Articles on Yoga Therapy

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Why more Western doctors are now prescribing Yoga Therapy [Full Article]

SUSAN ENFIELD, YOGA JOURNAL, FEB 3, 2016

With a growing body of research proving yoga’s healing benefits, it’s no wonder more doctors—including those with traditional Western training—are prescribing this ancient practice to their patients. What’s behind the trend, and will it help you feel better? YJ investigates.

In a small workout room with a handful of other Navy veterans, David Rachford looked out the window to watch the fringed leaves of a tall royal palm tree wave softly in the warm Southern California breeze. The soothing view eased the challenging exercise routine he was trying for the first time. It was just a simple twist, Supta Matsyendrasana (Supine Spinal Twist)—nothing like the rigorous daily training he’d done as a damage controlman on aircraft carriers—but his legs refused to cooperate, due to the painful nerve damage and severe sciatica he’d suffered as a result of a career-ending back injury. As an outpatient receiving pain-
management treatment at the Veterans Administration West Los Angeles Medical Center, Rachford was now required to attend this weekly yoga physical-therapy class. It was the last place he’d ever expected to find himself.

“I thought yoga was for thin, bendy, liberal, hippie vegetarians and affluent housewives, not tough, macho ‘warrior’ types,” says the 44-year-old, now a Web developer in Santa Barbara, California. “But at that time, I felt pretty broken. I was in a lot of pain and open to anything that might help. I was depressed and scared at the prospect of surgery, and mourning the loss of my health and my self-image of being a physically fit ‘tough guy.’” Rachford also worried he wouldn’t be able to hold his own in a yoga class. “I couldn’t bend much or stand more than a couple minutes without assistance,” he says.

A yoga therapist led Rachford and the rest of the group through gentle stretching poses, urging them to repeat the simple movements at home daily. He did, and sure enough, over the next few months, Rachford noticed his range of movement gradually increasing and his pain improving. “I became more aware of my breath, body, and sensations,” he says. “My yoga practice became the base that restored my health, taking me from smoking, having high blood pressure, and being overweight and pre-diabetic to being fit, active, and a picture of health. I’ve lost 50 pounds, my blood pressure is normal, and I can jog and hike without pain.”

Ancient Healing in a Modern Setting

In India, yoga masters have worked with students like Rachford for years, helping them heal chronic ailments, oftentimes by recommending specific postures. Here in the West, yoga has only recently become a component of medical care. However, a growing number of health care practitioners are turning to the ancient practice as a way to help their patients feel better. Yoga therapy is now recognized as a clinically viable treatment, with established programs at major health care centers, such as The University of Texas MD Anderson Cancer Center, Memorial Sloan Kettering Cancer Center, Cleveland Clinic, and many others. In 2003, there were just five yoga-therapy training programs in the International Association of Yoga Therapists (IAYT) database. Today, there are more than 130 worldwide, including 24 rigorous multi-year programs newly accredited by IAYT, with 20 more under review. According to a 2015 survey, most IAYT members work in hospital settings, while others work in outpatient clinics or physical therapy, oncology, or rehabilitation departments (and in private practice).

The health care world’s increased acceptance of yoga therapy is partly due to a significant body of clinical research that now documents yoga’s proven benefits for a range of health conditions, including back pain, anxiety, depression, and insomnia, as well as its ability to help reduce risk factors for cardiovascular disease and hypertension. Yoga has even been documented as a way to alleviate the side effects of cancer treatment.

“The size, quantity, and quality of clinical trials for yoga therapy are increasing exponentially, and it’s mostly happened over the past five years,” says longtime yoga researcher Sat Bir Singh Khalsa, PhD, an assistant professor at Harvard Medical School and co-author of the Harvard Medical School Guide e-book Your Brain on Yoga. In fact, more than 500 research papers on yoga therapy have been published in peer-reviewed journals, including the randomized, controlled, double-blind studies that are modern medicine’s gold standard, and the field now has its first professional-level medical textbook, Principles and Practice of Yoga in Health Care (Handspring Press, 2016), co-edited by Khalsa; Lorenzo Cohen, PhD; Shirley Telles, PhD; and Yoga Journal’s medical editor, Timothy McCall, MD. “The book’s publication is an indication of how far yoga and yoga therapy have come,” says McCall.

Yoga therapy has grown partly by piggybacking on yoga’s ever-increasing popularity. According to the Centers for Disease Control and Prevention’s National Health Interview Survey, in 2002 only 5 percent of the US population actively practiced yoga. By 2012, that number had nearly doubled, reaching 9.5 percent. At the same time, more practitioners believe yoga improves their health: In 2004, only 5 percent of readers surveyed by Yoga Journal said they did yoga for health reasons; in this year’s Yoga Journal and Yoga Alliance joint Yoga in America study, more than 50 percent of all respondents cited health as a motivator. Although funding for yoga research remains modest compared to funding for pharmaceutical research, it’s growing. In 2010, The University of Texas MD Anderson Cancer Center received more than $4.5 million—one of the largest yoga-related grants ever—from the National Institutes of Health’s National Cancer Institute to support an ongoing study of the efficacy of yoga as part of a treatment program for women with breast cancer. Results published so far are promising: Breast-cancer patients who practice yoga while undergoing radiation therapy have lower levels of stress hormones and report less fatigue and better quality of life.

