Yoga is frequently used for back pain relief. However, evidence was judged to be of only low- or moderate. To assess the efficacy and safety of yoga in patients with low back pain a meta-analysis was performed. Therefore Medline/PubMed, Scopus, and the Cochrane Library was searched to May 26 2020. Only randomized controlled trials (RCTs) comparing Yoga with passive control (usual care or waitlist), or an active comparator, for patients with low back pain, that assessed pain intensity or pain-related disability as a primary outcome were considered to be eligible. Two reviewers independently extracted data on study characteristics, outcome measures, and results at short-term and long-term follow-up. Risk of bias was assessed using the Cochrane risk of bias tool. 30 articles on 27 individual studies (2,702 participants in total) proved eligible for review. Compared to passive control, yoga was associated with short-term improvements in pain intensity (15 RCTs; mean difference (MD) -0.74 points on a numeric rating scale; 95%CI -1.04 to -0.44; standardized mean difference (SMD) -0.37 95%CI -0.52 to -0.22), pain-related disability (15 RCTs; MD -2.28; 95%CI -3.30 to -1.26; SMD -0.38 95%CI -0.55 to -0.21), mental health (7 RCTs; MD 1.70; 95%CI 0.20 to 3.20; SMD 0.17 95%CI 0.02 to 0.32) and physical functioning (9 RCTs; MD 2.80; 95%CI 1.00 to 4.70; SMD 0.28 95%CI 0.10 to 0.47). Except for mental health all effects sustained long-term. Compared to an active comparator, yoga was not associated with any significant differences in short- or long-term outcomes. In conclusion, yoga revealed robust short- and long-term effects for pain, disability, physical function and mental health, when compared to non-exercise controls. However these effects were mainly not clinically significant.

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