Yoga, tai chi and Pilates

Yoga, tai chi and Pilates are forms of exercise that combine movement with breathing and focused attention. They are often called mind-body exercise.

• Yoga uses body positions called poses, along with breathing exercises and relaxation or meditation. Most back pain studies used hatha, Iyengar or viniyoga styles, often adapted for people with back pain.
• Tai chi is a slow, flowing exercise that began in China. It uses gentle movements and shifts of weight from one leg to the other, combined with deep breathing.
• Pilates focuses on core strength, posture, flexibility, muscle control and breathing. It can be done on a mat or on special equipment.

Instructors’ training varies widely. Some physical therapists also build these methods into treatment. Most of the research is on long-lasting low back pain. There are fewer studies for neck pain.

Like other exercise, these practices can build strength and flexibility. The mind-body parts, such as slow breathing, relaxation and noticing how your body feels, may help ease muscle tension and stress.

Researchers think they may also help people feel less worried about moving and less focused on pain. How much each part matters is not known.

Finding a class

Look for beginner, gentle or therapeutic classes. Some are designed for people with back pain, and some use a chair for support. Tell the instructor about your pain and any health conditions before you start. Instructors can show easier versions of poses and movements.

It helps to learn the basics from a live instructor before relying on videos, so someone can check how you move. Costs vary. Ask about low-cost options near you.

During a class

In research studies, classes lasted about 40 to 90 minutes, once or twice a week, for about 10 to 12 weeks. Props such as blocks, straps and chairs help adapt poses to what your body can do.

Go only as far as feels comfortable. You can rest or skip any movement at any time.

At home

Practicing at home between classes is often encouraged. In one large trial, people were asked to practice about 30 minutes a day, using a video and a printed guide.

Yoga

The American College of Physicians lists yoga and tai chi among the first treatments to try for long-lasting low back pain, based on low-quality evidence. [1]

A large 2022 review of 21 studies found that, compared with no exercise, yoga improved pain and daily function by only a small amount after 3 months. The change was smaller than what most people would consider meaningful. [2]

Yoga worked about as well as other back exercises. In one US trial of 320 adults, a 12-week yoga program worked about as well as physical therapy for pain and function, but it did not clearly beat a self-care book. [2] [6]

Pilates

For long-lasting low back pain, Pilates reduced pain and disability more than minimal treatment, by a small to moderate amount, based on low to moderate quality evidence. Some reviews rank Pilates among the more effective types of exercise, but the evidence is low quality, and it has not been clearly shown to beat other exercise. [3] [15] [16]

Tai chi

Fewer studies have tested tai chi, and most were small. In one Australian trial of 160 adults with long-lasting low back pain, 10 weeks of tai chi classes lowered pain a little, compared with a wait list. [5] [12]

Neck pain

For long-lasting neck pain, a few small trials found that yoga and tai chi eased pain in the short term, and tai chi worked about as well as standard neck exercises. Pilates has not been shown to work better than other treatments for neck pain. [8] [9] [13]

Keep in mind

In these studies, people knew which treatment they were getting, which can make results look better than they are. Most studies followed people for only a few months, so less is known about the long run. There is also little research on these practices for new back or neck pain. [2] [3] [5]

The best choice may be the one you enjoy, can afford, and will keep doing.

Common and mild

• Sore muscles or stiff joints.
• A short-term increase in back pain. This was the most common side effect in yoga studies. Yoga had more side effects than no exercise, but about the same as other exercise.

Less common

• Strains or sprains, often from pushing too far into a stretch or pose.

Rare but serious

• Serious injuries are rare. Case reports have linked some serious problems to extreme practices, such as headstands, shoulder stands, the lotus position and forceful breathing.

Extra care

Go gently at first, and skip any movement that brings on your pain. Tell your clinician and your instructor before you start if any of these apply to you.

• Osteoporosis or low bone density. Deep forward bends of the spine may raise the risk of a spine fracture, so poses often need changing.
• Neck pain or neck arthritis. Poses that put weight on the head or neck, such as headstands and shoulder stands, strain the neck the most and are often avoided or changed.
• Glaucoma. Upside-down and head-down poses raise the pressure inside the eye for a short time.
• Very flexible joints. Pushing to the very end of how far a joint can move may strain it. Building strength and control may matter more than stretching further.
• Pregnancy. Prenatal or modified classes are often suggested. Hot yoga, and poses that keep you lying flat on your back for long periods, are usually avoided.

Stop any movement that sends pain, numbness or tingling down an arm or a leg, and tell your instructor and your clinician.

Other downsides

• Classes cost money and take time, and teaching quality varies.

When to get help

See the warning signs.