Whenever I teach a yoga class, I typically begin by asking students if they have any requests, if there are particular places in their bodies where they feel tension, tightness, or discomfort they’d like our session to address. The single most common reply is "neck and shoulders," which is the central reason for this book! Particularly in an evening class, where many students have come straight from work, tight shoulders, upper-back tension, and general neck pain are widespread.
In some people, stiffness in these areas is so pronounced that it becomes disabling. A prime example is a student I’ll call Susan, whose neck and shoulder tension was so severe that she had trouble turning her head to change lanes when driving. This made getting behind the wheel increasingly frightening. An office manager in her mid-forties, Susan sat hunched over a computer most of the day. Her posture was poor, with her chin jutted forward and her upper back rounded, and she carried so much tension in her upper body that her shoulders were raised up near her ears.
Fear brought Susan to yoga. After narrowly escaping a car accident, which she blamed on her inability to turn her head, she was so scared that she vowed to take action. A friend suggested that Susan accompany her to yoga class, and when Susan walked in the door, you could see the tension etched in her face. At first, when she lay on her back at the beginning of class, Susan’s neck was so stiff that she could barely rock her head from side to side. Her shoulders were so tight that she couldn’t raise her arms all the way up over her head. When I gently touched her shoulders and invited her to relax her muscles, there was very little movement; chronic tension had forged a kind of rigid "body armor" that resisted letting go.
Over time, with regular yoga practice, this rigidity began to soften. Like many people who habitually carry tension in their bodies, Susan was surprised to discover all the places in her body where she stored stress. And she was even more astonished that she could learn how to consciously relax and release these tense muscles, especially those in her neck, shoulders, jaw, and face. Her posture improved, and she found herself able to do things that were previously difficult or painful, such as reaching back to hook her bra and turning to look at something behind her. Now, after three years of regular yoga practice, Susan looks and feels wonderful, with beautiful posture that gives her an air of confidence, relaxed shoulders, smiling eyes, and a flexible neck that turns smoothly and easily. In the rare instances when she feels any twinge of neck or shoulder pain, Susan uses yoga postures and breathing practices to unlock tension and find relief.
These changes didn’t happen overnight. Yoga takes time, patience, and practice. But this ancient, holistic self-care discipline offers profound tools for healing on many levels—providing remedies that are practical, effective, and lasting. And yoga’s benefits can be particularly helpful in relieving a complex, multifaceted ailment such as neck and shoulder pain. In this chapter we’ll explore what modern medical science has learned about neck pain and its associated disorders, including why it’s such a common problem, who’s at risk, and what treatments work best. I’ll also offer an overview of the ancient Indian practice of yoga, examining why and how it can offer you profound healing from neck and shoulder pain.
While back pain generally commands more attention—in part, because it results in more work-related disability—neck pain is nearly as common. Consider these statistics from the Bone and Joint Decade 2000–2010 Task Force on Neck Pain and Its Associated Disorders (Haldeman, Carroll, and Cassidy 2008), an international group of clinician-scientists established in 2000 as part of the World Health Organization’s global initiative focusing on musculoskeletal disorders: Check with your physician, too, if you have a condition that may make you more prone to serious neck injury, such as previous neck surgery, history of cancer, inflammatory arthritis, or bone loss due to osteoporosis or corticosteroid treatment.
how yoga can help
Yoga is a profound system of holistic healing that originated more than five thousand years ago in India. The word "yoga" comes from the ancient Sanskrit word yuj, which means to"yoke" or "unite," and the practice is designed to unify many things. At the most basic level, yoga helps unite body and mind. At a deeper level, yoga seeks to unite the individual with the universal.
When people in the West say "yoga," they’re commonly referring to hatha yoga, one branch of this ancient discipline that focuses on physical postures, breathing exercises, and meditation. Hatha yoga teaches you how to relax and release tension, as well as strengthen weak muscles and stretch tight ones. It also helps balance and integrate mind, body, and spirit in order to enhance energy flow and stimulate the body’s own natural healing processes.
A common misconception is that yoga is only for the fit and flexible, and requires you to twist yourself into a pretzel and stand on your head. One of the most frequent comments I hear when people learn that I teach yoga is, "Oh, I could never do yoga; I’m not flexible enough," to which I typically reply, "That’s like thinking your house is too messy to hire a maid."
In fact, the only prerequisite for practicing yoga is being able to breathe!I’ve taught yoga to people with a wide range of health challenges, including cancer, heart disease, osteoporosis, arthritis, blindness, fibromyalgia, back pain, congestive heart failure, and leg amputation. While advanced postures like headstand are part of the yoga practice for some people, they’re by no means required. Your yoga practice should be tailored to fit your own abilities and needs. For many people, yoga involves simple yet powerful meditative movements that anyone can do.
