Is It Safe to Do Yoga If I Have Low Back Pain?
Medically reviewed by Devanshi Modi, PT, Cert. MDT, CMP — licensed physical therapist with over 15 years of clinical experience.
There is no one answer to this question, but research offers some useful guidance. For long-lasting (chronic) low back pain, yoga is one of the non-drug options the American College of Physicians recommends trying first[1]. In a Cochrane review of 21 trials in adults with chronic low back pain, yoga may lead to small improvements in back-related function and pain compared with no exercise (on average, smaller than the change usually considered meaningful to patients), and back-related function was probably about the same as with other back-focused exercise. Side effects, mainly increased back pain, may be more common with yoga than with no exercise (about 4 in 100 people vs about 1 in 100 over 6 to 12 months) but may be about as common as with other exercise[2]. Here are some guidelines to help you decide.
Self-Assess Your Pain
Check the level of your back pain:
1. Is it a severe, recent flare-up, or a dull, long-lasting (chronic) ache?
If your pain is severe or has flared up recently, in our clinic we usually suggest holding off on yoga for now, because it may aggravate the pain, and staying gently active with everyday activities while the flare settles before starting or returning to yoga. Yoga is not free of side effects: in trials of people with long-lasting back pain, the side effect reported most often was increased back pain[2]. The good news is that most people with a new episode of low back pain recover quickly[3].
2. Does the pain feel better after you move (even in a few directions?) or does it feel worse after you move?
If moving in certain directions eases your stiffness and pain, that is generally a good sign: in studies of people with low back pain, pain that eases with movement in a particular direction is linked with a better outlook[4]. Gentle yoga poses or stretches may be worth trying, keeping in mind that in trials of chronic low back pain the average benefit of yoga was small[2].
Choosing the Right Yoga Poses
Since Yoga exercises vary in difficulty, decide the Yoga poses (asanas) you may want to perform upfront. In our clinic, breathing exercises (pranayama, such as Om Pranayama) and meditation are usually the easiest place to start, because they don't require bending or twisting your back. Separately, mindfulness-based stress reduction (a structured mindfulness meditation program, which is not the same as simple breathing exercises) is among the non-drug treatments the American College of Physicians recommends for chronic low back pain[1]. If breathing exercises are painful while sitting unsupported on the floor, we suggest doing them sitting on a chair with your back supported.
Many yoga poses bend the spine forward, backward or sideways, or twist it.
Notice whether your back reacts to a particular kind or direction of pose. In studies of people with back or neck pain, about two-thirds had symptoms that eased, or moved out of the limb and back toward the spine, with movement in a particular direction, while about a third showed no such response[4]. So if poses in one direction bother you, poses in another direction may feel better, although this is not true for everyone. If holding a stretch for a long time is very painful, we suggest holding the pose for a shorter time.
Looking Beyond a Single Cause
For nearly all people with low back pain, it isn't possible to pinpoint one specific cause of the pain[3]. So instead of hunting for a single cause, in our clinic we look at how your back responds to different movements and at nearby areas that affect how you move, such as your hips. For example, on average, people with low back pain have weaker hip muscles (the muscles at the side and back of the hip) than people without back pain[5], although that link does not prove that weak hips cause back pain.
Exercise programs that are designed for the individual and supervised, including stretching or strengthening, may improve pain and function in chronic low back pain[6]. A physical therapist can help you choose and adapt yoga poses and exercises that suit your back.
Always Remember
- If a particular pose sharply hurts your back or leaves your symptoms worse afterward, skip it or ask for a modification. If your pain is long-standing, mild discomfort during exercise is not always a reason to stop: in a small review of trials in people with long-standing musculoskeletal pain (mostly shoulder, Achilles and heel pain; only one trial was in back pain), exercise programs that allowed some pain worked at least as well as pain-free programs[7].
- Listen to your body. Mild muscle soreness after exercise can happen: in exercise trials for chronic low back pain that carefully tracked side effects, these were mostly minor, such as muscle soreness[8]. In our clinic, we ask patients to scale back and let us know if their back pain is worse the next day or lingers as a dull, nagging ache, so we can adjust their program.
Get your low back evaluated at Spineck Physical Therapy (Ph: 551-208-3234) for guidance on which yoga poses suit your back right now and how to modify the ones that don't.
References
- Qaseem A, Wilt TJ, McLean RM, et al. Noninvasive treatments for acute, subacute, and chronic low back pain: a clinical practice guideline from the American College of Physicians. Ann Intern Med. 2017;166(7):514-530. doi:10.7326/M16-2367 · PubMed
- Wieland LS, Skoetz N, Pilkington K, et al. Yoga for chronic non-specific low back pain. Cochrane Database Syst Rev. 2022;11(11):CD010671. doi:10.1002/14651858.CD010671.pub3 · PubMed
- Hartvigsen J, Hancock MJ, Kongsted A, et al. What low back pain is and why we need to pay attention. Lancet. 2018;391(10137):2356-2367. doi:10.1016/S0140-6736(18)30480-X · PubMed
- May S, Runge N, Aina A. Centralization and directional preference: an updated systematic review with synthesis of previous evidence. Musculoskelet Sci Pract. 2018;38:53-62. doi:10.1016/j.msksp.2018.09.006 · PubMed
- de Sousa CS, de Jesus FLA, Machado MB, et al. Lower limb muscle strength in patients with low back pain: a systematic review and meta-analysis. J Musculoskelet Neuronal Interact. 2019;19(1):69-78. PubMed
- Hayden JA, van Tulder MW, Tomlinson G. Systematic review: strategies for using exercise therapy to improve outcomes in chronic low back pain. Ann Intern Med. 2005;142(9):776-785. doi:10.7326/0003-4819-142-9-200505030-00014 · PubMed
- Smith BE, Hendrick P, Smith TO, et al. Should exercises be painful in the management of chronic musculoskeletal pain? A systematic review and meta-analysis. Br J Sports Med. 2017;51(23):1679-1687. doi:10.1136/bjsports-2016-097383 · PubMed
- Hayden JA, Ellis J, Ogilvie R, et al. Exercise therapy for chronic low back pain. Cochrane Database Syst Rev. 2021;9(9):CD009790. doi:10.1002/14651858.CD009790.pub2 · PubMed
This article is for general education and is not a substitute for an individual evaluation by a licensed clinician.
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This article is for educational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. Always consult a licensed healthcare provider about your specific condition.