Yoga guide
Chronic pain, also called persistent or long-term pain, is pain that lasts or keeps coming back for more than 3 months, and about 4 in 10 adults in the UK live with it. It's real pain, even when no cause is found, and it can carry on because the nervous system has become more sensitive rather than because damage is still happening. Exercise is one of the main treatments NICE (the National Institute for Health and Care Excellence) recommends, of any type, and yoga is one of the best-studied kinds for long-lasting back pain: in trials it eased pain and improved everyday function by small amounts, about as much as other exercise.
Yoga won't cure chronic pain, and it sits beside your other care, such as your GP, a physiotherapist or a pain service, not in place of it.
This guide explains how persistent pain works, what the trials show for back, neck and widespread pain, how to start gently, breathing and relaxation, how much pain is OK, pacing and flare-ups, and the signs that need a doctor, with a free 30-minute class that has a stop point for bad days. If your pain has a name, such as fibromyalgia or arthritis, start with that guide too.
It means pain that lasts or keeps coming back for more than 3 months. About 4 in 10 UK adults have it, and between 1 in 10 and 1 in 7 have pain that badly limits them. As the British Pain Society puts it, not knowing the cause "does not mean it does not exist".
In long-term pain the nervous system can become more sensitive, so the warning system produces more pain than the tissues explain. "In long-term pain conditions, hurt does not mean that harm is taking place", says the British Pain Society.
NICE says to offer a supervised group exercise programme for chronic pain with no clear cause, and names no best type: its evidence covered mind-body exercise such as yoga and tai chi alongside other kinds.
In a Cochrane review of 21 trials (2,223 people), yoga improved pain by about 4.5 points out of 100 and everyday function by about 1.7 points on a 24-point scale after 3 months, compared with not exercising. Both are small, and about the same as other back exercise.
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For neck pain, fibromyalgia, knee arthritis and mixed chronic pain in older people, the trials are fewer and smaller, and the certainty is low or very low. Yoga may help, especially with sleep, tiredness and mood, but nobody can promise how much.
Do a planned amount on good and bad days rather than a lot on good days and paying for it afterwards, and in a flare keep moving gently rather than stopping. Pacing is widely taught, though the trial evidence for it is very low certainty.
NICE defines chronic pain as "Pain that persists or recurs for more than 3 months", and says "Other terms used include persistent pain and long-term pain". Chronic primary pain has no clear underlying cause, or is out of proportion to any injury or disease, as in fibromyalgia or non-specific back pain; chronic secondary pain comes from a condition such as arthritis. The two can happen together.
Across 19 UK population studies (139,933 adults), 35% to 51% had chronic pain, and 10% to 14% had pain that was moderately or severely disabling. It becomes more common with age and is more common in women.
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The International Association for the Study of Pain (IASP) defines pain as "An unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage". It adds that "Pain is always a personal experience that is influenced to varying degrees by biological, psychological, and social factors" and "A person's report of an experience as pain should be respected".
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NHS inform explains that "Chronic pain can cause changes in your brain and nervous system. These changes can cause the brain to continue to send out pain signals even when there is no harm or damage." Researchers call this central sensitisation, and how much of it each person has varies. Pain that comes mainly from this changed processing can happen on its own, as in fibromyalgia, or alongside other pain, as in long-lasting back pain.
"The close links between the emotion and pain centres in our brains make it almost impossible to have pain without difficult emotions as well", says NHS inform. Live Well with Pain adds a reminder: "this is not your fault".
NICE's main offer for chronic primary pain is supervised group exercise, alongside talking therapies, a single course of acupuncture or certain antidepressants for some people. Pain management programmes aim "to improve your quality of life, despite your pain, rather than reducing your pain", and a GP can refer you to a pain clinic. NHS inform lists "gentle tai chi or yoga" among ways to stay active. Yoga is the exercise part, not a replacement for the rest.
If your pain has a name, the guide for that condition has the specific poses and cautions. This page covers what they share.
Most yoga trials in chronic pain are in long-lasting low back pain. Almost none could blind the people taking part, outcomes are self-reported, and many trials are small.
