Understanding the Role Therapeutic Yoga in the Management of Chronic Musculoskeletal Pain for Physiotherapy Practice: Patient and Staff Perspectives

by Rachel Cox MSc BSc

Chronic musculoskeletal (MSK) pain represents a major global health challenge affecting millions of individuals and placing a substantial burden on healthcare systems, economies and society. In the United Kingdom alone, approximately 43% of adults live with chronic pain, with MSK conditions constituting the most prevalent cause (Dunn et al. 2024, Fayaz et al., 2016; Mills et al., 2019). Chronic MSK pain is associated with significant physical disability, psychological distress and social limitation, often persisting beyond normal tissue healing and lacking a clear pathological explanation (Dieppe, 2013). As a result, individuals frequently experience reduced quality of life, impaired function, and comorbid mental health conditions such as anxiety and depression (Vlaeyen and Linton, 2012; NICE, 2021).

Despite its prevalence, chronic MSK pain remains difficult to manage effectively. Traditional biomedical approaches, particularly pharmacological interventions, have demonstrated limited long-term benefit and are associated with adverse effects, dependence and escalating healthcare costs (Kalso et al., 2004; Noble et al., 2010). Consequently, contemporary clinical guidelines increasingly advocate for non-pharmacological, self-management and biopsychosocial approaches that empower patients to engage actively in their own care (SIGN, 2025; NICE, 2021). Physiotherapy, exercise-based interventions and psychologically informed treatments form the cornerstone of this approach; however, there remains a need to explore complementary strategies that address both the physical and psychosocial dimensions of persistent pain.

Yoga therapy (using the practices of traditional yoga as a therapeutic modality) has emerged as a promising complementary and alternative medicine (CAM) and mind–body therapy (MBT) within the management of chronic MSK pain. Rooted in ancient philosophical traditions, yoga integrates physical postures (asana), controlled breathing (pranayama) and mindful awareness to promote physical function, psychological wellbeing and self-regulation (Desikachar, 1999). In recent decades, yoga has been increasingly adopted within Western healthcare contexts, with growing evidence supporting its effectiveness in improving pain, function and quality of life in individuals with conditions such as chronic low back pain, osteoarthritis, neck pain and fibromyalgia (Ward et al., 2013; Wieland et al., 2017; Li et al., 2019).

Image: woman practising yoga and breath

The Research 

While quantitative research has provided valuable insight into the clinical effectiveness of yoga therapy, this body of evidence alone is insufficient to inform implementation in practice. Chronic pain is a subjective and multidimensional experience, influenced by individual beliefs, expectations, social context and prior healthcare encounters (Vlaeyen and Linton, 2012). As such, understanding how patients and healthcare staff perceive, experience and engage with yoga therapy is critical in determining its acceptability, feasibility and sustainability as a therapeutic intervention. Qualitative research offers a unique contribution in this regard, enabling exploration of lived experience, perceived benefits, barriers to participation and contextual factors that shape engagement with treatment (Pope et al., 2002).

To date, qualitative research examining yoga therapy for chronic MSK pain has remained fragmented, with individual studies focusing on specific populations, conditions or settings. No consensus exists regarding how patients and staff experience yoga therapy, nor how these perspectives may influence uptake and integration within healthcare services. Synthesising qualitative evidence is therefore essential to provide a coherent understanding of experiential factors and to inform person-centred, clinically relevant practice. A qualitative synthesis allows for the identification of shared themes across studies, offering insights beyond the findings of individual papers and supporting evidence-informed decision-making in physiotherapy and pain management services.

This essay critically synthesises qualitative evidence exploring the perspectives and experiences of patients and staff regarding the use of yoga therapy for the management of chronic MSK pain. Drawing on six qualitative research studies, it examines perceived benefits, facilitators and barriers to engagement, and considers the feasibility of implementing yoga therapy within clinical and community settings. By foregrounding experiential evidence, this essay aims to evaluate the role of yoga therapy as a holistic, self-management strategy and to discuss its implications for physiotherapy practice and future research.

