Yoga for Back Pain: 7 Poses, the Evidence Behind Them, and When to Stop

Three sources are worth knowing here, and they do not entirely agree.

The American College of Physicians puts Yoga on the first-line list. In its 2017 clinical practice guideline on noninvasive treatments for low back pain, published in the Annals of Internal Medicine, the ACP recommends that patients with chronic low back pain start with non-drug treatment—and names Yoga among them, alongside exercise, acupuncture, mindfulness-based stress reduction, Tai Chi and cognitive behavioral therapy. The reasoning is partly about benefit and partly about harm: these approaches carry fewer risks than the pharmacological alternatives.

A head-to-head trial found Yoga held its own against physical therapy. Saper and colleagues, writing in the Annals of Internal Medicine in 2017, randomized 320 adults with chronic low back pain—a predominantly low-income, racially diverse group—to twelve weekly Yoga classes, fifteen physical therapy visits, or an educational book. Yoga proved non-inferior to physical therapy, and participants in both the Yoga and physical therapy groups were significantly more likely than the education group to have stopped taking pain medication a year later.

The National Center for Complementary and Integrative Health, reviewing the same body of research, describes Yoga's benefit for low back pain as "a slight benefit" compared with no exercise—and adds, plainly, that "the small difference may not be important to patients".
Both things are true at once. Yoga is a reasonable, low-risk, guideline-endorsed option that performed as well as physical therapy in a well-designed trial. It is also not a dramatic intervention, and the average improvement across studies is modest. Anyone promising that a few poses will resolve years of back pain is telling you something the research does not support.
NCCIH is also clear that Yoga is not risk-free. It is "generally considered a safe form of physical activity for healthy people when performed properly, under the guidance of a qualified instructor", with the qualifiers doing real work. Older adults are advised to be particularly cautious, and the rate of Yoga-related injuries seen in emergency departments is higher in people aged 65 and over. Sprains and strains are the most common, with the knee and lower leg most often affected.
The practical conclusion: Yoga is worth trying for chronic back pain, it should be learned with qualified instruction rather than from a video, and it should be one part of a plan rather than the whole plan.

Why Yoga May Help a Painful Back

The mechanisms are not fully settled, but several plausible contributions show up consistently in the literature and in clinical practice.

• Movement itself. Prolonged rest tends to make chronic back pain worse, not better. Yoga is a structured way to move a back that has been guarded and under-used.
• Strength through the trunk and hips. Many Yoga postures load the muscles that support the lumbar spine, including the deep abdominals, glutes and hip stabilizers.
• Mobility where it is often missing. Tight hip flexors and hamstrings change how the pelvis sits, which changes the load on the lower back.
• Breath and the nervous system. Pain and stress amplify each other. Yoga's breathing and relaxation components address the second, which appears to influence how the first is experienced.
• Less fear of movement. Chronic pain often produces avoidance, and avoidance produces stiffness and weakness. A guided, gradual practice rebuilds confidence in moving.

Seven Yoga Poses for Back Pain, and How to Do Them Safely