Yoga Is Medicine
When most people think of medicine, they visualize something material, like a pill to be popped, a liquid to be swallowed, or an injection to be endured. Some might also consider surgery, tests, or procedures to be medicine, since these high-tech maneuvers can help diagnose and treat disease. But the ancient yogis realized a truth that modern medicine now confirms: simple movement offers profound healing benefits. Today, this notion is embraced by traditional healers and modern scientists, Eastern and Western physicians alike: appropriate movement enhances health, while inactivity impairs it.
In other words, movement is medicine. And it’s a medicine that’s extremely effective, free (or at least inexpensive), low risk, abundantly available, socially acceptable, and simple to do. The main "side effect" is looking and feeling better. In fact, Dr. Robert Butler, founding director of the National Institute on Aging, is fond of saying, "If exercise could be packed in a pill, it would be the single most widely prescribed, and beneficial, medicine in the nation" (Butler 2009). All it takes to achieve substantial health benefits is regular practice.
Over the last few decades, Western medicine has increasingly recognized the healing power of movement and prescribed physical activity as a safe and effective treatment to help prevent, relieve, and sometimes even cure a host of disorders. Solid scientific evidence (U.S. Department of Health and Human Services 2008) documents exercise’s therapeutic benefits in reducing the risk of, or helping heal, more than two dozen conditions, including heart disease, diabetes, certain cancers (colon, breast, pancreatic, and prostate), hypertension, arthritis, depression, osteoporosis, high cholesterol, stroke, asthma, sleep apnea, and even sexual dysfunction.
Physical activity, in the form of postures and breathing practices, is a central component of yoga, but the practice is much more than just a workout. Yoga is a powerful form of mind-body medicine that approaches health in a holistic manner, recognizing that physical ailments also have emotional and spiritual components. For example, neck pain may involve a wide array of contributing factors ranging from poor posture, weak muscles, and repetitive behaviors to stress, anxiety, and fear. Yoga is based on an appreciation for the interconnectedness of all aspects of our being, and seeks to unify and integrate the wide variety of factors that affect our health. At its heart, the practice is a comprehensive system for self-development and transformation.
Yoga offers a variety of techniques for healing, including:
Postures: Yoga poses help stretch and strengthen your body and are grounded in alignment principles that teach proper posture and healthy body mechanics. Being strong, supple, and well aligned enhances your body’s ability to meet the challenges of daily life with ease as well as its ability to release tension, improve circulation, and boost energy flow.
Breathing Practices: In a culture where people tend to be shallow "chest breathers," learning to breathe deeply and fully offers great physiological and psychological benefits. Bringing air down into the lowest portion of the lungs, where oxygen exchange is most efficient, triggers a cascade of changes: heart rate slows, blood pressure decreases, muscles relax, anxiety eases, and the mind calms. In contrast, chest breathing can lead to, or exacerbate, neck pain because it uses accessory respiratory muscles around the neck, such as the scalenes, to lift the chest, creating compression on the cervical spine (see chapter 2, figure 2.3, for an illustration of this area).
Mindfulness: Yoga is a practice of awareness that teaches us to be present in each moment and to be present in our bodies. This can be quite a challenge in our modern world, where people tend to live in the head while ignoring signals from the rest of the body to the extent that the body must scream in pain to get attention. Yoga counters this tendency to live from the neck up by helping us connect our minds and bodies through the breath. The practice invites us to bring our attention inward, recognize where we habitually hold tension, and learn to release it.
Meditation: Many of us tend to have chattering thoughts constantly rattling around in our heads: What’s next on my to-do list? Did I turn off the stove? I wonder what’s on TV tonight? This is a condition of chronic mental busyness that many meditation teachers call "monkey mind." Meditation is a powerful tool for calming the agitated mind, helping us to release distracting (and often anxiety-provoking) thoughts and to bring our attention and awareness to the present moment.
These varied tools work in a synergistic fashion. In his book, Yoga as Medicine, Dr. Timothy McCall (2007, 4) writes, "You stretch and strengthen your muscles, and that affects your circulation, digestion, and breathing. You calm and strengthen the nervous system, and it affects the mind. You cultivate peace of mind, and it affects the nervous system, the immune system, and the cardiovascular system. Yoga says that if you look clearly, you will see that everything about you is connected to everything else."
