For me, after a low back injury that left me unable to exercise for months, yoga was my saving grace. Back pain affects approximately 80% of Americans at some point in their lives. While 40% of patients are prescribed opiates for chronic non-specific back pain, most find the pain only temporarily subsides. Early research gave hope that yoga could serve as an alternative treatment for back pain. However, recent claims question if people can heal their backs by rolling out a yoga mat instead of popping pills.

Cochrane Back and Neck Group reviewed the outcomes of 12 selected studies that examined Iyengar Yoga, Hatha Yoga, or Viniyoga as treatments for back pain. The review was comprised of three groups: yoga versus no exercise; yoga compared to back-specific exercises; and yoga compared to general exercise. Though there was no conclusive evidence, the conclusions of the review suggest that yoga only minimally eases back pain.

Compared to no exercise, there was low-certainty evidence that yoga produced small to moderate improvements within three months. However, yoga is a practice that takes time to evolve. At six months, patients reported moderate-certainty of small to moderate improvements. Yoga was less effective compared to back-specific exercises. The report claims yoga offered little to no difference in pain within three months. Similarly, the outcomes in the control group examining yoga versus general exercise claimed little to no change in three months.

At best, the review’s conclusions are questionable. There were severe limitations in the original studies that impeded on accurate findings. Participants self-reported and were not blinded to the treatments. The researchers at Cochrane recognized the risk for serious bias, so they downgraded moderate-certainty ratings to low-certainty. Moreover, the duration of the original studies looked beyond three months only in the control group comparing yoga to no exercise, leaving a gap that questions if the pain would have improved with more time. Therefore, potentially, yoga can help with back pain more than Cochrane’s review suggests.

Five percent of people reported that their back pain increased. There could be a number of explanations for this. But the increase in discomfort and the overall suggestion that yoga may not help back pain begs the question: were people doing yoga safely? Though the participants were practicing in 45 to 60-minute classes under the guidance of an instructor, certain yoga postures are not appropriate for people with back pain or injury. There is no mention if modifications were made.

If you have back pain, here are some tips and modifications that can help alleviate and prevent pain in your practice:

Avoid deep forward folding if you have disc injuries

  • Either skip the forward folding all together or use props.
  • Keep the knees bent in folds to take pressure out of the back.
  • In standing forward folds, use blocks to touch the ground.
  • Be mindful in postures that require a deep fold as preparation, such as headstand prep.

Pay attention to the backside of the body

  • Back extensions can take pressure out of the low back for many people. But keep them gentle with postures such as Anuvittasana (Standing Backbend) and Bridge pose.
  • If your back pain is unrelated to herniated or bulging discs, stretching the hamstrings can loosen tight back muscles. Poses such as Janu Sirsana (Head to Knee Forward Bend) and Parsvottanasana (Pyramid pose) are good options.

Build core strength

  • Engaging mula bandha (root lock) and uddiyana bandha (abdominal lock) help strengthen the stabilizing muscles along the spine. The more you practice while engaging the bandhas, the safer other postures will become over time.
  • Add in more core work. Ardha Navasana (Half Boat pose) with hands behind the thighs will build strength without stressing the back. Also, you can easily add plank and side plank to any yoga sequence to build more strength.

Has yoga helped your back pain? What poses help? What poses do you avoid?