Effects of Yoga Therapy on Pain, Quality of Life, and Functional Ability in Chronic Low Back Pain Patients: A Systematic Review

Review Article

Ann Yoga Phys Ther. 2016; 1(2): 1010.

Effects of Yoga Therapy on Pain, Quality of Life, and Functional Ability in Chronic Low Back Pain Patients: A Systematic Review

Singh R*

Department of Physical Therapy, The Sage Collages, USA

*Corresponding author: Singh Rupali, Department of Physical Therapy, The Sage Collages, Troy, NY, USA. 65 1st Street Troy, NY, 12180, USA

Received: June 10, 2016; Accepted: September 26, 2016; Published: September 28, 2016


Chronic Low Back Pain (CLBP) is a common musculoskeletal condition that often results in significant physical and psychological impairments. Although conservative therapies are available for treatment, they don’t always address the comprehensive nature of pain. Yoga is an ancient discipline that incorporates practices to develop mental and physical health, and may be an effective intervention for treating chronic pain conditions. The purpose of this systematic review is to determine the effectiveness of yoga therapy for the treatment of CLBP. A comprehensive search using a combination of the words “yoga” and “chronic low back pain”, “yoga” and “back” and “yoga” and “chronic pain” was conducted, After meeting the selection criteria, articles were further analyzed and assessed for quality. Thirteen randomized control trials met the criteria for inclusion into the review. Post intervention, yoga therapy was highly effective treatment for reducing pain intensity and back related function, and moderately effective at improving quality of life, as compared to inactive controls. Limitations of this review include the high percentage of studies designed with inactive control groups and the use of non-study treatments, making it difficult to determine if the results are specifically attributable to yoga. This systematic review suggests that yoga therapy can have a positive effect on pain, functional disability, and quality of life in individuals with CLBP. Future research will need to be focused on establishing a dose response relationship that best treats CLBP.

Keywords: Chronic low back pain; Yoga; PEDro scale; Back related function


Low back pain is a common musculoskeletal condition affecting approximately 70- 85% of adults at some point in their lifetime [1,2]. Low back pain is one of the leading causes of functional disability and the second most frequent reason for medical consultation [2]. It is a costly musculoskeletal condition that imposes a high economic burden on individuals, employers, and the health care system [3]. The annual economic cost of chronic pain is US $600 billion in the US alone [3]. Lost work productivity is the primary driver of this economic burden, with an estimated amount of 250 million workdays lost per year [2,4]. Approximately 85-90% of low back pain cases will resolve within 8 to 12 weeks, but the remaining I 0-15% will develop chronic symptoms leading to substantial loss of function [2]. Despite the low proportion of cases, chronic low back pain accounts for a majority of the disability and costs associated with low back pain [2]. In addition to the physical impairments, several studies have indicated a high prevalence of comorbidities such as depression, anxiety, and sleep disturbances among patients with Chronic Low Back Pain (CLBP), increasing the complexity of treatment [2]. Current recommendations for CLBP management consist of patient education, pharmacotherapy, psychosocial interventions, physical therapy, and alternative therapies: including chiropractic care and yoga, and surgical interventions [2]. Psychosocial interventions include different types of psychotherapy and social and vocational training to provide support, education and guidance to people with chronic pain. Despite the wide range of treatment options available for CLBP, a vast majority of patients fail to achieve adequate pain relief and restoration of function [5]. Randomized control trials have been conducted over the past years evaluating all types of conservative, complementary, and surgical treatments for LBP [6]. Conservative treatments often include opioids, antidepressants, NSAIDs, muscle relaxants, orthosis, exercise, spinal manipulation, traction, and trigger point injections while complementary treatments consist of acupuncture and massage therapy [7,8]. Surgical procedures most commonly consist of spinal fusion, laminectomy, interlaminar implant, foraminotomy, discectomy, and disc replacements [4,7]. Unfortunately, many of the interventions commonly utilized for LBP, lack sufficient evidence of long-term efficacy [6]. Current guidelines suggest that exercise is beneficial for management of low back pain, but exercise treatments have only demonstrated small and short term effects [6]. Pain is the most common reason for patients to seek health care settings. Pain also has psychological factor associated with it besides the pathological factor. The first psychological process that occurs with pain is attention. Attention is directed toward noxious stimuli which can serve as a warning signal. Attention is followed by interpretation of pain. Interpretation involves cognitive processes used to interpret what the noxious stimuli mean [9]. When a painful stimulus has been attended to and interpreted as being a threat, strategies for dealing with this threat are initiated. These coping strategies involve cognitive and behavioral techniques like relaxation, to reduce the threat of pain [9]. CLBP is also characterized by both pathological and psychological components. In order to manage CLBP both pathological and psychological components must be addressed. Yoga has shown its effectiveness in addressing the pathological and psychological components [10]. Yoga is an ancient discipline that was first described in detail nearly 2000 years ago. It incorporates practices to develop mental and physical health, overall well-being, and inner harmony [11]. Yoga consists of some crucial elements, including physical postures, breathing techniques, relaxation and meditation [12]. It has been introduced and practiced in Western cultures over the past century, and includes practices of meditation, respiratory exercises, physical exercises, and postures. This form of treatment can be included in the spectrum of Complementary and Alternative Medicine (CAM) interventions that are not part of conventional medicine, but are used either in place of or in conjunction with other forms of treatment to improve health and well-being [2]. Additional advantages of yoga include improving health outcomes in both diseased and healthy populations, including blood glucose [13], heart rate variability, blood lipids, oxidative stress, and salivary cortisol [14]. Yoga also improves subjective measures of fatigue, pain, and sleeps [15] and can also reduce blood pressure, cholesterol levels [16], and body weight [17]. Yoga helps in improving musculoskeletal functioning, and increase endorphin levels resulting in decreasing pain and stress [18]. Yoga has also helped with the management and treatment of conditions like diabetes, COPD, hypertension, chronic urologic conditions, and some forms of cancer [18-24]. Yoga has also shown to be effective in treating psychological conditions. Duraiswamy, et al. investigated the effects of yoga on psychopathology, quality of life and social functioning in patients with schizophrenia, as compared to physical exercise. Psychopathology was assessed using Positive and Negative Syndrome Scale, quality of life was assessed by WHO Quality of Life BREF version and social functioning was assessed using social and occupational functioning scale. Group receiving yoga therapy had less psychopathology, greater social and quality of life as compared to group receiving physical exercise [25]. Since yoga can address pathological and psychological components, researchers have begun investigating its effects on chronic pain. Yoga has shown its effectiveness in treating many chronic pain conditions, including low back pain [19,26-28]. The purpose of this systematic review was to appraise and synthesize the current evidence on the effectiveness of yoga therapy for the treatment of chronic low back pain, with a focus on pain, quality of life, and functional assessments as treatment outcomes. The hypothesis of this systematic review was that yoga therapy is effective treatment of chronic low pain.


