Yoga for Neck Pain: A Review

Abstract

Objective:

This review aims to assess the effectiveness of yoga for neck pain.

Methods:

Three electronic databases (PubMed/Medline, Scopus, and Web of Science) were searched to identify studies on all types of neck pain. Eligible trials were published in the English language between 2010 and 2019. Eleven studies were included in the review. Primary outcome measures were neck pain intensity and neck disability. Secondary outcome measures were quality of life (QOL), neck range of motion (ROM), and anxiety.

Results:

Eleven studies (eight randomized controlled trials, one qualitative study, one 12-month follow-up, and one pilot study) on 544 patients with neck pain (chronic neck pain, common neck pain, myofascial pain syndrome of the neck, and chronic nonspecific neck pain) comparing yoga with home-based exercise or physiotherapy were included. Almost all studies reported a significant improvement in the yoga group compared with the control group. The results showed that yoga had a positive effect on neck pain intensity, neck disability, QOL, cervical ROM, and anxiety, renewed body awareness, and increased acceptance of pain and disability. The yoga intervention alone or with an integration of physiotherapy has been found to improve neck pain intensity.

Conclusion:

Yoga was found to have a significant effect on neck pain intensity and functional disability, improve pain tolerance, increase ROM, and reduce anxiety and may be a useful intervention for neck pain. However, studies of yoga on neck pain were with different forms of yoga and with varied duration of interventions. More research is needed to draw firm conclusions.

Introduction

Neck pain is a major musculoskeletal disorder in adults globally. The etiology may be complex and may involve ergonomic (such as the use of strong physical activity, force, and vibration, inadequate posture, and repetitive movement), personal (such as age, body mass index, genome, and history of musculoskeletal pain), behavioral (such as smoking and level of physical activity), and psychosomatic (such as job satisfaction, level of stress, anxiety, and depression) factors.¹ Previous studies have suggested that many patients with chronic neck pain use alternative or complementary methods to relieve their pain.^2
–4

Yoga comprises breathing postures (prānāyāma), meditation (dhyana), physical postures (āsana), and relaxation, which are used to enhance physical, emotional, and mental well-being.^5,6 The ultimate goal of yoga is to achieve the union of mind, body, and spirit. It has been shown to have a beneficial effect for reducing pain. It may help to relieve pain by downregulating the hypothalamic–pituitary adrenal axis and the sympathetic nervous system.⁷

Yoga has been used to improve neck posture and relieve neck pain.^{8

–18} There are many studies that have assessed the efficacy of yoga for neck pain; however, results are inconsistent. Many studies assessed yoga specifically for chronic neck pain or chronic nonspecific neck pain. The aim of this study was to review published trials on the effectiveness of yoga for all types of neck pain.

Methods

Three electronic databases (PubMed/Medline, Scopus, and Web of Science) were searched to identify studies on yoga for the management of neck pain. Eligible studies were published in the English language between 2010 and 2019. Full articles were reviewed to determine whether they met the selection criteria. Search terms were “neck pain,” “neck syndrome,” “myofascial pain of neck,” “chronic neck pain,” “yoga,” “yog,” and “mind sound resonance technique.” The retrieval process of the literature and key characteristics of eligible studies are depicted in Figure 1.

Figure 1.

Flow diagram of eligible studies.

Eligible studies included randomized controlled trials (RCTs), quasi-randomized controlled trials, randomized cross-over studies, case reports or follow-ups, and pilot studies, on any form or type of yoga intervention for neck pain. Studies excluded from this review were publications before the year 2010, RCTs with healthy participants, and review articles.

No restrictions were made on length, duration, type of yoga, and frequency of yoga programs. Eligible intervention studies included those evaluating yoga postures, breathing, meditation, and mind sound resonance techniques for neck pain. Neck pain conditions included common neck pain, chronic nonspecific neck pain, chronic neck pain, chronic mechanical neck pain, and myofascial pain syndrome of the neck. Studies on other health conditions were excluded.

Primary outcome measures were neck pain intensity and neck disability, as these two parameters are important predictors of clinical outcomes in neck pain. Secondary outcome measures were quality of life (QOL), neck range of motion (ROM), and anxiety, as these parameters were considered important in assessing all types of neck pain.

