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A growing percentage of the population is either participating in yoga or contemplating yoga for support of their health. The orthopedist will be better prepared to work with that population through a review of an introduction of yoga terminology, a neurophysiologic rationale for yoga therapeutics, and examples of clinical applications. These techniques offer a high utility of application through ready reference tables for taking an appropriate history, a guide of orthopaedic implications for the most common types of yoga practices, and a screening for risk management issues in conjunction with yoga. Those tools simplify the clinical application of yoga therapeutics in conjunction with traditional rehabilitation therapists that use the principles and yoga instructors. Additionally, there is a straightforward guide to practice development and referral marketing techniques with the yoga demographic market. The balance of techniques and theory addressing yoga therapeutics fosters a clinical confidence in the efficacy of adopting yoga as a complement to traditional orthopaedic care.

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Yoga Therapeutics: An Ancient, Dynamic Systems Theory

Matthew J. Taylor, M.P.T., R.Y.T.

Summary: A growing percentage of the population is either participating in yoga or

contemplating yoga for support of their health. The orthopedist will be better prepared

to work with that population through a review of an introduction of yoga terminology,

a neurophysiologic rationale for yoga therapeutics, and examples of clinical applica-

tions. These techniques offer a high utility of application through ready reference

tables for taking an appropriate history, a guide of orthopaedic implications for the

most common types of yoga practices, and a screening for risk management issues in

conjunction with yoga. Those tools simplify the clinical application of yoga therapeu-

tics in conjunction with traditional rehabilitation therapists that use the principles and

yoga instructors. Additionally, there is a straightforward guide to practice development

and referral marketing techniques with the yoga demographic market. The balance of

techniques and theory addressing yoga therapeutics fosters a clinical confidence in the

efficacy of adopting yoga as a complement to traditional orthopaedic care. Key

Words: Yoga—Yoga therapeutics—Mindful rehabilitation.

Yoga is one of the most visible complementary health

practices in America. There are participation estimates

that range from 20 to 30 million people up to as much as

23% of the population of the United States who practice

some form yoga.

25

Those levels of participation suggest

a high probability that some portion of the patients seen

in an orthopaedic practice will be practicing yoga or

seeking counsel on how to use yoga to complement their

health care. This article provides the information and

techniques surgeons need to make informed, prudent

decisions regarding the use of yoga for their patients.

The perspective of this article is that of an orthopaedic

physical therapist with 22 years of practice. I own both a

private orthopaedic physical therapy practice and a

health club. The practical, technique-oriented structure

for this article is a result of my experience teaching

hundreds of physical and occupational therapists across

the country how to integrate principles of yoga therapy

into physical rehabilitation. The article begins with an

introduction defining yoga and yoga concepts, and is

followed by a summary of practical orthopaedic practice

management issues related to yoga therapeutics. These

management issues are then supported with a review of

how yoga principles complement traditional orthopaedic

rehabilitation. An explanation of the rationale grounded

in current disablement models and dynamic systems

theory then generates a deeper understanding of the

efficacy of an appropriately prescribed yoga practice.

The reader will then find diagnosis-specific examples

offering a ready reference of prescriptions and contrain-

dications for the most common orthopaedic conditions.

Complementing the utility of the article are tables of

useful reference lists, glossaries, and practice tools. The

article concludes with a summary of how the mindful

principles of yoga can make use of the emergent findings

of mind–body science in orthopaedic practices of the

future.

YOGA AND YOGA CONCEPTS

"Yoga is the control of the fluctuations of the

mind." Patanjali's Yoga Sutra 1.2; c. 150 C.E.

It is important to understand that the western experi-

ence of yoga is typically a superficial or commercialized

version of the ancient practice. The media's use of yoga

to sell everything from pharmaceuticals to investment

From Taylor Physical Therapy, Ltd., and MyRehab, Inc., Scottsdale,

Arizona, USA.

Address correspondence and reprint requests to Matthew J. Taylor,

MPT, 13125 N. 99

th

Place, Scottsdale, AZ 85260; e-mail: matt@

yogatherapy.com

Techniques in Orthopaedics

®

18(1):115–125 © 2003 Lippincott Williams & Wilkins, Inc., Philadelphia

115

accounts has ingrained an image of lithe, spandex-clad

blissful boomers vying for "body beautiful"status. A

scholarly examination of the noncommercialized princi-

ples of yoga will close the gap between such a stylized

image and the typical orthopaedic clientele that make up

a clinical practice.

Definitions and History

The etymology of yoga is derived from the Sanskrit

verb yuj , meaning " to yoke or join together."This con-

cept is extolled in the modern-day marketing of "body,

mind, and spirit"in healthcare. A proper practice of yoga

is said to result in creating health or wholeness through

the rediscovery of the yoked reality of the human's

experience of a body, mind, and spirit. Feuerstein's

9

review of the term yoga states that technically it refers to

that enormous body of precepts, attitudes, techniques,

and spiritual values that have been developed in India for

more than 5,000 years. The postures (asanas), chanting,

and meditation frequently presented as yoga represent

only a small portion of what is described by Feuerstein

9

asapsychospiritual technology.

The practical application of yoga therapeutics to or-

thopaedics arises from what were traditionally consid-

ered secondary outcomes of having attained control of

one' s mind and subsequent spiritual development. As the

opening quotation suggests, yoga as a psychospiritual

technology is focused on controlling the fluctuations of

the mind, with the physical body serving as just one tool

toward that end. As the power of the mind is properly

harnessed and focused (stable, without fluctuation), the

physical outcomes are enhanced flexibility, posture, bal-

ance, strength, and physical health.

9,13,15

Before exam-

ining the science behind these orthopaedic outcomes, a

brief summary of the history of yoga and additional

concepts is in order.

Historical Summary

As a 5,000-year-old set of methods and technologies,

yoga is time tested. Yoga is an Indian life science

philosophy with a rich and varied history that goes

beyond the scope of this article. Although yoga evolved

out of the Hindu, Jaina, and Buddhist religious traditions

in India and draws on some of their concepts, it makes no

dogmatic demands of belief.

8

A common misperception

is that practicing yoga requires changing or modifying

one' s religious practice. This impediment to participation

is removed when it is understood that yoga is a spiritual

path or vehicle that has been practiced and adapted by

people of all creeds.

8

The elements of yoga directly addressing health con-

cerns are known as yoga therapeutics. These elements

were developed through the millennia closely aligned

with the Ayurvedic medical system of India. The com-

prehensive approach of classic Raja yoga (Table 1) can

be grossly likened to the widely embraced, present-day

self-development theories that extol the virtues of the

marketing theme body–mind–spirit. Beyond the familiar

emphasis on postures (asanas), breathing (pranayama),

and meditation, yoga includes five additional paths or

limbs of personal spiritual development for the well-

rounded, healthy person. These include the patient study-

ing their relationship with themselves, others, and their

spiritual beliefs in a higher power. This comprehensive,

proactive system of responding rather than reacting de-

velops personal responsibility and efficacy in facing a

challenge (e.g., orthopaedic trauma or elective interven-

tion). The individual's disciplined spiritual inquiry gen-

erates a willingness to examine and approach not only

the physical barriers, but also emotional, psychologic,

and spiritual barriers to healing. Such a willingness

empowers the entire orthopaedic rehabilitation process,

as addressed later in greater detail.

If this vast system of yoga had been packaged in a

neat, standardized package when it first appeared in the

United States late in the 19th century it would have been

integrated more readily into the culture and health care

system. As it was, the practice arrived in a wide array of

presentations, many shrouded in mysticism, strange

names, and episodes of cultlike popularity. According to

Feuerstein,

7

yoga underwent a marked change with its

introduction in the western world. He stated,

[f]rom a full-fledged spiritual discipline, it has

become a system of integrated health for body and

mind at best and mere fitness training at worst. Few

of its Western practitioners are aware of its original

TABLE 1. Eight-fold path of Raja yoga

Path Description

Yamas Moral precepts: nonharming, truthfulness,

nonstealing, chastity, greedlessness

Niyamas Qualities to nourish: purity, contentment, austerity

(exercise), self-study, devotion to a higher power

Asana Postures/movements: a calm, firm steady stance in

relation to life

Pranayama Breathing exercises: the ability to channel and

direct breath and life energy (prana)

Pratyahara Decreased reactivity to sensation: focusing senses

inward; nonreactivity to stimuli

Dharana Concentration; unwavering attention, commitment

Dhyana Meditation; mindfulness, being attuned to the

present moment

Samadhi Ecstatic union, flow, "in the zone,"spiritual support/

connection

A listing of the many facets of yoga beyond the familiar postures

(asana).