Search strategy

A peer reviewed literature search was conducted in May 2014 using the following electronic databases: Pubmed/Medline, Cinahl, Cochrane and Physiotherapy Evidence Database (PEDro). Initial search was comprehensive using a combination of the words “yoga” and “chronic low back pain”, “yoga” and “back” and “yoga” and “chronic pain”. Additionally, reference lists of identified original and review papers were reviewed for any cited articles that fit the criteria of this review. The literature retrieval process in depicted in (Figure 1).

Study selection

Inclusion criteria

To be eligible for analysis, studies needed to meet the following conditions:

Exclusion criteria

Data extraction

Two authors independently extracted data on characteristics of the study (e.g. trial design, randomization, blinding), patient population (e.g. age, diagnosis), intervention and control (e.g. type, duration, frequency), outcome measures (e.g. type, assessment time points), and results. Discrepancies were discussed with a third reviewer until consensus was reached.

Quality assessment

The 13 included articles were assessed for quality by 2 of the authors using the PEDro scale, which evaluates the internal validity and statistical information of a study. There are 11 items included in the scale, and all but 2 are based on the Delphi list (a list of trial characteristics that is related to trial “quality”). One item on the PEDro scale interprets information regarding external validity, and is therefore not included in the final scoring, making the reported score out of 10. Items assessed by this scale are: random allocation, concealed allocation, similarity at baseline, subject blinding, therapist blinding, assessor blinding, >85% follow up for at least one key outcome, intention-to-treat analysis, between group statistical comparison for at least one key outcome, and point and variability measures for at least one key outcome [29]. Scoring is interpreted using the following descriptive scale: 9-10 Excellent, 6-8 Good, 4-5 Fair, < 4 Poor. Eleven (85%) of the articles scored a 6-8/10 and 2 (15%) scored 4-5/10. Scores for the individual articles are listed in (Table 1).

Citation:Singh R. Effects of Yoga Therapy on Pain, Quality of Life, and Functional Ability in Chronic Low Back Pain Patients: A Systematic Review. Ann Yoga Phys Ther. 2016; 1(2): 1010.