Yoga for cervical spondylosis (neck arthritis): the nerve signs, poses to avoid or change, and what the evidence shows

A normal part of ageing

The NHS: "Cervical spondylosis is a normal part of ageing and many people do not have any symptoms." On MRI scans, 87.6% of 1,211 symptom-free volunteers aged 20 to 70 had bulging discs, including most people in their 20s.

Sources 1, 2

No published randomised trial of yoga in cervical spondylosis

The only published yoga study we found is an uncontrolled Indian study of 30 people, with no comparison group. Two Indian randomised trials (117 and 62 people) are registered as completed, but we found no published results; we didn't search the Indian trial registry or Indian databases.

Sources 3, 4, 5, 6

Yoga helps long-lasting neck pain in general, a little and for a while

In trials of long-lasting neck pain without a specific cause, yoga eased pain and disability more than usual care in the short term, and about as much as other exercise. Those trials weren't in neck arthritis, so the evidence is borrowed.

Sources 7, 8

Neck and shoulder-blade strength has the best support

A Cochrane review found that neck, shoulder-blade and arm strengthening eases long-lasting neck pain, and that stretching on its own may not. In a small trial in neck arthritis, isometric neck exercises lowered disability more than care without exercise.

Sources 9, 10

Know the two nerve problems

A pinched nerve root (pain, tingling or numbness in one arm) usually improves over weeks to months. Pressure on the spinal cord (degenerative cervical myelopathy) shows as clumsy hands, numbness, unsteadiness, falls or bladder changes, mostly over 50, and needs a doctor before any class.

Sources 11, 12, 13

Leave out poses that load the neck or drop the head back

In headstand the head carries up to 40 to 48% of body weight, and headstand is the pose most often named in case reports of yoga harm. Scans show the spinal canal narrowing when the neck bends back, and a man with neck arthritis had spinal cord and artery injuries after a yoga session. That evidence is from scans and case reports, not trials.

Sources 14, 15, 16, 17

Age changes in the neck's discs and joints

The NHS: "Many people over 40 get cervical spondylosis as part of getting older." When it causes symptoms, they are neck and shoulder pain or stiffness that can come and go, and headaches that often start at the back of the neck. A previous neck injury or a family history makes it more likely. Physiotherapists' professional body notes that wear and tear, arthritis and disc degeneration are found in people without neck pain too.

Sources 1, 18

Common on scans without symptomsStrong evidence

In 1,211 volunteers with no neck symptoms, 87.6% had bulging discs and 5.3% had some pressure on the spinal cord, more often after 50. Across 19 studies, cord compression without symptoms was found in about a quarter of healthy people, more often with age.

Sources 2, 19

How it usually goes

The NHS: "It usually takes a few weeks for treatment to work, although the pain and stiffness can come back." NHS inform says most new or flare-up neck problems begin to settle within 8 weeks.

Sources 1, 20

How yoga loads the neck

Headstand puts a large share of your body weight through your head. Shoulder stand and plough put weight through a neck bent forward at the end of its range (no study has measured those loads). Poses that drop the head back, such as fish, camel, wheel and a deep upward-facing dog, take the neck to the end of its backward range, where scans show the spinal canal narrowing.

Sources 14, 17

Cervical spondylosis or cervical spondylitis?

"Cervical spondylitis" is often used, especially in India, to mean spondylosis. Strictly, spondylitis means inflammation, as in ankylosing spondylitis, which has its own yoga guide.

Pinched nerve or spinal cord?Strong evidence

Pressure on the spinal cord from neck arthritis (degenerative cervical myelopathy) shows as neck or limb pain and stiffness, clumsy hands (buttons, handwriting, dropping things), numbness, imbalance, frequent falls or incontinence, mostly in people over 50. Early signs are subtle: in one study the average delay to diagnosis was 2.2 years, and 43% were first diagnosed with carpal tunnel syndrome.

Evidence summarised in the US guideline found only 18% of people with myelopathy reported improvement and 67% got worse over time, and those treated with surgery did better. Arm pain with tingling in one arm is more likely a pinched nerve; both hands, or your balance, is the urgent pattern.