Results

Two hundred twenty studies were identified related to the search terms: 59 were identified from Pubmed/Medline, 47 from Scopus, and 114 from Web of Science. Of the 220 studies screened, 30 were removed due to being duplicates and 190 titles and abstracts were screened. After title retrieval, 171 studies were excluded either because they were not related to yoga or neck pain or were review articles. The remaining eligible 11 studies, with 544 patients, were included in this review. Key characteristics of eligible studies are depicted in Table 1.

Table 1.

Characteristics of Included Studies

Author, year	Region	Design	Sample size (mean age in years)	Type of neck pain	Comparison	Program length	Outcome measures	Results/conclusions
Yogitha, 2010⁹	India	Randomized parallel two-arm control design	60 (mean age 41.03 ± 15.54 years for yoga group; 42.23 ± 14.30 years for control group)	Common neck pain	Physiotherapy+yogic MSRT Physiotherapy+nonguided supine rest	10 days	Primary: 1. PAS 2. Neck muscle tenderness 3. Neck disability score 4. Movement of neck Secondary: 1. BP 2. Pulse rate 3. State and trait anxiety (STAI-Y1)	Yoga with MSRT had a significant effect on common neck pain in reducing pain, neck muscle tenderness, and improving flexibility.
Cramer, 2013¹¹	Germany	Qualitative study using semistandardized interviews	18 (mean age 19–59 years)	Chronic neck pain	90-minute Iyengar yoga once a week (only one group) No control group	Nine weeks	1. Drawing of neck and shoulder before and after yoga protocol 2. Semistandardized interviews used to explore body proportion, emotional status, coping skills	1. Active inner involvement during yoga sessions 2. Renewed body awareness 3. Perceived internal locus of control 4. Cognitive reappraisal of physical activity 5. Increased acceptance of pain and disability
Michalsen, 2012¹²	Germany	RCT	77 (mean age 47.9 ± 7.9 years)	Chronic neck pain	Nine-week Iyengar yoga Self-care exercise program	Nine weeks	1. VAS 2. Pain at motion 3. Functional disability (NDI) 4. QOL (SF-36) 5. Psychological outcomes (CES-D)	Yoga was a more effective treatment for chronic neck pain and had a beneficial effect on QOL and psychological aspects
Cramer, 2013³	Germany	RCT	51 (mean age 47.8 years)	Chronic nonspecific neck pain	Nine-week yoga course Exercise group: self-care manual or home-based exercise program	Nine weeks	1. Neck pain intensity (VAS) 2. Functional disability (NDI) 3. Pain at motion (VAS) 4. Health-related QOL (SF-36) 5. Cervical ROM 6. Proprioceptive acuity 7. Pressure pain threshold	Yoga was more effective in relieving chronic nonspecific neck pain compared with home-based exercise. Yoga also influenced the functional status of neck muscles
Cramer, 2013¹³	Germany	12-month follow-up	51 (mean age 47.8 years)	Chronic nonspecific neck pain	Yoga control (home-based exercise) After 10 weeks, the control group also started an Iyengar yoga program Both groups attended a nine-week Iyengar yoga program	Nine weeks (90 minutes/week)	1. Neck pain intensity (VAS) 2. Functional disability (NDI) 3. Health-related QOL (SF-36) 4. Generic disability (NDI) 5. Global improvement	Nine-week yoga intervention improved pain and functional disability in chronic nonspecific neck pain patients for at least 12 months after completion
Sharan, 2014¹⁴	India	Pilot study	8 (mean age 24.8 ± 1.25 years)	Cervical myofascial pain syndrome	Hatha yoga (prānāyāma, āsanas, and meditation)	Four-week program	1. CROM 2. Hand grip and pinch strength (Jamar hand grip dynamometer, Jamar pinch meter, respectively) 3. Pain threshold (Wagner Algometer) 4. DASH 5. NDI 6. SF-36	Grip and pinch strength improved significantly. Active and passive CROM improved. Significant improvement in quality of health and pressure threshold of trigger points and decreased disability
Jeitler, 2015¹⁵	Germany	RCT	89 (mean age 49.7 ± 10.5 years)	Chronic neck pain and psychological distress	Jyoti meditation Home-based exercise	Eight weeks	1. Change of mean pain at rest 2. Pain at motion (VAS) 3. Functional disability (NPDQ) 4. Pain-related bothersomeness 5. Perceived stress–CPSS 6. QOL-SF36 7. Depression-CES-D	Meditation may be a supportive alternative for chronic neck pain patients for reduction of pain and pain tolerance
Dunleavy, 2016²	United States	qRCT (quasi-randomized parallel controlled study)	56	Chronic mechanical neck pain	Control group (exercise) Pilates (thoracic flexibility exercise, light upper extremity weights, increased balance challenge using foam rollers, upright seated endurance exercise Yoga (breathing, postures to address alignment, strength, and flexibility and relaxation)	12 weeks	Primary: 1. NDI 2. Pain ratings-NRS 3. Range of movement 4. Postural measurements	Pilates and yoga exercises when done under supervision were equally effective in decreasing disability and pain compared with the control group for patients with chronic mechanical neck pain
Kim, 2018¹⁶	Korea	qRCT	38 (mean age 20.8 ± 1.2/21.1 ± 1.2 years)	Nonspecific neck pain	Yoga Exercise	Eight weeks	1. Neck pain intensity-VAS	Yoga significantly reduced neck pain intensity in university students compared with the exercise group
Ulug, 2018¹⁷	Turkey	RCT	56 (mean age 18–50 years)	Chronic neck pain	Pilates Yoga Isometric exercises	Six weeks	1. Cervical motion with goniometer 2. Pain severity (Mc Gill pain scale) 3. Disability (NDI) 4. QOL (Nottingham Health Profile) 5. Emotional status (Beck Depression Inventory)	Pain, disability, depression, and QOL improved equally in all groups (all P < 0.05); muscle thickness values of semispinalis capitis increased only in the Pilates group (P = 0.02)
Rajalaxmi, 2018¹⁸	India	RCT	40 (mean age 35–55 years)	Chronic mechanical neck pain	Yoga Pilates T'ai chi Control group (neck isometric exercises)	Three weeks	1. Northwick Pain Park Questionnaire 2. Tampa Scale for kinesiophobia	Yoga was more effective for patients with chronic mechanical neck pain than Pilates, t'ai chi, and isometric neck exercises

