Yoga for Neck Pain Relief

The effects of a relaxation technique in Yoga practice for neck pain relief was published in a study, Complimentary effect of yogic sound resonance relaxation technique in patients with common neck pain, International Journal of Yoga 2010;3:18-25.

Neck pain is one of the very common complaints across the globe, with a prevalence of nearly 13% and a lifetime prevalence of nearly 50%. Women are more likely than men to develop neck pain. Neck and shoulder pain has also become an increasingly common health complaint among adolescents, where the prevalence is found to be higher in girls than in boys. It is one of the frequent causes for sickness absenteeism that could disrupt a nation's economy apart from disrupting the personal and professional life of a victim.

Though the exact cause is unknown, altered neck mechanics, advanced age-related changes or degenerative disc disease, additional load on the neck, occupational hazards as in computer professionals or call center workers, faulty sleeping habits and the use of improper neck pillows and sudden violent jerking injuries to the neck as in whiplash injury are some of the causing factors.

The article refers to "Common neck pain" which is not due to any organic lesion accounts for more than 80% of neck pain. We often call this Mechanical Neck Pain. Psychological stress that may be associated in any of these factors cannot be undermined. Depression and anxiety are well-known undesirable side effects of chronic neck pain, often leading to a behavioral therapy approach to neck pain relief.

Since the underlying pathology of neck disorders remains unclear, the treatments are aimed at relief of pain and stiffness. The conventional conservative methods include non-steroidal anti-inflammatory drugs, physical measures such as heat, ultrasound, manipulation and exercises.

The article references a lack of response to traditional therapies directed at common neck pain. The authors noted studies comparing a brief physiotherapy intervention on 268 patients (for 7 days) with usual physiotherapy (for 14 days) for common neck pain and showed that latter may be only marginally better than the former. Spray and stretch (vapo-coolant spray followed by passive stretching) was compared to laser therapy and a placebo, with no significant difference between the groups and no significant reduction in pain. A study conducted to investigate the use of traction in two randomized controlled trials revealed the difference between the groups to be small and not significant. Symptomatic improvement was better with a combination of neck traction, short wave diathermy and electro acupuncture, than a combination of TENS, collar, rest and education in moderate quality neck pain.

With growing dissatisfaction with these conventional therapies, the authors note a pressing need for complementary measures and indicate that yoga seems to hold promise through its multifaceted approach to healing. They note studies have established the role of yoga in decreasing the pain and disability in chronic low back pain, along with improved flexibility within 1 week to 4 months of yogic intervention with no adverse effects.

Yoga has also been found to be an effective tool in reducing stress levels. This study used Mind Sound Resonance Technique as one of the advanced guided yoga relaxation techniques that can be practiced in supine (lying on back) or sitting posture for achieving the goal of positive health, will power, concentration and deep relaxation.

The yoga method was not any specific exercise, but was developed using the concepts from traditional texts that talk about the power of Om (Mandukya Upanishad) and Nadanusandhana (Hatha Yoga Pradipika) for achieving internal mastery over the modifications of the mind (Patanjali's definition of yoga). Mind Sound Resonance Technique opens up the secret of traditional chants called Mantras. Mind Sound Resonance Technique was one of the components of the intensive integrated yoga program that was used as the intervention for a low back pain study. Although Mind Sound Resonance Technique has been used routinely as a component of the integrated approach to yoga therapy for treatment of neck pain and back pain at the authors yoga therapy health home and the orthopedic center with encouraging results, the results of these studies were not published. This study was planned with an aim to evaluate the efficacy of an add-on program of this yoga-based relaxation technique and compare it with the conventional physiotherapy technique. The authors hypothesized that the yoga group would show better improvement than the control group in measures of pain, tenderness, disability, flexibility and state anxiety.

Patients with common neck pain due to muscle spasm (myalgia) or strain of the neck muscles, ligament strain, degenerative conditions without any neurological impairment and who were advised physiotherapy by the consulting orthopedic surgeon were included in the study.

The Yoga group received yoga-based relaxation technique that included Mind Sound Resonance Technique after a short quick relaxation technique, by way of a prerecorded audio tape played with head phones for a period of 20 minutes, after 30 minutes of conventional physiotherapy.

The role of stress and the value of relaxation in general after the conventional physiotherapy were explained by the research officer. The yoga group had a separate session to explain the meaning and other details of the intervention and was taught the technique through personal instructions by the yoga therapist for half an hour on the 1st day. From the second day onward, they were asked to practice the same in supine position by listening to the prerecorded audio tape on head phones in the annex room of the physiotherapy department of the hospital.

