Yoga and exercise for back pain: what UK guidance says

The NHS says back pain can have many causes and it is not always obvious what causes it. A common cause is an injury such as a pulled muscle. Medical conditions like a slipped disc, sciatica or ankylosing spondylitis can sometimes cause back pain, and very rarely it can be a sign of a serious problem such as a broken bone, cancer or an infection.

Arthritis UK adds that back pain often does not have one simple cause. It may be due to lack of exercise leading to a stiff spine and weak muscles, strains or sprains, poor posture or an inadequate work or home set-up. It also notes that up to 6 in 10 people will have back pain at some time in their lives, and that it is rarely a sign of a serious problem.

The NHS back pain page lists yoga among activities that may help ease back pain, alongside walking, swimming and pilates. It does not set out a specific yoga programme, and it places yoga within a wider message to keep active and to try exercises and stretches for back pain.

Arthritis UK is more specific about the role of exercise. It says staying active is the most important way you can help yourself, because it keeps the muscles around the spine strong, gives more support to the bones and joints and takes pressure off them. It lists swimming, walking, yoga, pilates and going to the gym among the best exercises for back pain and suggests choosing something you enjoy so that you are more likely to stick with it.

NICE guideline NG59 on low back pain and sciatica does not name yoga. It recommends that a group exercise programme (biomechanical, aerobic, mind-body or a combination of approaches) is considered within the NHS for people with an episode or flare-up of low back pain, with the type of exercise chosen to take account of the person's needs, preferences and capabilities. A yoga class could fit within that broad category, but the guidance does not say that yoga in particular is better than other approaches.

Arthritis UK says exercise might make your back feel a little sore at first, but this does not usually mean you are harming it. It suggests starting gently, building up gradually, and doing regular small amounts of activity, adding a little more each day. It also says that if you stop being active for a long time, back muscles can weaken and not moving can make your back stiffer and more painful.

The NHS advises speaking to a GP before starting if you have not exercised for some time or have medical conditions, and notes that the intensity should match your fitness. If you are new to yoga, a beginner class led by a qualified teacher who knows about your back pain is a sensible starting point, so postures can be adapted.

• Tell the teacher about your back pain before the class starts.

• Move within a comfortable range and avoid pushing into sharp pain.

• Stop if your pain gets worse and get advice from a GP, as the NHS advises.

• Build up slowly rather than doing a long session straight away.

• Combine yoga with walking or other activity you enjoy.

The NHS suggests taking anti-inflammatory medicine such as ibuprofen if suitable (not everyone can take it, and a pharmacist or GP can advise), noting that paracetamol on its own is not recommended for back pain. It also suggests an ice pack or a heat pack wrapped in a tea towel, and trying exercises and stretches.

NICE guidance advises against several approaches for low back pain, including belts or corsets, foot orthotics, traction, acupuncture, and spinal injections. It says manual therapy may be considered only as part of a treatment package that includes exercise.

The NHS says to see a GP if back pain does not improve after a few weeks of home treatment, stops you doing day-to-day activities, you have lost weight without trying, there is a lump or swelling or your back has changed shape, it does not improve after resting or is worse at night, it is worse when coughing, sneezing or pooing, or it is coming from the top of your back. In many areas you may be able to refer yourself to NHS community musculoskeletal (MSK) services for help such as physiotherapy.

Ask for an urgent GP appointment or call 111 if you have back pain and feel hot, cold, shivery or generally unwell, or the pain is severe, starts suddenly or is getting worse quickly.

Call 999 or go to A&E if you have back pain and pain, tingling, weakness or numbness in both legs, a loss of feeling around your genitals or anus, changes in bladder or bowel function, chest pain, or the pain started after a serious accident. Arthritis UK also lists difficulty controlling or passing pee, loss of bowel control, numbness around the back passage or genitals and leg weakness as signs needing urgent medical attention. Do not rely on exercise if these symptoms are present.

The NHS says other treatments may be recommended if pain does not get better after a few weeks: group exercise sessions and physiotherapy, manual therapy, cognitive behavioural therapy to help cope with pain, and, for long-term lower back pain only, a procedure to seal off some of the nerves in the back. If back pain is caused by a medical condition like a slipped disc and other treatments have not helped, surgery may be an option.

NICE says imaging should not routinely be offered in non-specialist settings for low back pain, and that spinal fusion and disc replacement should not be offered for low back pain except as part of a trial. Arthritis UK says X-rays are rarely used for back pain because many causes involve soft tissues that do not show up on them.

Through the NHS, back pain is usually managed in primary care with advice, self-care and, if needed, referral to physiotherapy or MSK services, sometimes by self-referral.

Some people also pay for private physiotherapy or classes. NICE says manual therapy should only be part of a package including exercise, and advises against several treatments often marketed for back pain, so it is worth asking any provider what the evidence is for what they propose.