116 M. J. TAYLOR

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purpose and only a handful of practitioners ever go

beyond the level of posture (asana) practice.

7

It was only during the early 1970s when western

science turned its focus on the system of integrated

health and the physiologic benefits of meditation that

yogic science slowly began to be mainstreamed, marking

another chapter in its history of development.

2

During

the last decades of the 20th century, the work of pioneers

like Benson, Ornish, Kabat–Zinn, and Garfinkel brought

yoga therapeutics into traditional medical aware-

ness.

2,10,17,23

During this same period on the other side of

the world, the Indian inquiries were slowly beginning to

incorporate western research standards and methods of

rigor and control in their voluminous studies. This brings

us to today, where yoga therapeutics is given editorial

consideration in this journal as a potential technique in

orthopaedics.

Additional Terminology and Concepts of Yoga

Some additional terminology will help to situate yoga

further in the physician's understanding of where yoga

therapeutics came from and the potential relationships in

practice management. As mentioned previously, there is

currently a bewildering array of styles and schools of

yoga, each of which carries different orthopaedic impli-

cations. Some general concepts of yoga will serve as a

frame of reference to allow the physician to manage and

understand patients'concerns and questions.

Foremost is what defines a yoga teacher or a yoga

therapist? Currently in the United States anyone can

claim to be a yoga instructor and teach yoga despite

having no training. The orthopaedic implications are

obvious. All yoga is considered "instruction in yoga"

from a legal perspective because there technically is no

intended therapeutic effect. This technicality has thus far

allowed yoga instructors to avoid governmental regula-

tion and oversight. There are yoga teachers that market

themselves as yoga therapists , but in legal terms they are

merely offering yoga instruction. The yoga community

itself is struggling to define their scope of practice and to

develop standards for training and certification. At this

time there is only a voluntary national registry of schools

and teachers (www.yogaalliance.org) that provides two

levels of training certification at 200 and 500-hour levels

of training. The use of the initials RYT (registered yoga

teacher) is granted for properly registered members. The

work of defining and registering an additional certifica-

tion of yoga therapist is even earlier in development,

with formative discussions and organizational consider-

ations just beginning to occur.

What are the practical implications for the orthope-

dist? Each instructor may have evidence of having at-

tended a training program, but none are tested by third-

party regulatory agencies for minimal competency

standards. Therefore, no blanket assumptions about any

single teacher can be made, and each must stand on their

own merits and professionalism. With that understood,

how does one make sense of the many schools and

styles?

Confusion develops around the various types of yoga

because in our culture of brand identification, the tradi-

tional categories of yoga, teacher lineages, and blended

business names have generated a myriad of types of

yoga. Please see the recommended resources at the

conclusion this article for a detailed explanation, but

consider the following as a frame of reference to assist a

basic understanding. Hatha (hut-hah ) yoga is the most

popular and prevalent type of yoga in the West. Hatha

yoga is a subcategory of the Hindu yoga tradition, which

along with other categories such as Raja, Bhakti, Laya,

Karma, and Jnana, and others, composes one hierarchical

level of classification. Under Hatha there are then de-

scending levels of classification mixed by teacher , lin-

eage, and brand name. Table 2 provides a useful refer-

ence sheet of these subcategories of types and the

orthopaedic implications for the styles of yoga most

often practiced in the United States. Most likely any

other type mentioned by a patient will be a subcategory

or brand of one of these styles.

A yoga instructor's level of competence in managing

orthopaedic conditions varies tremendously depending

on the individual's background and experience. There-

fore, the need for due diligence is required when coun-

seling patients regarding their practice or considering a

referral to a yoga program. The following closer inspec-

tion of practice implications is intended to generate the

reader' s interest in an in-depth consideration of the

physiology of yoga and its role in orthopaedic care.

ORTHOPAEDIC PRACTICE MANAGEMENT

ISSUES

Recalling the high levels of participation in yoga cited

at the outset, there are a number of practice management

issues worthy of consideration. These issues cover the

gamut from optimizing patient care to facilitating practice

growth. This presentation of the utility of understanding

more about yoga precedes a detailed description of the

medical rationale presumed in these practice issues.

Yoga as a Complement to Care

Yoga, properly prescribed not only supports the phys-

ical conditioning of the patient but facilitates the more

117YOGA THERAPEUTICS

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subtle aspects of dealing with an orthopaedic condition.

Working in a group setting, such as a yoga class, pro-

vides social/emotional support not often found in tradi-

tional rehabilitation, and can integrate principles learned

in physical and occupational therapy. My experience is

that these patients will be less isolated and tend to be

more proactive in their rehabilitation, allowing the sur-

geon to focus on the technical aspects of patient man-

agement. Tables 3 through 5 are included as clinical tools

TABLE 2. Styles of yoga

Type of

yoga Orthopedic implications

Hatha A generic term that ranges from simple to moderately

difficult postures, some breath work, and a wide

range of training variance. Frequently the YMCA or

hospital course offered. Supervision: Varies widely.

Iyengar The most widely recognized approach to Hatha yoga.

Focuses on precise performance, which can both

protect joint alignment, but also lead to cumulative

microtrauma and hypermobility by attempting a

prescribed form that is not accessible because of an

individual' s unique morphology. Supervision: Ranges

from very specific with quality support/props for

students with orthopedic limitations to an almost

militaristic, authoritarian approach in which students

are literally pushed into proper alignment.

Ashtanga A very athletic, intense physical practice that moves

rapidly between postures. Demands a high level of

motor integration and is prone to generating overuse

microtrauma/hypermobility. Supervision: Varies,

limited knowledge of closed-chain kinematics, and

tends toward a competitive mode.

Power Marketed by various schools. A very athletic, aerobic

type of practice with high-speed components

including jumps, difficult balance poses, and rapid

motor progression sequences. Supervision: Varies

more widely than Ashtanga, limited knowledge of

closed-chain kinematics, and tends toward a

competitive mode.

Bikram Also known as "hot " yoga. Physical practice of a

standard sequence in a room heated to 100–110 ° F.

Overuse patterns due to the use of the same

sequence and overstretching due to both temperature

and instructor encouragement. Can be very

demanding and take on a zealous dedication.

Supervision: Generally close supervision but usually

verbally pushing for greater range of motion and

holding of positions beyond fatigue.

Viniyoga Allows for individual variance of form of the postures

and trained in identifying and correcting faulty

movement patterns. Supervision: Extensive training,

more tolerant of orthopaedic anomalies, and stresses

personal nonviolence in practice.

Kripalu A "softer " Hatha yoga practice with gentle

progressions. Supervision: Varies, but tends to stress

establishing a personal knowledge with students.

Integrative A Hatha yoga style that trains and emphasizes

modification for individuals with medical challenges.

Instructor' s medical background varies widely.

Supervision: Stresses medical screening and program

modification; encouraged to refer problems to

medical professionals.

Restorative A very gentle practice of sustained, supported postures

emphasizing relaxation and minimal force. Can be

very beneficial for a wide range of medical

problems. Supervision: Varies and can be a portion

of many of the above styles.

The most common types of yoga practiced and associated orthopae-

dic concerns.

TABLE 3. Components of a typical yoga class

Session component Description

Warmup Varies widely to include a question/answer

period, light stretching, chanting, guided

imagery, casual conversation, or silent

focusing

Breathing regulation

(Pranayama) Ranges from none to long periods of

practicing a variety of breathing exercise,

normally in a seated position; generally 5

to 10 minutes

Postures (Asanas) Hundreds of variations, done in supine,

prone, sitting, standing, or inverted

positions. Ranges from a few held for a

long period of time to many done for 1 to

2 minutes. Can be static or strung together

in flowing sequences (vinyasas). Intensity

varies with the posture, the duration, and

the recovery periods allowed.

