Yoga for Neck and Shoulder Pain

IIn our high-stress, hurried world—filled with financial pressures, information overload, “terror alerts” and sleeplessness—many people feel the weight of the world on their shoulders. Add to this emotional tension the physical stress of sedentary lifestyles with long hours spent hunched over computers and, all too often, the result is a serious pain in the neck.

What’s more, the problem doesn’t stop there. Chronic neck pain is linked to a host of related disorders, including headache, jaw soreness, and pain radiating into the shoulders, upper back and arms. In addition, the slumped posture that can lead to neck pain may also compress internal organs, contributing to digestive, circulatory and respiratory problems.

As a mind-body practice, yoga offers powerful tools to help relieve and prevent neck pain. Physically, yoga postures help stretch tight muscles, strengthen weak ones and teach proper alignment, which relieves strain on the neck and shoulders. Psychologically, yoga is a potent stress reliever that also encourages awareness—a process that sheds light on habitual stress patterns and emotional reactions and can help us move with diligence and compassion in the direction of health. Energetically, yoga breathing enhances vital energy and recharges the entire system.

How Widespread Is the Problem?

Neck pain and its associated disorders are much more common than anyone previously believed and have become a major cause of disability around the world (Lindgren 2008). Consider these statistics from the Neck Pain Task Force, an international group of clinician-scientists established in 2000 as part of the World Health Organization’s Bone and Joint Decade, a global initiative focusing on musculoskeletal disorders (Haldeman et al. 2008):

• Most people can expect to experience some degree of neck pain in their lifetimes.
• Each year, between 11% and 14.1% of workers report being limited in their activities because of neck pain.
• Most people with neck pain do not experience a complete resolution of symptoms. Between 50% and 85% will report a recurrence of neck pain 1–5 years after the initial experience.

Neck pain is often difficult to manage, concluded the Task Force, which stressed the importance of empowering people with neck pain to participate in their own care. The scientists found that in most cases, things that keep us moving—including exercise and manual therapy—are good. In contrast, things that stop us from moving—including soft collars—are bad (Hurwitz 2008). Avoiding smoking, keeping physically active and maintaining a positive thought process proved to be helpful. People who tend to worry and become angry in response to neck pain had a poorer prognosis, while those who were optimistic were more likely to experience pain relief (Carroll et al. 2008).

Putting Your Head on Straight

While neck pain sometimes results from trauma, such as a sports injury or whiplash from a car accident, by far the most common cause is stress on muscles and ligaments, often stemming from poor postural habits. Two major postural problems that yoga can relieve, and sometimes eliminate, are asymmetry and forward-head posture.

Asymmetry is an imbalance of our physical structure that is often related to how we use our bodies repetitively over time. These habits of use are frequently linked to our preference for using our dominant hand. For example, right-handed people tend to hold things (such as telephones and babies) on their left side to keep their dominant hand free to take notes, stir pots and so on. One-sided sports (golf, bowling, tennis) and one-sided jobs (machine operator, concert cellist, house painter) can also lead to physical imbalances over time, so that one shoulder may be higher or sit more forward than the other.

Yoga practice is designed to help the body become as symmetrical as possible, with all sides—right and left, front and back, top and bottom—having equal or appropriate strength and flexibility. Even for people with scoliosis or other structural abnormalities, yoga practice can be extremely therapeutic, helping to cultivate as much balance and symmetry throughout the body as possible.

Forward-head posture is a misaligned relationship between the head and the shoulders, where the head protrudes in front of the shoulders and the upper back rounds. The next time you’re in a coffee bar, watch people sitting rounded over their computers, and you’ll see prime examples of how the muscles of the neck, shoulders and upper back must work hard to counterbalance the weight of the heavy head against the pull of gravity. At the same time, this kind of slumped sitting causes the muscles in the front of the neck and chest to tighten and shorten, drawing the head even farther forward. As the chest collapses, the chin juts out to keep the gaze forward, creating further compression in the neck. This postural misalignment also puts pressure on nerves and blood vessels in the arms, which can increase the risk of repetitive stress injuries, such as carpal tunnel syndrome and thoracic outlet syndrome. Learning how to bring the head into proper alignment over the shoulder girdle is a key element of yoga postures such as mountain pose (see “Essential Postures for Neck and Shoulders”) and can offer profound relief.

The Emotional Connection

Our psychobiological habits—how we respond emotionally and physically to stress—also play an important role in neck and shoulder pain. For example, when we’re faced with fear, anxiety or other stressors, a very common reaction is to tighten muscles in the upper back, shoulders and neck—in effect, lifting the shoulders up toward the ears. Other common stress reactions—including teeth grinding, brow furrowing, lip pursing and breath holding—can also bring tension into these areas.