So it should come as no surprise to learn that yoga therapists don’t just tell their clients, "Take this pose and call me in the morning." Practicing physical postures can be extremely beneficial in preventing and relieving neck pain and other ailments, buttrue healing involves both what you do on the mat and how you live your life. If the minute you leave your yoga mat, you begin to slump and tense your shoulders, you’ll make less progress in relieving your neck pain than if you bring the teachings of yoga into your day-to-day activities. For example, paying attention to sitting and standing with good posture throughout your day; using a headset instead of holding the phone between your shoulder and ear; and taking slow, deep breaths whenever you feel stressed are basic ways to integrate yoga practice into your life.
Yoga also teaches that it’s not just what you do, but how you do it that’s critical. Unlike the Western exercise mentality that says the harder you work, the better the results, in yoga we often go deeper, not by working harder but by "playing softer," an inquisitive approach to the practice that cultivates the ability to relax, release, and let go. Yoga encourages you to balance effort and surrender, courage and caution—to challenge yourself but never strain. In yoga practice, learning how to "undo" is as important (and for some people more important) as learning how to "do." (See chapter 5, "How to Practice.") Rather than muscle your way into a yoga pose, you learn to relax into it—using the tools of gravity, patience, and the breath—to allow the pose to deepen and unfold.
Over time, with regular practice, the lessons learned on the yoga mat begin to influence how you live in the world. So when your boss comes charging into your office with an urgent assignment, instead of engaging in your habitual reaction of tensing your shoulders and gritting your teeth, you may find yourself responding by pausing to take a deep, slow breath and then consciously relaxing your shoulders. Or when turbulence begins to bounce the plane you’re flying in, you may close your eyes, turn your attention to your breath, and begin lengthening your exhalations to calm your body and mind. Yoga teaches you how to relax and breathe as you bring yourself into challenging postures on the mat so that when you find yourself in challenging positions in daily life, you can draw on these skills to keep yourself balanced and healthy.
Exploring the Evidence
Western medical research into yoga’s therapeutic benefits is relatively new, but it’s booming—with more than a thousand studies involving yoga listed in the National Library of Medicine’s research database, PubMed (ncbi.nlm.nih.gov/pubmed). Currently in the United States, more than sixty-five federally and privately supported clinical trials are under way examining yoga’s benefits for a variety of conditions, including insomnia, heart failure, pediatric headaches, epilepsy, diabetes, obesity, hot flashes, arthritis, post-traumatic stress disorder, and cigarette addiction (ClinicalTrials.gov, clinicaltrials.gov, s.v., "Yoga"). And an emerging body of literature suggests that yoga can relieve a wide array of ailments, including chronic low-back pain, hypertension, irritable bowel syndrome, menopausal and perimenopausal symptoms, depression, anxiety, fibromyalgia, carpal tunnel syndrome, and obsessivecompulsive disorder. Yoga’s effect on neck pain has not yet been the subject of published scientific study, but strong evidence for yoga’s effectiveness in relieving back pain gives hope that research will eventually support yoga as effective self-care for neck pain as well (Sherman et al. 2005).
One clear benefit of yoga that most experts agree on is its ability to relieve stress, which is extremely important, since 60 to 90 percent of all doctor’s office visits in the United States are stress related (Benson 1996). Stress has been shown to have wide-ranging effects on emotions, mood, and behavior. In her book, Self-Nurture (2000, 28), pioneering mind-body medicine expert Alice D. Domar notes that "chronic stress can trigger continually high levels of stress hormones (for example, adrenaline and cortisol) that produce elevated blood pressure or heart rate, increased oxygen consumption, weakened immune systems, and other physiologic imbalances that eventually lead to symptoms or even full-blown diseases." Domar calls yoga a "powerful approach...for relaxation and reinvigoration of mind and body" (42), and writes that many of her patients "report that yoga is among the most effective stress-relieving methods they’ve ever practiced" (112).
Yoga is increasingly being used in modern medical settings as an adjunct therapy for a wide array of health concerns—from heart disease to hot flashes. Some pioneering medical centers (such as Duke Integrative Medicine, where I practice yoga therapy), clinics, and private studios offer individualized yoga sessions known as yoga therapy. In these one-on-one sessions, a yoga therapist adapts the practice to suit your specific needs, creating a personalized yoga program designed for practice at home. Typically, this involves yoga postures, breathing exercises, and relaxation techniques. Yoga therapy can be particularly helpful for people who are unable to participate in a regular group class or who have specific concerns, such as fibromyalgia, hypertension, or asthma. The goal of these sessions is to empower you to progress toward greater health and well-being.
