Comparing Types of Yoga for Chronic Low Back and Neck Pain in Military Personnel: A Feasibility Randomized Controlled Trial

Erik J Groessl, Danielle Casteel, Symone McKinnon, Adhana McCarthy, Laura Schmalzl, Douglas E Chang, Ian M Fowler, Crystal L Park, Erik J Groessl, Danielle Casteel, Symone McKinnon, Adhana McCarthy, Laura Schmalzl, Douglas E Chang, Ian M Fowler, Crystal L Park

Abstract

Background: Chronic low back pain (cLBP) and chronic neck pain (cNP) are highly prevalent conditions and common reasons for disability among military personnel. Yoga and other mind-body interventions have been shown to safely decrease pain and disability in persons with cLBP and/or cNP but have not been adequately studied in active duty military personnel. The objective of this study was to examine the feasibility and acceptability of delivering 2 types of yoga (hatha and restorative) to a sample of active-duty military personnel with cLBP/cNP.

Methods: Military personnel with cLBP and/or cNP (n = 49; 59% men) were randomized to either hatha or restorative yoga interventions. Interventions consisted of in-person yoga 1-2x weekly for 12 weeks. Feasibility and acceptability were measured by rates of recruitment, intervention attendance, attrition, adverse events, and satisfaction ratings. Health outcomes including pain and disability were measured at baseline, 12 weeks, and 6 months. Means and effect sizes are presented.

Results: Recruitment was completed ahead of projections. Over 90% of participants agreed or strongly agreed that they enjoyed participation, liked the instructor, and would like to continue yoga. Retention rates were 86% and 80% at 12 week and 6 month assessments, respectively. Intervention attendance was adequate but lower than expected. There were small to moderate reductions in back-pain related disability, pain severity and pain interference, and improvements in quality of life, grip strength, and balance. In general, effects were larger for those who attended at least 50% of intervention classes. Participants with cNP tended to have smaller outcome improvements, but conclusions remain tentative given small sample sizes.

Conclusions: Results demonstrate feasibility for conducting a randomized controlled comparative effectiveness trial of yoga for cLBP and cNP among active duty military personnel. Acceptability was also established. Ongoing work will enhance the intervention for cNP and establish feasibility at another military facility in preparation for a fully-powered comparative effectiveness trial.ClinicalTrials #NCT03504085; registered April 20, 2018.

Keywords: Chronic pain; disability; feasibility; military personnel; yoga.

Conflict of interest statement

Declaration of Conflicting Interests: The author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: Copyright Statement for Military Service member authors CDR Fowler is a military Service member or employee of the U.S. Government. This work was prepared as part of my official duties. Title 17, U.S.C., §105 provides that copyright protection under this title is not available for any work of the U.S. Government. Title 17, U.S.C., §101 defines a U.S. Government work as a work prepared by a military Service member or employee of the U.S. Government as part of that person’s official duties.

© The Author(s) 2022.

Figures

Figure 1.
Figure 1.
Randomized Trial Flowchart.