Relaxation/guided

imagery Usually done supine for 5 to 20 minutes

toward the end of class

Meditation Varies; sometimes not included, other styles

can range from 5 to 30 minutes or more.

Generally done in a seated position.

Closing Varies; ranges from a simple verbal

salutation, to open discussion or quiet

socializing after class.

The physical demands in a standard yoga class to provide under-

standing of participant needs and activities.

TABLE 4. Guide for assisting patients in finding a yoga

teacher

Suggestion Limitations/cautions

Established referral

relationships Presumes existing relationships;

personalities may conflict

Local hospital

wellness programs Quality of instruction varies because such

programs tend to underpay instructors

or allow too large of class size

Check registry Toll free 1-877-964-2255 or

www.yogaaliance.org; no competency

testing, only indicates certain minimal

training hours

Yellow pages Need to interview instructors, ask for

references, ensure they do an intake

medical screen, and observe classes to

monitor teacher style and supervision/

corrections

Check with affiliate

rehabilitation groups Wide variance in direct relationships with

yoga teachers, past experiences, and

concerns regarding professional "turf"

infringement by studios

Reference list to provide patients when inquiring about beginning a

yoga practice.

118 M. J. TAYLOR

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for implementing all these practice management sugges-

tions.

Yoga as Pre- and Postoperative Patient Support

The sports psychology techniques that currently use

breathing and guided imagery are actually an ancient part

of yoga. These peak performance coaching techniques

work well to prepare the patient for a procedure, manage

postoperative pain, and cooperate fully with traditional

rehabilitation. The mindful awareness of body position,

excessive muscle tension, and decreased reactivity to

pain stimuli facilitates the therapist's work and mini-

mizes unnecessary reactive patient calls to the surgeon's

office.

Yoga Studios Can be Excellent Referral Sources

Establishing a networking relationship with area yoga

studios can be a valuable source of referrals. Studios

instruct a wide range of clients, many with latent or

unmanaged orthopaedic conditions that become a prior-

ity to the client as they progress in their practice. A

student with a degenerative meniscus can avoid the

condition on the couch, but those that seek to continue

participation in yoga will want appropriate management

from a surgeon who does not dismiss their practice as

unimportant. The surgeon 's reciprocal referral of pa-

tients' posttraditional rehabilitation serves to complete

the relationship. For instance, sending new clients to a

yoga studio that competently manages chronic back pain

sets up a long-term, mutually beneficial practice devel-

opment relationship.

An Improper Yoga Practice Can be a Source of

Orthopaedic Injury for Patients

Marketing an expertise in managing orthopaedic con-

ditions that develop in complementary practices (e.g.,

yoga, Tai Chi, martial arts) creates a market specialty

niche with demographics that are well suited for using

medical services. A surgeon's willingness and empathy

in continuing yoga participation is preferred over "pre-

scriptions and rest"care. Such an active, generally afflu-

ent patient creates a strong internal marketing mecha-

nism that works well along with the previously noted

networking with the studio owners.

In addition, the lack of regulatory oversight and use of

last week's aerobics instructor as this week's yoga in-

structor also generates a fair number of orthopaedic

conditions. These patients can then be referred to instruc-

tors within the physician's network of competent yoga

teachers, allowing the patient to continue their practice

safely, and establishing a long-term practice relationship

with that patient.

Yoga Can Facilitate Professional and Personal

Development

My interest in yoga stems from attending a yoga class

in my own studio more than 6 years ago. After only 8

weeks of weekly attendance, a prior chronic and increas-

ingly debilitating lumbar disc condition was nearly to-

tally resolved. My entire professional focus shifted to a

mind– body inquiry after such a dramatic effect on a

condition that had been resistant to years of traditional

orthopaedic physical therapy approaches. For the reader,

a personal practice of yoga would not only reap the

associated health benefits, but also serves as a direct

learning tool in a practical kinesiology laboratory .To

actually experience the relief of sacroiliac discomfort

from the active recruitment of peroneus longus is a

completely different experience than reading a textbook

postulating the same. So in addition to personal relief

from the discomforts of long hours in the operating

room, yoga can offer advanced practical training in the

TABLE 5. Medical history questions for yoga practitioners

Question Orthopedic Implications

What type of yoga do you

practice? See Table 2, styles of yoga.

How do you feel the day

after class? There should be no pain or

stiffness. Recovery should be

minimal if they are under

biomechanical control.

Would you describe the

tempo as "fast? " Takes a high level of motor

integration to maintain good

biomechanical alignment in a

"fast " class.

How does your instructor

respond when a student

reports feeling pain?

Postures should be modified,

supported with props, or

abandoned after direct

observation by the teacher.

Warning if no direct

observation or assessment.

Does your instructor ever

push you into a position as

a correction?

There are some instructors who

forcefully manipulate student's

positions, whereas others offer

gentle correction or subtle

realignment alternatives.

Have you had constant aches

and pains since beginning

yoga?

Surprisingly a number of students

"expect " to hurt after yoga.

They should be more

comfortable and move with

greater case.

Can you show me which

postures seem to help or

hurt the most?

Often seeing the movement or

position will spotlight the

offending mechanical

dysfunction or, in the case of

relief, identify the corrective

mechanical input.

A reference list of medical history questions to ask patients that

practice yoga.

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dynamics of the human movement system not available

in journals.

Yoga Offers a More Readily Accepted Referral

Alternative for Certain Disorders

The prevalence and influence of anxiety and mild

depression that accompanies some orthopaedic condi-

tions is well-known.

18,21,22

Most patients will resist re-

ferral to mental health care for mild symptoms of both

confounding conditions. A proper yoga practice has been

demonstrated to have a positive influence on affect and

will generally encounter less resistance as well as avoid-

ing the stigma of such a diagnosis.

3,19,24

Although not intending to imply that yoga is a substi-

tute for an appropriate mental health referral, the integral

power of yoga to support the whole person ' s experience

when dealing with acute or chronic orthopaedic challenges

is noteworthy. The following depiction of the yoga health

model, and its neurophysiologic and motor principles, will

satisfy professional concerns about implementing any of

these practice management techniques.

ORTHOPAEDIC PRINCIPLES OF YOGA

The introduction of tools and techniques of practice

management should have raised as many questions as it

answered. What is the rationale behind yoga? Is there

any evidence to the support that rationale? What assump-

tions of traditional orthopaedic practice does yoga chal-

lenge? These are but a few of the questions this section

will address. Beginning with a brief review of the tradi-

tional assumptions that underlie a high percentage of

current orthopaedic practice, the science of systems the-

ories will be introduced as a bridge between the two

perspectives. The understanding of how the yogic model

is inclusive of traditional orthopaedic practice leads to a

discussion of how yoga is incorporated into rehabilita-

tion now, how it can be used as a prescription by the

orthopedist, and risk management issues surrounding

such a prescription.

The Yoga Health Model

Yoga as a life science philosophy is concerned with

what constitutes knowledge , and subsequently, knowing

in the human experience. The previously mentioned list

of action steps, reference tables, and practice suggestions

are forms of practical or action knowing. Although

someone could be given a cookbook of action steps to

reduce successfully a high percentage of classic anterior

glenohumeral dislocations, such practical knowing is

superficial or dissatisfying at best. The technician is

transformed to a professional when placed in the context

of conceptual knowing from journal reading and experi-

ential knowing from internships and residencies. The

technician develops the art of medicine, in addition to the

techniques, only by studying and understanding the as-

sumptions and relationships behind orthopaedic practice.

Using yoga therapeutics as a technique is enriched by

exploring its assumptions and relationships as well.

The Traditional Perspective

The assumptions underlying traditional orthopaedic

practice are often left unexamined and offer an opportu-

nity to appreciate better how yoga supports patient care.

