Cleveland Clinic researchers found that a 12-week therapeutic virtual yoga program for chronic low back pain can be a feasible, safe and effective treatment option. The findings are published in JAMA Network Open.

Chronic low back pain is very common—up to 20% of adults worldwide have long-lasting or recurrent lower back pain. In severe cases, the pain can make it difficult to walk, sleep, work or do daily activities.

Clinical guidelines recommend the use of non-pharmacologic treatments first, such as physical therapy or in-person yoga classes. With this study, researchers examined whether virtual yoga classes would also be effective for the treatment of chronic low back pain. The findings show that participants who practiced virtual yoga classes reported reduced back pain intensity and improved back-related function.

"Attending yoga classes in person can be challenging," said Robert Saper, M.D., MPH, chair of the Department of Wellness and Preventive Medicine at Cleveland Clinic, and senior author of the study. "This research shows that a virtual yoga class program can be a safe and effective therapeutic option for the treatment of chronic low back pain."

Researchers performed a 24-week randomized clinical trial that involved 140 eligible participants with chronic low back pain. The average age of the participants was 48 and more than 80% were female. The study participants were members of Cleveland Clinic's Employee Health Plan from Northeast Ohio and Florida. The study was conducted from May 2022 through May 2023.

The research team conducted assessments to determine baseline measures, such as pain intensity score and back-related function using the Roland Morris Disability Questionnaire. Participants were then randomly assigned to either the "yoga now" group or the "yoga later" control group.

Seventy-one participants were enrolled in the yoga now group, which included virtual live-streamed yoga group classes for 12 weeks followed by a 12-week assessment period. Sixty-nine participants were enrolled in the yoga later control group and continued with their usual medical care. After the research ended, the yoga later group was offered non-study yoga classes.

Cleveland Clinic yoga instructors delivered a 12-week program designed to maximize effectiveness and safety, adapted for virtual delivery, and intended for participants with chronic low back pain.

Following the baseline assessment, participants were reassessed at six weeks, 12 weeks, and 24 weeks for low back pain intensity, back-related function, pain-medication use, and sleep quality.

At the end of the 12-week virtual yoga program, yoga now participants reported six times greater reductions in pain intensity scores and 2.7 times greater improvements in back-related function compared with participants who had not taken the yoga classes.

Additionally, 34% fewer patients in the yoga now group reported using pain medication, and they reported 10 times greater improvement in sleep quality compared to the yoga later group. At 24 weeks, the improvements in pain and back-related function were sustained.

"Yoga offers a comprehensive approach to managing low back pain, a condition for which traditional treatments often fall short," said Hallie Tankha, Ph.D., research faculty in the Department of Wellness and Preventive Medicine at Cleveland Clinic, and first author of the study. "Now we must work to increase access to this safe and effective treatment."

Dr. Saper plans to continue this important research with a larger and more diverse sample of patients from multiple health care systems.