Table of 1 - Research Papers Analysed (will open a Google Sheet table)

Critical Thematic Synthesis: Perceived Benefits of Yoga Therapy

Across the six qualitative studies included in this synthesis, participants consistently described a range of perceived benefits associated with yoga therapy for chronic MSK pain. These benefits extended beyond physical symptom relief and encompassed psychological, social and self-management dimensions. This theme was evident across diverse pain conditions and settings, suggesting that yoga therapy may address multiple aspects of the chronic pain experience in ways that align closely with biopsychosocial models of care.

1. Physical Benefits and Functional Improvement

Patients frequently reported improvements in physical function, mobility and bodily awareness following participation in yoga therapy. Across studies involving chronic low back pain, chronic neck pain and rheumatoid arthritis (RA), yoga was described as facilitating gentle, controlled movement that enabled participants to engage in physical activity without exacerbating pain (Tul et al., 2011; Ward et al., 2011; Cramer et al., 2013). Unlike conventional exercise, yoga was perceived as adaptable and non-threatening, allowing individuals to work within their own limits while gradually rebuilding confidence in movement.

Participants often emphasised improved flexibility, posture and strength, alongside a greater awareness of bodily alignment and movement patterns. This enhanced body awareness appeared to play a key role in reducing fear of movement, a well-established contributor to chronic pain-related disability (Vlaeyen et al., 1995). Rather than viewing pain as a signal to avoid activity, patients described learning to distinguish between discomfort and harm, supporting more active engagement in daily activities (Tul et al., 2011). These findings echo physiotherapy principles that emphasise graded exposure and movement confidence as central to chronic pain rehabilitation.

Staff perspectives further reinforced these perceived physical benefits. Healthcare professionals involved in implementing yoga programmes reported observing improvements in patients’ posture, movement quality and functional participation (Waddington et al., 2017). Importantly, staff noted that yoga provided a structured yet flexible approach to exercise that could be adapted for individuals with varying levels of pain, disability and comorbidity. This adaptability was viewed as a key advantage over more prescriptive exercise programmes, particularly within group-based pain management settings.

2. Psychological and Emotional Benefits

Beyond physical improvements, psychological benefits emerged as a dominant theme across all patient-focused studies. Participants frequently described reductions in stress, anxiety and low mood, alongside enhanced emotional regulation and coping capacity (Tul et al., 2011; Cramer et al., 2013a; Greysen et al., 2017). Yoga therapy was often perceived as providing a sense of calm and mental clarity, which participants associated with both the breathing components and the mindful focus on bodily sensations.

Several patients described yoga as shifting their relationship with pain, rather than eliminating it. This reframing of pain experience was characterised by increased acceptance, reduced catastrophising and a greater sense of control. Such changes are clinically significant, as maladaptive cognitive responses to pain are strongly associated with disability and poor outcomes in chronic MSK conditions (Vlaeyen and Linton, 2012). Through yoga practice, participants reported developing skills that enabled them to respond to pain with less fear and distress, supporting emotional resilience.

From a staff perspective, these psychological benefits were viewed as central to the value of yoga therapy within pain management services. Healthcare professionals highlighted improved patient confidence, motivation and engagement with self-management strategies following participation in yoga-based programmes (Waddington et al., 2017). Staff also noted that patients who engaged in yoga appeared more receptive to other aspects of multidisciplinary pain management, suggesting potential synergistic effects within integrated care pathways.

3. Yoga as a Coping and Self-Management Tool

A particularly salient finding across the studies was the role of yoga therapy as a long-term coping strategy. Participants frequently described yoga as a tool they could use independently to manage symptoms beyond the clinical setting. This included applying breathing techniques during pain flares, using gentle stretches to reduce stiffness and adopting mindful awareness to manage stress and emotional responses (Tul et al., 2011; Greysen et al., 2017).

This perceived transferability of skills is highly relevant within the context of chronic pain management, where sustained self-management is essential. Patients valued the sense of autonomy and empowerment that yoga provided, contrasting it with passive treatment modalities that offered only temporary relief. For some participants, yoga facilitated a shift from reliance on healthcare services towards greater self-efficacy and ownership of their condition.