As a broad generalization, these assumptions are based

on a mechanical reductionist perspective. That is, the

orthopedist constructs an understanding of both the eti-

ology and the treatment plan (mechanics) for the patient

by identifying and isolating (reduction) variables (parts)

in the history and clinical presentation. The dominant,

but not only, assumption underlying most of clinical

practice can be summarized as the following: identify the

faulty part or parts, identify techniques or prescriptions

to apply, apply them, monitor the response through form

and function of the parts on follow-up.

The traditional perspective is by its nature a linear,

cause– effect model that seeks to simplify complex con-

ditions to manageable components. Although the incred-

ible successes of modern orthopaedics rest on this model,

there also exists a risk of adopting a somewhat myopic

view of the "parts " of the patient that may result in

missed opportunities for facilitating healing of the whole

person. It is important to note the difference between

healing and curing. For many orthopaedic patients, cur-

ing or a return to prior physical function is not possible

or realistic. Healing is defined as being able to integrate

their new levels of function into a balanced, positive

lifestyle. This potential for healing is assumed to exist

within every patient and forms a basic assumption of

orthopaedic practice. By nature, humans are far more

than a mechanical assembly of parts and, as every sur-

geon knows, even the simplest fracture can evolve into a

complex, frustrating case. One model that can better

support the circular, confounding relational effects of

emotions, economics, and motivation on orthopaedic

care is a systems approach.

A Systems Perspective

Dr. Marrow ran her hand across her forehead and

back through her hair as she shook her head looking

down at the two charts in her hand. She had performed

total knee arthroplasties on the left knee of each of the

ladies in room 402—same day, same surgical team,

similar age, same body type, similar radiographs, simi-

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lar level of preoperative impairment, same prostheses

manufacturer, same intraoperative degree of range of

motion, and same therapist. Why did one have very little

pain and the expected range of motion, whereas the other

complains and barely gets out of bed, let alone performs

her exercises?

This fictitious narrative is a presentational knowing of

the need to adopt a relational perspective. Practicing

orthopedists have almost certainly shared what amounts

to a similar, universal experience in patient care. Al-

though the facts and parts may differ, the presentation of

such a story never the less points to a true knowing to

complement conceptual/factual and experiential knowl-

edge. The conundrum presented leaves the surgeon with

two choices: The patient is deficient at some essential

level and the situation cannot be helped, or there are

confounding circumstances and relationships that require

comprehension to access the potential for healing in the

difficult patient. A brief review of a systems perspective

will set the foundation for the integral model of health

presented in yoga.

Capra summarizes the criterion for shifting from a

mechanistic to systems thinking approach.

5

The concept

of systems is not a new approach. What is different is

how systems concepts are translated into practice. From

a parts perspective, if a system is in dysfunction, the

appropriate specialist is called in to manage that part of

the whole patient. A systems perspective demands a

reversal of the "whole divided into understandable parts"

view to a "parts only understood within the context of the

whole" view. Additionally the systems perspective em-

phasizes the need for the systems-thinking physician to

develop the ability to switch between both perspectives.

Therefore the systems-thinking orthopedist is inclusive

of the traditional mechanical perspective, but more fre-

quently and with greater credence, assesses the whole

patient and their multiple systems. Systems or complexity

thinking is the logical consequence of the quantum

mechanical theory that emphasizes that no event or

process can occur in isolation, to include human move-

ment. In fact, taken to its conclusion, there are no parts

at all, only relationships.

5

In medicine, the field of psychoneuroimmunology

offers exciting theoretic (conceptual) implications for

orthopaedics. Through verifiable inquiry, psychoneuro-

immunology is demonstrating the physical manifestation

of human experiences such as emotions, thinking, and

spiritual experiences. These relationships are not unidi-

rectional, linear cause–effect relations, but circular, com-

plex networks of interdependent phenomenon that man-

ifest as "difficult " patients in clinical practice. For

instance, extending the narrative of the uncooperative

postarthroplasty patient can illustrate these principles.

Dr. Marrow discovers after a few minutes of quiet

conversation with the patient that the patient's former

neighbor had to move to a nursing home after her knee

surgery and she fears the same will happen to her. Dr.

Marrow invested 2 minutes to describe not only the

positive operative findings, but also the patient's re-

sources of sharp cognition, strong social support, and

excellent rehabilitative services that differed from her

neighbor' s experience. As she did so, the patient expe-

rienced a sense of compassion and caring, coupled with

new thought patterns, which shifted her arousal system

from sympathetic to parasympathetic, allowing her to

discontinue the unconscious protective clutching of her

knee with her hamstrings that consequently suppressed

the previous reciprocal inhibition of her quadriceps,

which had earlier made terminal extension efforts diffi-

cult and more painful. The patient' s subsequent therapy

visit resulted in independent straight-leg raising, greater

stability in gait, and self-looping positive thought pat-

terns reflecting optimism, further dampening sympa-

thetic override, making her a more enjoyable patient to

work with in therapy, which motivated greater efforts on

the therapist's part, and so on.

A concise and accessible summary of theory, patient

management, and preferred practice patterns in physical

rehabilitation is the Guide to Physical Therapist Practice

(or Guide).

11

The succinct coverage of the development

of current disablement models graphically depicts how

cultural beliefs and behaviors, spirituality, social inter-

actions, social activities, reasoning, ability, anxiety, de-

pression, morale, and role function impact human move-

ment through impairment and disability.

11

The outcomes

portion of the Guide demonstrates how a complex, dy-

namic systems mode of delivery also satisfies functional

limitation, patient satisfaction, and secondary prevention

for orthopaedic patients.

Psychoneuroimmunology and the Guide offer concep-

tual insight into the linking of this network of relation-

ships. Great bedside manner has long practiced these

concepts as presentational knowledge, or the art of

connections. Examining the yoga health model will re-

veal the fact that yoga therapeutics is an ancient dynamic

systems theory first conceptualized 4,300 years ago, and

only now is being rediscovered by western science.

The Model and Rationale

The yogic model of health describes health as balance

and awareness within an open, free-flowing, living sys-

tem of interaction and interdependence between all as-

pects of human experience. The modern reference to

121YOGA THERAPEUTICS

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body–mind– spirit is analogous to the more than 2,000-

year-old concept of shariras in yoga. These shariras were

amodern derivation from a framework that traces back c.

3,000 to 4,000 years to the Taittiriya–Upanishad, which

hints at the Vedanta doctrine of the sheaths or koshas.

9

Koshas, or bodies as they are sometimes described,

denote layers or envelopes within the realm of the pa-

tient' s experience and are listed in Table 6. Health is said

to be optimized when the individual maximizes aware-

ness and integration between all five of the allegorically

porous, thin bodies of human experience. Theoretically,

imbalance or absence of awareness at any of the five

levels results in dysfunction or disease, manifesting ei-

ther directly or indirectly in one or more of the koshas.

30

Leaping back into 21st century theory, the holistic/

quantum view also maintains that no orthopaedic condi-

tion exists, impacts, or results as a consequence of a

single kosha level, and thus thorough care must include

consideration at each kosha. The narrative patient's knee

condition was the result of multiple factors that might

have included genetics (physical), carelessness (emotion-

al/reactive) leading to accidental trauma, or even spiri-

tual, from excessive kneeling at church.

Yoga through the techniques and methods of the eight

paths listed in Table 1 develops awareness and stability

of the process of interaction and communication (mind)

of these koshas. From a technical philosophic under-

standing, yoga (the yoking) is not a connection of three

or five separate parts, but a fully integrated whole with-

out parts, much as modern-day quantum theory de-

scribes. For the purposes of this article, however, using

the metaphor of a dynamic systems theory serves to

bridge the dominant western view to the integral yoga

perspective.

It is beyond the scope of this article to describe the

science behind each of the eight paths. Aware of that

constraint, a discussion of how the postures/poses (asa-

nas) enable a yoga instructor to support the patient at all

kosha levels will provide a glimpse of the science behind

yoga.

The neurophysiologic rationale of yoga therapeutics

has been documented by Taylor and Majmundar.

30

Briefly, the rationale is that performance in the human

movement system is impacted not only by structure and

physiology, but is also influenced by emotional, psycho-

logic, and spiritual conditions. The increased perception

of proprioceptive information, awareness of thoughts and

emotions, decreased cortical activity, and the develop-

ment of nonreactivity to physical sensation result in the

attainment of positive functional outcomes. Classically,

the functional goal of the yogi was the elimination of

postural sway, and from this practice it is believed comes

the objective measures of increased flexibility, strength,

and balance/postural stability.

