Is yoga good for back pain?

Is yoga good for back pain? For long-term lower back pain, it can help, roughly as much as other back exercise. A Cochrane review of 21 trials found that yoga improved pain and day-to-day function a little compared with no exercise, and did about as well as exercise programmes aimed at the back. The average improvements were small, and yoga led to more flare-ups of back pain than doing nothing. Here is the detail, and what it means if you spend your days sitting.

Is yoga good for back pain? The short answer

• Compared with no exercise: a small improvement on average, with more people reporting their back as better.
• Compared with other back exercise: about the same for function; for pain, the evidence is uncertain.
• Safety: about as safe as other exercise, though some people’s back pain flares.
• Which to choose: the Cochrane authors say it may come down to availability, cost and preference.

What the Cochrane review found

The most complete summary is the 2022 Cochrane review of 21 trials with 2,223 people with long-term non-specific low back pain, meaning pain with no single identifiable cause. The trials came from the USA, India, the UK, Croatia, Germany, Sweden and Turkey. Most participants were women in their 40s or 50s, and most trials used Iyengar, hatha or viniyoga (Wieland et al., 2022).

Yoga compared with no exercise, at three months:

• Function improved by 1.69 points on a 24-point disability questionnaire (low-certainty evidence).
• Pain fell by 4.5 points on a 100-point scale (moderate certainty).
• In four trials, people who did yoga were more than twice as likely to say their back pain had improved or gone (low certainty).
• Quality of life probably improved a little. Depression scores barely changed.

Yoga compared with back-focused exercise, such as physiotherapy, in eight trials with 912 people: there was probably little or no difference in function at three months. Whether there is any difference in pain remains uncertain.

What “clinically unimportant” means

The review calls the improvements against no exercise “small and clinically unimportant”. That has a specific meaning. Researchers set a threshold for the smallest change a person would notice: 5 points on that disability questionnaire, and 15 points for pain. The average improvements with yoga fell short of both.

Averages can hide a spread, though: an average below the threshold can still include people who improved a lot. That may be why more of the yoga group rated their back as better. And all the trials shared a weakness: people knew they were doing yoga and rated their own pain, which the review counts as a high risk of bias. The authors noted that blinded comparisons would be unlikely to find a clinically important benefit.

The trials behind it

Three larger trials show what this looks like in practice.

• Yoga, stretching or a book. In the USA, 228 adults with long-term back pain were given 12 weekly yoga classes, 12 weekly stretching classes, or a self-care book. At 12 weeks, the yoga group had better function and fewer symptoms than the book group, and function was still better at 26 weeks. Yoga was not better than the stretching classes at any point (Sherman et al., 2011).
• Yoga in the UK. 313 adults with long-term or recurring back pain received an education booklet, and half were also offered 12 gradually progressing classes over three months. The yoga group had better back function at 3, 6 and 12 months, but similar pain scores to usual care. 60% of those offered yoga went to at least six of the twelve classes. Twelve people in the yoga group reported side effects, mostly increased pain, against two in the usual care group (Tilbrook et al., 2011).
• Yoga or physiotherapy. 320 adults, mostly on low incomes, were given 12 weekly yoga classes, 15 physiotherapy visits, or an educational book. Yoga was no less effective than physiotherapy for function and pain, and both groups were around 21 to 22 percentage points less likely to be using pain medication at 12 weeks than the education group. Yoga was not, however, better than education for function or pain. Improvements lasted a year (Saper et al., 2017).

Across the three, yoga usually did better than a book or usual care for function, though not in every trial, and about as well as other active treatment.

How yoga compares with other exercise

For long-term lower back pain, exercise in general has moderate-certainty evidence of reducing pain compared with no treatment or usual care (Hayden et al., 2021). When the same team compared exercise types in 217 trials, Pilates, McKenzie therapy and functional restoration came out ahead on average. Their practical conclusion was still to encourage people to do the exercise they enjoy, because that is what they keep doing (Hayden et al., 2021).

Guidelines leave room for yoga. NICE recommends considering a group exercise programme, including mind–body approaches, chosen around a person’s needs and preferences (NICE NG59). The American College of Physicians lists yoga among the first options for long-term back pain, rated as low-quality evidence (Qaseem et al., 2017). The NHS says activities such as walking, swimming, yoga and Pilates may help ease back pain (NHS).

If you are weighing up the options, see Does Pilates help back pain? and Is walking good for back pain?.

The calm part may count too

Yoga combines movement with breathing and relaxation, and that side has been tested indirectly. In a trial of 342 adults with long-term back pain, an eight-week mindfulness course that included meditation and yoga led to more people improving in function and pain at six months than usual care (Cherkin et al., 2016). If stress is part of your back pain, Can stress cause back pain? looks at the evidence.

Is yoga safe for your back?

For most people, about as safe as other exercise. A review of 94 trials with 8,430 participants found no difference in side effects or serious side effects between yoga and usual care or other exercise. Yoga had more minor side effects than psychological or education programmes (Cramer et al., 2015).

For back pain specifically, the Cochrane review found more side effects with yoga than with no exercise, mostly increased back pain: about 43 per 1,000 people against 9. Compared with other exercise, the rate was similar (84 against 91 per 1,000).

Injuries do happen outside trials. US emergency departments saw 29,590 yoga-related injuries between 2001 and 2014, according to national injury surveillance data. The trunk was the most commonly injured area (46.6%), and sprains and strains made up 45.0% of diagnoses. The injury rate was highest in people aged 65 and over (Swain & McGwin, 2016).

Some practical points follow from the research:

• Pick a class that resembles the trials. They used structured programmes for people with back pain, several of them built up gradually. A gentle or beginners’ class is closer to that than a fast, advanced one.
• Take care with deep forward bends if you have osteoporosis. A UK consensus statement recommends avoiding postures with a high degree of spinal flexion, during exercise or daily life (Brooke-Wavell et al., 2022).
• Stop if it hurts. The NHS advises stopping back exercises if your pain gets worse, and seeing a GP for advice.
• Get pain down the leg checked first. If you have pain, tingling or numbness running down a leg, such as sciatica, ask a GP or physiotherapist which poses suit you.

Yoga for people who sit all day

The larger trials used one class a week. The rest of the week, the participants went on with their lives, which for many people means long hours in a chair. A weekly class and regular movement through the working day are not competing options. Our guide to microbreaks looks at how often to get up.

Several exercises in the Bavelu app borrow from yoga, and each has its own page showing one exercise: the cat-cow stretch, child’s pose, the cobra stretch and pigeon pose.

When to see a doctor

See a GP if your back pain has not improved after a few weeks, stops you doing day-to-day activities, is worse at night, or you are worried. Ask for an urgent appointment or contact 111 if you feel hot, cold, shivery or generally unwell, or the pain is severe and starts suddenly or gets worse quickly.

Call 999 or go to A&E if back pain comes with pain, tingling, weakness or numbness in both legs, loss of feeling around your genitals or anus, changes in bladder or bowel control or in sexual sensation or function, chest pain, or follows a serious accident (NHS). These red flags need a doctor before any class. There is more on back pain at a desk in lower back pain from sitting. If your pain has gone on for months, a physiotherapist can help you choose what to try; see how much physiotherapy costs.

What to take from it

• Yoga is a reasonable option for long-term lower back pain, with small average benefits over no exercise.
• It does about as well as other back exercise, including physiotherapy in one trial.
• Flare-ups happen more than with no exercise, about as often as with other exercise.
• Choose what you will keep doing. That matters more than the exact type.