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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All About the Spine Anatomy and Movements

by Shari

Recently in my classes and private sessions I have been receiving a lot of questions about the spine and exactly how it moves in different yoga poses. I thought I would do a blog post to summarize basic spinal anatomy and what the yoga practitioner needs to consider when practicing. I believe it is important for us to learn about spinal movements so we can begin to understand why one movement feels good to do while another movement either hurts or just doesn’t “go anywhere.” Many of our teachers are very skilled in the instructions they give us, but, for me, I always think that it is important to understand the why (I have never been very good about blindly following orders).

Let’s start with the anatomy of the spine. The spine is composed of separate vertebrae, which are separated into five regions of the spine. The cervical spine is the neck area and there are seven cervical vertebrae. The thoracic region is the area that begins at the level of the collarbones (clavicle) and extends all the way down to the waist. The thoracic vertebrae connect to the ribs, and there are 12 thoracic vertebrae and 12 paired ribs. The lumbar region begins at the bottom of the rib cage and extends into the pelvis. There are five lumbar vertebrae and the last vertebra sits on top of the sacrum. The sacrum consists of five vertebrae fused into a single bone (the five are initially un-fused at birth, but begin to fuse in our late teens). It is joined on each side to the pelvis and sits deep to the pelvic basin. At the bottom of the sacrum, we find the coccyx, which is composed of three vestigial vertebrae—our “tail” of bygone days.

It is important when learning about the spine to view it from multiple angles, including sideways, front facing and back facing. When you view it from these three angles, you can begin to appreciate the beauty and complexity of the spine. Some of the things that you may notice immediately when looking at pictures or, better yet, a three-dimensional model, of the human spine is that the various regions look different. The cervical vertebrae are petite and small in size, the thoracic vertebrae are bigger, with longer and more angled spinous processes, and the lumbar vertebrae are much more massive and substantial.

Also, it is apparent that the spine is not a rod but has four basic curves. The cervical region curves inward (concave), the thoracic spine curves outward (convex), the lumbar spine curves inward (concave), and the sacral region curves outward (convex). The shape of the spinal curves are important for transferring the load/weight. Maintaining those curves with weight-bearing forces keeps the spine healthy with minimal deterioration of joint surfaces. The cue that we sometimes hear in yoga class to keep our spine “straight” is a misnomer, because naturally the spine is curved! We don’t want to take the curves away but we do want to balance where the movement occurs.

Another point to consider is that the shape of the spine will change when we move through a range of motion in our daily lives as well as in our asana practice. Whenever we sit, stand, walk, reach, lie down, and so on, we are changing spinal position. Sometimes the adjustments are small and imperceptible, and other times they are much more global. Going from sitting to standing changes the spinal curves in small degrees, while going into a deep forward bend or backbend changes the curves more dramatically. The muscles that attach to the spine are forever working to keep the spine stable in whatever position we are in.

There are four specific movements that the spine moves through. When we bend forward and curve the spine (reversing the lordosis of the cervical and lumbar region and exaggerating the curve of the thoracic region) this is called flexion. We cause spinal flexion in forward bends whether in a chair or seated on the floor. The degree of forward bend is generally limited by our leg and back flexibility. Some very common forward bends that require different degrees of flexion could be Seated Forward Bend (Paschimottanasana) and Plow pose (Halasana), which you could think of as an upside down from of Seated Forward Bend.

Why do I say there are different degrees of flexion? Well, for someone who is very tight in their legs or in their back muscles, just the act of sitting in Staff pose (Dandasana) with a lift under their pelvis is very challenging. Their natural inclination might be to sit in a rounded back or flexed spine position to start and then when they bend forward even more this becomes an unhealthy forward bend because there isn’t good distribution of the change in the spinal curve.

For the tighter student, learning to sit with their spine in neutral curves is the way to begin practice for spinal safety. The student who has a lot of flexibility in their hamstrings may have tight back muscles so when they bend forward there is no change in their spinal curves—both examples are extremes.

The key to healthy forward bends, whether in Paschimotanasana or Halasana, is for there to be “ease” in the bend.  The same principles apply to standing forward bends like Pyramid pose (Parsvottanasana). Props like chairs, bolsters, and blocks allow you to find the shape of the pose without the struggle of getting into a pose you aren’t ready for.

The opposite of flexion is extension. In extension, the curves of the cervical and lumbar region are deepened and the curve in the thoracic region is lessened. We extend our spines in classic backbends like Upward Bow pose (Urdva  Danurasana) Upward-Facing Dog pose (Urdva Mukha Svanasana), and Camel pose (Ustrasana).

Of course, our spines can also twist, as when we turn to look behind us in a car. We twist our spines in seated twists, such Bhajrajasana, or Marichyasana, and in standing poses, such as Triangle pose (Trikonasana) and  Revolved Triangle pose (Parivrtta Trikonasana). And in certain poses we combine both flexion and twisting as in Parivrtta Janu Sirsasana. Poses with both extension and twisting are less common, but one example is the One-Legged Downward-Facing Dog pose with a twist.

Finally, we can side bend, as when we reach down to pick up something like a handbag or grocery bag that is next to our foot. We side bend our spines in side-bending yoga poses, such as Gate pose (Parighasana). And in many poses we combine both side bending and twisting, such as in Triangle pose (Trikonasana) and and Revolved One-Legged Forward Bend (Parivrtta Janu Sirsanana). Generally, we don't purely side bend without some twisting or purely twist without some side bending, though the primary movement will look like side bending or rotation.

The key concept to protecting your spine in all your poses is understanding where we want to encourage the movement and how to distribute the movement so as not to cause excessive motion  at one vertebral level. Another key concept is to avoid using momentum to push through “resistance.” When we are overly aggressive in attempting to gain motion this is where injury will surely occur.

So let’s break down this concept of spinal motion a bit more. If we understand that different parts of our spine move more in certain movements, does this mean that certain asanas will affect different parts of the spine differently? Yes, absolutely! The cervical and lumbar regions are concave when the spine is at rest. When we move into a backbend, these areas become more concave in relation to the curve reversal of the thoracic region. Because the thoracic region is stabilized from the front (anteriorly) by the rib cage and from the back (posteriorly) by the long spinous process, there is relatively less curve reversal from convex to concave in this region. As we move into a forward bend, the rounding of the thoracic curve increases into more of a convex shape. The opposite occurs in the cervical and lumbar spines; they start in relative concavity and as the forward bend moves throughout the spine, their shape changes from concave to relatively convex.

In twists, it is important to encourage full spinal involvement, but also to understand that the majority of the twist will occur in the cervical region, followed by the thoracic region and lastly the lumbar region. There is very limited rotation of the lumbar vertebra due to their specific structural construction. Also, please try to avoid allowing your spine to round or flex whenever doing twists. The key to healthy twists is to keep the spine long, with a good conscious control of maintaining the curves as you twist. This is often erroneously called keeping the spine “straight”, but now you know better when you hear this cue from a teacher!

When you practice, try to picture how your spine changes shape from the starting position into the position of the asana and then back to starting position. This is your experiential anatomy lesson of flexion (forward bending) and extension (backward bending), and twists. 

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