Staff echoed these observations, describing yoga therapy as supporting self-management goals central to contemporary pain services (Waddington et al., 2017). The low-cost, group-based nature of many yoga programmes was viewed as advantageous, particularly in resource-constrained healthcare systems. Staff also highlighted that yoga could be continued in community settings or at home, extending its impact beyond formal treatment episodes.

4. Social Connection and Support

Social benefits, while less consistently reported, nevertheless emerged as an important subtheme. Group-based yoga sessions were described as fostering a sense of belonging and shared understanding among participants with chronic pain (Ward et al., 2011; Greysen et al., 2017). Patients valued the opportunity to engage in activity alongside others with similar experiences, which helped reduce feelings of isolation commonly associated with chronic pain.

For some participants, the group environment also contributed to motivation and adherence, providing encouragement and normalising challenges associated with pain and physical limitation. Staff recognised these social dimensions as enhancing patient satisfaction and engagement, further supporting the feasibility of yoga therapy as part of multidisciplinary pain management services (Waddington et al., 2017).

Facilitators and Motivators for Engagement

Across the six qualitative studies, a range of facilitators and motivators were identified that influenced engagement with yoga therapy for chronic MSK pain. These factors operated at individual, interpersonal and organisational levels and were central to determining whether patients initiated, sustained and derived benefit from yoga practice. Understanding these facilitators is essential for translating evidence into effective clinical implementation.

1. Desire for Physical and Psychological Improvement

A primary motivator for patients engaging in yoga therapy was the desire to improve both physical function and psychological wellbeing. Many participants reported turning to yoga after experiencing limited success with conventional treatments, expressing a willingness to explore alternative approaches that addressed the multidimensional nature of their pain (Combs and Thorn, 2014; Tul et al., 2011). Yoga was perceived as offering a holistic intervention that aligned with personal health goals, particularly for individuals seeking non-pharmacological options.

Patients frequently described being motivated by anticipated improvements in mobility, pain management and stress reduction. In some cases, prior positive experiences with yoga or other mind–body therapies reinforced expectations of benefit, increasing readiness to engage. Importantly, these expectations were often reshaped through experience, with participants reporting that initial scepticism was replaced by sustained motivation once benefits were perceived (Atkinson and Permuth-Levine, 2009; Greysen et al., 2017). This highlights the dynamic nature of motivation and underscores the importance of early positive experiences in supporting adherence.

2. Support and Encouragement from Others

Interpersonal encouragement emerged as a key facilitator across studies. Recommendations from healthcare professionals were particularly influential in legitimising yoga as a therapeutic option. Patients reported greater confidence in engaging with yoga when it was endorsed by trusted clinicians, including physiotherapists and pain specialists (Combs and Thorn, 2014; Ward et al., 2011). Such endorsement appeared to counteract concerns that yoga might be unsafe or inappropriate for individuals with chronic pain or inflammatory conditions.

Support from family members, peers and other participants also played a significant role. Group-based yoga sessions created opportunities for shared encouragement and mutual understanding, reinforcing motivation and normalising challenges associated with chronic pain (Ward et al., 2011; Greysen et al., 2017). These social influences not only facilitated engagement but also contributed to sustained participation by fostering accountability and emotional support.

From a staff perspective, professional commitment and belief in the value of yoga therapy facilitated successful implementation. Staff involved in delivering or coordinating yoga programmes described strong clinical motivation to provide patients with accessible, non-pharmacological options aligned with self-management principles (Waddington et al., 2017). This clinical drive was viewed as essential in overcoming logistical challenges and advocating for yoga therapy within organisational structures.

3. Accessibility, Adaptability and Class Environment

Practical and environmental factors also influenced engagement. Patients consistently highlighted the importance of accessible class formats, including convenient scheduling, appropriate class duration and manageable physical demands (Tul et al., 2011; Greysen et al., 2017). Adaptability of yoga practices was particularly valued, with participants emphasising the importance of modifications that accommodated pain, fatigue and fluctuating symptoms.

The class environment emerged as a significant facilitator. Patients described feeling more comfortable and confident in settings that were perceived as welcoming, non-judgemental and supportive. Trust in the yoga instructor was central to this experience, with participants valuing instructors who demonstrated understanding of chronic pain, provided clear guidance and prioritised safety (Cramer et al., 2013a; Ward et al., 2011). This trust appeared to reduce anxiety about injury or symptom exacerbation, supporting deeper engagement with the practice.