Asanas or postures are yoga therapeutic tools that

share much in common with the rehabilitation counter-

part, therapeutic exercise, and will be a part of almost

every yoga instruction in the West. There are literally

thousands of asana from which to choose to create an

environment of mindfulness and kosha awareness.

14

One

definition of asana is that of a postural pattern created by

deviating the head and trunk from the center of gravity

and having the pattern maintained purposefully for a

length of time, and then released in a smooth and

effortless manner.

30

The postural pattern is initiated

slowly and with attention to internal proprioception and

maintaining a full diaphragmatic breath. These patterns

are prescribed and performed using a minimum amount

of voluntary effort and energy expenditure for its main-

tenance and adjustment. True asana is described classi-

cally as having the qualities of stability (sthira), ease

(sukha), and effortlessness or minimized effort (prayant

shaithilya).

9,13

An asana is not a braced or artificially

sustained "pose " that would create or maintain inappro-

priate or sustained biomechanical stress to soft tissue or

articular surfaces.

Furthermore, another helpful description of asana is

that the final posture (the "picture " in the book) is

achieved through a natural sequence of stages, challeng-

ing the patient from midline stability to distal control,

TABLE 6. Clinical translations of koshas

Sanskrit Common name Description

Anna-maya-kosha Food sheath (physical) Comprised of the physical, solid aspect of a human (e.g., cells,

organs, bones, joints, etc.)

Prana-maya-kosha Life force sheath (vital or

bioenergetic) The bioelectrical forces and breath are a portion of prana; similar

to Chi or Qi concepts in Chinese medicine

Mano-maya-kosha Thought/primitive mind sheath

(emotional/reactive) Includes emotions, reactive thinking, reflexes or subcortical

function; is largely shared with the rest of the animal kingdom

Vijnana-maya-kosha Wisdom/higher mind sheath

(creative/relational) Includes the higher cortical functions of reflection, intuition,

planning, and creativity; not as developed in animals

Ananda-maya-kosha Bliss sheath (spirit) Sometimes equated to the soul or spirit of the patient

A glossary of the five aspects of the human experience described by the yogic health model.

122 M. J. TAYLOR

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restoring stability, articular alignment, and motor se-

quencing to address both primary and secondary impair-

ments. Each ministage creates a potential temporary

disequilibrium by deviating the position of the center of

gravity relative to the midline or the base of support. The

patient progresses mindfully, through all key compo-

nents of functional movement along a continuum from

the core, proximal to distal, toward the full postural

pattern with symmetry along the midline to ensure each

ministage is mastered through integration of the koshas.

Should they experience fear or pain, the asana is modi-

fied to maintain the parasympathetic autonomic nervous

system to avoid cortical stimulation and subcortical com-

pensatory motor patterns.

From the yoga therapeutic perspective, asana is also an

attitude that is psychophysiologic in nature, in which the

state of mind or mindfulness is of the utmost importance,

hence linking the physical position with the higher ko-

shas. Every asana has the potential to have an effect on

each of the five koshas. Assessed imbalances (e.g., fear,

tension, anger, lethargy) can be facilitated by using

corrective asana. Because yoga is an experiential philos-

ophy, try the following: Sit in a slumped, forward head

posture for 10 breaths and sense the joy and enthusiasm

of the asana. Now, contrast that with upright, chest lifted

upward and arms spread wide overhead, face soft for 10

breathes. Feel the attitudinal difference? Every asana

contains some of those subtle experiences as well as the

neurophysiologic responses discussed earlier.

Additionally, the stated postural efficiency depends on

well-integrated and counteracting postural reflexes.

There must be highly coordinated action between numer-

ous muscles and joints to maintain optimum joint me-

chanics, as well as an adequate foundation of muscle

tone and control.

16

The proprioceptors, exteroceptors,

and visceroreceptors convey moment-to-moment infor-

mation of head and body position in space to the lower

brain structures of the midbrain, cerebellum, basal gan-

glia, and reticular activating system (pons and medul-

la).

1,12

This maintenance of a postural pattern and the

equilibrium of the body during movement or stability in

the asana is performed subcortically as an autonomic

nervous system function. Muscles, ligaments, and joints

are also stretched statically in a passive response to

gravity during the ministage or maintenance phase of

asana. There is minimal voluntary effort as the decreased

cortical activity and inward focus allows for the integra-

tion of the tonic system responsible for postural control

and stability. Muscle tone is regulated as the feedback

from the various muscle spindle fibers (types Ia and II),

and the Golgi tendon organs are allowed to integrate both

peripherally and subcortically in a balanced or homeo-

static autonomic nervous system.

31

This allows attain-

ment of the general rehabilitation goal of posture that is

stable and sustains equilibrium of the body mass for safe

interaction with the environment.

Asanas are often practiced as pairs, known as coun-

terposes.

6

Biomechanically this creates balance by soft-

tissue lengthening, hyaline cartilage compression and

distraction, and reversing intervertebral disc pressures

and dural stretch. These counterforces are also delivered

to the internal organs, composed of smooth muscle or the

glands of the endocrine system. The patient experiences

the more subtle effects of the higher koshas through this

counterbalance, bringing about a balance in emotions

and the biochemical manifestations of that balance. This

mechanical stimulation coupled with the relaxation re-

sponse has been cited as one potential source of many of

the nonmusculoskeletal benefits of yoga.

20

The yoga therapist can be seen to possess many tools

and techniques that go beyond this brief introduction to

asana. These tools are also being incorporated into tra-

ditional rehabilitation settings by physical and occupa-

tional therapist across the country. The next section

shares some of the ways yoga facilitates traditional

rehabilitation.

TABLE 7. Practical therapeutic yoga applications

Technique Rationale and Description

Breath assessment/instruction,

pranayama Optimize autonomic nervous

system through the relaxation

response

Guided imagery and

restorative yoga, meditation

and samadhi

Capture Benson's

2

"remembered

wellness" for motor patterns

Pre- post-body scan, asana Embody proprioceptive baseline

and intervention effects

ADL instruction, asana Create conscious movement

awareness

Journaling, niyamas: self-

study Explore, analyze, and deal with

psychoemotional/stress issues

Clinic environment, niyamas:

purity Facilitate a mindful,

introspective, and stress-

reduced environment

Home programs, asana Create movement sequences that

are whole body, core initiated

for subtle awareness and

increased compliance

Group instruction, yamas and

niyamas Economic, socially, emotionally

rewarding to address chronic

needs

Therapeutic exercise, asana Synchronized with breath,

whole body, core initiated

Didactic education, self-study Offering new perspectives of

mind– body science

Techniques used in traditional rehabilitation clinics that incorporate

components of yoga therapeutics.

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Integrating Yoga Therapy Into Rehabilitation

The principles of yoga therapeutics do not replace

traditional methods, but rather complement all the tools

already used within therapy. Clinicians readily accept the

concept of psychologic influences on movement perfor-

mance in sports and performing arts. The challenge is

having acknowledged this influence, what can the clini-

cian do to affect the mind? Table 7 offers a brief listing

of ways that therapists are modifying practices to incor-

porate not only the mind, but the spirit as well within a

conservative setting.

26 –28,30

The work of integrating

these techniques has only been formally presented as

continuing education during the last 4 years.

29

The pressures and demands of managed care, along

with increasing out-of-pocket coverage under direct ac-

cess settings will lead to a notable expansion of options

for rehabilitation consumers. Those practices that offer a

more comprehensive and compassionate setting will at-

tract value-minded patients who would have shunned the

impersonal, rushed atmosphere of many traditional or

managed care settings. This will include practices that

use group models of healing to complement the one-on-

one delivery of services. The system theories science

behind these methods suggests such methods will lead to

greater outcomes, although that has yet to be evaluated in

the literature.

4

In the meantime, the section that follows

summarizes specific orthopaedic conditions that can ben-

efit from a referral to a yoga therapeutic setting, be it in

a studio or clinic setting.

