Low back pain affects a substantial proportion of adults. Currently, the treatment options are limited and often fall short. A new review asks if yoga, tai chi, and qigong might prove effective in reducing pain.

Low back pain is common but difficult to treat. Could yoga offer respite?
The latest review concludes that these practices may benefit some people with low back pain. However, because there is so little high quality research, it is currently impossible to reach reliable conclusions.

According to the National Institute of Neurological Disorders and Stroke, around 80% of adults in the United States experience low back pain at some point in their lives. Current treatments include medications such as opioids, self-care, surgery, and physical therapy.

Because of the significant health and cost implications of opioids and major surgery, physical therapy is starting to receive increased attention from researchers.

As the authors of the new review explain, chronic low back pain “often contributes to emotional distress, including depression, anxiety, sleep disturbance, and social isolation,” and “no effective treatment has been identified.”

Finding a drug-free, low cost intervention for low back pain could change millions of lives. As complementary and alternative therapies become more popular, some researchers are keen to understand whether or not they could benefit people with low back pain.

The review, which now appears in the journal Holistic Nursing Practice, set out to investigate how effective they might be.

Focusing on the alternatives
The authors of the review hailed from Florida Atlantic University’s College for Design and Social Inquiry and the Christine E. Lynn College of Nursing, both in Boca Raton, FL.

They focused on “movement-based mind-body interventions” — specifically, yoga, tai chi, and qigong. All three have both a physical and a meditative aspect to them.

“We reviewed data to determine the effects of movement-based mind-body interventions on chronic back pain, psychological factors, coping strategies, and quality of life in people […] with back pain,” explains corresponding review author Juyoung Park, Ph.D. She adds:

“Our goal was to provide a comprehensive assessment of the effects of these interventions to be able to offer information across disciplines to implement evidence-based interventions to reduce such pain.”

Following a thorough search of the existing research papers, the authors found just 32 studies that met their criteria. These included 3,484 participants. Twenty-five of the studies focused on yoga, four examined tai chi, and three looked at qigong.

Overall, the authors conclude:

“A majority of the 32 reviewed articles showed [movement-based mind-body interventions] to be effective for treatment of [low back pain], reporting positive outcomes such as reduction in pain or psychological distress (e.g., depression and anxiety), reduction in pain-related disability, and improved functional ability.”

No firm conclusions
Although the authors’ conclusions are positive, there are sizable limitations to the review, and it is still difficult to draw solid conclusions from the data that are currently available.

One limitation is that the new paper is a narrative review. This type of review collates information about a given topic and provides an overview.

Narrative reviews do not generally involve any data analysis. In fact, the authors explain that they did not carry out a meta-analysis “because some of the selected studies showed low methodological quality and did not report an effect size across the studies.”

Also, the effects of yoga, tai chi, and qigong on back pain have not received much attention, so there have been no large studies on the matter. The largest study in the review included 320 participants and the smallest just 25.

Similarly, some of the studies were relatively brief. The shortest lasted 6 weeks, which means that the researchers could not ascertain the long-term effects of these interventions.

The authors also note that many of the papers did not clearly explain how the original teams ran their experiments. For instance, they explain that although 26 of the 32 trials claimed to be randomized controlled trials, “most studies did not report in detail the specific process of randomization, allocation concealment, or blinding.”

Indeed, Park explains, “We need more clinical trials and empirical evidence” before doctors can prescribe these types of intervention for low back pain.

Additional research is particularly important because some of the studies did report some adverse events. As the authors outline, “11 yoga studies, one tai chi study, and one qigong study reported mild joint and back pain.”

However, although significant doubt remains, that does not mean that engaging the mind and body in this way does not help ease back pain. There is a significant psychological component to chronic low back pain, so testing methods that address the brain and body at once seems, on paper, to be a sensible approach.

To answer the question posed in the title, we still don’t know if yoga, tai chi, or qigong can help relieve low back pain.