Yoga for Pain: What the Science Says

Low-Back Pain

For patients with chronic low-back pain, recent evidence-based clinical practice guidelines from the American College of Physicians gave a strong recommendation based on moderate-quality evidence that clinicians and patients should initially select nonpharmacologic treatment with exercise, multidisciplinary rehabilitation, acupuncture, or mindfulness-based stress reduction. The guidelines also strongly recommend, based on low-quality evidence, several mind and body approaches, including yoga.

What Does the Research Show?

• A 2022 systematic review and meta-analysis of 27 studies (2,702 participants in total) found that compared with passive control, yoga was associated with short-term improvements in pain intensity, pain-related disability, mental health, and physical functioning. Except for mental health, all effects were sustained long-term. 
• A 2022 Cochrane review of 21 trials involving a total of 2,223 participants concluded that there is low-to-moderate certainty of evidence that yoga compared to no exercise results in small and clinically unimportant improvements in back-related function and pain. The authors of the review also noted that there is probably little or no difference between yoga and other back-related exercise for back-related function at 3 months, although it remains uncertain whether there is any difference between yoga and other exercise for pain and quality of life. 
• A 2020 review of 25 randomized controlled trials examined the effects of yoga for back pain and found that 20 studies reported positive outcomes in variables such as pain or psychological distress (e.g., depression and anxiety), or energy. However, no significant difference in treatment effect on pain and disability was seen between yoga and physical therapy at 6 weeks.
• A 2018 report from the Institute for Clinical and Economic Review analyzed data from 28 randomized clinical trials of mind and body therapies (including yoga) for chronic low-back pain. The analysis showed that participants in the yoga group had a moderate level of certainty of having small health benefits (both decreased pain and improved function) when added to usual care compared with usual care alone.
• A 2018 report by the Agency for Healthcare Research and Quality evaluated 8 trials of yoga for low-back pain (involving 1,466 total participants) and found that yoga improved pain and function both in the short term (1 to 6 months) and intermediate term (6 to 12 months). The effects of yoga were similar to those of exercise.
• 2017 clinical practice guidelines issued by American College of Physicians (ACP) strongly recommended yoga, based on low-quality evidence, as initial treatment for patients with chronic low-back pain. A systematic review supporting the 2017 clinical practice guidelines evaluated 14 randomized controlled trials and found that yoga was associated with lower pain scores, although the effects were small and were not always statistically significant.

Neck Pain

There is some evidence that yoga may provide short-term improvements for neck pain.

What Does the Research Show?

• A 2024 systematic review and network meta-analysis of 18 studies involving a total of 1,442 participants found that of the various mind and body practices included in the review, yoga plus hot sand fomentation was the most effective in reducing pain intensity and functional disability, and improving the quality of physical life in patients with chronic non-specific neck pain. In addition, participants in the yoga group achieved the most improvement in cervical mobility.
• A 2023 systematic review of 25 systematic reviews and meta-analyses involving a total of 17,321 participants with chronic neck pain found low-to-high certainty of evidence that motor control exercise, Pilates exercises, resistance training, traditional Chinese exercise, and yoga have short-term positive effects on pain and that all exercise types except resistance training, show positive effects on disability compared to nonexercise controls.
• A 2019 meta-analysis of 10 randomized controlled trials involving 686 participants concluded that yoga may relieve neck pain intensity, improve pain-related function disability, increase cervical range of motion, improve quality of life, and boost mood. The review authors noted that it was difficult to make a comprehensive summary of all the evidence due to the different session and durations of the yoga interventions, and the different outcome measurement tools in the study.

Headaches

There is some evidence, based on a few randomized controlled trials, that yoga may improve the intensity of headache pain, and may help reduce frequency and duration of headaches.

What Does the Research Show?

• A 2023 clinical practice guideline published in The Journal of Headache and Pain gave a B grade of recommendation for aerobic exercise, moderate-continuous aerobic exercise, yoga, and exercise and lifestyle recommendations for the improvement of symptoms, disability, and quality of life in patients with migraine.
• A 2022 meta-analysis of six randomized controlled trials found that compared with control group for migraine, yoga therapy was associated with decreased pain intensity, headache frequency, and headache duration.

Arthritis

Results from clinical trials suggest that some mind and body practices, including yoga, may be beneficial additions to conventional treatment plans for patients with arthritis, but some studies indicate that these practices may do more to improve other aspects of patients’ health than to relieve pain.

What Does the Research Show?

• A 2024 systematic review and meta-analysis of 8 studies involving a total of 756 participants with knee osteoarthritis found that generally, yoga may be effective in reducing pain and stiffness, and it can also improve the physical function of patients. 
• A 2022 review of 23 studies on some mind and body practices, such as yoga, found that yoga’s effect on pain in patients with rheumatoid arthritis remains unclear. Although participants showed improvements in pain scores, pain disability, pain intensity, acceptance of chronic pain, and self-efficacy regarding pain in four studies, three other studies found no change in pain levels. 
• A 2022 randomized controlled trial evaluated the effectiveness of an unsupervised 12-week online yoga program involving 212 participants with knee osteoarthritis. The study found that compared with online education only, an unsupervised online yoga program improved physical function but not knee pain during walking at 12 weeks, although more yoga participants than control participants did not attain the minimal clinically important difference for both measures. Also, knee stiffness, quality of life, and arthritis self-efficacy at 12 weeks improved more with yoga than the control intervention. Benefits were not sustained at 24 weeks. 

Safety

• Yoga is generally considered a safe form of physical activity for healthy people when performed properly, under the guidance of a qualified instructor. However, as with other types of physical activity, injuries can occur. The most common injuries are sprains and strains. Serious injuries are rare.
• People with health conditions, older adults, and pregnant women may need to avoid or modify some yoga poses and practices.

References