409: Efficacy of Integrated Yoga Therapy vs Physiotherapy in Chronic Low Back Pain in Elderly Patients

Topic: Clinical Science
Subtopic: Pain category (ICD-11), Chronic primary musculoskeletal pain, Pain in special populations (e.g. neonates, children, teens, elderly, neurodegenerative diseases)

Background and Aims: Age-related musculoskeletal degeneration, poor posture, sarcopenia, and osteoarthritis contribute to the burden of chronic low back pain in elderly population, affecting mobility and reducing their quality of life. The management of chronic back pain is also difficult in elderly as these patients are particularly susceptible to the side effects of conventional pharmacotherapy and interventions. Among non-pharmacological treatments, Physiotherapy, based on stretching and strengthening exercises, focuses primarily on physical rehabilitation, while Integrated Yoga Therapy (IYT) integrates the mind-body connection, potentially addressing both the physical and psychological dimensions of pain, offering a holistic approach to pain management. The current study was designed to compare the feasibility and efficacy of Integrated Yoga Therapy with conventional Physiotherapy in reducing pain intensity, back disability, and improving spinal flexibility in elderly patients having long standing low back pain. Serum IGF-1 levels were also compared to assess the effect of treatment on pain hypersensitivity at spinal level.

Methods: In this randomized controlled trial, after ethical committee approval and written informed consent, total sixty elderly patients of more than 60 years having moderate to severe intensity chronic low back pain were randomly allocated into two groups: IYT Group received 60- min sessions of Integrated Yoga Therapy, 5 days/week for 2 weeks, then home-based practice for 10 weeks. Yoga therapy was given by a trained Yoga therapist having a minimum 5 years’ experience. Practices included loosening, stretching, asanas, pranayama, relaxation, and meditation. PT Group received standard stretching and strengthening exercises. Both groups underwent 12 weeks of therapy with regular follow-ups. Primary outcome was reduction in pain intensity measured by Numerical Rating Scale (NRS, 0-10). The worst pain, least pain, and average pain during the week were recorded. Secondary outcomes included spinal flexibility, Oswestry Disability Index (ODI), serum IGF-1 levels. The feasibility and adaptability of the treatment was also assessed.

Results: Total 60 patients were randomized into IYT and PT groups. The demographic profile was comparable. Current pain and worst pain scores showed significant reduction from 1st week onwards in both the groups, while average pain reduction was seen from 2nd week in IYT group and from 4th week onwards in PT group, 11 patients in IYT group and 5 patients in PT group showed significant improvement in back disability after 3 months. Flexibility was measured by goniometer for flexion, extension, right and left lateral flexion, and right and left lateral rotation. IYT group showed significantly better improvement in all measures as compared to PT group after 1st and 3rd month (p<0.01). Adherence to treatment was high in both the groups, with minor dropouts. No serious adverse events recorded. The IGF-1 levels were significantly less from baseline at 1st and 3rd month in IYT group but not in PT group.

Conclusions: Our trial indicates that yoga is not only safe and feasible non- pharmacological therapy in elderly population but also comparable in efficacy to physiotherapy in the management of chronic back pain, with added advantages in improving flexibility, potential biomarker modulation, and remote accessibility. Our study also provides novel insights by evaluating IGF-1, a biomarker implicated in pain hypersensitivity through its effects on dorsal-root ganglion excitability and T-type channel currents. The observed reduction in IGF-1 in IYT group suggests that yoga may modulate biological pathways relevant to nociception, complementing its physical and psychological benefits. This mechanistic dimension, rarely examined in yoga research, highlights an avenue for future exploration. In conclusion, our findings support the integration of yoga as a viable therapeutic option within multidisciplinary pain management strategies for the elderly. The limitations of our study included relatively short follow-up and absence of psychological outcome measures like depression, anxiety, and sleep quality.

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Presenting Author: Neerja Bharti
Submitting Author: NEERJA BHARTI

Senior Author: Neerja Bharti

IASP 2026 Global Year theme of Neuropathic Pain: Yes

• Dr. Ishita Sood: MD - PGIMER, Chandigarh