Clinical Applications

A summary review of yoga application in orthopae-

dics is available in Taylor and Majmundar.

30

Yoga as a

rehabilitative intervention gained national attention with

a study on yoga for carpal tunnel.

10

The only prerequisite

for patient participation in yoga therapeutics is that they

be breathing. Powerful programming is available for a

TABLE 8. Clinical applications and risk management considerations

Condition Specific Requests Precautions/Risks

Concomitant conditions "Adhere to standard contraindications"These include diabetes, hypertension, cardiac disease,

detached retinas, hernias, and glaucoma, for which

there are standard prohibitions of certain practices of

yoga, but can be safely practiced within those

limitations

Rheumatoid arthritis "Headstands/shoulderstands prohibited; call with

questions" Upper cervical laxity; monitoring of flare-ups and excess

fatigue; emphasize joint alignment and protection

Osteoporosis/osteopenia " Neutral spine forward bends; minimal twisting;

emphasize back bends and chest openers" Probably the most worrisome of all the conditions; a

phone interview ascertaining the instructor's knowledge

base is warranted; properly instructed though the

response can be dramatic

Osteoarthritis " Use props/supports for comfort and alignment;

modify postures per limitations" Specify any unstable joints or interarticular degeneration

limiting motion

Joint arthroplasties "List range-of-motion limitations; no jumping or

twisting through involved joints" Determine whether the instructor understands range-of-

motion terminology

Chronic spine pain "List imaging findings, weakness or sensory

deficits, and contraindications for lifting/spinal

movements"

Caution the patient to proceed slowly, report any

peripheralization of symptoms, and invite questions

from the instructor

Amputees " Any stump limitations or circulation precautions"Minimal precautions; instructor must be familiar with

asanas adaptations

Ligamentous/tendon repairs "List range-of-motion and strength precautions"Invite dialog between physical therapist and instructor to

ensure protection of the repair

Postfracture " List range-of-motion and strength precautions"Issue guidance regarding endurance or maximum

sustainable stretch sensation

Repetitive stress syndromes;

fibromyalgia/chronic fatigue

syndrome

"Restorative yoga; open chest (upper extremity)

and hips (lower extremity); use a "cooling"

practice for this "hot " condition"

Instructor should provide close monitoring of symptom

response. It is all right to proceed with a general

diffuse parathesia sensation, but avoid symptom

exacerbation promptly

Patellofemoral dysfunction "Open the hips; emphasize prone strengthening

and balance postures; maintain neutral knee

alignment in all postures"

Avoiding symptom production, and emphasizing proximal

chain mobility and stability is key

Rotator cuff dysfunction "Chest openers; no sharp shoulder pain; optimize

alignment of arms on weight-bearing postures" Emphasis on proximal mobility and stability rather than

shoulder range of motion is important; ice after practice

Hip pain and impingement "Hip openers; no sharp hip pain; optimize

alignment of legs on weight-bearing postures" Once flexibility improves, ensure stability is integrated

through standing and balance postures

A reference list of common orthopaedic conditions, the suggested prescription notation for yoga therapeutic intervention or guidance, and the risk

management issues specific to that condition.

124 M. J. TAYLOR

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broad list of diagnostic categories from prenatal to end-

of-life care.

Bearing in mind the wide variance of expertise and

training noted earlier among yoga instructors, there are

certain cautions within prescriptions that should be

noted. Table 8 provides a list of common orthopaedic

conditions, specific requests to make for that condition,

and cautions/limitations specific to yoga practices. This

tool of risk management considerations should offer

ethical contentment for protecting the welfare of your

patients while opening up the availability for accessing

the benefits of yoga.

CONCLUSION

Yoga therapeutics offers a wholistic system of sup-

porting the recovery of many orthopaedic conditions.

Proper diligence and communication can provide the

orthopaedist with not only ancillary support of rehabili-

tation issues, but also has the potential for practice

development through referral relationships with yoga

providers. Guided by the resources and tools provided,

orthopaedists can initiate referrals, answer their patients'

questions, and address their patients'interest in yoga

with accuracy and confidence.

REFERENCES

1. Allum B, Hulliger M. Afferent control of posture and locomotion.

In: Progress in Brain Research. New York: Elsevier, 1989:80.

2. Benson H, Stark M. Timeless Healing: The Power and Biology of

Belief. New York: Fireside, 1997:25–47.

3. Berger BG, Owen DR. Mood alteration with yoga and swimming:

aerobic exercise may not be necessary. Percept Motor Skills

1992;75:1331–43.

4. Bronson K. The therapeutic benefits of yoga. Orthop Phys Ther

Pract 2002;14:11–5.

5. Capra F. The Web of Life. New York: Anchor Books, 1996.

6. Desikachar TKV. The Heart of Yoga. Rochester: Inner Traditions,

1995.

7. Feuerstein G. Hatha-Yoga: May the Force Be With You [Yoga

Research & Education Center Web site]. January 13, 2003. Avail-

able at http://www.yrec.org/hatha.html. Accessed January 21,

2003.

8. Feuerstein G. Is Yoga a Religion? [Yoga Research & Education

Center Web site]. December 31, 2001. Available at http://www.

yrec.org/hatha.html. Accessed January 9, 2003.

9. Feuerstein G. The Yoga Tradition. Prescott: Hohm Press, 1998:

178.

10. Garfinkel MS, Singhal A, Katz WA, et al. Yoga-based intervention

for carpal tunnel syndrome. JAMA 1998;280:1601–3.

11. The guide to physical therapist practice. 2nd ed. Phys Ther 2001;

81:9 –746.

12. Horak, FB. Clinical measurement of postural control in adults.

Phys Ther 1987;67:1881–5.

13. Iyengar BKS. The Tree of Yoga. Boston, Shambhala, 1989.

14. Iyengar BKS. Light on Yoga. New York: Shocken: 1976:60.

15. Jain SC, Rai L, Valecha A, et al. Effect of yoga training on exercise

tolerance in adolescents with childhood asthma. J Asthma 1991;

28:437–42.

16. Janisse M. The therapeutic use of yoga. Orthop Phys Ther Pract

2002;14:7–12.

17. Kabat– Zinn J. Full Catastrophe Living. New York: Delta, 1990.

18. Kabat– Zinn J. An outpatient program in behavioral medicine for

chronic pain patients based on the practice of mindfulness medi-

tation: theoretical considerations and preliminary results. Gen

Hosp Psychiatry 1982;4:33–47.

19. Khumar SS, Kaur P, Kaur S. Effectiveness of Shavasana on

depression among university students. Indian J Clin Psychol 1993;

20:82–7.

20. Monro R, Nagarathna R, Nagendra HR. Yoga for Common Ail-

ments. New York: Simon & Schuster, 1990:26.

21. Nespor K. Pain management and yoga. Int J Psychosom 1991;38:

76 –81.

22. Nespor K. Psychosomatics of back pain and the use of yoga. Int

J Psychosom 1989;36:72–8.

23. Ornish D, Scherwitz L, Billings JH, et al. Intensive lifestyle

changes for reversal of coronary heart disease. JAMA 1998;280:23.

24. Schell FJ, Allolio B, Schonecke OW. Physiological and psycho-

logical effects of Hatha-yoga exercise in healthy women. Int

J Psychosom 1994;41:46 –52.

25. Taylor MJ. What Is Yoga Therapy? [MyBalance Seminars Web

site]. October 12, 2002. Available at http://www.yogatherapy.com/

whatis.htm. Accessed January 4, 2003.

26. Taylor MJ. Yoga For the Elderly: Geriatric Yoga Therapeutics.

GeriNotes: APTA Geriatric Section Jan 2001.

27. Taylor, MJ. Yoga therapeutics in neurologic physical therapy:

application to a patient with Parkinson's disease. Neurol Rep

2001;25:56.

28. Taylor MJ. Putting the movement system back in the patient: an

example of wholistic physical therapy. Orthop Phys Ther Pract

2000;12:15–20.

29. Taylor MJ. Biography [MyBalance Seminars Web site]. September

12, 1998. Available at http://www.yogatherapy.com/biography.htm.

Accessed January 27, 2003.

