Friday Q A Safe Neck Movements

Self portrait at the age of eighty three by Hokusai

Q: I was wondering if you could do a post about the safety of neck movements in older yoga practitioners (maybe 60 and up?). I teach a beginner yoga class for seniors in the Downtown Oakland Senior Center. I do like to incorporate some neck movements into our practice but just recently I got to read Swami Satynanda Saraswati’s book (Asana, Pranayama, Mudra, Bandha) and he mentions that elderly people should not do the neck movements he suggests in his Pawanmuktasana Part 1 series (chin to chest, head turning to side, ear to shoulder, head rolls (I don’t do that one with the seniors). He also suggests that cervical spondylosis patients should strictly avoid forward bending of the neck. What I mostly heard before is to be careful about back bending the neck. Would you advise patients with arthritis in the cervical spine not to do any neck movements? Or just perhaps do only 50% of their range of motion?

A: Thanks for this important question! Here at YFHA, we have written quite a bit about neck pain, neck arthritis, and normal movements of the spine, including the neck area, and other aspects of the neck (please see the end of this post for a list of recommended posts from our archives).

Before writing my answer to you, I did an online search for clear guidelines on range of motion exercises for the neck for older adults, without much luck. One study Effect of an upper-body flexibility intervention on neck range of motion in older women tried to determine if having older women practice a set of neck and upper body range of motion exercises twice a week could improve their neck range of motion. The study noted that as adults age, they often experience a decrease in mobility that can make driving a car or even safely crossing a street while checking for traffic to their right and left difficult, resulting in decreased ability to safely move about their community. They were hoping to determine a way to help turn this around. Sadly, the study did not show any significant change in neck mobility, but suggested that doing the exercises more than twice a week might change that outcome.

Before I go any further, let me clarify a few definitions for those readers new to the topic of neck problems in general:

Cervical Spondylosis: According to the Mayo Clinic cervical spondylosis is “a general term for age-related wear and tear affecting the spinal disks in your neck. As the disks dehydrate and shrink, bone spurs and other signs of osteoarthritis develop. More than 90 percent of people older than age 65 have evidence of cervical spondylosis and osteoarthritis that can be seen on neck X-rays. Most of these people experience no symptoms from these problems.”

Facet Joint Arthritis: This is a form of arthritis that affects the facet joints of the neck located behind the area of the discs, and can occur alone or in conjunction to the disc changes described above.

As for the cautions that Swami Satynanda Saraswati gives in his book, I cannot directly comment on them, as I don’t have a copy of the book and I can’t check to see if he references any sources for these recommendations. However, I have some general guidelines I use when suggesting range of motion exercises to my older students.

Disc Changes

For those with significant disc changes, including degenerative disc disease with symptoms or disc herniation causing symptoms, I recommend limiting forward bending of the neck, especially if any force is being applied to the neck. Examples of poses that might overload the neck for these students include Bridge pose, Rabbit pose, and even Child’s pose if the chin is tucked and the head is resting on the floor. As to whether non-weight bearing flexion of the neck is okay, such as standing in Mountain Pose and nodding the chin to the chest, careful experimentation could be tried and if there are no worsening of any neck symptoms, some practitioners might benefit from maintaining range of motion in that direction.

Facet Joint Arthritis

For those with facet joint arthritis that is symptomatic, extension of the neck and head (tipping the head back) can be aggravating. Therefore, caution is recommended in taking the head and neck back into extension (backbend) or extension combined with rotation. Camel Pose is an example of a neck position that I recommend be avoided by practitioners with this kind of neck arthritis. However, gentle head lifts, such as in Locust pose and low Cobra pose, could possibly help maintain some extension range of motion in the neck while also helping to strengthen the muscles at the back of the neck. And gentle chin lifts combined with chin tucks could also be tried cautiously. Empower your students to notice the effects of the movements and make appropriate adjustments as they go along.

Basic Range of Motion Movements

It is reasonable to share some basic range of motion movements with older adults and let them monitor whether the stretching sensations that arise are acceptable or not, and allow them to limit the movements to a degree that allows the movements to be done pain free. I usually suggest simple seated or standing positions to begin. Then I have my students try simple rotation of the head and neck to the right and left, moving with the breath, which I call Owl Turns. Inhale as you turn your head to the right, exhale as you turn back to center, inhale as you turn your head to the left, and exhale as you turn back center, and repeat for perhaps 2 to 3 rounds. I usually follow that with simple side-bending movements, which I fondly refer to as Curious Dog Tips, where you inhale as you bring your right ear towards your right shoulder without letting your head rotate, and exhale as you return your head to center, and then repeat on the left side. Two to three rounds of Curious Dog Tips is a good test of how a practitioner might handle that motion.

Like our reader, I tend to avoid the head circles or head “rolls” that are sometimes taught in modern yoga classes, as these seem to have the potential to aggravate a lot of necks, young and old (see Thursday Q&A: Head Rolls).

I hope these suggestions will both give older readers of YFHA some ideas to work with and yoga teachers out them some options to share with their students.

Previous posts that can give our readers a good background understanding of the neck region of the spine include:

1. For a basic understanding of the spine as a whole and how it moves: All About Spine Anatomy and Movements 
2. For a look at pain in the neck generally: A Literal Pain in the Neck 
3. For a study on Degenerative Disc Disease, which can affect the cervical spine: Degenerative Disk Disease and Yoga 
4. A general discussion of arthritis in the spine: Arthritis of the Spine 
5. My recommendations for working with neck spasms and strains: Neck Muscle Strain and Spasm, Part 2 

—Baxter

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