# Exercise as it relates to Disease/Yoga or exercise for chronic lower back pain?
### What is the background to this research?

Chronic lower back pain (CLBP) is something that can effect many adults though their life time, whether it be from injury through sports, traumatic injury, pregnancy, osteoporosis, slipped disks or spinal irregularities such as pars syndrome, scoliosis, lordosis and many more. Chronic lower back pain is defined as pain that persists over 12 or more weeks and is a main cause for missed work days or time off work and can lead to other illnesses such as depression. CLBP can cause people to become unmotivated, miss out on opportunities and find it difficult completing everyday tasks and this will impact greatly on an individuals quality of life.There are many ways people look at treating CLBP from stretching, physiotherapy, chiropractics, strengthening specific muscles such as core, legs and back and traction. These can all be effective ways of helping to reduce pain. This article looks at using yoga to help prevent CLBP vs exercise vs a self guide book to back pain over 12 weeks.

### Where is the research from and what kind of research was this?

The study took place in Washington State and Idaho from a nonprofit, integrated health care system, Group Health Cooperative. The study is a randomised comparison to see the difference in back pain after a 12 week trial comparing yoga, exercise and a self guided book to back pain. The study was sent to 6913 people between 20 and 64 all these people are patients who have sought medical practice about back pain of these 6913, 101 took place in the study.

### What did the research involve?

The research involved randomly assigning people to 1 of 3 groups, 75 min viniyoga class once a week over 12 weeks, 75 min exercise workout designed by a physical therapist over 12 weeks or a self care back pain book to be used over the 12 weeks. Aiming to see which group had the largest reduction in CLBP over the 12 week period.

### What were the basic results?

The initial thought from all participant would be that the exercise and yoga groups would have a similar and better effect than the book group. The results then showed that the book group had no significant change until week six then a slight consistent drop until week 12 where they then stopped seeing results. The exercise group showed continuous reductions in pain over the 12 week period but reductions in pain where much greater in the first 6 weeks. The yoga group had even greater reductions in pain consistently over the 12 week period. After the 12 week period only 12% of the yoga participants returned to seek medical help for CLBP compared to 19% of the exercise group and 32% of the book group.

### How did the researchers interpret the results?

The researchers interviewed the participants over the phone with a questionnaire every 6,12 and 26 weeks. The questionnaire was comprised of 23 questions which included a modified Roland Disability Scale to determine level of back pain as well as how "bothersome" their back pain was. From this they were able to compile results into graphs, tables and statistical analysis of chi-square tests, Mann–Whitney U test and linear regression all to determine differences between the groups.

### What conclusions should be taken away from this research and what are the implications?

This study has shown that yoga has had the greatest impact on reducing CLBP when compared to an exercise program or a self guided book to back pain. Although there are implications that could also have an effect on the results. Such as having an instructor every session to help push you through and make sure correct technique is being used, the book group was self directed which meant it was all up to them they had no motivation of an instructor to push them through and attend each week. The program designed by the physical therapist also could've been to load baring and not have focused on specific muscle groups that contribute to supporting the lower back, as one lady had to quit the study from a strained back after an exercise session. The type of yoga was also designed for people who have back issues, and is not your generic yoga session which may have resulted in results being bias.

### Further reading

More information on the study can be found here: http://annals.org/article.aspx?articleid=718899&issueno=12&atab=10. More information about how to exercise to reduces CLBP or yoga exercises can be found here:http://www.yogajournal.com/category/poses/yoga-by-benefit/back-pain/ http://www.webmd.com/back-pain/lower-back-pain-10/default.htm

## References

* ↑ Ninds.nih.gov. Low Back Pain Fact Sheet: National Institute of Neurological Disorders and Stroke (NINDS) [Internet]. 2015 [cited 30 September 2015]. Available from: http://www.ninds.nih.gov/disorders/backpain/detail_backpain.htm
* ↑ Sherman K. Comparing Yoga, Exercise, and a Self-Care Book for Chronic Low Back Pain. Annals of Internal Medicine. 2005;143(12):849
* ↑ Ninds.nih.gov. Low Back Pain Fact Sheet: National Institute of Neurological Disorders and Stroke (NINDS) [Internet]. 2015 [cited 30 September 2015]. Available from: http://www.ninds.nih.gov/disorders/backpain/detail_backpain.htm
* ↑ Sherman K. Comparing Yoga, Exercise, and a Self-Care Book for Chronic Low Back Pain. Annals of Internal Medicine. 2005;143(12):849
* ↑ Sherman K. Comparing Yoga, Exercise, and a Self-Care Book for Chronic Low Back Pain. Annals of Internal Medicine. 2005;143(12):849
* ↑ Sherman K. Comparing Yoga, Exercise, and a Self-Care Book for Chronic Low Back Pain. Annals of Internal Medicine. 2005;143(12):849
* ↑ Sherman K. Comparing Yoga, Exercise, and a Self-Care Book for Chronic Low Back Pain. Annals of Internal Medicine. 2005;143(12):849
* ↑ Sherman K. Comparing Yoga, Exercise, and a Self-Care Book for Chronic Low Back Pain. Annals of Internal Medicine. 2005;143(12):849
* ↑ Yoga Journal. Yoga for Back Pain [Internet]. 2015 [cited 30 September 2015]. Available from: http://www.yogajournal.com/category/poses/yoga-by-benefit/back-pain/
* ↑ WebMD. What You Can Do About Low Back Pain [Internet]. 2015 [cited 30 September 2015]. Available from: http://www.webmd.com/back-pain/lower-back-pain-10/default.htm