By Tori Zirul, M.Sc. and Sat Bir Singh Khalsa, Ph.D.
Burning and radiating pain, as well as limited range of motion; symptoms of neck pain range from headaches to tingling fingertips and, in severe cases, can compromise quality of life. Neck pain is a generalized term for various mechanical or neuropathic cervical spine conditions. The cervical spine is composed of seven vertebrae, C1-C7, and eight nerve roots. Each vertebra in the spinal column has a hollow center called the foramen; this allows the spinal cord to extend from the brain to the lumbar spine in order to deliver messages from your body and its parts to your brain or vice versa. Degenerative changes to the foramina puts stress on the nerves leading to pain and neuropathic disorders. Additionally, mechanical causes of neck pain originate from tightness in the muscles of the neck or back.
Despite the different causes of chronic neck pain, the presenting complications are similar. Whether if it is nerves or muscles causing symptoms, chronic neck pain could create limitations such as a more sedentary lifestyle, compromised dexterity and functional ability, and depression. Furthermore, physical symptoms create their own set of challenges in the social and professional lives of those suffering. Symptoms could become so severe that affected individuals need to take medical leave from work or face the difficult decision of spinal surgery. In 2019, the World Health Organization classified neck pain as one of the leading causes of disability, estimating that between one and three to one and five individuals, including children, suffer from neck pain or musculoskeletal conditions. There are multiple risk factors for neck pain including: genetics, sleep disturbances, psychopathology such as anxiety or depression, and lifestyle like smoking or physical inactivity. In addition, there are gender differences, with a higher prevalence of neck pain in women as compared to men. The ultimate cause of neck pain remains unclear and treatment is generally geared towards pain management and easing stiffness. Prescription medications and opioids have, traditionally, been go-to treatment options used to mask the debilitating effect of chronic neck pain. While muscle relaxers and opioids can help alleviate symptoms and anti-inflammatories ease the muscles, habitual use comes with a cost. There are significant risks to these options like side-effects, dependency, and prolonged structural misalignments, and so other treatment strategies have been under investigation.
In 2019, a paper in the Journal of Clinical Medicine concluded that the most effective mode of treatment for neck pain is physical exercise. It reviewed multiple treatment modalities from education to psychological approaches to targeted or general exercise. Recently, education of pain neuroscience has been a popular approach to treatment, however, it is more effective when combined with somatic interventions. This allows for an awareness of the body and the knowledge of pain aggravators, while simultaneously strengthening the body. Generally, results are largely inconclusive, however, multiple studies support the idea that exercise appears to be an effective modality for pain. The combination of breath work, physical-postures, and meditation with mindfulness allows for ease of stress and tension in the mind and body. Poses like cat and cow or cobra (Bhujangasana) specifically target spinal health by increasing flexibility and mobility. In addition, the mindfulness aspect of yoga is manifested and applied throughout daily activities and help change the mental-distress and emotional reactivity that are known to be associated with pain perception.
Furthermore, breathwork has been shown to help alleviate the stress and emotion response on the body through the autonomic nervous system, thereby relieving tension in the body and relaxing the musculature and nervous system hyperarousal. While there is a need for more research, yoga is beginning to gain popularity due to the aforementioned holistic nature of both the physical and mental and emotional benefits. In one of the earlier investigations of yoga for neck pain, Andreas Michalsen and colleagues published a paper in 2012 on the impact of yoga as a treatment for neck pain. The study included a 9-week yoga program to elucidate its usefulness as compared to a self-care and exercise education program for pain management. During the 9-week period, subjects participated in a weekly, 90-minute, Iyengar yoga class. Participants in both groups were evaluated for relief in pain and changes in mood like depression, anger, fatigue, etc. The study showed pain reduction and demonstrated improvement in assessed psychological outcomes like depression and fatigue. However, this study was relatively weak in that it was a short-term study that used a relatively small sample size and the control group also showed improvement.