Staff perspectives reinforced the importance of adaptability and instructor expertise. Healthcare professionals noted that yoga programmes were more successful when instructors were trained to work with clinical populations and when classes could be tailored to individual needs (Waddington et al., 2017). Such flexibility was viewed as essential in maintaining inclusivity and preventing attrition among participants with higher levels of disability or fear of movement.

4. Cost and Information Provision

Affordability was identified as a facilitator, particularly when yoga programmes were offered at low or no cost within healthcare or community settings. Patients expressed greater willingness to engage when financial barriers were minimised, recognising yoga therapy as a potentially ongoing self-management strategy rather than a short-term intervention (Combs and Thorn, 2014). Staff similarly identified low-cost group classes as a feasible model within constrained healthcare budgets (Waddington et al., 2017).

Accurate and accessible information also played a critical role in facilitating engagement. Participants valued clear explanations regarding what yoga therapy involved, its potential benefits and how it differed from general exercise or fitness-based yoga classes. Misunderstandings or lack of information were associated with apprehension, whereas informed expectations supported confidence and motivation (Combs and Thorn, 2014). This underscores the role of healthcare professionals in providing education and framing yoga therapy as a credible, evidence-informed intervention.

Barriers and Challenges to Yoga Therapy

Despite the broadly positive perceptions of yoga therapy, participants across the six studies also identified a range of barriers that limited engagement and implementation. These challenges operated at individual, social and organisational levels and highlight important considerations for integrating yoga therapy into chronic MSK pain management services.

1. Physical and Psychological Burden of Chronic Pain

The inherent burden of chronic MSK pain itself was frequently cited as a barrier to participation in yoga therapy. Patients described fluctuating symptoms, fatigue and pain flares that made regular attendance challenging (Tul et al., 2011; Greysen et al., 2017). For some individuals, fear of exacerbating pain or causing injury led to avoidance of physical activity, including yoga, despite recognition of its potential benefits. This fear of movement is a well-documented contributor to disability in chronic pain populations and can significantly undermine engagement with therapeutic exercise (Vlaeyen et al., 1995).

Psychological barriers such as low mood, anxiety and reduced self-confidence further compounded these challenges. Some participants expressed doubts about their physical capabilities or questioned whether yoga was suitable for people with long-standing pain or inflammatory conditions such as rheumatoid arthritis (Ward et al., 2011). These concerns were often rooted in previous negative experiences with exercise or a lack of exposure to adapted forms of yoga, underscoring the need for reassurance and graded introduction.

2. Negative Beliefs, Stereotypes and Preconceptions

Misconceptions and preconceived beliefs about yoga emerged as a prominent barrier across several studies. Patients described yoga as being associated with flexibility, physical fitness or spiritual practices that they felt were incompatible with their own identities or physical limitations (Combs and Thorn, 2014; Ward et al., 2011). Such stereotypes contributed to apprehension and reluctance to engage, particularly among individuals with limited prior exposure to yoga.

These findings align with broader research suggesting that cultural perceptions of yoga may deter participation among certain demographic groups, including men and older adults (Atkinson and Permuth-Levine, 2009). Importantly, some participants reported that these beliefs were challenged through experience, with initial scepticism giving way to more positive perceptions following participation. However, for those who did not engage, these misconceptions remained a significant barrier, highlighting the importance of targeted education and inclusive messaging.

3. Practical and Financial Constraints

Practical barriers such as cost, accessibility and time constraints were consistently reported. Patients noted that yoga classes outside of clinical settings could be expensive, limiting their ability to continue practice independently (Combs and Thorn, 2014; Greysen et al., 2017). Travel distance, scheduling conflicts and competing life responsibilities further hindered participation, particularly for individuals managing work, caregiving roles or fluctuating health.

From a staff perspective, organisational constraints posed significant challenges to implementation. Healthcare professionals described difficulties related to funding, space allocation, staffing and administrative support when integrating yoga therapy into existing services (Waddington et al., 2017). Time pressures within clinical settings and competing service priorities also limited the capacity to deliver or sustain yoga programmes, despite perceived benefits.