NICE: "Offer a supervised group exercise programme to people aged 16 years and over to manage chronic primary pain." Exercise "reduced pain (23 studies) and improved quality of life (22 studies) compared with usual care", and the committee "did not specify what type of exercise should be used". Its evidence review named yoga and tai chi as mind-body exercise, found a benefit for pain from very low and low quality evidence, and "could not infer if one type of exercise had more benefit than another".
For low back pain, NICE says to consider group exercise that can be biomechanical, aerobic or mind-body, and the World Health Organization (WHO) says a structured exercise programme "may be offered", with yoga among the types considered. The American College of Physicians lists yoga among the first non-drug treatments to try. The US NCCIH (National Center for Complementary and Integrative Health) sums it up: "For low-back pain, a large amount of research has been done, and the evidence suggests a slight benefit."
In the Cochrane review (21 trials, 2,223 people), yoga improved function by 1.69 points on the 24-point Roland-Morris scale (low certainty) and pain by 4.53 points out of 100 (moderate certainty) at 3 months, compared with no exercise. Both are below the differences the review counted as noticeable (5 and 15 points). All the trials were at high risk of bias because people knew which group they were in. Another review of 27 trials and an overview of 13 reviews came to similar conclusions, and a US review rated the evidence that yoga improves function in the short term as moderate.
Against other back exercise (8 trials, 912 people), "There is probably little or no difference" for function. In 228 adults, yoga "was not superior to conventional stretching exercises at any time point"; in 320 lower-income adults, 12 weekly classes were as good as 15 physiotherapy sessions. A 2026 review of 7 trials found yoga "was not statistically superior to exercise comparators" for pain.
In the UK trial of 313 adults at 13 community venues, 12 weekly classes improved back function by 2.2 points at 3 months and by about 1.5 to 1.6 points at 6 and 12 months against usual care, though pain scores were similar between the groups. In the Boston trial, people in the yoga and physiotherapy groups used less pain medicine than those given a book, and gains held at a year. Live-streamed classes eased pain by 1.5 points out of 10 more than a waiting list in 140 adults.
In 120 veterans with many health conditions, weekly classes were no better than an education book for pain or disability, though more people in the yoga group felt much improved (39% against 19%). In 150 veterans, twice-weekly classes improved disability at 6 months but not at 12 weeks. In Germany (274 people), yoga, eurythmy and physiotherapy exercise did equally well, and none reached a clinically meaningful change.
In 3 small trials (188 people), yoga eased neck pain and disability more than usual care in the short term, and a review of 10 trials drew "a very cautious conclusion" of benefit. An analysis of 40 trials concluded "There is not one superior type of physical exercise for people with chronic non-specific neck pain" (very low quality). Our yoga for neck pain guide has more.
Across 7 trials (362 people) of yoga, tai chi and qigong, sleep, tiredness, low mood and quality of life improved, but pain didn't overall, and "only Yoga yielded significant effects on pain" in subgroups. Cochrane rated the evidence for movement therapies very low quality, and a 2025 review found only 3 yoga trials (116 women). European guidelines give exercise their only strong recommendation. Our yoga for fibromyalgia guide covers it.
In knee osteoarthritis, yoga eased pain at low certainty across 14 studies, and an online programme improved function but not knee pain. In middle-aged and older people with chronic pain, tai chi, yoga and qigong eased pain by a moderate amount at low certainty, but "were not superior to traditional physical exercises". Six small trials reported large improvements in low mood and anxiety with yoga, at low to very low certainty.
Exercise of any kind eased chronic back pain by about 15 points out of 100 against no treatment in another Cochrane review, and across 157 reviews of all kinds of pain, "Aerobic, resistance, yoga, Pilates, and tai chi were effective". These come from different sets of trials, so read yoga's smaller figure as small and no larger than other exercise, not as worse. Analyses that rank exercise types are low certainty; their authors advise people to do "the exercise that they enjoy to promote adherence". No treatment for long-lasting back pain had a clinically important long-term effect, and there's no single best dose.
