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Image result for yoga wikipedia A recent study found that yoga is as good as physical therapy in reducing chronic back pain in a diverse group of low-income patients. In those sticking with the program and attending the most yoga classes, yoga was better in the long-term than physical therapy and much better than just receiving educational advice about back pain. Both physical therapy and yoga reduced pain medication use by 20% at 12 weeks. These findings are supported by other research finding that yoga improves pain, function, reduces medication use, and practicing yoga long-term results in positive brain changes (such as more gray matter in the brain). From Medscape:

Yoga as Good as Physical Therapy for Back Pain

Yoga is as good as physical therapy (PT) in reducing chronic low back pain, the most common pain problem in the United States, new research shows. "Our study showed that yoga was noninferior to physical therapy for a diverse group of low-income patients," said Robert B. Saper, MD, director of integrative medicine, Boston Medical Center, Massachusetts. "Its effectiveness was most obvious in the most adherent patients." Dr Saper presented his study at the American Academy of Pain Management (AAPM) 2016 Annual Meeting. 

Previous research has shown that yoga improves pain and function and reduces medication use. For example, a 2013 meta-analysis demonstrated small to medium effect sizes for yoga in short-term and long-term back pain–related disability. Research also shows that PT is effective in treating patients with back pain. PT is considered a conventional therapy and is the most common nonpharmacologic referral by physicians for chronic low back pain, Dr Saper said. 

For this new study, researchers enrolled 320 adult patients from Boston-area community health centers who had chronic back pain with no obvious anatomic cause, such as spinal stenosis. The patients were predominantly nonwhite and low income, with a relatively low education level. The patients had "quite high" pain scores (average of 7 out of 10 on a pain scale) and were "quite disabled" in terms of their back pain, said Dr Saper. Almost three quarters were using pain medication, with about 20% taking opioids....Patients were randomly assigned to one of three groups: yoga, PT, or education.

To develop the structured yoga protocol, Dr Saper and his colleagues organized an expert panel, which reviewed the literature on the topic. The final product was a 75-minute weekly class with a very low student-to-teacher ratio. The classes began with short segment on yoga philosophy (nonviolence, moderation, self-acceptance). Participants were then given mats on which to do the simple yoga poses. They received a DVD to practice these at home. The PT group had 15 one-on-one 60-minute sessions that included aerobic exercise. PT personnel were trained to help coach patients on fear avoidance. The education group got a comprehensive book on back pain.

Both the PT and yoga sessions continued for 12 weeks, after which patients were followed to 52 weeks. During this postintervention period, patients in both the yoga and PT groups were randomly assigned to maintenance (drop in yoga classes or more PT sessions) or just at-home practice. Overall adherence was not great. The mean number of yoga classes and PT sessions attended during the initial phase was 7.

The primary question being addressed was whether yoga is not inferior to PT at 12 weeks. The study showed that for function (score on the Roland-Morris Disability Questionnaire), yoga and PT "are exactly the same, ie noninferior," said Dr Saper, adding that, "they are not terribly different from education at 12 weeks...."What that means is that for every two patients who go to yoga, about 50% of them are going to have a clinical response."....comparing the various interventions, "yoga is actually superior" to PT and is "quite a bit" superior to education, said Dr Saper. At baseline, about 70% of participants were using medication. At 12 weeks, such use was down by about 20% in both the yoga and PT groups, and hadn't changed in the education group. A similar number of yoga and PT subjects reported being "very improved" and "very satisfied," said Dr Saper.

Yoga proved to be safe, with only mild, usually transient exacerbations of back pain.....Larger studies are needed to develop better strategies to enhance adherence, he said. The new study "adds to our knowledge in suggesting that a) yoga is as good as the standard of care, non pharmacologic therapy, and b) it can be done in a diverse population, including a low income, non-English speaking population in Boston. So it takes away some of those barriers to recommending it."

There's also evidence that yoga has a positive impact on the brain. According to M. Catherine Bushnell, PhD, National Center for Complementary and Integrative Health, National Institutes of Health, long-time yoga practitioners have more gray matter than matched physically active controls. "Gray matter goes down with age, but yoga practitioners have a flat line; you don't see this age-related decrease in gray matter that you see in other healthy people,".... And there seems to be "quite a robust" relationship between how long a person has done yoga and positive brain changes, she said. "The number of years a person has practiced yoga, the more gray matter at multiple sites in the brain." Yoga influences areas of the brain that are important for pain modulation, said Dr Bushnell. It is a "complex activity" that involves not only exercise but also breath control and meditation.


So many people I know complain of carpal tunnel syndrome, especially those who spend hours every day at a computer keyboard. Carpal tunnel syndrome is a hand and arm condition of numbness, pain, tingling, etc. caused by a pinched nerve in your wrist (pressure or compression of the median nerve). Treatments vary from physical therapy to steroids to surgery, with surgery being the recommended option by many doctors. So what is best?

A study with women randomly assigned to manual (physical) therapy or surgery suggests that from months one to 3 physical therapy was better and more effective, especially in pain relief. At the 6 months and one year follow-up, both groups were similar in outcome - in improvements in pain, symptoms, and functioning of the hands. What was nice in this study was that all assessments, baseline and follow-ups, were done by a blinded assessor - that is, a person who did not know what treatment was used on the patient.  Bottom line: a major intervention (surgery) may be unnecessary. From Medical Xpress:

PT beats surgery for quick relief of carpal tunnel pain

For women with carpal tunnel syndrome (CTS), physical manual therapies are similarly effective to surgery in the medium and long term, and may be more effective in the short term, according to a study published in the November issue of The Journal of Pain.

César Fernández-de-las Peñas, P.T., Ph.D., from the Universidad Rey Juan Carlos in Madrid, and colleagues compared the effectiveness of surgery versus physical therapy consisting of manual therapies, including desensitization maneuvers, in CTS. The interventions were either three sessions of manual therapy (physical therapy group; 60 patients) or decompression/release of the carpal tunnel (surgical group; 60 patients).

The researchers found that 55 women in the physical therapy group and 56 in the surgery group completed follow-up at 12 months. In adjusted analyses there was an advantage for the physical therapy group at one and three months in mean pain, the worst pain, and function. At six and 12 months, the changes in pain and function were similar between the groups. At all follow-ups the two groups had similar improvements in the symptoms severity subscale of the Boston Carpal Tunnel Questionnaire.

"This study found that surgery and physical manual therapies, including desensitization maneuvers of the central nervous system, were similarly effective at medium-term and long-term follow-ups for improving pain and function, but that physical therapy led to better outcomes in the short term," the authors write.