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"For a person with garden-variety back pain who is willing to move their body, the bottom-line is that a beginner's yoga class geared for back pain or a very intensive stretching exercise program would be equally suitable as a treatment," said study lead author Karen J. Sherman, an associate professor of epidemiology at the University of Washington and a senior investigator with the Group Health Research Institute in Seattle.
"Now we're not talking about a person with severe back pain who is unable to move their body," Sherman cautioned. "But for the typical back-pain patient both approaches are certainly better than what people usually do, which is take some meds and tough it out. And both seem to afford more clinically meaningful improvements than simply giving a patient a self-care book."
The study is published online Oct. 24 in the Archives of Internal Medicine.
Patients face a plethora of options for relieving back pain, including medication, massage therapy and chiropractic treatment. But such approaches often come at significant cost, without much assurance of effectiveness, the authors said.
With that in mind, they set out to explore the potential benefit of exercise in various forms.
Between 2007 and 2009, Sherman and her associates focused on 228 chronic low-back pain patients residing in the state of Washington.
Nearly 60% of the participants were already using medication (usually nonsteroidal anti-inflammatories) at the time of the study launch.
Patients were divided into three different treatment groups: a yoga class group (92 patients), a stretching class group (91 patients) and a self-care book group (45 patients).
For three months, the two class groups participated in weekly 75-minute-long classes designed for patients who had never tried either yoga or stretching.
The yoga group was exposed to the techniques of "viniyoga," which involved breathing exercises, deep relaxation and a range of simple postures.
Those in the stretching class engaged in strengthening exercises alongside stretching techniques targeting all the major muscle groups, with emphasis on the trunk and legs.
In addition, the yoga and stretching groups received instructional videos and were asked to practice 20 minutes a day.
Those in the self-care group received a copy of The Back Pain Helpbook, which outlines causes of back pain and offers advice centered on solo exercise techniques and potentially helpful lifestyle changes.
All the participants were interviewed midway through treatment, at the end of treatment, and three months after treatment was completed.
The result: Although back-related function improved among all the participants, those in the yoga and stretching groups were functionally better off than the self-care group at the study's end and three months later.
Yoga and stretching participants were also twice as likely as the self-care group to have cut back on pain medication.
"In both groups, people had less pain and were more able to carry on with their lives in terms of the activities of daily living," Sherman said.
Sherman noted that the yoga classes were highly physical in nature, while the stretching classes involved an above-average amount of long-held stretching and relaxation.
"It's worth noting that not all classes are the same," she said. "You need to find one that's appropriate for your situation. And depending where you are that can be tricky, particularly for stretching classes for which you'd want a trainer with a therapeutic orientation. Not the sort of thing you'll find in a typical gym."
Acknowledging the higher cost of classes compared to a self-help book, Sherman said, "I think it would be worth the investment to really learn how your body operates. And then perhaps eventually go off and do it on your own."
Study co-author Dr. Richard A. Deyo, a professor of evidence-based medicine in the department of family medicine at Oregon Health and Science University in Portland, suggested that the larger message for patients is simple: Exercise can help.
"Yoga is certainly an option," he said. "But if you like stretching better, that's fine, too. Walking, that's fine. Swimming, that's fine. Biking, that's fine. Basically, what's important is that you choose an activity you enjoy doing. Because you're more liable to keep it up."
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