Across 94 yoga trials (8,430 people), "yoga appears as safe as usual care and exercise". In back pain trials, yoga brought more side effects than no exercise (43 against 9 in 1,000 people, mostly more back pain) but about the same as other exercise; in the UK trial, 12 of 156 people in the yoga group reported one, mostly increased pain. Across 70 reviews of exercise for back pain, side effects were mostly soreness and short-lived increases in pain, mainly in yoga studies.
This is the rule our pain guides use, borrowed from osteoarthritis research:
Advice to stop if anything hurts is written for people without long-term pain. With chronic pain, some soreness when you start something new is common and usually settles: across Cochrane exercise reviews, "most adverse events were increased soreness or muscle pain, which reportedly subsided after a few weeks". Stop at once for sharp, new or spreading pain, chest pain or feeling unwell (our reading).
The back pain trials used gentle beginners' classes, mostly Iyengar, hatha or viniyoga. In the Boston trial, "Each class began with relaxation and meditation exercises, yoga breathing, and yoga philosophy" before the poses. They ran 12 weekly classes over about 3 months (75 minutes each in Seattle and Boston), with practice at home encouraged.
Our editorial starting point, matching our chronic pain and Pilates guides: in weeks 1 and 2, 15 to 20 minutes of gentle yoga two or three times a week, mostly sitting and lying down, plus a few minutes of slow breathing each day and a short walk on other days. Each week without a flare lasting more than a day or two, add a few minutes or poses; after a flare, go back to the last week that felt manageable. NICE's committee noted that "many people with chronic primary pain find it difficult to be physically active", so start lower than you think. The NHS's 150 minutes of moderate activity a week is a long-term aim, not a starting point.
Look for a small, slow beginners' or gentle class, tell the teacher about your pain, and ask for chair options. NCCIH advises talking with your health care providers about any complementary approaches you use, and avoiding extreme practices if you're new to yoga.
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From the slow breathing move page and our gentle yoga classes. The NHS says that when pain is intense, rather than taking shallow, rapid breaths, "breathe slowly and deeply".
See the movement on the 3D figure: Slow breathing (6 breaths a minute)
Across 30 trials, there was "low-quality evidence that mindfulness meditation is associated with a small decrease in pain", with better mood and quality of life. NICE found "not enough evidence for relaxation therapy, mindfulness or psychotherapy" to recommend them, though what there was suggested some benefit.
Added to other care, slow deep breathing eased spinal pain in 223 people at low certainty, and a review of pain and breathing found paced slow breathing linked to less pain in some studies, with the reasons unclear. The NHS says "Practising relaxation techniques regularly can help to reduce persistent pain".
Keep your eyes open, shorten it or skip it, and choose a teacher who offers choices (our suggestion). Leave out forceful breathing and long breath-holds, as NCCIH advises beginners.
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"Pacing is about choosing when to take a break from an activity, before pain, tiredness or other symptoms become too much. In other words, not carrying on until pain forces you to stop", says Live Well with Pain, which calls doing too much on good days "boom and bust". NHS inform: "Pacing can help because it allows you to do things within your limits." The British Pain Society: "It pays to start gently and build up slowly."
Set the practice by time or by the number of poses, not by how you feel on the day: the same 20 minutes on good and bad days. On a good day, stop while you could do more; on a bad day, do the first half, or just the breathing and lying-down poses (our suggestion, as on our chronic pain guide).
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A 2026 review of 9 studies (873 people) of pacing by planned amounts found "mixed findings across outcomes" with "very low confidence in the evidence". An older review found pacing "does not reduce the severity of pain" but eased stiffness and the interference of tiredness. In one NHS pain service's pacing programme, 39% had dropped out by the end. It's sensible, widely taught advice rather than a proven treatment.
If activity is regularly followed, hours or days later, by a crash out of proportion to what you did, see a GP. That pattern can be a sign of ME/CFS (myalgic encephalomyelitis or chronic fatigue syndrome), where NICE advises against programmes with fixed increases in activity, so this page's advice to build up gradually isn't for ME/CFS. Our yoga for chronic fatigue guide covers it.
