0.001) and between the groups (RMANOVA, p<0.001) in pain, tenderness, back disability, and spinal flexibility with greater improvement in the yoga group than in the control group. Pain in the yoga (39.9%, 66%, 85%, 98.9 %) and control (25.5%, 45%, 63%, 74%), tenderness in the yoga (60%, 81%, 95%, 99 %) and control (37%, 51%, 60%, 80.7%), back disability in the yoga (55%, 81%, 96%, 99.7 %) and control (35%, 53%, 63.8%, 80.7%), movements- flexion in yoga (77%, 126%, 183%, 232%) and control (33%, 64%, 99%, 132%), extension in yoga (75%, 113%, 130%, 132%) and control (34%, 68%, 102%, 121%), right lateral flexion in yoga (78%, 113%, 126%, 129%) and control (32%, 66%, 99%, 117%), left lateral rotation in yoga (76%, 109%, 119%, 120%) and control (33%, 67%, 100%, 113%), right lateral rotation in yoga (70%, 107%, 136%, 143%) and control (29%, 58%, 89%, 114%), left lateral rotation in yoga (66%, 103%, 129%, 130%) and control (28%, 55%, 84%, 107%). All these improved in the yoga group better than the control group on the 21st day, the 3rd month, the 6th month, and at one year, respectively.

Conclusion: IAYT an add-on to conventional physiotherapy provides significantly better improvement than therapeutic exercises alone in patients suffering from CLBP.

Keywords: Chronic low back pain; Integrated approach of yoga therapy; Therapeutic exercises; Physiotherapy


Low back pain is a common condition comprising a major health problem worldwide [1]. Low back pain was identified by the Pan American Health Organization as one of the top three occupational health problems to be targeted by surveillance within the WHO Region of the Americas. Thirty-seven percent of Chronic Low Back Pain (CLBP) worldwide and 39% of CLBP in South East Asia, including India and China, is attributable to occupational ergonomic stressors, both physical and psychosocial [2]. Campbell, et al. report that in the United States the estimated annual cost to society of back pain is between £13 billion and £33 billion ($20–50 billion) [3]. Low back pain is the most prevalent musculoskeletal condition and the most common cause of disability in developed nations [4]. As part of the Global Burden of Disease 2010 Study (GBD 2010), the global burden of musculoskeletal conditions was estimated using updated methods that address the methodological limitations of previous GBD studies. Burden was expressed in Disability-Adjusted Life Years (DALYs) [5]. The lifetime prevalence of low back pain is estimated at 60–85%, while the annual prevalence in the general population ranges from 15–45% [6]. In about 85% of these cases, low back pain is secondary to nonspecific or functional causes, meaning that no specific underlying anatomic etiologic condition can be identified [7]. Back pain patients incur up to 75% more medical expenditures than patients without back pain [8]. The most commonly prescribed medications for low back pain are Nonsteroidal Anti-Inflammatory Drugs (NSAIDs), skeletal muscle relaxants, and opioid analgesics [9]. Benzodiazepines, systemic corticosteroids, antidepressant medications, and antileptic drugs are also prescribed [10]. According to Chou, et al. NSAIDs and skeletal muscle relaxants are moderately effective for short-term pain relief, while tricyclic antidepressants showed small to moderate effects; there was also fair evidence that acetaminophen, tramadol, benzodiazepines, and gabapentin provide pain relief [9]. The utilization rates for injection therapies have risen about 250% between 1994 and 2001; however, the evidence for these therapies is controversial [11]. Lastly, surgical treatment of non-specific low back pain has not been shown to be reliably successful [12]. Depending on the outcome measure or surgery utilized, “success” rates for surgery for low back pain only range from 40% to 65% [11]. Patients who do not improve after treatment with self-care activities and/or medications are good candidates for non-pharmacological treatments. Non-pharmacological treatments include physical treatments (i.e., heat, ice, ultrasound, and massage therapy), spinal manipulation and forms of injection therapy [9]. A biopsychosocial approach is now considered to be the gold standard for treating chronic pain [13].

Although the causal relationship between psychological symptoms and CLBP is complex, research evidence indicates that psychological symptoms often improve in low back pain patients after exercise interventions, even if the interventions were not specifically designed to affect the psychological symptoms. Conversely, placebo or sham treatments for low back pain have not resulted in significant changes in psychological symptoms. Data from the National Center for Complementary and Alternative Medicine (NCCAM) show that the usage of Complementary and Alternative Medicine (CAM) treatments for all conditions is on the rise in the US [11]. Reviews, meta-analyses, [14–16] and practice guidelines from the American Pain Society and the American College of Physicians [9] support yoga as an evidence-based treatment for CLBP with at least moderate benefit. Five large (n = 90–313) and five smaller Randomized Controlled Trials (RCTs) (n = 20–60) support yoga’s effectiveness for reducing pain and improving function in adults with CLBP [17]. The present research was planned to study the effects of yoga as an adjunct to physiotherapy-the standard conventional treatment in the management of chronic low back ache-as there were no studies on chronic low back ache comparing yoga to physiotherapy [18].


One hundred twenty patients with CLBP from the outpatient department of Ebnezar Orthopedic Center, Parimala Health Care Services, and Bengaluru were recruited for the study. A sample size of 120 was obtained by calculating the effect sizes based on the mean and standard deviation of an earlier published interventional study [19] (Table 1) includes the baseline characteristics. One hundred twenty patients of both genders with CLBP, aged 18–75 years, were included in the yoga group (41.29±15.87) and in the control group (41.63±13.48).