Assessments through the clinical examination by the orthopedic surgeon before recruitment included (a) history of all health problems followed by examination for assessment of the degree and type of neck pain, (b) neurological examination to look for any motor or sensory deficit, (c) X-rays of the cervical spine in antero-posterior and lateral views. The primary outcome measures used were visual pain analog scale, neck muscle tenderness, neck disability index for questions related to pain intensity, personal care, work, concentration, lifting, reading, driving, recreation, headache and sleeping, and movements of the neck. Secondary outcome measures included blood pressure (BP), pulse rate (PR) and state anxiety inventory (STAI-Y1). BP was measured using a sphygmomanometer on day 1 and day 10 after the treatment. PR was counted manually for 1 minute before the treatment was started on 1st and 10th day.

Instructions were given in the recorded tape to feel the resonance all over the body both during loud (Ahata: heard) and mental chanting (Anahata: unheard). This is done alternately starting from Ahata 'A' followed by Anahata 'A' repeated three times. This is followed by similar repetitions of all other chants. Resonance generated by Mind Sound Resonance Technique helps in revitalizing the internal energy in the body. It takes to deeper layers of silence, wards off all fears and stresses. It can lead to an experience of tremendous expansion and rest that forms the basis of the healing power of these traditional chanting called Mantras. This type of mindfulness techniques that involve deep levels of mind and body relaxation have the ability to reduce the sympathetic nervous system activation and increase parasympathetic nervous system activity and restore homeostasis or balance.

The authors observed that there is significant improvement in all variables in in the yoga than a control group without the yoga.

The authors discuss meaning and comparison of a few earlier studies suggest the usefulness of relaxation techniques in reduction of pain and improvement of flexibility by reduction in muscle tension in patients with chronic neck pain. A study showed that 65% of the patients felt lesser pain after practicing mindfulness meditation for 10 weeks in patients with chronic pain, who had not improved with traditional medical care. They noted three randomized trial controls on yoga for chronic low back pain using Viniyoga and Iyengar yoga therapy showed reduction in pain and functional disability with non-significant changes in the control group. In a study done on patients with chronic low back pain, a short-term intensive residential yoga program was compared with intensive residential physical exercise program. The yoga group showed significantly better improvement in pain-related disability and spinal flexibility.

A review on the evidence for mind body therapies such as guided relaxation, meditation, imagery and cognitive-behavioral therapy in the treatment of pain-related medical conditions concluded that these strategies may be an appropriate adjunctive treatment for chronic neck and low back pain as they offer better stress management techniques, coping skills training and cognitive restructuring

A review of the psychological risk factors in back and neck pain indicates a clear link between psychological variables with neck and back pain. Results of prospective studies show that the psychological variables were related to onset of pain, acute, subacute and chronic pain. Stress, distress or anxiety as well as mood and emotions, cognitive functioning and pain behavior were found to be significant factors.

Tension that is associated with stress is stored mainly in the neck muscles, diaphragm and the nervous system. If these areas are relaxed, stress gets reduced, minimizing the impact of stress. It has also been suggested that the presence of depressive symptoms predicts future musculoskeletal disorders. Stress can cause spasms by interfering with co-ordination of different muscle groups involved in the functioning of the neck.

Yoga is an ancient Indian science and way of life which includes the practice of specific postures, regulated breathing and meditation. Yoga texts mention that the root cause of many diseases can be traced to lifestyle and amplified likes and dislikes at the mind level. The distressful emotional surges (called aadhi) may percolate into the physical frame manifesting as diseases. Yoga is fast advancing as an effective therapeutic tool in physical, psychological and psychosomatic disorders. Brain imaging studies have shown that meditation shifts the brain activity in the prefrontal cortex from the right hemisphere to the left indicating that the brain is re-oriented from a stressful fight or flight mode to one of acceptance, a shift that may indicate better contentment.

The causes of common neck pain being multifactorial, there is sufficient evidence in the literature to demonstrate a requirement to draw treatment options from many sources in order to achieve a favorable pain relief outcome.

The study demonstrated several strengths: (a) Common neck pain of both the categories, physical (degenerative) and psychological (muscle spasm) were included; (b) it used a standardized randomization procedure; (c) there was baseline matching of confounding factors such as age, sex, height, weight and BMI; (d) assessment was multidimensional including both objective and subjective parameters; (e) because the duration of the yoga intervention was short, the acceptability and adherence to the therapy was good; (f) As Mind Sound Resonance Technique was played using a cassette in the therapy sessions, it could be reproduced in the exact way for all cases.

This study has shown that yoga relaxation through Mind Sound Resonance Technique adds significant additional benefits to conventional therapy for common neck pain by reducing pain, disability and state anxiety and improving flexibility.