Back pain: How do yoga, tai chi and qigong work?

A large proportion of adults are affected by low back pain. The treatment options are currently limited, and are often short. A new review asks if yoga, tai chi, and qigong may prove effective in pain reduction.

Yoga exercises at home
Low back pain is common but difficult to treat. Could yoga offer respite?

The latest review suggests that some people with low back pain can benefit from those practices. Nonetheless, since there is so little work of high quality, credible conclusions can not be drawn at this time.

According to the National Institute of Neurological Disorders and Stroke, at some point in their lives about 80 percent of people in the United States experience low back pain. Current treatments include prescription medications, self-care, surgery, and physical therapy.

Since opioids and major surgery have significant health and cost consequences, physical therapy is starting to receive increased attention from the researchers.

Chronic low back pain “also leads to emotional distress, including depression, anxiety, sleep disturbance, and social isolation,” as the writers of the new review note, and “no effective treatment has been found.”

Finding a drug-free, low-cost cure for low back pain could improve millions of lives. As holistic and alternative treatments become more common, some researchers are keen to understand whether people with low back pain may benefit from them or not.

The review, now published in the journal Holistic Nursing Practice, was aimed at exploring how effective they might be.

Focusing on the alternatives

The research authors come from the Institute for Design and Social Practice at Florida Atlantic University and the Christine E. Lynn School of Nursing, both located in Boca Raton, FL.

They concentrated on “mind-body treatments based on movement”— specifically, yoga, tai chi, and qigong. We all three have both a meditative and a physical aspect.

In order to determine the impact of movement-based mental-body interventions on chronic back pain, psychological causes, coping strategies and quality of life in people[…] with back pain, we reviewed results, “states the corresponding study 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.”

After a thorough search of the existing research papers, the authors found only 32 research that met their requirements. Those were 3,484 participants. Twenty-five of the yoga-focused studies, four studied tai chi, and three looked at qigong.

The authors conclude, on the whole:

“Most of the 32 studies reviewed found[ motion-based mental-body interventions] to be effective in treating[ low back pain], documenting positive outcomes such as pain reduction or psychological distress (e.g. depression and anxiety), pain-related disability reduction and increased functional capability.”

No firm conclusions

Although the findings of the authors are positive, the analysis has substantial limitations, and it is still difficult to draw solid conclusions from the available data.

One drawback is that the new paper is a study of narratives. A type of analysis gathers information on a given topic and provides an summary.

Narrative reviews usually do not require an analysis of the data. The authors actually state that they did not conduct a meta-analysis “because some of the selected studies showed poor methodological quality and did not report an effect size across the studies.”

However, not much attention has been paid to the consequences of yoga, tai chi, and qigong on back pain, so there have been no large studies on the matter. The review’s largest study comprised 320 participants, and the smallest only 25 participants.

Some of the studies were likewise relatively brief. The shortest lasted 6 weeks, and the researchers were unable to determine the long-term effects of these treatments.

The writers also note that many of the articles didn’t explain explicitly how their studies were conducted by the original teams. For example, they note that while 26 of the 32 trials reported to be randomized controlled trials, “most research did not report in depth on the actual randomization, allocation concealment, or blinding process.”

However, Park states, “We need more clinical trials and empirical evidence” before doctors can prescribe such forms of intervention for low back pain.

Further research is especially important because some of the studies have reported some adverse events. As the authors note, “11 studies of yoga, one study of tai chi, and one study of qigong reported moderate joint and back pain.”

However, while some skepticism remains, this does not mean that engaging mind and body in this way does not help to ease back pain. Chronic low back pain has a significant psychological aspect, and testing methods that address the brain and body at once would seem to be a sensible approach on paper.

We still don’t know whether yoga, tai chi, or qigong will help relieve low back pain, to answer the question posed in the article.

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