BP, blood pressure; CES-D, Centre for Epidemiologic Studies Depression Scale; CPSS, Cohen Perceived Stress Scale; CROM, cervical range of motion; DASH, disabilities of the arm, shoulder and hand; MSRT, mind sound resonance technique; NDI, Neck Disability Index; NPDQ, Neck Pain and Disability Questionnaire; PAS, Pain Analog Scale; RCT, randomized controlled trial; ROM, range of motion; SF-36, Short Form 36; qRCT, quasi randomized controlled trial; QOL, quality of life; VAS, Visual Analog Scale.

Yoga therapy had a median length of nine weeks with a median frequency of one weekly session. Yoga interventions were under the guidance of experienced yoga instructors. Yoga interventions included exercises, postures, and meditation. Various types of neck pain were included: chronic neck pain, chronic mechanical neck pain, myofascial pain syndrome of the neck, and chronic nonspecific neck pain. Most studies assessed neck pain intensity and disability. The control group in almost all studies included isometric exercises, Pilates, self-exercise, or t'ai chi. Iyengar yoga was the main style of yoga used in the included studies. This style of yoga focuses more on physical postures than breathing or meditation.

Almost all studies showed a significant improvement with yoga on neck pain intensity, neck disability, cervical ROM, anxiety, and QOL. The present study results are consistent with previous reviews and meta-analyses on the effect of yoga on neck pain.

Conclusion

This review was performed to evaluate the effectiveness of yoga on various types of neck pain. To the best of our knowledge, this study is the first review to assess yoga for all types of neck pain. Previous reviews included only chronic nonspecific neck pain or chronic neck pain. Yoga was found to have a significant effect on neck pain intensity and functional disability, improve pain tolerance, increase ROM, and reduce anxiety. Yoga may be a useful intervention for neck pain; however, more research is needed to draw firm conclusions.

Included studies of yoga for neck pain had small samples, different forms of yoga, and varied duration of interventions. There was also a high risk of bias due to nonblinded trials. Also, self-exercises in the control group were not under proper guidance, which may affect results. In addition, most outcome measures were subjective and follow-up data for almost all studies were not provided. Possibilities for future clinical trials include an integrated approach of both physiotherapy and yoga for neck pain.

Footnotes

Author Disclosure Statement

No competing financial interests exist.

Funding Information

No funding was received for this study. ■

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