Beth Cox, Yoga Practitioner, CNHC member. www.yogapractice.co.uk gives a personal, referenced account of why yoga is successful at treating mechanical neck pain

One of the most common causes of neck pain is whiplash associated disorder (WAD). There is a clear explanation of what can cause whiplash injuries and some of the symptoms associated with the injury on the home page of fixmyspine. One of the symptoms often seen with WAD injuries is the loss of muscular control of deep muscles in the neck.  This lack of control leads to compensation from the surrounding superficial muscles, which can fatigue easily and become over tense and tight in order to attempt to control the movement of the neck.

Simple movements such as those practiced through yoga can help to relax neck muscles and alleviating neck pain. By using muscles to move the neck we will be promoting blood flow which will help heal the area.  Often when we’re in pain we naturally want to protect where it hurts and might try to avoid moving areas; however, in most cases it is actually better to keep as mobile as possible and work with movements that don’t exacerbate the pain.

Guidelines for WAD treatment suggest that exercise based on individual assessment is likely to be better than general exercise in improving function.

People often seek physical manipulation for pain relief which can reduce symptoms.  However therapy guidelines for whiplash injuries suggest that a combination of manipulation and exercise may be more effective than manipulation alone for people with WAD in reducing pain, improving function and increasing patient satisfaction.

Guidelines also suggest that strengthening exercises may be more effective than passive treatment in improving function and in reducing pain. iv

There is evidence to show that supervised exercise following a detailed clinical evaluation tends to improve the rate of recovery.  Before beginning exercise after an injury, it is important that you have an assessment with a medical expert to diagnose the problem and check no further investigations are required.

There are many guides available online (in the form of exercise sheets or online videos) that give suggestions for performing simple neck movements.  Several of these suggest strengthening neck muscles by pushing your head against your hand and applying resistance against the movement.  If you were to follow these guides without medical advice there is a risk of them causing more problems. I would therefore recommend you seek a diagnosis and then follow an exercise programme designed specifically for your neck issue, rather than following a generic set of exercise.

How can yoga help people with neck pain?

Following a yoga practice has been shown to be more effective in relieving chronic nonspecific neck pain than following a self-care manual exercise program.

“Yoga reduced neck pain intensity and disability and improved health-related quality of life. Moreover, yoga seems to influence the functional status of neck muscles, as indicated by improvement of physiological measures of neck pain.”

I have taught yoga to people who have suffered trauma or degeneration in their cervical spine. It’s been rewarding to see changes with yoga students over the course of a few months and in some cases longer-term transformation over a number of years. I’ve seen real improvements, where people are able to regain movements we often take for granted, such as putting on their coat more easily or turning their head whilst driving.  This has also been reflected in students finding themselves able, with medical supervision, to reduce or eliminate the need for painkillers to manage their pain.When teaching yoga in these situations I design a practice specific to the individual, with the aim of helping them to stabilise the area and then gradually building up mobility and strength.  The yoga practice I plan would vary form person to person. There are no set exercises I would recommend without assessing an individuals movements and discussing how their pain affects them.

I start by teaching a new student a personal, manageable yoga practice that explores what movement is appropriate for them to do on a regular basis.   As their mobility and strength improves their yoga practice evolves in terms of choice of yoga postures relative to range of movement and breath capacity. With whiplash injures it is important to build up movement very slowly in the first few weeks, movements would develop a couple of weeks after the injury and would probably be very different 12 weeks after the trauma.

Doing a short regular practice is as important as building up the level of movement gradually. Rather than doing a long practice once a week, I advise students practice at least 5 – 6 times a week; this may range from a single daily practice or a shorter practice done twice a day.  When following a home practice I suggest biweekly review meetings where I can make appropriate changes to the practice according to a person’s progress. Longer-term students have found that their yoga practice evolves from being a recovery practice to a supportive practice to avoid problems re-occurring.

‘Sustained yoga practice seems to be the most important predictor of long-term effectiveness of improvement in neck pain.’

Although I’ve said that each student is unique in how I would design a practice there are some key movements and yoga postures I’d avoid in the beginning or even in the long term, if someone had a whiplash injury or other neck pain.

Things to avoid…

Although not a yoga posture I would suggest avoiding neck rolling. Head circles may compress the cervical discs and may also damage nerves and blood vessels in the neck. In the early stages of a flair-up of neck pain I would advise people to be very careful with weight bearing arm movements, as these will engage muscles in and around the neck.  So to begin with I’d suggest modifying the range and direction of arm movements, this could then be developed as mobility and strength improve.

Initially I’d suggest avoiding extremes of head movement.  I would gradually introduce short-range neck movements where there isn’t any strain or need to support the weight of the head.  Eventually building up to more weight bearing head movements in postures such as the downward and upward facing cat.

As a general rule I would avoid rotating the neck in strong asymmetrical work such as standing or lying twists and even side bends.  I would also initially avoid anything that would over stretch the neck area such as in two-foot support. Neck extensions such as those used in upward facing dog and some forms of cobra would also need to be introduced carefully and gradually if appropriate.

I would strongly advise against practicing a shoulder or headstand which may seem the last thing you would want to do.  I was surprised when I spoke to someone recently who had an undiagnosed neck issue, prior to meeting me she said she had regularly being doing the shoulder stand at home because she thought it would be good for her neck.

How to choose a yoga practitioner?

If you are looking for yoga as a therapy, make sure the practitioner is extensively trained and belongs to a recognized accredited body with high standards. There is an art in designing yoga for personalised therapeutic purposes and different skills are required from planning general yoga classes.  I would advise looking for a practitioner who is suitably trained and experienced in working with yoga therapeutically and teaching individuals who have specific health conditions or injuries.

If you are in the Swansea area and are interested in practicing yoga designed for your needs, I offer a free consultation where we can discuss how individual yoga lessons may help you.  To find our more please contact Beth Cox, at Yoga Practice (e-mail beth@yogapractice.co.uk; website www.yogapractice.co.uk).

Beth Cox trained as a Yoga Practitioner with the Centre for Yoga Studies on a 5 year course accredited by British Wheel of Yoga and Yoga European Union and British Council for Yoga Therapy, she has been teaching individual yoga students since 2011.  Beth is also a registered member of the Complementary and Natural Healthcare Council (CNHC) which is accredited by the Professional Standards Authority for Health and Social Care.

K. Dunleavy et. al. (2015) Comparative effectiveness of Pilates and yoga group exercise interventions for chronic mechanical neck pain: quasi-randomised parallel controlled study. Physiotherapy. Available online 2015 Available from www.sciencedirect.com/science/article/pii/S0031940615038080 [Accessed Jan 2016]

2 5. Moore A., Jackson A., Jordan J., Hammersley S., Hill J., Mercer C., Smith C., Thompson J., Woby S., Hudson A. (2005) Clinical Guidelines for the physiotherapy management of Whiplash Associated Disorder: A Quick Reference Guide. Available from: www.warwickphysio.com/uploads/documents/WAD%20guidelines.pdf [Accessed Jan 2016]

3 Cramer H et. al. (2013) Randomized-controlled trial comparing yoga and home-based exercise for chronic neck pain. Clinical Journal of Pain 29: 216-23 Available from www.ncbi.nlm.nih.gov/pubmed/23249655 [Accessed Jan 2016]

4 Cramer H, et. al. (2013) Yoga for chronic neck pain: a 12-month follow-up. Pain Medicine. 14:541-8.  Available from http://www.ncbi.nlm.nih.gov/pubmed/23387504 [Accessed Jan 2016]