New Study Shows Pandiculation Relieves Lower Back and Neck Pain

Chronic back pain and neck pain are disabling conditions experienced by many people at some point during their lifetimes. A new study published in September 2022 demonstrates the efficacy of using pandiculation to relieve chronic back and neck pain by releasing chronic muscle tension.

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The global problem of back and neck pain

The Global Burden of Disease Study 2017 reports that 577 million people around the world are affected by back pain at any one time. In 2019, the CDC’s National Health Interview Study found that 39% of American adults had experienced back pain in the previous three months.

Lower back pain is the leading cause of disability worldwide, taking a financial toll on individuals and governments and contributing to rising health insurance costs, painkiller abuse, and mental health issues.

The Mayo Clinic Symposium on Pain Medicine reports that neck pain occurs in more than 30% of US adults each year, and nearly 50% of these cases become chronic or recurring. And in 2017, there were 288.7 million cases of neck pain worldwide, an increase of 75% from the 164.3 million cases in 1990.

While the global population is aging, becoming less physically active, and experiencing rising levels of stress, these factors aren’t to blame for the entire problem of chronic back and neck pain.

Sadly, many back and neck pain patients receive inappropriate treatment. While most cases can be alleviated with physical therapies, patients are all too often prescribed opioid painkillers or encouraged to have costly surgeries which have inconsistent results. Not only do doctors and hospitals want to be reimbursed for treatment, but they also simply don’t understand the underlying cause of chronic musculoskeletal pain.

Addressing the underlying cause of chronic musculoskeletal pain

Most chronic musculoskeletal pain develops as a result of learned motor patterns, or what we commonly refer to as muscle memory. As we repeat the same movements and postures over and over, they become deeply learned by our nervous system. Our nervous system starts to keep the muscles involved in those patterns somewhat contracted all the time in order to help us be efficient. Unfortunately, the side effects of developing muscle memory are chronically tight muscles, loss of muscular control, and loss of sensation.

Somatic education relieves chronic musculoskeletal pain by retraining these deeply learned muscular patterns. Types of somatic education include the Alexander Technique, the Feldenkrais Method®, and Hanna Somatic Education (HSE), also known as Clinical Somatic Education (CSE).

While previously published studies have demonstrated the efficacy of the Alexander Technique and the Feldenkrais Method® for relief of back and neck pain, no studies of HSE/CSE had been published until now. HSE/CSE is unique in the field of somatic education and all movement modalities because it uses the technique of voluntary pandiculation, which releases chronic muscle tension by resetting the gamma feedback loop.

HSE/CSE is a method of self-care in which each individual is taught how to retrain their nervous system to release chronic muscle tension and improve posture and movement. The intention of HSE/CSE is to empower people to take care of themselves and become the expert in their own musculoskeletal functioning.

About Qiuju Huang, the author of the study

Qiuju Huang worked at the Johns Hopkins Aramco Healthcare (JHAH) in Saudi Arabia as a senior nurse clinician for 20 years. A serious injury to her lower back caused disc protrusion, and the pain prevented her from exercising and limited her ability to work. After trying nearly everything to heal her pain, she discovered Hanna Somatic Education. HSE exercises relieved her pain and allowed her to resume exercise, so she enrolled in professional training at the Novato Institute for Somatic Research & Training to become a Hanna Somatic Educator.

Qiuju had many patients at the Employee Health Clinic who had chronic muscle pain similar to hers. Their pain led them to take painkillers and visit the doctor regularly, with limited results. Many of them felt helpless. Hospital management supported Qiuju in teaching HSE exercises to her patients with chronic pain, and she witnessed incredible improvements in their pain levels and functioning. She worked with hundreds of patients in the Employee Health Clinic, and ultimately completed this retrospective study on the effects of HSE for patients with chronic neck and/or back pain.

Methodology of the study

This retrospective study included 103 patients ranging in age from 27 to 71 years old who had experienced lower back pain and/or neck pain for longer than two months. All patients participated in between two and five private sessions of HSE over the course of 2-8 weeks. All sessions were taught by Qiuju Huang, a certified Hanna Somatic Educator.

In the HSE sessions, Huang taught the patients how to practice self-care exercises that utilize the technique of voluntary pandiculation. Voluntary pandiculation involves first slowly contracting muscles in a concentric contraction, then slowly allowing the muscles to lengthen while resisting the force of gravity or hands-on resistance provided by the educator (an eccentric contraction). The purpose of the HSE sessions was to teach the patients how to practice these self-care exercises regularly on their own at home.

The patients’ pain levels were recorded before and after each session of HSE. The pain levels were assessed using the Wong-Baker FACES Pain Rating Scale on a scale of 0–5 (0 = no pain; 5 = the worst possible pain). Medication use and number of doctor visits before and after the HSE intervention were also recorded.

Results of the study

Pain levels:
After completing a mean of 2.8 HSE sessions, the mean lower back pain rating decreased from 3.3 to 0.6, a decrease of 81%. The mean neck pain rating decreased from 3.1 to 0.6, a decrease of 80%. The mean pain rating of patients who had both lower back and neck pain decreased from 3.4 to 0.7, or 79%.

Use of pain medication:
After six months, the number of patients (out of a total 103) using pain medication decreased from 53 to 14, a reduction of 73.5%. The reduction in the use of medication for patients with lower back pain was 87.5%, with neck pain was 73%, and with both neck and low back pain was 61.5%.

Number of doctors’ visits:
The mean number of doctor visits during the six months prior to receiving HSE sessions was 2. This was reduced to a mean of 0.5 visits in the six months following the HSE sessions. The reduction in the mean number of doctors’ visit for patients with lower back pain was 84%, with neck pain was 83%, and with both lower back and neck pain was 61%.


The study found that patients had significant reductions in lower back and/or neck pain after completing about three sessions of HSE and practicing the exercises regularly on their own at home. The 6-month follow-up showed that pain reductions were sustained, as 73.5% of patients stopped using pain medications, and the mean number of doctors’ visits was reduced overall by 75%.

The study authors write: “The findings of this study indicate that HSE is an effective and sustainable method of reducing spinal pain…Further investigations are recommended regarding evidence-based treatment of HSE in patients with muscle pain.”

This is the first study of HSE/CSE and voluntary pandiculation that has been published in a peer-reviewed academic journal. Since the findings were so significant, it is hoped that this research will lead to future studies exploring how HSE/CSE and voluntary pandiculation relieve a variety of chronic musculoskeletal pain.

You can read the full study here: Effect of Hanna Somatic Education on Low Back and Neck Pain Levels.