30. Taylor MJ, Majmundar M. Incorporating yoga therapeutics into

orthopedic physical therapy. Orthop Phys Ther Clin North Am

2000;9:341–60.

31. Werner JK. Neuroscience: A Clinical Perspective. Philadelphia:

WB Saunders, 1980.

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, Vol. 18, No. 1, 2003

... Bireyin fiziksel, zihinsel, duygusal ve spirütüel boyutlarına denge ve sağlık getirmek için tasarlanmış eski bir disiplindir (1). Yoga kelimesi Sanskritçe yuj kelimesinden köken alır, 'bağlamak, bir araya gelmek' anlamına gelir (2). Yoganın 8 kolu vardır. ...

... Yoganın 8 kolu vardır. Bunlar: yamalar (ahlaki kurallar), niyamalar (beslenecek nitelikler), asanalar (postürler/hareketler), pranayama (nefes egzersizleri), pratyahara ( duyuların geri çekilmesi), dharana (konsantrasyon), dhyana (meditasyon), samadhi (kendini gerçekleştirme, aydınlanma) (2,3). ...

Z E T Yoga, binlerce yıl önce Hindistan'da ortaya çıkan, bireyin fiziksel, zihinsel, duygusal ve spirütüel boyutlarına denge ve sağlık getirmek için tasarlanan eski bir disiplindir. Son yıllarda sağlık için yoga uygulaması dünya çapında popüler hale gelmiştir. Esnekliği artırmak, genel kondisyonu, genel sağlığı, fiziksel uygunluğu iyileştirmek ve stresi azaltmak yogaya başlamak için en çok bildirilen nedenlerdir. Yoga yararlı etkilerinden dolayı alternatif bir terapatik yaklaşım olarak bilinir. Klinik yoga, hastalığı önlemek, iyileştirmek ve/veya düzeltmek için geleneksel yoga uygulamalarının kullanımını içerir. Romatizmal hastalıklar eklemlerde ağrı, şişlik, sertlik ve fonksiyon kaybına neden olarak bireylerin yaşam kalitesinde azalma ve engelliliğe neden olabilir. Artrit hastalarının yönetiminde ilaç ve cerrahi müdahalenin yanı sıra öz-yönetim, fizik tedavi, ergoterapi, kilo kaybı gibi farmakolojik olmayan yaklaşımlar önerilmektedir. Öz yönetimin ve fiziksel aktivitenin artmasının rolü, artritin tedavisinde büyük önem taşır. Terapatik etkilerinden dolayı yoga romatizmal hastalığı olanlar için alternatif bir yaklaşım olarak düşünülebilir. Son yıllarda romatoid artrit, osteoartrit ve fibromyalji gibi romatizmal hastalıklarda yoganın etkinliğinin araştırıldığı çalışmalar artmaktadır. Mekanizması tam olarak açıklanamasa da yoganın özellikle ağrı üzerine olumlu etkileri olduğu bildirilmiştir. Ayrıca hastalık semptomları, fonksiyon, psikolojik durum, uyku ve yaşam kalitesinde iyileşmeler bildirilmiştir. Fiziksel duruşlar, nefes çalışmaları, meditasyon ve yoga felsefesi birlikte uygulandığında daha etkili sonuçlar gözlenmiştir. Fakat çalışmalardaki randomizasyon eksiklikleri, küçük örneklem büyüklükleri, yoga müdahalelerinin standardizasyonunun olmaması ve müdahalelerin değişen dozajları nedeniyle çalışma sonuçlarının dikkatli yorumlanması gereklidir. Çalışmaların tüm bu sınırlamalarına rağmen, yoga artrit için umut verici bir yöntemdir. Yoga, romatoid atrit, osteoartrit, fibromyalji sendromu olan hastalar için yardımcı bir tedavi olarak düşünülebilir. A B S T R A C T Yoga is an ancient discipline that emerged in India thousandans of years ago, designed to bring balance and health to the physical, mental, emotional and spiritual dimensions of the individual. Yoga practice for health has become popular worldwide in recent years. Increasing flexibility, improving overall condition, overall health, physical fitness, and reducing stress are the most reported reasons for starting yoga. Yoga is known as an alternative therapeutic approach due to its beneficial effects. Clinical yoga involves the use of traditional yoga practices to prevent, cure and / or ameliorate disease. Rheumatic diseases can cause pain, swelling, stiffness and loss of function in the joints, leading to decreased quality of life and disability. In the management of arthritis patients, non-pharmacological approaches such as self-management, physical therapy, ergotherapy, weight loss, as well as drug and surgical intervention are recommended. The role of self-management and increased physical activity is of great importance in the treatment of arthritis. Due to its therapeutic effects, yoga can be considered as an alternative approach for those with rheumatic disease. In recent years, studies investigating the effectiveness of yoga in rheumatic diseases such as rheumatoid arthritis, osteoarthritis and fibromyalgia have been increasing. Although the mechanism is not fully explained, yoga has been reported to have positive effects especially on pain. In addition, improvements in disease symptoms, function, psychological state, sleep and quality of life have been reported. More effective results were observed when physical postures, breathing exercises, meditation and yoga philosophy were applied together. However, due to lack of randomization in studies, small sample sizes, lack of standardization of yoga interventions and changing dosages of interventions, study results should be interpreted with caution. Despite all these limitations of studies, yoga is a promising method for arthritis. Yoga can be considered as an adjunct therapy for patients with rheumatoid atritis, osteoarthritis, fibromyalgia syndrome.

... Yoga is a non-invasive and non-pharmacological method that has been shown to improve strength and flexibility [46]. The regular practice of yoga has been shown to be beneficial for both mind and body, for various reasons, including increased spinal flexibility, improved circulation of cerebrospinal fluid, and enhanced release of endorphins and serotonin [47,48]. It also has the capacity to raise the threshold of pain perception [4,17]. ...

• Yogyata Wadhwa
• Ahmad H. Alghadir
• Zaheen Ahmed Iqbal

Background: Delivering a child is a very stressful experience for women. Pregnancy and labor entail complex events that are unique to each individual female. The management of labor pain is often done using analgesics and anesthesia, which have been shown to have some side effects. More comprehensive data are needed to provide clinically significant evidence for clinicians to confidently prescribe exercises to patients. This study was done to evaluate the effect of antenatal exercises, including yoga, on the course of labor, delivery, and pregnancy outcomes. Methods: A retrospective study was conducted among 200 primiparous subjects (aged 20–40). A questionnaire was provided to the subjects to obtain their demographic and obstetrical information 6 weeks after delivery, and their hospital records were also assessed for further details. Based on the nature and details obtained for the antenatal exercises, subjects were divided into two groups: control and exercise. Outcome measures included the need for labor induction, self-perceived pain and perceived exertion during labor, duration and nature of the delivery, newborn infant weight, maternal weight gain, history of back pain, and post-partum recovery. The total maternal weight gain (in kilograms) was calculated from weight at 6 weeks after delivery minus the weight at 12–14 weeks of gestation. Back pain during pregnancy and self-perceived labor pain were measured using a visual analog scale (VAS). The overall perceived exertion during labor was measured using an adapted Borg scale for perceived effort. Results: The subjects who followed regular antenatal exercises, including yoga, had significantly lower rates of cesarean section, lower weight gain, higher newborn infant weight, lower pain and overall discomfort during labor, lower back pain throughout pregnancy, and earlier post-partum recovery compared to those who did no specific exercises or only walked during pregnancy. Conclusions: This retrospective study showed that regular antenatal exercises, including yoga, result in better outcomes related to the course of labor, delivery, and pregnancy. These results notably indicated that pregnant women should be active throughout pregnancy and follow a supervised exercise program that includes yoga unless contraindicated. We require further large-scale prospective studies and quasi-experimental trials to confirm the observed findings.

... Therapeutic yoga is a form of physical activity that incorporates connecting the mind, body, and spirit as a holistic wellness practice [22,23]. Therapeutic yoga has been safely implemented for people with chronic stroke after discharge from rehabilitation [24][25][26][27]. ...

