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Comparison of yoga versus stretching for chronic low back pain: protocol for the Yoga Exercise Self-care (YES) trial.

Sherman KJ, Cherkin DC, Cook AJ, Hawkes RJ, Deyo RA, Wellman R, Khalsa PS - Trials (2010)

Bottom Line: This study will assess whether yoga is effective for treating chronic low back pain compared with self care and exercise and will explore the mechanisms responsible for any observed benefits.Primary outcomes will be back-related dysfunction and symptom bothersomeness.In addition, data will be collected on physical measurements (e.g., flexion) at baseline and 12 weeks and saliva samples will be obtained at baseline, 6 and 12 weeks.

View Article: PubMed Central - HTML - PubMed

Affiliation: Group Health Research Institute, 1730 Minor Avenue, Suite 1600, Seattle, WA, USA. sherman.k@ghc.org

ABSTRACT

Background: Back pain, one of the most prevalent conditions afflicting American adults, is the leading reason for using complementary and alternative medicine (CAM) therapies. Yoga is an increasingly popular "mind-body" CAM therapy often used for relieving back pain and several small studies have found yoga effective for this condition. This study will assess whether yoga is effective for treating chronic low back pain compared with self care and exercise and will explore the mechanisms responsible for any observed benefits.

Methods/design: A total of 210 participants with low back pain lasting at least 3 months will be recruited from primary care clinics of a large healthcare system based in Seattle. They will be randomized in a 2:2:1 ratio to receive 12 weekly yoga classes, 12 weekly conventional therapeutic exercise classes of comparable physical exertion, or a self-care book. Interviewers masked to participants' treatment group will assess outcomes at baseline and 6, 12 and 26 weeks after randomization. Primary outcomes will be back-related dysfunction and symptom bothersomeness. In addition, data will be collected on physical measurements (e.g., flexion) at baseline and 12 weeks and saliva samples will be obtained at baseline, 6 and 12 weeks. Information will be collected on specific physical, psychological, and physiological factors to allow exploration of possible mechanisms of action through which yoga could relieve back pain and dysfunction. The effectiveness of yoga will be assessed using analysis of covariance (using general estimating equations - GEE) within an intention-to-treat context. If yoga is found effective, further analyses will explore whether yoga's benefits are attributable to physical, psychological and/or physiological factors.

Conclusions: This study will provide the clearest evidence to date about the value of yoga as a therapeutic option for treating chronic back pain, and if the results are positive, will help focus future, more in-depth, research on the most promising potential mechanisms of action identified by this study.

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Model describing possible mechanisms underlying the effectiveness of yoga for chronic low back pain.
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Figure 1: Model describing possible mechanisms underlying the effectiveness of yoga for chronic low back pain.

Mentions: While the mechanisms of action responsible for yoga's potential positive effects on back pain patients are unclear, there are a number of plausible mechanisms, including physical movement, relief of physical and mental stress, and enhanced body awareness to reduce maladaptive movements and posture [19]. Figure 1 depicts a heuristic model, derived from the literature and comments from yoga teachers and participants in an earlier study of yoga [19]. The model includes several pathways by which yoga might improve back-related dysfunction or pain. The model hypothesizes that yoga may decrease the pain and/or dysfunction of persons with chronic back pain through positive effects on one or more of three major pathways: physical functioning of the back, cognitive appraisal about back pain, and general affect and stress. We further hypothesize that any positive effects of yoga on affect and stress will be associated with improvements in neuroendocrine stress mediators. These hypothetical pathways provide a framework for testing some of the most important potential mechanisms of action for yoga and for identifying which ones are most promising for future research. The hypothesized pathways by which yoga may lead to improved outcomes for persons with back pain are indicated in Figure 1 by solid arrows. The broken arrows represent some of the most important hypothesized secondary relationships. We consider model testing in this trial as exploratory with the primary goal of laying the groundwork for future studies that will more definitively elucidate yoga's mechanisms of action in the relief of back pain.