References

    1. Von Korff M, Saunders K. The course of back pain in primary care. Spine. 1996;21(24):2833-2837.
    1. Guo HR, Tanaka S, Halperin WE, Cameron LL. Back pain prevalence in US industry and estimates of lost workdays. Am J Publ Health. 1999;89(7):1029-1035.
    1. Andersson GB. Epidemiological features of chronic low-back pain. Lancet. 1999;354(9178):581-585.
    1. Vällfors B. Acute, subacute and chronic low back pain: Clinical symptoms, absenteeism and working environment. Scand J Rehabil Med Suppl. 1985;11:1-98.
    1. Currie SR, Wang J. Chronic back pain and major depression in the general Canadian population. Pain. 2004;107(1-2):54-60.
    1. Sullivan MJL, Reesor K, Mikail S, Fisher R. The treatment of depression in chronic low back pain: review and recommendations. Pain. 1992;50(1):5-13.
    1. Manchikanti L, Pampati V, Beyer C, Damron K, Barnhill RC. Evaluation of psychological status in chronic low back pain: Comparison with general population. Pain Physician. 2002;5(2):149-155.
    1. Thompson JW, Bower S, Tyrer SP. A double blind randomised controlled clinical trial on the effect of Transcutaneous Spinal Electroanalgesia (TSE) on low back pain. Eur J Pain. 2007;12(3):371-377.
    1. Bilterys T, Siffain C, De Maeyer I, et al. Associates of insomnia in people with chronic spinal pain: A systematic review and meta-analysis. J Clin Med. 2021;10(14):3175.
    1. Burns JW, Gerhart J, Rizvydeen M, Kimura M, Burgess HJ. Morning bright light treatment for chronic low back pain: Potential impact on the volatility of pain, mood, function, and sleep. Pain Med. 2020;21(6):1153-1161.
    1. Luo X, Pietrobon R, X Sun S, Liu GG, Hey L. Estimates and patterns of direct health care expenditures among individuals with back pain in the United States. Spine. 2004;29(1):79-86.
    1. Chou R, Qaseem A, Snow V, et al. Diagnosis and treatment of low back pain: A joint clinical practice guideline from the American College of Physicians and the American Pain Society. Ann Intern Med. 2007;147(7):478-491.
    1. Chou R, Huffman LH. Medications for acute and chronic low back pain: A review of the evidence for an American Pain Society/American College of Physicians clinical practice guideline. Ann Intern Med. 2007;147(7):505-514.
    1. Chou R, Huffman LH. Nonpharmacologic therapies for acute and chronic low back pain: A review of the evidence for an American Pain Society/American College of Physicians clinical practice guideline. Ann Intern Med. 2007;147(7):492-504.
    1. Chou R, Deyo R, Friedly J, et al. Nonpharmacologic therapies for low back pain: A systematic review for an american college of physicians clinical practice guideline. Ann Intern Med. 2017;166(7):493-505.
    1. Knox J, Orchowski J, Scher DL, Owens BD, Burks R, Belmont PJ. The incidence of low back pain in active duty United States military service members. Spine. 2011;36(18):1492-1500.
    1. Roy TC. Diagnoses and mechanisms of musculoskeletal injuries in an infantry brigade combat team deployed to Afghanistan evaluated by the brigade physical therapist. Mil Med. 2011;176(8):903-908.
    1. Kang HK, Mahan CM, Lee KY, Magee CA, Murphy FM. Illnesses among United States veterans of the Gulf War: A population-based survey of 30,000 veterans. J Occup Environ Med. 2000;42(5):491-501.
    1. Patzkowski JC, Rivera JC, Ficke JR, Wenke JC. The Changing face of disability in the US Army. J Am Acad Orthop Surg. 2012;20(suppl 1):S23-S30.
    1. McGeary D, Moore M, Vriend CA, Peterson AL, Gatchel RJ. The evaluation and treatment of comorbid pain and PTSD in a military setting: An overview. J Clin Psychol Med Settings. 2011;18(2):155-163.
    1. Spelman JF, Hunt SC, Seal KH, Burgo-Black AL. Post deployment care for returning combat veterans. J Gen Intern Med. 2012;27(9):1200-1209.
    1. Coulter ID, Hilton L, Walter J, Brown KS. Integrative pain management centers in the military: The challenges. Mil Med. 2016;181(9):1033-1039.
    1. Hurst S, Maiya M, Casteel D, et al. Yoga therapy for military personnel and veterans: Qualitative perspectives of yoga students and instructors. Compl Ther Med. 2018;40:222-229.
    1. Schmalzl L, Powers C, Henje Blom E. Neurophysiological and neurocognitive mechanisms underlying the effects of yoga-based practices: Towards a comprehensive theoretical framework. Front Hum Neurosci. 2015;9:235.
    1. Groessl EJ, Sklar M, Chang D. Yoga for low back pain: A review of concepts and literature. In: Norasteh AA, ed. Low Back Pain 2 . Rijeka, Croatia: InTech; 2012.
    1. Sherman KJ, Cherkin DC, Wellman RD, et al. A randomized trial comparing yoga, stretching, and a self-care book for chronic low back pain. Arch Intern Med. 2011;171(22):2019-2026.
    1. Tilbrook HE, Cox H, Hewitt CE, et al. Yoga for chronic low back pain. Ann Intern Med. 2011;155(9):569-578.
    1. Groessl EJ, Liu L, Chang DG, et al. Yoga for military veterans with chronic low back pain: A randomized clinical trial. Am J Prev Med. 2017;53(5):599-608.
    1. Yu W, Ravelo A, Wagner TH, et al. Prevalence and costs of chronic conditions in the VA health care system. Med Care Res Rev: MCRR. 2003;60(3 suppl l):146S-167S.
    1. Agha Z, Lofgren RP, VanRuiswyk JV, Layde PM. Are Patients at veterans affairs medical centers sicker? Arch Intern Med. 2000;160(21):3252-3257.
