Because we lose elasticity with age and don't have elastin as part of our diet, stretching is imperative. It increases our flexibility while helping to decrease back and joint pain.

Stretching Key to Yoga's Back Pain Relief

By Kristina Fiore, Staff Writer, MedPage Today Published: October 24, 2011 Reviewed by Robert Jasmer, MD; Associate Clinical Professor of Medicine, University of California, San Francisco and Dorothy Caputo, MA, RN, BC-ADM, CDE, Nurse Planner = Yoga can help improve symptoms of chronic lower back pain, but it's likely not the meditation component that does the trick, researchers found. There were no differences in functional improvement between yoga and plain stretching exercises, although both were better than self-care, Karen Sherman, PhD, MPH, of Group Health Research Institute in Seattle, and colleagues reported online in the Archives of Internal Medicine. "We expected back pain to ease more with yoga than with stretching, so our findings surprised us," Sherman said in a statement. "The most straightforward interpretation of our findings would be that yoga's benefits on back function and symptoms were largely physical, due to the stretching and strengthening of muscles" and not the discipline's focus on mindfulness. Sherman and colleagues explained that there are few effective treatments for low back pain. Some studies have shown that yoga may be beneficial, though these had considerable limitations, they said. So they conducted a trial of 228 adults with moderate chronic low back pain, who were randomized to one of three interventions: 12 weekly yoga classes devoted largely to stretching and strengthening the back and leg muscles Conventional stretching exercises also focused on back and leg muscles A self-care book giving advice on exercise and lifestyle modifications Overall, 63% of yoga attendees and 82% of stretching class attendees said they practiced at home three or more days per week. About half of those in the self-care book group said they read at least two-thirds of the book. Sherman and colleagues found that function improved over time in all groups, but there were significant differences among the three groups at all time points. After adjustment, yoga was superior to self-care at 12 weeks in terms of improved function, and remained superior at 26 weeks (P<0.001 for both). Yet it wasn't superior to conventional stretching at any time point, the researchers found. Sherman noted that the stretching classes included a lot more stretching than in most such classes, and the style of stretching may have been more like that of yoga. "People may have actually begun to relax more in the stretching classes than they would in a typical exercise class," Sherman said in the statement. "In retrospect, we realized that these stretching classes were a bit more like yoga than a more typical exercise program would be." The researchers noted that except at 12 weeks, when yoga proved superior to self-care, there were no differences among treatment groups when rating how much their symptoms bothered them. But compared with self-care, those who did yoga or stretching were more likely to rate their back pain as better, much better, or completely gone at all follow-up times. Also, more patients in the yoga and stretching groups were able to decrease their medications compared with the self-care group. The study was limited because all of the patients were selected from a single site, were relatively well-educated and functional, and had no follow up beyond 26 weeks. It was also limited because "disappointed self-care participants might have been more likely to report worse outcomes," the researchers cautioned. Still, Sherman said the results "suggest that both yoga and stretching can be good, safe options for people who are willing to try physical activity to relieve their moderate low back pain." Yet, she noted, that it's "important for the classes to be therapeutically oriented, geared for beginners, and taught by instructors who can modify postures for participants' individual physical limitations." In an accompanying editorial, Timothy Carey, MD, MPH, of the University of North Carolina in Chapel Hill, said the results of the trial are actionable for practice. "Healthcare providers should feel comfortable referring patients to either yoga or physical-therapy-led classes," Carey wrote. "Either seems to be helpful." Still, he noted that more high-quality studies are needed to help patients and clinicians determine which types of physical treatments are most appropriate. The study was supported by the National Center for Complementary and Alternative Medicine. Neither the researchers nor the editorialist reported any conflicts of interest.   Primary source: Archives of Internal Medicine Source reference: Sherman KJ, et al "A randomized trial comparing yoga, stretching, and a self-care book for chronic low-back pain" Arch Intern Med 2011; DOI: 10.1001/archinternmed.2011.524. Additional source: Archives of Internal Medicine Source reference: Carey TS "Comparative effectiveness studies in chronic low back pain" Arch Intern Med 2011; DOI: 10.1001/archinternmed.2011.519.