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NICE: "A flare-up is a sudden, temporary worsening of symptoms." A cause may not be found: "Sometimes setbacks can happen for no obvious reason at all", says Live Well with Pain. See your GP if a flare brings new symptoms.
Arthritis UK: "The general advice is to focus on slow and gentle movement during a flare up, rather than stopping altogether." Live Well with Pain: "Cutting back on activity, but still being gently active, is the key". Do the flare-day poses below, or the first block of a gentle class, once or twice a day.
"Having a setback plan ready can help you get back on track sooner": agree in advance what helps, what you'll cut back and when to get help. Then build back up over a few days from the last level that felt manageable. Flare plans are expert advice; they haven't been tested in trials (our reading).
Learning how pain works made little difference on its own, but added to exercise it led to "greater clinical improvements", across 16 reviews. In 12 trials its short-term effect on pain had "low clinical relevance", while fear of movement eased by an amount that mattered; a 2026 review of 12 trials found a small effect on pain. NICE found no clinically important effect on quality of life from education alone, but "a possible benefit for pain and no evidence of harm".
Slow breathing: "At least 5 minutes, done regularly as part of your daily routine"; crocodile breathing: "5 minutes of easy nose breathing, about 4 seconds in and 6 out" (the move pages' doses); in a class, 2 minutes of slow breathing. Easy pose: 1 to 2 minutes, on a folded blanket or the edge of a chair (our fibromyalgia class).
Heel slides: "10 slow repetitions each side, once or twice a day"; windshield wipers: "10 slow passes side to side, 2 rounds" (the move pages' doses). Pelvic tilt into bridge: 8; double knee hug: 2 holds of 20 to 30 seconds; reclined figure four and supine twist: 45 seconds each side, a cushion under the top knee (our fibromyalgia class).
3D demoSupine heel slideBeginner · No equipment
3D demoHip windshield wipersBeginner · No equipment
3D demoPelvic tilt into bridgeBeginner · No equipment
3D demoDouble knee-to-chest stretchBeginner · No equipment
3D demoReclined figure four (eye of the needle, Sucirandhrasana)Beginner · No equipment
3D demoSupine spinal twist (Supta Matsyendrasana)Beginner · No equipmentSeated upper-back lift: 5 holds of 3 to 5 seconds (our chair yoga class). Breath reach: "5 breaths, exhale longer than inhale"; seated march: "1 to 2 minutes as a warm-up" (the move pages' doses). Cat-cow seated: 6 slow rounds; thoracic rotation seated: 5 each side with 5-second holds (our fibromyalgia class).
Mountain pose: 5 slow breaths; warrior II: 3 breaths each side with a short stance; chair pose: 2 holds of 3 to 5 breaths (our fibromyalgia class). Hip hinge fold: "5 slow folds, 3 breaths at the bottom" (the move page's dose), hands on the chair seat. Sit to stand: 5 to 8, pushing on your thighs if you need (our editorial starting point, from our chair yoga class).
Sphinx: 2 holds of 3 to 5 breaths; locust: 3 holds of 3 breaths (our fibromyalgia class). Bird dog one limb at a time: 5 each arm and leg, holding 3 to 5 seconds; bridge: 8 to 10 slow lifts (our yoga for posture class). Skip sphinx and locust if arching pinches or sends symptoms down a leg.
Child's pose: "Hold 1 to 3 minutes, breathing into the back ribs"; reclining bound angle: "Rest 2 to 5 minutes with a support under each thigh"; corpse pose: "Lie still for at least 5 minutes, up to 10" (the move pages' doses). Lie on your side or sit if lying flat isn't comfortable.
From our chronic pain flare-up routine: slow breathing, 2 minutes; heel slides, 5 each leg; windshield wipers, 5 slow passes; seated march, 1 minute; corpse pose, 2 minutes. Repeat it 2 or 3 times through the day with rest in between.
Headstands, shoulder stands and the plough aren't needed, and NCCIH advises beginners to avoid them; deep backbends and deep forward folds weren't part of the trial classes' early weeks, so swap deep folds for the hip hinge; leave fast flows such as sun salutations until gentle practice feels easy; and skip heated classes while you're starting out or in a flare. Our suggestions: no trials of hot or yin yoga in chronic pain were found.
