Online yoga classes relieved chronic lower back pain and reduced the need for pain medication, a new study suggests.

People with back pain who completed 12 weeks of live-streamed virtual yoga classes also slept better and moved around more easily than participants on a waiting list for classes, according to the study published early November in Open JAMA Network reported.

“Their pain levels have really been cut in half,” said Dr. Robert Saperlead author of the study and chair of the Department of Wellness and Preventive Medicine at the Cleveland Clinic.

“I find it very exciting because we have a large portion of our patients, 95% of the patients, that we sometimes don’t know what to do for,” said Dr. Roger Hartl, neurosurgical director of Och Spine at New York-Presbyterian/Weill Cornell Medical Center, who was not involved in the study.

Virtual yoga would be something to offer these patients, he added. “Why not, if it works, it’s safe and effective?”

Americans spend approximately $135 billion annually on health care related to lower back pain, and a estimated 80% of adults suffers from it, previous studies showed.

The new study focused on healthcare workers, a group suffering from high levels of back pain.

The study authors note that patients often have difficulty attending in-person yoga classes. “As a result, higher-risk medications and other interventions are often prescribed, despite their limited effectiveness and risk of adverse effects,” the study said.

After the COVID-19 pandemic forced many yoga teachers to offer classes online, Saper and his colleagues decided to test the effectiveness of virtual yoga in what they believe to be the first study of the gender.

Researchers divided 140 Cleveland Clinic Employee Health Plan patients in Ohio and Florida with chronic low back pain into two groups: one received virtual hatha yoga classes and the other was on a list waiting for yoga.

At the start of the study, participants, mostly college-educated white women aged 38 to 59, reported a back pain level of about 6 out of 10. After six weeks, the level of pain reported by yoga students fell to 4, and after six months it fell to 3. The pain levels of those on the waiting list remained constant.

At the start of the study, 74% of participants were taking some form of painkillers. Six months later, less than a third of yoga practitioners were taking painkillers, while more than half of patients on the waiting list continued to take aspirin, ibuprofen, opioids and others painkillers.

“I think it expands the list of options for patients,” Saper said of the study results.

Earlier this year, Hartl d’Och Spine and colleagues published a similar study demonstrating that a 12-week virtual program of tai chi, qigong, and meditation relieved pain and improved sleep in adults with lower back pain.

“Obviously yoga is somewhat different,” Hartl said, “but I certainly think this is all moving in the right direction, which is that these types of virtually guided interventions can be very helpful in patients.”

Many previous studies have demonstrated the benefits of yoga or other back-related exercises for relieving chronic lower back pain or improving function. The quality of evidence in many of these cases was not high, however, one study authors note. Cochrane Review 2021. Part of the reason is that it’s difficult to blind participants to the fact that they’re doing yoga.

Saper noted that yoga, “like many other self-care practices, is not a quick fix.”

First of all, practitioners must learn how to practice yoga postures correctly and safely. The study’s classes were geared toward beginning yoga students, and trained teachers showed students how to use supportive props, like blocks and chairs, to tailor poses to their skill levels.

Students participating in the study received video recordings and detailed workbooks to help them practice alone and safely.

National Institutes of Health considers yoga generally safe “for healthy people when practiced properly, under the guidance of a qualified instructor”, but warns: “as with other forms of physical activity, injury may occur.”

Studies have documented a series of injuries related to yoga, especially among older people.

Three of the participants in the new study who took yoga classes reported temporary flare-ups of back pain, likely yoga-related.

Saper advises people with back pain to ask their doctor if yoga therapy is right for them. People with chronic pain should only take yoga classes geared toward them, he said.

Saper also tells yoga practitioners to “listen to your body as you move and adjust accordingly.”

Stretching can cause discomfort, he said. But he added: “If you feel pain, you should step out of the pose or ask the instructor for variations.

Ronnie Cohen is a San Francisco Bay Area journalist focused on health and social justice issues.

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