In a 2017 meta-analysis in the journal Clinical rehabilitation, Holger Cramer et al. in Germany evaluated 3 studies including a total of 188 patients with chronic non-specific neck pain comparing yoga to usual care. They concluded that a consistent yoga practice had benefit for neck-pain and associated factors like quality of life and mood. The paper showed that the yoga interventions that included meditation and breathwork appeared to be more effective than those focusing more on the physical exercises and postures. Overall, the analysis confirmed the benefit of yoga as a complementary treatment and the need for more research. In addition to the meta-analysis above, Cramer et al. also published multiple studies on the benefits of yoga for neck pain. The research published included long and short-term studies for yoga as treatment for chronic neck pain. Of the various studies, different styles of yoga: Iyengar, Viniyoga, Hatha Yoga, and non-specified varieties were tested. Although there were reported improvements like decreased pain, increased range of motion, increased quality of life and mood, from each study, there was no significant correlation between the style of yoga and its corresponding benefit. Furthermore, there was no obvious correlation between increased frequency of practice with increased well-being demonstrated in the studies; practicing once weekly appeared to be sufficient. However, a sustained long-term practice that was continued beyond the duration of the study showed favorable outcomes. Cramer’s studies supported the concept of adding yoga to conventional treatment plans due to physical and mental benefits of yoga with its low associated risks of practice.
Researcher Naime Ulug and colleagues studied the effectiveness of Pilates and yoga for neck pain using ultrasound imaging as an outcome measure and published their results in the Journal of Rehabilitation Medicine recently in 2018. The treatment program spanned 6-weeks, the first half was class-based, while the second was independent and home based and compared yoga, Pilates, and targeted neck exercises in respective groups. The study found, a neck muscle associated with head and neck extension, in the group practicing Pilates, but not yoga. The increased size of the muscle was used as an indicator of improved strength. While Pilates was the only exercise group to show changes in muscle, all groups showed improved quality of life and range of motion, with decreased markers for disability and pain. Although, the study had limitations like partial supervision, short duration, and no progressive resistive exercise, it introduced a useful new diagnostic methodology of ultrasound imaging, and confirmed the benefits of complementary practices like yoga and Pilates. Neck pain is a major global health concern with no current ideal conventional therapy. Overall, there is promising supporting evidence for the use of yoga as a tool for neck pain management.
Future research with yoga is necessary to determine the best duration and frequency of practice and the best types of exercises to receive maximum and targeted benefit for neck pain reduction. Investigation to study the independent contribution of postures, meditation, and breath-work associated with a yoga practice is also needed. In addition, it would be beneficial for studies to include more rigorous documentation on drop-outs and adverse effects as most studies have reported that as problematic. Although, additional research with larger sample sizes is needed to move this area of research forward, there is encouraging evidence supporting the usefulness of yoga as a complementary treatment option to reduce neck-pain and increase quality of life in this disorder.
Tori Zirul is a certified yoga instructor, reiki healer, and scientist. She received her M.Sc. in Molecular Biology, with a concentration in virology, and finds immense joy in writing and speaking about the fields of science and yoga. It is her passion to combine the practice of yoga with the conceptual understanding of how it changes people from the cellular level. She is perpetually driven by a child-like curiosity that is especially evident in her love for science, yoga, art, and travel.
Sat Bir Singh Khalsa, Ph.D. is the KRI Director of Research, Research Director for the Kripalu Center for Yoga & Health, and Assistant Professor of Medicine at Harvard Medical School. He has practiced a Kundalini Yoga lifestyle since 1973 and is a KRI certified Kundalini Yoga instructor. He has conducted research on yoga for insomnia, stress, anxiety disorders, and yoga in public schools. He is editor in chief of the International Journal of Yoga Therapy and The Principles and Practice of Yoga in Health Care and author of the Harvard Medical School ebook Your Brain on Yoga.