Comparative Effects of Structured Yoga and Conventional Therapeutic Exercise on Pain and Disability in Chronic Mechanical Low Back Pain: A Short-Term Randomized Study

TL;DR

A short-term yoga program provided similar or slightly better pain and disability relief than conventional exercise for chronic low back pain.

Contribution

A direct comparison of structured yoga versus conventional therapeutic exercise in chronic low back pain using a randomized trial.

Findings

Both yoga and conventional exercise significantly reduced pain and disability in participants with chronic low back pain.

Yoga showed statistically significant but clinically modest advantages over conventional exercise in pain and disability outcomes.

No serious adverse events occurred in either group during the six-week study.

Abstract

Background

Chronic mechanical low back pain (CMLBP) is a common cause of disability, and exercise-based interventions are first-line management. Yoga has emerged as a mind-body alternative, but evidence comparing yoga with conventional therapeutic exercise (CTE) remains inconsistent.

Objective

This study aims to compare the short-term effects of a structured yoga program versus CTE on pain intensity, analgesic use, and functional disability in adults with CMLBP.

Methods

A single-center, parallel-group randomized, comparative study was conducted in a tertiary care center in North India. Sixty participants (ages 25-40 years) with CMLBP were randomized (1:1) to either yoga (25-minute supervised sessions twice weekly + home practice) or CTE (50-minute supervised daily exercise) for six weeks. Primary outcomes were pain intensity (visual analog scale (VAS)) and weekly analgesic consumption. The secondary outcome was functional disability (Oswestry Disability Index (ODI)). Analyses followed the intention-to-treat principle. Between-group comparisons used independent t-tests and analysis of covariance (ANCOVA) (adjusting for baseline). Clinical significance was evaluated using established minimal clinically important difference (MCID) thresholds (VAS ≥ 1.5-2.0; ODI ≥ 10).

Results

All 60 participants completed the study (adherence: ≥90%). Both groups demonstrated significant within-group improvements in VAS, ODI, and analgesic use (all p < 0.001; large effect sizes d = 2.02-3.82). Between-group analysis favored yoga for all outcomes: VAS reduction showing yoga 4.26 vs. CTE 3.60 (t = 2.78, p = 0.007; d = 0.71, adjusted mean difference = 0.6 points; 95% CI 0.20-1.06); ODI reduction showing yoga 21.7 vs. CTE 17.2 (t = 3.21, p = 0.002; d = 0.82; adjusted mean difference = 4.5, 95% CI 1.73-7.67); and analgesic reduction showing yoga 7.9 vs. CTE 6.8 (t = 2.21, p = 0.031; d = 0.56, adjusted mean difference = 1.0 tablet/week, 95% CI 0.3-2.3), not significant after Bonferroni correction (α = 0.0167). Between-group differences for VAS (≈0.6) and ODI (≈4.5) did not exceed MCID, indicating clinically modest advantages despite statistical significance. No serious adverse events occurred.

Conclusion

A short-duration, structured yoga program resulted in greater short-term improvement in pain, disability, and analgesic use than a higher-dose CTE regimen, although the clinical superiority was modest. Yoga may represent a time-efficient, low-burden alternative, rather than a definitively superior intervention. Larger, multicenter trials with long-term follow-up and dose-matched protocols are warranted.

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