The research on yoga as a helpful component of cancer treatment has expanded the most, says Khalsa. “These days, it’s hard to find a major US cancer center that does not have a yoga program,” he says. “Patients are demanding, and spending more on, complementary medicine like acupuncture, chiropractic, massage, and yoga.”

What is Yoga Therapy?

For many yogis, simply practicing yoga regularly improves overall well-being and strength. However, fast-paced vinyasa classes are not for everyone, especially those suffering from a health challenge or injury. Yoga therapy serves as a safe alternative. Led by yoga teachers who’ve received additional training to work with clients with various health conditions, the styles and formats differ widely, ranging from chair yoga in hospitals and elder-care facilities to small, focused therapeutic classes and one-on-one sessions.
“In yoga therapy, we work on individuals, not conditions,” says McCall, a former internist who now trains yoga therapists with his wife, Eliana Moreira McCall, at their Summit, New Jersey, yoga therapy center. That’s because patients often have multiple, overlapping conditions, he says: “For instance, we may work on back pain, but the client also ends up sleeping better and becomes happier.” Some therapists focus on physical mechanics, while others bring in Ayurvedic healing principles and factor in diet, psychological health, and spirituality to create a holistic, customized plan.

As a new professional field, yoga therapy has only recently become more established. Over the past 12 years, the IAYT has made major strides with its mission to establish yoga as a respected and recognized therapy in the West, from publishing an annual peer-reviewed medical journal to presenting at academic research conferences. With an NIH grant, the group has created rigorous standards and is now accrediting training programs and beginning to certify therapist graduates. “Our goal is a certification that is respected not only by those steeped in the yoga tradition, but also by the many health care fields we work in partnership with,” says John Kepner, IAYT’s executive director.

Increasingly, yoga therapy is making inroads in conventional health care settings. At Manhattan Physical Medicine and Rehabilitation in New York City, Loren Fishman, MD, author of Healing Yoga, regularly uses yoga alongside traditional treatments to treat scoliosis, rotator cuff syndrome, and other neuromuscular problems. “Many physicians have come to appreciate the beneficial effects of yoga, says Fishman.”

Patients—even the most skeptical—
are experiencing the benefits of yoga therapy firsthand. When Stacey Halstead was plagued by chronic insomnia, she made an appointment with her family doctor, whom she hoped would prescribe sleeping pills. But after chatting with Halstead about stressors in her life, the doctor instead suggested she try yoga to see if it helped release tension and manage stress. “I was furious with her,” says Halstead. “I was exhausted and wanted something to help me now.” She agreed to try yoga for six weeks, but only with her doc’s promise to consider medication if the experiment failed. To Halstead’s great surprise, yoga did help her sleep—and Halstead hasn’t requested those sleep meds.

Results from several studies show that Halstead’s outcome—and the positive results experienced by countless patients who are turning to yoga therapy—is common. In the newest scientific studies, researchers are using genomic expression and brain imaging to understand how yoga affects practitioners on a cellular and molecular level. “Researchers take blood samples before and after yoga practice to see which genes have been turned on and which were deactivated,” says Khalsa. “We’re also able to see which areas of the brain are changing in structure and size due to yoga and meditation.” This kind of research is helping take yoga into the realm of “real science,” he says, by showing how the practice changes psycho-physiological function.

The Future of Yoga Therapy

Given rising health care costs and challenges, experts agree yoga is a safe, relatively affordable complementary therapy. But making it more accessible to those with less access is key. “Health care providers and the yoga community need to continue to reach out to people of color and in lower socioeconomic levels—populations that suffer more stress and higher rates of lifestyle-related diseases,” says McCall. One important step would be changes in insurance coverage, says Fishman. “I would like to see health care institutions and insurance companies accept yoga as a reimbursable treatment for specific conditions, some of which have already been proven and some of which are currently being studied,” he says.

It will take time to shift both practitioners’ and patients’ attitudes toward yoga. Many from both groups still view yoga as strictly a supplement to conventional treatment rather than a primary approach. However, increasing access to yoga therapy and a growing body of scientific evidence documenting its benefits are cultivating a sense of optimism among those immersed in this work. “I see a bright future where yoga and other mind-body practices become more accepted within standard medical care, as our medical system starts to move away from a more limiting illness model to a more enlightened wellness model of health,” says Lorenzo Cohen, PhD, professor and director of the Integrative Medicine Program at MD Anderson Cancer Center and grandson of the famed early Western yoga teacher, the late Vanda Scaravelli. The most powerful shift may be the one that happens within each of us—when we take responsibility for our own health, do our practice, and allow for transformation and healing to occur.