4. Class Suitability and Instructor Expertise

Concerns regarding class suitability and instructor competence were raised by both patients and staff. Participants emphasised the importance of instructors having appropriate training and understanding of chronic pain conditions. Negative experiences or perceptions of instructors lacking clinical awareness undermined trust and deterred engagement (Cramer et al., 2013a; Ward et al., 2011). For patients with complex or fluctuating symptoms, inappropriate pacing or lack of modification increased anxiety and risk of disengagement.

Staff similarly highlighted the challenge of ensuring adequate instructor training and clinical governance. Identifying instructors with both yoga expertise and an understanding of chronic pain was viewed as essential yet difficult, particularly within publicly funded healthcare systems (Waddington et al., 2017). These concerns underscore the need for clear standards, collaboration between healthcare professionals and yoga instructors, and appropriate training pathways.

5. Information Gaps and Healthcare Integration

A lack of clear information regarding yoga therapy was identified as a barrier at both patient and system levels. Patients reported uncertainty about what yoga therapy involved, how it differed from general yoga classes and whether it was supported by evidence (Combs and Thorn, 2014). Inadequate information from healthcare providers contributed to hesitation and reinforced perceptions of yoga as an “alternative” rather than legitimate therapeutic option.

Healthcare professionals also described challenges in integrating yoga therapy within established care pathways. Limited awareness, unclear referral processes and uncertainty regarding clinical responsibility created barriers to adoption (Waddington et al., 2017). These findings highlight the importance of embedding yoga therapy within multidisciplinary frameworks, supported by clear communication, education and organisational commitment.

Summary 

Taken together, the findings demonstrate that yoga therapy is perceived as a multifaceted intervention with potential physical, psychological and social benefits for individuals with chronic MSK pain. However, engagement and implementation are shaped by a complex interplay of personal beliefs, social support, practical considerations and organisational structures. Addressing these barriers is essential to realise the full potential of yoga therapy within chronic pain management.

Implications for Physiotherapy Practice and Service Delivery

The qualitative synthesis presented in this essay has important implications for physiotherapy practice and the delivery of chronic MSK pain services. By foregrounding patient and staff perspectives, the findings highlight how yoga therapy may complement existing physiotherapy interventions and contribute to holistic, person-centred pain management, while also identifying considerations for effective implementation.

The perceived benefits of yoga therapy closely align with core physiotherapy principles underpinning chronic pain management. Improvements in movement confidence, flexibility and functional participation reflect the emphasis on graded activity, movement re-education and fear reduction within physiotherapy-led rehabilitation (Vlaeyen et al., 1995; Hartvigsen et al., 2018). Participants’ enhanced body awareness and improved movement quality suggest that yoga therapy may support proprioceptive retraining and motor control, key components of MSK physiotherapy. In addition, the psychological benefits reported, including reduced anxiety, improved emotional regulation and increased self-efficacy, align with the growing emphasis on psychologically informed physiotherapy.

A key implication of the synthesis is the role of yoga therapy in promoting self-management and patient autonomy. Participants valued yoga as a transferable skill that could be applied independently to manage symptoms and stress beyond the clinical setting, consistent with contemporary guidance prioritising supported self-management (NICE, 2021; SIGN, 2025). Physiotherapists are well positioned to facilitate this process by introducing yoga-based principles, educating patients on safe movement and referring appropriately to adapted yoga programmes. Framing yoga therapy as an active self-management strategy may reduce reliance on ongoing healthcare input and support long-term behaviour change.

Education and communication emerged as central to facilitating engagement. Misconceptions and stereotypes regarding yoga acted as barriers, particularly among individuals unfamiliar with mind–body practices. As trusted healthcare professionals, physiotherapists play a critical role in providing clear, evidence-informed explanations, differentiating therapeutic yoga from fitness-based practices and emphasising adaptability for individuals with pain and disability. Such communication may be particularly important for engaging underrepresented groups.