3D demoSupported headstand (Salamba Sirsasana)Expert · A wall
3D demoSupported shoulderstand (Salamba Sarvangasana)Advanced · No equipment
3D demoPlow pose (Halasana)Advanced · No equipment
3D demoWheel pose (Urdhva Dhanurasana)Advanced · No equipment
3D demoCamel pose (Ustrasana)Intermediate · No equipment
3D demoSeated forward fold (Paschimottanasana)Intermediate · No equipment
3D demoSun salutation A (Surya Namaskar A)Intermediate · No equipmentStart with our 30-minute gentle yoga class: it was built for fibromyalgia, and its chair options, slow transitions, stop point and long rest suit most long-term pain. Use the stop point on bad days and in your first week. The yoga for back pain class follows a large back pain trial's first weeks; the chair classes suit days when the floor is too much; the flare-up routine is for bad days; the restorative class and breathing exercises are rest, not exercise.
A gentle 30-minute yoga class for fibromyalgia: breathing, seated loosening, standing poses holding a chair, then floor poses and a long rest, with a stop point.
30 minBeginner19 movesNo equipmentA gentle 20-minute yoga sequence for back pain, based on the first weeks of a 12-week trial programme: lying, all-fours and standing poses, then rest.
20 minBeginner12 movesFirm cushionA free 20-minute chair yoga class for older adults: slow breathing, gentle seated stretches and twists, standing poses holding the chair, and a calm finish.
20 minBeginner18 movesBench or box, something with weightA 15-minute chair yoga routine done entirely sitting: slow breathing, neck, shoulder and wrist stretches, seated twists and side bends, and a calm finish.
15 minBeginner16 movesBench or boxA 10-minute routine for a pain flare-up: slow breathing, small gentle moves lying and sitting, a short stroll if you can, then rest. Repeat later in the day.
10 minBeginner10 movesBand, bench or boxA 45-minute restorative yoga sequence: five fully supported poses held for 4 to 10 minutes each, with slow breathing and a long final rest.
45 minBeginner6 movesFirm cushion, wallA 6-minute breathing routine: slow breathing, crocodile breathing, alternate nostril breathing, box breathing and 4-7-8 breathing.
6 minBeginner5 movesNo equipmentA 25-minute gentle yoga class for complete beginners and over-50s: slow breathing, a warm-up, supported standing poses, floor poses and a closing rest.
25 minBeginner14 movesNo equipmentFollow a plan at a slower pace than written, repeating a week whenever you need to (our suggestion, as on our chronic pain guide).
A free 8-week walking plan for beginners: build to 150 minutes of brisk walking a week, with intervals, hills and two short strength sessions.
6 training days40 minBeginner2 days a weekYour first four weeks: two, then three short strength sessions a week at home plus walks, building gently to a full routine.
2 training days20 minBeginnerThese are the warning signs from our chronic pain and back pain guides, word for word. Long-term pain is real pain, and new or changing pain still deserves a check. This is general information, not a diagnosis. A&E means accident and emergency; in the US, call 911 for 999.
Don't drive yourself to A&E.
NHS inform: "Talking therapies, like counselling, can also be helpful in managing the impact of pain on your mental health. Speak to your GP to discuss your options."
If you are thinking about suicide or can't keep yourself safe, call 999 or go to A&E (accident and emergency). For urgent help, call Samaritans free on 116 123, any time, or in England call 111 and select the mental health option. In the US, call or text 988.
Leg symptoms are the exception: stop or shrink any movement that sends pain, pins and needles or numbness further down your leg. If leg symptoms move back towards your spine, that is a good sign, even if your back aches a little more for a while.
Arm symptoms are the exception. If an exercise 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. (A hospital leaflet on nerve glides allows a short-lived rise in symptoms but not one lasting over an hour; the rest of this rule is this site's suggestion.)
Call 999 if:
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.
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Your GP first. In many areas you can refer yourself to NHS physiotherapy without seeing a GP. A GP can refer you to a pain clinic or a pain management programme, and the NHS names support groups such as Pain Concern and Action on Pain.