    1. Cramer H, Lauche R, Hohmann C, et al. Randomized-controlled trial comparing yoga and home-based exercise for chronic neck pain. Clin J Pain. 2013;29(3):216-223.
    1. Dunleavy K, Kava K, Goldberg A, et al. Comparative effectiveness of pilates and yoga group exercise interventions for chronic mechanical neck pain: quasi-randomised parallel controlled study. Physiotherapy. 2016;102(3):236-242.
    1. Anheyer D, Haller H, Lauche R, Dobos G, Cramer H. Yoga for treating low back pain: A systematic review and meta-analysis. Pain. 2021;163(4):e504-e517.
    1. Wieland LS, Skoetz N, Pilkington K, Vempati R, D'Adamo CR, Berman BM. Yoga treatment for chronic non-specific low back pain. Cochrane Database Syst Rev. 2017;1:CD010671.
    1. Iyengar BKS. Light on Yoga . Revised ed. New York, NY: Schocken; 1979.
    1. Highland KB, Schoomaker A, Rojas W, et al. Benefits of the restorative exercise and strength training for operational resilience and excellence yoga program for chronic low back pain in service members: A pilot randomized controlled trial. Arch Phys Med Rehabil. 2018;99(1):91-98.
    1. Manik RK, Mahapatra AK, Gartia R, Bansal S, Patnaik A. Effect of selected yogic practices on pain and disability in patients with lumbar spondylitis. Int J Yoga. 2017;10(2):81-87.
    1. Groessl EJ, Schmalzl L, Maiya M, et al. Yoga for veterans with chronic low back pain: Design and methods of a randomized clinical trial. Contemp Clin Trials. 2016;48:110-118.
    1. Groessl EJ, Weingart KR, Aschbacher K, Pada L, Baxi S. Yoga for veterans with chronic low-back pain. J Alternative Compl Med. 2008;14(9):1123-1129.
    1. Cleeland CS, Ryan KM. Pain assessment: global use of the Brief Pain Inventory. Ann Acad Med Singapore. 1994;23(2):129-138.
    1. Keller S, Bann CM, Dodd SL, Schein J, Mendoza TR, Cleeland CS. Validity of the brief pain inventory for use in documenting the outcomes of patients with noncancer pain. Clin J Pain. 2004;20(5):309-318.
    1. Chen W-H, Revicki DA, Lai J-S, Cook KF, Amtmann D. Linking pain items from two studies onto a common scale using item response theory. J Pain Symptom Manag. 2009;38(4):615-628.
    1. Roland M, Fairbank J. The roland-morris disability questionnaire and the oswestry disability questionnaire. Spine. 2000;25(24):3115-3124.
    1. Sherman KJ, Cherkin DC, Erro J, Miglioretti DL, Deyo RA. Comparing yoga, exercise, and a self-care book for chronic low back pain. Ann Intern Med. 2005;143(12):849-856.
    1. Vernon H. The neck disability index: State-of-the-art, 1991-2008. J Manipulative Physiol Therapeut. 2008;31(7):491-502.
    1. Jenkinson C, Layte R, Jenkinson D, et al. A shorter form health survey: Can the SF-12 replicate results from the SF-36 in longitudinal studies? J Publ Health. 1997;19(2):179-186.
    1. Krupp LB, LaRocca NG, Muir-Nash J, Steinberg AD. The fatigue severity scale. Arch Neurol. 1989;46(10):1121-1123.
    1. Pepper CM, Krupp LB, Friedberg F, Doscher C, Coyle PK. A comparison of neuropsychiatric characteristics in chronic fatigue syndrome, multiple sclerosis, and major depression. J Neuropsychiatry Clin Neurosci. 1993;5(2):200-205.
    1. Lorig K. Outcome Measures for Health Education and Other Health Care Interventions . Thousand Oaks, CA: Sage Publications; 1996.
    1. World Health Organization . The Alcohol Use Disorders Identification Test: Guidelines for Use in Primary Care. Geneva, Switzerland: WHO. 2001.
    1. Radloff LS. The CES-D scale. Appl Psychol Meas. 1977;1:385–401.
    1. Andresen EM, Malmgren JA, Carter WB, Patrick DL. Screening for depression in well older adults: Evaluation of a short form of the CES-D. Am J Prev Med. 1994;10(2):77-84.
    1. Smith BW, Dalen J, Wiggins K, Tooley E, Christopher P, Bernard J. The brief resilience scale: assessing the ability to bounce back. Int J Behav Med. 2008;15(3):194-200.
    1. Forbes D, Hawthorne G, Elliott P, et al. A concise measure of anger in combat-related posttraumatic stress disorder. J Trauma Stress. 2004;17(3):249-256.
    1. Groessl EJ, Maiya M, Schmalzl L, Wing D, Jeste DV. Yoga to prevent mobility limitations in older adults: Feasibility of a randomized controlled trial. BMC Geriatr. 2018;18(1):306.
    1. Rantanen T, Guralnik JM, Foley D, et al. Midlife hand grip strength as a predictor of old age disability. JAMA. 1999;281(6):558-560.
    1. Berg KO, Wood-Dauphinee SL, Williams JI, Maki B. Measuring balance in the elderly: Validation of an instrument. Can J Public Health. 1992;83(suppl 2):S7-S11.
    1. Vellas BJ, Wayne SJ, Romero L, Baumgartner RN, Rubenstein LZ, Garry PJ. One-leg balance is an important predictor of injurious falls in older persons. J Am Geriatr Soc. 1997;45(6):735-738.
    1. Cohen J. Statistical Power Analysis for the Behavioral Sciences . 2nd ed. New York, NY: Lawrence Erlbaum; 1988.
    1. 2019 Demographics of the Military Community . Department of Defense (DoD), Office of the Deputy Assistant Secretary of Defense for Military Community and Family Policy (ODASD (MC&FP)). 2019.
    1. Furlan AD, Pennick V, Bombardier C, van Tulder M, Editorial Board CBRG. 2009 updated method guidelines for systematic reviews in the cochrane back review group. Spine. 2009;34(18):1929-1941.

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