Comparison of yoga versus stretching for chronic low back pain: protocol for the Yoga Exercise Self-care (YES) trial.

Sherman KJ, Cherkin DC, Cook AJ, Hawkes RJ, Deyo RA, Wellman R, Khalsa PS - Trials (2010)

Model describing possible mechanisms underlying the effectiveness of yoga for chronic low back pain.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2864260&req=5

Figure 1: Model describing possible mechanisms underlying the effectiveness of yoga for chronic low back pain.
Mentions: While the mechanisms of action responsible for yoga's potential positive effects on back pain patients are unclear, there are a number of plausible mechanisms, including physical movement, relief of physical and mental stress, and enhanced body awareness to reduce maladaptive movements and posture [19]. Figure 1 depicts a heuristic model, derived from the literature and comments from yoga teachers and participants in an earlier study of yoga [19]. The model includes several pathways by which yoga might improve back-related dysfunction or pain. The model hypothesizes that yoga may decrease the pain and/or dysfunction of persons with chronic back pain through positive effects on one or more of three major pathways: physical functioning of the back, cognitive appraisal about back pain, and general affect and stress. We further hypothesize that any positive effects of yoga on affect and stress will be associated with improvements in neuroendocrine stress mediators. These hypothetical pathways provide a framework for testing some of the most important potential mechanisms of action for yoga and for identifying which ones are most promising for future research. The hypothesized pathways by which yoga may lead to improved outcomes for persons with back pain are indicated in Figure 1 by solid arrows. The broken arrows represent some of the most important hypothesized secondary relationships. We consider model testing in this trial as exploratory with the primary goal of laying the groundwork for future studies that will more definitively elucidate yoga's mechanisms of action in the relief of back pain.

Bottom Line: This study will assess whether yoga is effective for treating chronic low back pain compared with self care and exercise and will explore the mechanisms responsible for any observed benefits.Primary outcomes will be back-related dysfunction and symptom bothersomeness.In addition, data will be collected on physical measurements (e.g., flexion) at baseline and 12 weeks and saliva samples will be obtained at baseline, 6 and 12 weeks.

View Article: PubMed Central - HTML - PubMed

Affiliation: Group Health Research Institute, 1730 Minor Avenue, Suite 1600, Seattle, WA, USA. sherman.k@ghc.org

ABSTRACT

Background: Back pain, one of the most prevalent conditions afflicting American adults, is the leading reason for using complementary and alternative medicine (CAM) therapies. Yoga is an increasingly popular "mind-body" CAM therapy often used for relieving back pain and several small studies have found yoga effective for this condition. This study will assess whether yoga is effective for treating chronic low back pain compared with self care and exercise and will explore the mechanisms responsible for any observed benefits.

Methods/design: A total of 210 participants with low back pain lasting at least 3 months will be recruited from primary care clinics of a large healthcare system based in Seattle. They will be randomized in a 2:2:1 ratio to receive 12 weekly yoga classes, 12 weekly conventional therapeutic exercise classes of comparable physical exertion, or a self-care book. Interviewers masked to participants' treatment group will assess outcomes at baseline and 6, 12 and 26 weeks after randomization. Primary outcomes will be back-related dysfunction and symptom bothersomeness. In addition, data will be collected on physical measurements (e.g., flexion) at baseline and 12 weeks and saliva samples will be obtained at baseline, 6 and 12 weeks. Information will be collected on specific physical, psychological, and physiological factors to allow exploration of possible mechanisms of action through which yoga could relieve back pain and dysfunction. The effectiveness of yoga will be assessed using analysis of covariance (using general estimating equations - GEE) within an intention-to-treat context. If yoga is found effective, further analyses will explore whether yoga's benefits are attributable to physical, psychological and/or physiological factors.

Conclusions: This study will provide the clearest evidence to date about the value of yoga as a therapeutic option for treating chronic back pain, and if the results are positive, will help focus future, more in-depth, research on the most promising potential mechanisms of action identified by this study.

Show MeSH
Related in: MedlinePlus