I have lots of patients with back pain. Lots and lots and lots. Take a gander at the number of chiropractors in your town and you’ll see how common back pain is. Their bread and butter is treating low back pain. Ten percent of the population suffers from low back pain, with higher percentages among those on disability, in low-wage jobs often requiring frequent lifting and of lower socioeconomic status.
We doctors – and I’m included in that “we” – went off the rails when we were treating back pain with opioids. The thought was that opioids were not addictive except to a very small percentage of the population.
Well guess what? We were wrong. But as I have said time and time again, medicine is messy. Sometimes we stumble on our way to success. We overused opioids, so now is the time to pull back and pursue other avenues of wellness.
Why did this happen? Perhaps because it’s easier to write a prescription than it is to counsel patients on non-drug ways to treat pain. But it’s also what patients want, too. Taking a pill is simpler and requires less time and effort than getting chiropractic manipulation, massage therapy or acupuncture, for example.
Still, we doctors often send patients to physical therapy because PT is an excellent mainstay of back pain treatment. Now a new study from the “Annals of Internal Medicine” shows that yoga may work just as well as PT.
Researchers from Boston Medical Center randomly assigned participants to 12 weekly yoga classes, 15 physical therapy visits or an educational book and newsletters about coping with chronic low back pain. Both the PT group and the yoga group were better three months later than the “get a booklet” group. And one year later, it was the same result – PT and yoga showed similar improvements ahead of the third group.
There is a caveat here. Physical therapists are great. They evaluate patients, teach and prescribe exercises and offer stellar follow-up care. When I send people to PT, they don’t usually get 15 visits, like this study. That’s more than is needed. Usually, in several visits you will get a program that’s tailor-made for you.
But the study shows that for many, yoga might work if done right. I am sure the yoga instructors involved here didn’t just tell each patient to do “downward dog,” but also created a specific exercise program for each person.
It’s a reasonable alternative for treating back pain that we doctors should consider.
Dear Doc: I read your article about knee exercise being as good as arthroscopy for meniscus injuries. I get bouts of excruciating pain in my right knee that wakes me many nights. I’ve gone to a physical therapist with no results.
I have a stationary bike that I use for exercise, but not faithfully because I’m not sure it’s the right kind of workout. Can you tell me what exercises I should be doing to get rid of the pain and strengthen my knees? – G.W. from Buffalo
Dear G.W.: This is a good example of where PT shines. A good physical therapist will tell you what to do, but you need motivation and they can’t supply that.
The study I referenced above showed that doing exercises every day for three months was the trick. This on-and-off thing you’re doing is not enough. You need more.
By the way, if you Google “quad sets” and “short arc quads,” you’ll find excellent exercises to start your program. Stay well.