Sources 13, 1

A pinched nerve usually improvesEmerging evidence

In 205 people with arm pain from a pinched nerve for under a month, arm pain eased over 6 weeks with wait and see, and a collar or physiotherapy speeded the first 6 weeks a little. Across trials, people improved over time whatever the treatment; one review found most recovered fully within 2 to 3 years, with the biggest improvements in the first 4 to 6 months. Exercise eased pain on low-certainty evidence, and in a review, nerve glides eased long-lasting neck and arm pain by about 2 points out of 10.

Sources 11, 21, 12, 22, 23

Pressure on the spinal cord needs a specialistStrong evidence

A spine guideline suggests surgery or a supervised trial of structured rehabilitation for mild myelopathy, and surgery if it gets worse. Neck manipulation should never be used with it, a clinical review says. A neurosurgical consensus warns that someone with severe compression can get suddenly worse after a minor fall, so balances and inversions that risk a fall onto the head are poses to leave out (our reading).

Sources 24, 13, 25

Why head-back poses matter hereEmerging evidence

When the neck bends back, the spinal canal narrows, and scans taken in that position can show compression that standard scans miss. Case reports describe reduced blood flow to the back of the brain during head-back poses, and spinal cord and artery injuries after a yoga session in a man with neck arthritis. This comes from scans and case reports, not trials, but it is why this guide leaves those poses out.

Sources 17, 26, 16

Yoga in cervical spondylosis itselfMixed evidence

In an Indian study of 30 people with mild to moderate spondylosis and no nerve signs, six short yoga practices a day for 8 weeks, alongside usual medicines, went with neck disability falling from about 18 to about 7 on a 0 to 50 scale, but there was no comparison group. Two randomised trials in Jaipur, of 117 and 62 people, are registered as completed, with no results posted, and we found no published results.

Sources 3, 4, 5, 6

Yoga for long-lasting neck painEmerging evidence

Across 3 trials (188 people), yoga eased pain and disability more than usual care in the short term; a review of 10 trials (686 people) agreed, but most had only short-term results and none could blind people to their group. In the two main German trials, 9 weekly Iyengar classes eased pain more than self-care or a home exercise manual. A year later, people who kept practising did best, but there was no comparison group by then.

Sources 7, 27, 28, 29, 30

No better than other exerciseEmerging evidence

An overview of 25 reviews rated the benefit of yoga against no exercise as low certainty for pain and moderate for disability, in the short term only, with no difference from other exercise. An analysis of 40 trials found no single best type of exercise for long-lasting neck pain.

Sources 8, 31

Strength has the best supportEmerging evidence

A Cochrane review of 27 trials found moderate-quality evidence that strengthening the neck, shoulder blades and arms eases long-lasting neck pain, and that stretching on its own may not help. It found no high-quality evidence for any exercise.

Source 9

Small trials in neck arthritis itselfMixed evidence

In 24 people with neck arthritis, 4 weeks of isometric neck exercises lowered disability more than care without exercise. In 60 people, the two groups doing exercise improved more than the group given medicines alone. Both trials were small and short, and neither tested yoga.

Sources 10, 32

What guidelines sayStrong evidence

A Canadian guideline for neck pain lasting more than 3 months says clinicians may consider education with range of motion and strengthening exercises, qigong or yoga, among other options; its review found supervised Iyengar yoga more effective than home exercise, with small effects. The US physiotherapy guideline recommends mixed exercise for long-lasting neck pain and doesn't put yoga above it.

Sources 33, 34, 35

Side effects: mostly brief, with rare serious onesEmerging evidence

In 94 trials, yoga was about as safe as usual care and other exercise. In surveys, about 5% of people who practise yoga had a side effect in a year, mostly sprains and strains. In case reports, headstand, shoulder stand and forceful breathing were the practices most often named, and over half the people had a problem beforehand.