From a service delivery perspective, the findings suggest that yoga therapy may be most effectively implemented within structured, group-based programmes integrated into existing pain services. Group formats support social engagement and cost-effectiveness; however, successful implementation requires organisational support, clear referral pathways and appropriate clinical governance. Collaboration between physiotherapists and qualified yoga therapists may offer a pragmatic model ensuring patient safety while maintaining professional oversight.

Overall, the synthesis suggests that yoga therapy has the potential to enhance physiotherapy practice when integrated thoughtfully, supported by education, collaboration and service-level commitment.

Limitations of the Evidence and Future Research Directions

Despite providing valuable insight into experiences of yoga therapy for chronic MSK pain, the qualitative evidence base presents several limitations that must be considered when interpreting findings. A prominent limitation is the lack of demographic diversity across studies. Women were disproportionately represented, reflecting common patterns in yoga participation but limiting transferability to male populations. Gendered perceptions of yoga may influence engagement and experience, indicating a need for research that more actively includes male participants.

Cultural and geographical limitations further restrict generalisability. Most studies were conducted in Western, high-income countries, and findings may not translate to populations with differing cultural beliefs surrounding pain, exercise and mind–body practices. In addition, several studies focused on specific MSK conditions, such as chronic low back pain or rheumatoid arthritis, reducing applicability across the broader spectrum of chronic MSK disorders encountered in physiotherapy practice.

Methodological limitations were also evident. Sample sizes were small, and while appropriate for qualitative research, they constrain the breadth of perspectives captured. Variation in qualitative methodologies and analytical approaches complicates synthesis, and limited reporting of researcher reflexivity in some studies raises the potential for interpretive bias. 

The heterogeneity of yoga interventions represents an additional challenge. Differences in yoga styles, class formats, duration and instructor expertise limit the ability to identify which components most strongly influence patient experience. Furthermore, self-selection bias may be present, as participants who engaged in yoga and volunteered for qualitative studies may have been more motivated or predisposed to perceive benefit, potentially underrepresenting negative experiences.

Future research should prioritise more diverse samples, clearer intervention descriptions and mixed methods designs that integrate experiential data with clinical outcomes. Longitudinal qualitative research may also enhance understanding of the sustainability of perceived benefits and long-term engagement with yoga therapy.

Conclusion

Chronic MSK pain presents a significant challenge for individuals and healthcare systems, requiring management approaches that extend beyond symptom reduction to address psychological, social and functional dimensions. This essay has critically synthesised qualitative evidence exploring patient and staff perspectives on yoga therapy for chronic MSK pain, drawing on six qualitative studies to examine perceived benefits, facilitators and barriers to engagement.

The synthesis indicates that yoga therapy is widely perceived as a holistic intervention that supports physical function, psychological wellbeing and self-management. Participants described improvements in movement confidence, body awareness and emotional regulation, alongside enhanced coping strategies and a more accepting relationship with pain. These perceived benefits align closely with biopsychosocial models of pain and contemporary physiotherapy principles, suggesting that yoga therapy may complement existing rehabilitation approaches rather than act as an alternative to conventional care.

However, engagement with yoga therapy is shaped by a complex interplay of personal beliefs, social support, practical accessibility and organisational structures. While facilitators such as clinician endorsement, adaptability and supportive group environments promote engagement, barriers including fear of movement, misconceptions about yoga, financial constraints and limited-service integration remain significant. Staff perspectives highlight additional challenges related to training, governance and resource allocation, underscoring the importance of structured implementation within multidisciplinary frameworks.

The findings emphasise the value of qualitative evidence in informing clinical practice by illuminating experiential factors that influence acceptability and sustainability. For physiotherapy practice, yoga therapy may offer a feasible adjunct to chronic pain management when integrated thoughtfully, supported by education, collaboration with trained instructors and clear referral pathways. Importantly, yoga therapy appears to support self-management and patient autonomy, key priorities in long-term pain care.

Despite promising findings, limitations within the evidence base restrict generalisability, highlighting the need for more diverse samples, clearer intervention descriptions and mixed-methods research. Overall, this essay demonstrates that yoga therapy holds potential as a person-centred, biopsychosocial intervention for chronic MSK pain, provided that experiential insights are used to guide its integration into clinical practice.

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