The Somatic Connection  |   April 2013
Yoga vs Home-Based Exercise for Chronic Neck Pain
Author Affiliations
  • Michael A. Seffinger, DO
    Western University of Health Sciences College of Osteopathic Medicine of the Pacific, Pomona, California
  • Edward B. Lin, OMS III
    Western University of Health Sciences College of Osteopathic Medicine of the Pacific, Pomona, California
Article Information
The Somatic Connection   |   April 2013
Yoga vs Home-Based Exercise for Chronic Neck Pain
The Journal of the American Osteopathic Association, April 2013, Vol. 113, 353-355. doi:
The Journal of the American Osteopathic Association, April 2013, Vol. 113, 353-355. doi:
Cramer H, Lauche R, Hohman C, et al. Randomized-controlled trial comparing yoga and home-based exercise for chronic neck pain. Clin J Pain. 2013;29(3):216-223.  
Chronic neck pain has become a significant public health issue, with an average lifetime prevalence of just less than 50%.1 In a study examining national expenditure trends related to back and neck pain, Martin et al2 estimated that individuals with spinal problems incurred nearly $86 billion in related health expenditures in 2005, whereas those with cancer and diabetes had related health expenditures of $89 billion and approximately $98 billion, respectively. Researchers have investigated the myriad benefits that exercise provides to physical and psychological health, as well as how improving these factors can contribute to the reduction and management of musculoskeletal pain.3,4 Interest in yoga as a form of exercise to relieve pain associated with musculoskeletal disorders is growing; however, more evidence-based research is needed to prove the efficacy of yoga vs more traditional exercise regimens. In Resolution H-257 (A/2004-Osteopathic Manipulative Treatment of the Cervical Spine), the American Osteopathic Association recommends the use of osteopathic manipulative treatment (OMT) for cervical spine somatic dysfunction. The most reliable cardinal finding that supports the diagnosis of somatic dysfunction is tenderness upon palpation. Although it has yet to be determined how yoga measures up to OMT as a treatment modality for chronic neck pain related to somatic dysfunction, or whether it should be recommended as an adjunct to OMT, it would be important to know if yoga relieved tenderness to palpation, at least, and eventually determine if it relieves somatic dysfunction with or without OMT. To assess whether yoga alleviated physical (pressure pain) and subjective findings related to chronic neck pain, researchers from the Department of Internal and Integrative Medicine at the University of Duisburg-Essen in Essen, Germany, conducted a randomized controlled trial on the effects of a 9-week yoga intervention. 
Patients were included in this study if they were aged between 18 and 60 years, had nonspecific neck pain for at least 5 days per week during the previous 3 months, and had a mean neck pain intensity of at least 40 mm on a 100-mm visual analog scale (with 0 mm indicating no pain and 100 mm indicating the worst pain imaginable). Patients were excluded from study participation if they had inflammatory rheumatic disease, active oncologic disease, affective disorder, addiction, or psychosis; if they had recently undergone invasive spinal procedures; or if they were pregnant. They were also excluded if they could not practice yoga; if they had practiced yoga within the previous 12 weeks; or if they had started a new treatment for their neck pain in the previous month or were planning to start one during the next 9 weeks. Researchers completed screening of 227 participants by telephone, using the aforementioned criteria, and 51 patients qualified for and completed the study. 
To evaluate the effects of Iyengar yoga vs a home-based exercise program as an intervention for chronic nonspecific neck pain, researchers randomly assigned the 51 patients to either a yoga group (n=25) or a home-based exercise group (n=26) (ie, the active control group). All patients completed psychosocial questionnaires and had physiological measurements obtained at baseline. Present pain was the primary outcome measure and was assessed on a 100-mm visual analog scale. Subjective secondary outcome measures, including pain on motion, functional disability, and health-related quality of life, were assessed using a 100-mm visual analog scale, the Neck Disability Index, and the Short Form-36 Health Survey questionnaire, respectively. Objective secondary outcome measures included cervical range of motion, proprioceptive acuity, and the pressure pain threshold. 
The participants who were assigned to the yoga group were taught Iyengar yoga postures that targeted the muscles of the neck and shoulder region. Iyengar yoga is a style of yoga that includes variations of classical yoga postures, with emphasis given to proper postural alignment and the use of props to help maintain such alignment. For 9 weeks, the yoga group practiced Iyengar yoga in weekly 90-minute sessions led by a certified Iyengar yoga instructor. An individual who had a master's degree in psychology and who specialized in working with patients with chronic pain was also present to assist the instructor. In addition to their weekly yoga sessions, patients were required to practice yoga at home for 10 minutes per day and to record daily home practice times in a log. In contrast, participants in the home-based exercise group received self-care exercise manuals. They were also expected to practice at home for 10 minutes per day and keep detailed records of their activity. Patients in both groups were instructed to maintain their usual pain management regimens. 
An investigator blinded to group allocation repeated all physiological measurements at week 9 (after the yoga intervention). At baseline, sociodemographic variables and neck pain characteristics did not differ between the 2 groups; however, after the yoga intervention, the yoga group reported significantly less neck pain intensity than did the home-based exercise group, with a mean between-group difference of −13.9 mm (95% confidence interval, −26.4 mm to −1.4 mm; P=.03). Moreover, the yoga group demonstrated decreased functional disability and clinically significant improvement in several parameters on the Short-Form-36 Health Survey questionnaire, including mental health and bodily pain. The yoga group also exhibited significantly better results for the physiologic secondary outcome measures, greatly outperforming their counterparts in the home-based exercise group. 
The authors of this study concluded that Iyengar yoga provided more pain relief for patients with chronic nonspecific neck pain than did home-based exercise. Furthermore, as illustrated by the physiologic measurements of chronic neck pain, yoga seemed to help improve the functional status of the cervical musculature. Some limitations of this study include the inability to blind patients to treatment group allocation and the lack of an instructor-guided experience for the home-based exercise group. Future studies might incorporate a physical therapist experienced in training patients with chronic musculoskeletal disorders, as well as examine the effects of Iyengar yoga in a long-term follow-up of patients. More and more studies are demonstrating the effect that yoga can have on the alleviation of musculoskeletal pain. Some studies may even suggest that yoga is a more effective modality than OMT. For osteopathic physicians, the question now becomes: Should yoga be considered an adjunct therapy to OMT? 
Fejer R, Kyvik KO, Hartvigsen J. The prevalence of neck pain in the world population: a systematic critical review of the literature. Eur Spine J. 2006;15(6):834-848. [CrossRef] [PubMed]
Martin BI, Deyo RA, Mirza SKet al. Expenditures and health status among adults with back and neck problems [published correction appears in JAMA. 2008;299(22):2630]. JAMA. 2008;299(6):656-664. [CrossRef] [PubMed]
Key TM, Gross A, Goldsmith C, Santaguida PL, Hoving J, Bronfort G, Cervical Overview Group. Exercise for mechanical neck disorders. Cochrane Database Syst Rev. 2005;(3):CD004250.
Elkiss ML, Jerome JA. Chronic pain management. In: Chila AG, executive ed. Foundations of Osteopathic Medicine. 3rd ed. Baltimore, MD: Lippincott Williams & Wilkins; 2011:253-275.