Sources 36, 37, 38, 15

During yoga

NHS inform's neck exercise advice: rate your pain from 0 to 10. During exercise, 0 to 3 is minimal and 4 to 5 is acceptable; 6 or more is too much. If it goes higher, do fewer repetitions, move more slowly or rest longer between movements.

Exercise should not make your neck worse overall. Soreness from a new exercise should ease quickly, and your neck should be no worse the next morning. Stop any exercise that makes your symptoms worse or causes new pain.

Arm symptoms are the exception, as in our neck pain guides. If a pose sends pain, tingling or numbness further down your arm, or the extra symptoms last more than an hour afterwards, make the movement smaller or leave it out.

Stop and get checked for dizziness, double vision, slurred speech, trouble swallowing or any of the warning signs above.

Source 39

Come out of a pose that brings on dizziness

If a pose that tips your head back or turns it hard brings on dizziness, blurred vision or a sudden headache, come out slowly and sit down. If it doesn't settle within a few minutes, treat it as one of the urgent signs above, and don't repeat that pose (our suggestion, from case reports).

Sources 26, 38

Tell the teacher

Tell the teacher about your neck, any arm or hand symptoms and any past neck injury or operation, and that you'll skip the poses below (our suggestion).

You can say no to any hands-on adjustment, and a teacher registered with Yoga Alliance must get your explicit consent each time.

Call 999 or go to A&E

These are the same warning signs as our neck pain guides. In the US, call 911 for 999, and use your doctor's urgent line or urgent care for NHS 111. A fall from a headstand or shoulder stand counts as a neck injury.

• Call 999 or go to A&E after a neck injury if the person is unresponsive, has severe neck pain or cannot move their head, has fallen from a height such as 5 or more stairs, or is drunk or has taken recreational drugs. Do not drive yourself. Being 65 or over, a dangerous fall or crash (from more than 1 metre or 5 stairs, diving, a high-speed or rollover crash, being thrown from a vehicle, a bicycle collision or an accident on a motorised recreational vehicle), or tingling in the arms or legs after an injury puts you at high risk of a broken neck: get checked.
• Call 999 or go to A&E: a stiff neck and you can't look at bright lights; a very painful headache; a very high or very low temperature, feeling hot or cold to the touch, or shivering; confusion, slurred speech or not making sense; a rash that does not fade when you press a glass on it; or a first seizure (fit). These can be signs of meningitis. Call too for any other symptoms you're worried might be meningitis.
• Call 999 or go to A&E: a headache that came on suddenly and is extremely painful; numbness or weakness in the face or body; a drooping face, or being unable to lift both arms and keep them up; difficulty speaking, swallowing, balancing, walking or remembering; double vision or loss of vision; drowsiness or confusion. A torn neck artery often starts with headache and neck pain, sometimes with dizziness or tingling, so head or neck pain unlike any you have had before needs checking.
• Call 999 or go to A&E: new problems walking, loss of bladder or bowel control, or a sudden loss of coordination, such as difficulty doing up buttons. These can be signs of pressure on the spinal cord.
• Call 999: chest pain that spreads to your arm, neck or jaw, especially with breathlessness, sweating or feeling sick. It could be a heart attack.

Sources 1, 20, 40

Get help the same day

Same day (urgent GP appointment or NHS 111): severe neck pain that starts suddenly or gets worse quickly; heaviness or weakness in the arms or legs; pins and needles in an arm along with neck or arm pain; or pain between the shoulder blades.

Same day: clumsiness in your hands, or numbness, pins and needles or weakness in one or both arms, that is getting worse; problems with balance or walking since the neck pain started; or neck pain with a severe headache.

Arm weakness or numbness that keeps getting worse, severe pain that painkillers and rest do not touch, or an unexplained fever.

Sources 1, 20

See a doctor or physiotherapist

Neck pain or stiffness that has not eased after a few weeks, or after 8 weeks of looking after it yourself; painkillers are not helping; or you are worried. In many areas you can refer yourself to NHS physiotherapy.