In addition, a growing number of hospital-based wellness centers offer yoga classes for general well-being, as well as yoga classes designed for specific groups, such as breast cancer survivors; people with MS, heart disease, and chronic pain; and adolescents with eating disorders. Therapeutically oriented yoga classes are usually based on a gentle style of yoga.It’s important to recognize that there are many different schools and kinds of yoga—including some that are quite challenging. For example, Ashtanga yoga is very athletic, while Kripalu yoga tends to be gentler.
It’s fine to attend a yoga class to complement your practice with this book, as long as the class is appropriate for you and is taught by a well-trained and experienced yoga instructor. Unfortunately yoga’s booming popularity has resulted in some classes that are called yoga but are actually "yoga-flavored" exercise classes taught by instructors whose training consists of attendance at a weekend yoga workshop. (See the resources section for help finding qualified yoga instruction.) If you attend a large group yoga class that’s too demanding for your specific fitness level or one that’s taught by a poorly trained or inexperienced instructor, you may risk injury. Ask prospective teachers how long they’ve taught yoga, where they studied, and, equally important, how long they’ve practiced yoga and whether or not they have a personal yoga practice. Authentic yoga instruction is rooted in a teacher’s own yoga practice, and the best yoga teachers live their yoga on and off the mat. A skilled yoga instructor will not be a drill sergeant but will act as a facilitator—pointing you in the direction of your own "inner guru" (teacher) and helping you explore what works best for you.
the heart of the practice
Although yoga practices are designed to enhance our well-being, yogic tradition doesn’t view improved health as an end in itself but, rather, as a quality necessary to properly connect with the spirit. The ancient yogis considered disease to be an obstacle to enlightenment. After all, it’s difficult to sit still in meditation and unite with the divine if you have a pounding headache or a stiff neck. Likewise, if illness or sedentary habits have left you too weak and inflexible to sit comfortably, yoga postures and breathing practices can help you become healthy and strong enough to sit quietly and meditate. The body is considered a temple of the soul, and yoga practice helps maintain this precious vessel.
The focus of yoga practice is to quiet the mind. The Yoga Sutras of Patanjali, the ancient text that sets forth the teaching of yoga in 196 succinct aphorisms, states: "Yoga is the restriction of the fluctuations of consciousness."
Since a peaceful, stable mind is essential to well-being, the many tools of yoga are all designed to help calm the mind and harness its power for physical, psychological, emotional, and spiritual healing.
When the mind and body are peaceful, it’s much easier to hear that "still, small voice" of the heart. Just as it’s difficult to see the bottom of a lake when the air is agitated by wind—making the waters choppy and turbulent—it can be difficult to connect with our spirit when we’re physically and emotionally restless. But when everything becomes calm and peaceful, we can see clearly to the bottom of the lake and to the innermost recesses of our heart.
In the yogic tradition, the spirit is often called our "true self" or "ultimate nature." These teachings hold that our spirits are alike—and that they’re formless, immortal, and blissful. The familiar salutation, Namaste, a Sanskrit greeting typically said at the end of yoga class, translates—in short form—to "I honor you." But the more accurate explanation of this simple greeting is this:
I honor the place in you that is the same in me.
I honor the place in you where the whole universe resides.
I honor the place in you of love, light, truth, and peace.
When you are in that place in you, and I am in that place in me,
We are one.
Please be aware that, while yoga has a spiritual component, it’s not a religion. You don’t need to believe in any specific deity or even to believe in God at all to practice yoga. People of all faiths, as well as agnostics and atheists, are regular yoga practitioners. And it’s fine to embrace those aspects of the practice that appeal to you and ignore the rest. Modifying the practice to suit your needs applies not just to postures but to the spiritual dimension as well.
how to use this book
If you’re like many people, who think yoga is a kind of exercise, and you picked up this book to learn some "healing moves," hang in there. We offer dozens of illustrated postures in chapter 5, a detailed guide to proper sitting and standing posture in chapter 4, and a summarized "Neck Check" of easy, portable yoga practices to do on and off the mat in chapter 6.
By now I hope you understand that the profound healing available through yoga centers on uniting your body, mind, and spirit. Chapter 2 examines neck and shoulder pain from the perspective of the physical body—discussing anatomy, posture, and body mechanics—and offers insights into how the yoga practice can bring relief. Chapter 3 explores how emotions and stress influence neck pain, and offers the yogic perspective on the "energy body," with practical strategies you can use to learn how to identify and release habitual patterns of tension. Feel free to skip ahead to the postures and practice directions if you like, but be sure to come back to these foundational chapters for a comprehensive grounding in the yogic teachings, which will deepen your practice and enhance its healing power.