Rachford, the Navy vet, is now a trained yoga teacher and leads classes at the publishing company where he works. He also teaches community classes. “We tend to want immediate cures for pains or injuries, and Western medicine is very much geared toward prescriptions and surgery,” he says. “But yoga doesn’t work that way. As Sri K. Pattabhi Jois said, ‘Do your practice and all is coming.’ Yoga helps me deal with stress and has allowed me to release addictions and harmful behaviors. It has set me free from pain and suffering, which allows peace, joy, and health to be present in my life.”

An Introduction to Yoga Therapy

Yoga therapy utilizes poses, breathing techniques, and meditation to benefit and improve overall health.

TIMOTHY MCCALL, M.D., YOGA JOURNAL, AUG 28, 2007

While any type of yoga can bring health benefits, yoga therapy involves employing a variety of yoga practices to try to improve a health condition or to ease a natural process, such as pregnancy or menopause. Among the yogic tools used therapeutically are asana (the physical postures), Pranayama (breathing exercises), meditation, and guided imagery. Although many people don't realize it, yogis also consider diet an integral part of yoga and therefore of yoga therapy.

Why Yoga?

Therapeutic yoga is an inherently holistic approach, simultaneously working on the body, mind, and spirit. Various yoga practices systematically strengthen different systems in the body, including the heart and cardiovascular system, the lungs, muscles, and the nervous system. Yoga practices can improve function of the digestive system, foster psychological well-being, and improve oxygen delivery to tissues. Yoga also can help the body more efficiently remove waste products, carcinogens, and cellular toxins.

Most people in the West live stressful lives, and yoga—and by extension yoga therapy—is perhaps the best overall stress reduction system ever invented. Stress has been linked to a wide variety of medical problems, from migraine headaches and irritable bowel syndrome to potentially life-threatening conditions such as diabetes, osteoporosis, and heart disease. Since persistently high levels of stress hormones, particularly cortisol, can undermine function of the immune system, here too yoga can help.

While yoga by itself can alleviate a number of problems, it is particularly effective as a complement to other forms of health care, both alternative and conventional. Studies suggest, for example, that yoga therapy can lessen the side effects of chemotherapy and radiation treatments for people with cancer and facilitate faster recovery after bypass surgery. In clinical trials, many patients with asthma, type II diabetes (formerly known as adult-onset diabetes), or high blood pressure who began a regular practice of yoga were able to either lower their drug dosage, or eliminate some pills entirely. Less medication means fewer side effects, and, sometimes, very substantial cost savings.

One Step at a Time

While yoga is strong medicine, in general it is slow medicine. The key to successful yoga therapy is an incremental approach, which tends to be safer and more effective than more aggressive strategies. It is best to begin yoga [therapy] as medicine slowly and ramp up the intensity and duration of practice only as circumstances allow. For some students, particularly those with serious medical problems, therapeutic yoga might begin with only a posture or two, or a single breathing exercise, until the student is ready for more.

In any yoga therapy session, ideally you only want to teach a student as much as they are going to be able to practice at home. Better to teach a few things well than to have them try to do more with less precision. An exception to this rule would be when you teach a specific series of practices in one session in order to teach the student to relieve a current symptom, with only a small portion of the total practice assigned as homework. More experienced students, of course, may be able to handle much more.

One Size Does Not Fit All

Probably the most common misconception I see regarding yoga therapy it that there is one particular pose or sequences of practices that is therapeutic for a condition. People often ask me, for example, what pose they should do for lower back pain or for Parkinson's disease. The answer is that it depends.

No two people are alike. People have different strengths and weaknesses, different degrees of overall health and fitness, and different levels of experience with yoga. Even people with exactly the same condition—say breast cancer—may vary in disease severity, their stage of treatment, and the amount of time they can devote to their yoga practice. Many people have more than one condition, and practices you might normally suggest for one problem could be contraindicated for another. Each of these factors will have a major impact on your choice of recommended practices.

As I travel throughout India and the United States to research yoga therapy, I notice that even masters who write books and articles recommending specific sequences for particular conditions often don't use these sequences when they work with students. Instead, they evaluate the individual in front of them and decide what is best on a case-by-case basis. What worked for a student one day may not work the next if they've just had a fight with their spouse or have come down with a cold. Even a style like Kundalini Yoga (in the style of Yogi Bhajan), which recommends specific sequences (called kriyas) for particular conditions, suggests that teachers use their discretion in deciding when a kriya is appropriate and whether the recommended timings should be modified.

Think of recommended sequences as a jumping-off point to consider how to treat a student, not as cookbook prescriptions. Sometimes you'll choose something that seems like it ought to work, but doesn't work when the student tries it out. Strained breathing, glazed eyes, or difficulty in execution that precludes practicing the sequence at home are all signs that you may need to try another approach. Being mindful and attentive, making subtle observations, and adjusting your prescription accordingly are all practices of a good yoga therapist.

Dr. Timothy McCall is a board-certified specialist in internal medicine, Yoga Journal's Medical Editor, and author of the forthcoming book Yoga as Medicine(Bantam Dell). He can be found on the Web at www.DrMcCall.com.

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