Neck pain with feeling generally unwell, or that started while you were ill with another condition such as rheumatoid arthritis or cancer; or neck pain with blurred vision, ringing in the ears or dizziness.

Severe pain that is constant or disturbs your sleep, a fever or unexplained weight loss, or a history of cancer, inflammatory arthritis, tuberculosis (TB), a weakened immune system, neck surgery or a violent injury. Serious causes are very rare, but these need checking.

See a GP if you have pain and stiffness for more than a week, especially if you're over 50, it's in both shoulders (often the neck and hips too) and the stiffness lasts longer than 45 minutes in the morning. It can be polymyalgia rheumatica.

No improvement after 6 weeks of exercise, or arm symptoms still there beyond 6 to 12 weeks.

Nerve symptoms and trouble with daily life more than 3 months after an injury: a guideline advises referral for medical investigation.

Sources 41, 20

Who should change what

With glaucoma, or high blood pressure that isn't under control, skip headstands, shoulder stands and long head-down holds. With osteoporosis, swap deep forward folds for a flat-back hinge from the hips, and twist smoothly. In pregnancy, our yoga in pregnancy guide covers the changes. NCCIH advises beginners to avoid headstands, shoulder stands, the lotus position and forceful breathing.

If you're hypermobile, don't use mobility work to push further: the NHS says "do not overextend your joints just because you can". See a GP if you think you have joint hypermobility syndrome: for example, your joints keep dislocating, or you keep getting sprains, strains, pain or stiffness.

A joint pain that is sharp, gets worse during a session, lingers into the next day or changes how you move is a reason to use an easier version, and to see a GP or physiotherapist if it keeps happening (the rule in our plans). Muscle soreness for a day or two after something new is normal. In a hot class, stop if you feel dizzy, sick or unwell; our hot yoga guide lists the signs of heat illness.

Source 42

Chest pain or fainting while exercising: call 999

Call 999 if:

• You get sudden pain or discomfort in your chest that doesn't go away; it can feel like squeezing or pressure, burning or indigestion.
• The pain spreads to your left or right arm, or your neck, jaw, stomach or back.
• You have chest pain and feel sweaty, sick, light-headed or short of breath.
• Someone faints while exercising, can't be woken within 1 minute, or has chest pain or a pounding, fluttering or irregular heartbeat.

Sources 43, 44

Breathlessness

Call 999 or go to A&E (accident and emergency) straight away for severe difficulty breathing (gasping, choking or not able to get words out), a chest that feels tight or heavy, pain that spreads to your arms, back, neck and jaw, lips or skin turning very pale, blue or grey, or sudden confusion. If you're more short of breath than usual, or your heart is racing, fluttering or skipping beats, contact NHS 111.

Source 45

Before you start

The NHS advises getting advice from a healthcare professional first if you have a health problem, an injury or symptoms, or have recently had a heart attack or an operation.

"Yoga can reverse cervical spondylosis"Emerging evidence

No study shows the scan changes reversing with yoga or exercise, and they are common without pain. A study finding healthier-looking neck discs in yoga teachers compared 36 people at one time point. Exercise can change pain and function.

Sources 2, 46, 9

"Your scan explains your pain"Strong evidence

Most symptom-free adults have bulging discs on MRI, and the NHS calls spondylosis a normal part of ageing.

Sources 2, 1, 18

"Neck circles and big stretches loosen arthritic joints"Mixed evidence

Stretching alone may not help long-lasting neck pain, and NHS inform's neck exercises are small, separate movements built up little and often. Work up to the stiff point, not through it.

Sources 9, 39

"Cobra, camel and fish are the best poses for cervical spondylosis"Mixed evidence

These are often recommended, but bending the neck back narrows the spinal canal on scans, and case reports link head-back poses with reduced blood flow to the back of the brain. A low cobra with your eyes on the floor is a different, gentler pose.

Sources 17, 26

"Headstand strengthens a weak neck"Emerging evidence

No trial shows it. The head carries up to 40 to 48% of body weight in headstand, and it is the pose most often named in case reports of yoga harm.

Sources 14, 15