Stand near a wall or a chair for balance poses and get up slowly from lying down (our suggestion). Keep taking your medicines as prescribed, and talk to your GP or pharmacist before changing them.
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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.
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.
In the Cochrane review, yoga eased back pain by about 4.5 points out of 100 against no exercise, and no treatment for long-lasting back pain had a clinically important long-term effect across 551 studies. NHS inform says chronic pain "may not be cured or fixed", though "For some people the pain may reduce over time".
In long-term pain the warning system becomes more sensitive, and "hurt does not mean that harm is taking place". The NHS: "if you become more active gradually, it's unlikely you'll cause any damage or harm". New, changing or spreading pain still needs checking.
NICE recommends exercise and staying active for chronic primary pain, and in a flare the advice is gentle movement rather than stopping altogether.
"Carrying on physical activity to the point of unmanageable pain or exhaustion is rarely helpful", says the British Pain Society. Use the pain rule and pace yourself.
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Pain is "always a personal experience" shaped by body, mind and circumstances, and "A person's report of an experience as pain should be respected". Not knowing the cause "does not mean it does not exist".
It's about as good as other exercise for back pain, and NICE could not say one type of exercise was better than another. The best exercise is the one you'll keep doing.
The commonest side effect is a short-lived rise in pain, a little more often than with no exercise and about as often as with other exercise. Start small and pace it.
Mindfulness eased pain by a small amount at low quality, and slow breathing helped mainly as an add-on. They help many people cope, which matters in its own right.
It can be, especially for long-lasting back pain, where trials show small improvements in pain and everyday function, about as much as other exercise. For neck pain, fibromyalgia and knee arthritis there are fewer, smaller trials. NICE recommends exercise for chronic pain without naming a type, so yoga is one good option.
No study shows that, and the average benefit is small. Many people find they can do more and feel better even when the pain doesn't go away, and NICE notes that quality of life can improve even if the pain stays the same.
The trials mostly used gentle beginners' classes of Iyengar, hatha or viniyoga, with breathing and relaxation as well as poses. A small, slow class where you can sit or use a chair is a sensible start, and no style has been shown to beat another.
The big back pain trials used one class a week for 12 weeks, plus practice at home. Start shorter if you need to, with 15 to 20 minutes two or three times a week, and build up slowly.
In long-term pain the nervous system can be more sensitive, so new movements can hurt without causing damage. In trials, the commonest side effect was a short-lived rise in pain. Start smaller, keep to about 5 out of 10, settling by the next morning, and build up slowly.
Aim for pain no higher than about 5 out of 10, back to your usual by the next morning; if it isn't, do less next time rather than stopping. Stop for sharp pain, a joint giving way, or pain, pins and needles or numbness travelling down an arm or leg.
Keep moving gently rather than stopping: a shorter, easier practice, slow breathing, or our flare-up routine once or twice a day. Then build back up from the last level that felt manageable, and see a GP if a flare brings new symptoms.
Doing a planned amount and taking a break before pain or tiredness gets too much, rather than doing a lot on good days and paying for it afterwards. It's widely taught in NHS pain services, though the trial evidence is very low certainty.
Yes, it's a good way to start or to keep going on bad days, and our chair and gentle classes can be done mostly sitting. No trial has compared chair and mat yoga for chronic pain.
They can help you relax and cope: mindfulness eased pain by a small amount across 30 trials, and slow breathing helped spinal pain as an add-on, both at low certainty. If a long relaxation leaves you feeling worse, keep your eyes open, shorten it or skip it.
We found no trial of hot yoga in chronic pain. Start with a gentle, unheated class, and see our hot yoga guide for the signs of heat illness.
No: yoga sits beside your care. See a GP about new or changing pain, and ask about a pain clinic or pain management programme if you're struggling to cope.
Exercise education, not a personal prescription, and clinical review of these guides is pending. If you are pregnant, have a health condition such as glaucoma, high blood pressure or osteoporosis, or have had recent surgery, check with a doctor, midwife or physiotherapist before starting, and stop for sharp or increasing pain. Health disclaimer.
