Anote with a disturbing message lay on my desk. Somehow I knew it would come. According to the note, yoga, that Lycra-woven sweetheart of trendy wellness, finally went and kissed somebody else’s boyfriend. And, boy, are they going to be mad. At first blush, I wondered if the message was a vicious rumor started by jealous chiropractors, or maybe the acupuncture crowd. Soon enough, I realized this came from the prom queen herself, Johns Hopkins Hospital.
The note really wasn’t a note at all, but a recently posted Johns Hopkins Health Alert (johnshopkinshealthalerts.com). It enthusiastically spilled the beans about a study that demonstrated yoga was better at reducing back pain than physical therapy. To rub salt in the wound, the alert reported the pain-relieving capacity of physical therapy had been compared to the pain-relieving capacity of a self-help book—and yoga was significantly better than both.
And, the study behind this revelation about yoga, physical therapy, and low back pain didn’t bubble up from some fringe article in the alternative medicine press. No. It was a randomized, controlled trial conducted by MDs and PhDs published in Annals of Internal Medicine.
Maybe we should all just take a breath.
When Johns Hopkins—the same Johns Hopkins ranked No. 1 overall among American hospitals by US News and World Report—reports yoga outperforms physical therapy in any measure, we have a teachable moment. When people who have chronic low back pain see a major health care power report about the pain relief potential of yoga, it may be all the endorsement that population needs to drop a physical therapy program and test the yoga waters. The population of back pain sufferers is not insignificant. Low back pain is the most commonly reported type of pain in America, according to National Institutes of Health surveys. And an editor’s note tucked away in the Annals of Internal Medicine, revealed the number of people in this country who practice yoga specifically for low back pain relief sits at 1 million.
So is yoga a competitive threat to physical therapy for the population of patients who suffer low back pain?
It is not the birthright of physical therapy to have its pick of all the patients who legitimately need physical therapy. PTs and DPTs by definition are better educated about anatomy and physiology than instructors at the corner yoga shop. And, physical therapy is essential to treat conditions such as traumatic brain injury (TBI), limb loss, or scoliosis, to name a few. But how important is that to someone whose pain is caused by a simple muscle strain? How much revenue for the average physical therapy clinic is generated by TBIs compared to streams of individuals seeking relief for low back pain?
The temptations yoga offers are strong, and things for which physical therapy doesn’t yet have a response. For example, those who seek out yoga for back pain relief may unexpectedly find the meditative and spiritual aspects of yoga appealing. Also, the sense of community around a yoga studio may be a draw particularly for seniors, who often enjoy group settings and interaction. And, worth noting, an hour of yoga is a fraction of the cost of an hour of therapy. If a patient with low back pain perceives yoga and physical therapy provide similar levels of pain relief, the battle over price point begins to look all uphill.
Some PTs, however, seem to be warming to the convergence of therapy and yoga. Searching the Internet, it becomes apparent there is a small population of yoga studios owned and operated by PTs who are, perhaps, exploring a complementary business model. One physician is even catching the wave. Loren Fishman, MD, is medical director of Manhattan Physical Medicine and Rehabilitation in New York City. Fishman is a medical doctor who also teaches therapeutic yoga. He says the idea of prescribing yoga for back pain in the future will boil down to proper diagnosis—those who can correctly diagnose the cause of back pain will also be those who prescribe yoga as treatment. In a recent Q&A at yogajournal.com, Fishman offers advice for this eventuality: “Yoga therapists need to learn a good deal of medicine; medical people need a lot of practical information about yoga.”
Maybe it’s time to reach out to an experienced yoga teacher to talk about collaborating on treatment for patients or patient referrals. Or are you going to let someone else kiss your sweetheart?