Humans are hard-wired with this mind-body link. When we’re under stress, our bodies release adrenaline and other hormones into the bloodstream, prompting a cascade of physiological changes—including tensing of the muscles and an increase in heart rate—to boost our ability to react to an emergency. This is helpful for “fight or flight”—for example, if we need to run for our lives from a tiger. But when stress is chronic, muscles may stay tense and never, or rarely, let go. In some people, this pattern becomes so ingrained that, without even realizing it, they develop a rigid “body armor” of tight, overused muscles in the neck and shoulders.

Awareness of this problem is the first step in learning to let it go. One of my yoga students has developed the simple mantra “Relax your shoulders,” which she frequently recites mentally to herself—for example, if she’s having trouble sleeping or when she’s stuck in traffic or waiting in line. “I never realized how much tension I hold in my shoulders,” she told me. “But whenever I consciously think about it, I realize that my shoulders are up around my ears. When I take a deep breath and invite my shoulders to relax, everything softens and lets go.”

One of the simplest and most effective stress busters is yoga breathing. Many people in Western cultures breathe shallowly, from the chest. But a proper deep breath, also called deep diaphragmatic breathing or yoga belly breathing, is the body’s own built-in relaxation mechanism. When we bring air down into the lower portion of the lungs, where oxygen exchange is most efficient, it triggers a cascade of calming physiological changes: the heart rate slows, blood pressure decreases, muscles relax, anxiety eases and the mind quiets down (Krucoff 2000). The relaxed, abdominal breath is nature’s own “anti-stress” medicine—and it’s free, simple and right under our noses. Learning how to do it is a central part of yoga practice.

Essential Postures for Neck and Shoulders

Not surprisingly, the National Center for Complementary and Alternative Medicine reports that there is “growing evidence to suggest that yoga works to enhance stress-coping mechanisms and mind-body awareness” (NCCAM 2008). The following postures can be particularly useful in helping prevent and relieve neck pain.

Mountain Pose. This pose teaches the basics of proper alignment. Stand with feet hip width apart, weight evenly distributed on both legs. Lengthen up through the top of your head—as if it was magnetic and the sky above you held a powerful magnet. Relax your shoulders down away from your ears. Imagine there is a light at the center of your chest and shine it forward, not down. “Stack your joints” so that if someone looked at you from the side, they’d see your knees over your ankles, your hips over your knees, your shoulders over your hips, and your ears over your shoulders.

Shoulder Shrugs and Circles. These movements relax tension in the neck and shoulders. On an inhalation, shrug your shoulders up toward your ears, then exhale and drop them down. If you like, make a “ha” sound on the exhalation. Make slow, easy circles with your shoulders, being sure to go in both directions. Then “bicycle” the shoulders, one circling clockwise while the other circles counterclockwise. Move slowly and mindfully—do not rush!

Dragonfly. This pose strengthens muscles in the back. Lie belly down with forehead or chin on the floor, arms at the sides. On an inhalation, lift up the head, neck, shoulders, upper back, arms and legs. On an exhalation, relax down. Repeat several times, moving with the breath. If you like, turn your head to one side when you relax down, then bring your head back to center when you come up; turn the head to the opposite side on the next exhalation down. Continue for 6–10 slow, easy breaths, synchronizing your movement with your breath.

Supported Backbend. This pose stretches muscles in the front of the neck, shoulders and chest. Place a block under a bolster and rest back onto this support, keeping your knees bent and feet on the floor. Use a towel or blanket for extra support, if necessary, to maintain the natural curve in your neck. Allow your arms to open out to the sides and relax down, stretching out the front of your shoulders and chest. Set a timer for 5–10 minutes and allow your breath and gravity to invite your muscles to relax, release and let go.

Yoga for Life

In addition to practicing these postures, try integrating yoga into your daily life by noticing what’s happening to you physically, energetically, mentally and emotionally throughout your day. Do your best to sit, stand and move with good posture. Avoid staying in a fixed position for too long; instead, get up and stretch, walk a bit and breathe deeply. Recognize that good posture is not just something reserved for yoga class; when practiced off the mat, too, it can offer profound healing.

While self-care is the best treatment for the vast majority of people who experience neck pain, certain “red-flag” symptoms may be signs of more serious conditions—such as cancer, fracture or infection—and indicate the need for medical attention. It is essential that your clients seek medical assistance if they have any of these red-flag symptoms:

• numbness, tingling, or weakness in the arm or hand
• pain caused by an injury, accident or blow
• swollen glands or a lump in the neck
• difficulty swallowing or breathing

Clients should also check with a physician if their neck pain concerns them or if they have a condition that makes them more prone to serious neck injury (e.g., previous neck surgery, history of cancer, inflammatory arthritis, or bone loss due to osteoporosis or corticosteroid treatment).