... From previous studies, the insight has been gained that yoga works through reduction in associated pain and stiffness by realigning the skeletal structure, strengthening muscles around the joints, and stretching tight joint structures. [26] For example, the frequent joint motion when practicing yoga has physiologic effects at the cellular level. Because in vitro production of pro-inflammatory interleukin-1 z and tumor necrosis factor decreases under low-level intermittent fluid pressure, yoga exercise may reduce fluid pressure, which, in turn, preserves cartilage that would allegedly be lost by immobilization. ...

Background: Recent studies have shown beneficial effects of complementary and alternative therapies such as Yoga, Ayurveda, and Naturopathy on osteoarthritis (OA), but combining these therapies will have any synergistic effect and will be feasible and safe or not is not known. Aim: This study aimed at assessing feasibility and compare the effect of Ayurveda and Naturopathy as an add‑on to Yoga in individuals with knee OA. Materials and Methods: This study involved forty seven individuals (21 males and 26 females) in the age range of 45.19 ± 3.39, suffering from knee OA since 3.37 years admitted in a residential holistic therapy hospital. They were allocated into one of the three treatment programs based on their preference and clinician's advice: (a) Yoga (n = 16), (b) Yoga + Ayurveda (n = 21), and (c) Yoga + Naturopathy (n = 10). Assessments were done at baseline and after 1 week of respective treatment program using knee injury and OA outcome score (KOOS), perceived stress scale, visual analog scale for pain intensity, and stiffness index. Furthermore, physiological and anthropometric measures were assessed. Data were analyzed using paired t‑tests and one‑way ANOVA for within and between groups comparison, respectively, using SPSS version 10.0. Results: No side effects were reported by the individuals in any of the groups. Within‑group comparisons showed significant improvement in all the variables except blood pressure in all the three groups and body mass index, heart rate (HR), and respiratory rate in Yoga + Naturopathy group. Between‑group comparison showed significant improvement in Yoga group as compared to Yoga + Naturopathy group for KOOS subscale ‑ sports function (P = 0.049; F = 3.24) and for HR (P = 0.025, F = 4.014) in Yoga group as compared to Yoga + Ayurveda group. Conclusion: Although addition of Ayurveda and naturopathy to yoga therapy for short term did not yield significant results, it was found to be feasible and safe. Current study also suggests yoga as monotherapy to be as effective as other CAM therapies in the treatment of OA in a short‑term residential setup. Seven days yoga therapy improved clinical symptoms, anthropometric measures, and psychological states of individuals with knee OA.

... According toWHO, yoga is deemed to belong to the Complementary and Alternative Medicine (CAM) field, as a form of non-medication therapy [11]. This understanding reflects the yoga therapeutics, that is the elements of yoga directly addressing health concerns, in which yoga is used to treat health-threatening conditions [7]. Recent evidence highlights positive effects of yoga for people with an increased risk of cardiovascular disease [12] and as add on therapy for treating carpal tunnel syndrome [13], depression [14], rheumatoid arthritis [15] and cancer [16]. ...

Background: Evidence suggests yoga is a safe and effective intervention for the management of physical and psychosocial symptoms associated with neurological conditions. However, heterogeneity in the components and reporting of clinical yoga trials impedes both the generalization of study results and the replication of study protocols. The aim of this Delphi survey was to address these issues of heterogeneity, by developing a list of recommendations of key components for the design and reporting of yoga interventions for neurological conditions. Methods: Recognized experts involved in the design, conduct, and teaching of yoga for neurological conditions were identified, and invited to contribute to the Delphi survey. 12 of the 38 experts contacted agreed to participate. Round 1 presented an open-ended question, allowing panelists to individually identify components they considered key to the design and reporting of yoga interventions for neurological conditions. Results: Twelve panelists completed the one round of the Delphi survey. Panelists provided 35 comments to the Round 1 question. These comments were then reduced to 13 items such as breathing exercises, posture, cognition, meditation, balance, etc. Conclusions: Expert have provided a non-prescriptive reference list for the design and reporting of yoga interventions for neurological conditions. It is anticipated that future research incorporating the Delphi guidelines will facilitate high quality international research in this field, increase homogeneity of intervention components and parameters, and enhance the comparison and reproducibility of research into the use of yoga for the management of neurological conditions. KEY WORDS: Yoga, neurological conditions, Delphi

... Η γιόγκα αποτελεί μία από τις πιο αναγνωρίσιμες μορφές εκγύμνασης, τεντώματος και διαλογισμού. Θεωρείται ότι τροποποιεί τις αντιδράσεις στο στρες βελτιώνοντας παράλληλα την αυτοπεποίθηση, την ευεξία ενώ συντελεί στην ηρεμία και τη χαλάρωση (downloa Malathi & Damodaran, 1999' Taylor, 2003. ...

• Διπλωματική Εργασία
• Eleni Papadopoulou

The purpose of this master's thesis is the design, the implementation and the evaluation of an adult training program at stress management through laughter yoga. It is a case study of a group of trainees who experience intense stress. The questionnaire they completed, represented quantitatively stress according to physical indicators, emotional indicators, behavioral indicators, indicators of sleep and of personal habits at the beginning and in the end of the training program. The educational program was designed according to the goals of the participants and the goals of the research. It lasted for two months and at its end, it was evaluated in total. The questionnaires' data that answered the research questions was cross examined to the information collected via personal interviews and clues from the researchers' journal. Improvement at physical indicators was conducted as the participants noticed lower frequency of upset stomach or stomach quivers and of headaches. The quality of sleep was also improved because their sleep became easier and wasn't interrupted many times without reason. In addition, positive change was noticed at emotional indicators especially at the frequency of anger and emotional outbursts. On the other hand, it wasn't noted any change at personal habits indicators. The participants maintained their everyday routine.

... Increasing internal proprioception, increased awareness of thoughts and feeling as a subsequent of yoga asana can cause to reach positive functional outcome, for instance a rise in pain threshold. Yoga intervention can lead to make competing impulses in the central nerves system which can have a great influence on preventing painful stimulation through increasing release of endogenous endorphins and serotonin [15]. ...

• Manisha Vajpeyee
• Shivam Tiwari
• Kavita Jain
• Atulabh Vajpeyee

Aim To investigate impact of Yoga and Music Intervention on anxiety, stress, and depression levels of health care workers during the COVID-19 outbreak. Methods This study was conducted to assess psychological responses of 240 healthcare workers during COVID-19 outbreak. We used Yoga and Music Intervention in normal and abnormal subjects based on Depression Anxiety and Stress Scale-42 (DASS-42). Results Of all 209 participants, 105 (50.23%) had symptoms of depression (35.88%), anxiety (40.19), and stress (34.92%) alone or in combination. The data suggest that there is significant improvement in test scores after intervention. Majority of persons with abnormal score exhibited improved DASS-42 score on combined interventions of Yoga and music compared to control group. Even subjects without abnormalities on DASS-42 score also showed improved DASS-42 scores in intervention ( n = 52) group compared to nonintervention ( n = 52) group. Conclusions Our findings highlighted the significance of easily available, simple, inexpensive, safe nonpharmacological interventions like Yoga and Music therapy to overcome stress, anxiety, and depression in present times.

• Liu Rong
• Lijing Dai
• Yan-Qiong Ouyang

Background The efficacy of yoga on delivery outcomes remaining controversy. Objectives To evaluate the effects of prenatal yoga on delivery outcomes. Methods The Cochrane Library, PubMed, Embase, Web of Science, CINAHL and Elsevier databases were searched from inception to January 22, 2020, and randomized, quasi-randomized and non-randomized controlled trials evaluating the effect of yoga on the delivery outcomes in pregnant women were included. The methodological quality was assessed by the Cochrane Collaboration's tool. Meta-analysis was performed using Revman 5.3. Results This meta-analysis identified that yoga improved vaginal delivery, decreased premature delivery and birth weight of newborns, shorten the labor duration. Conclusion Prenatal yoga is an effective complementary medicine to improve delivery outcomes and not to increase the risk of fetus, which is worth recommending to pregnant women. But studies involved in this meta-analysis were not all of high quality. The Registration Number in PROSPERO is CRD42019132490.

Purpose: To adapt the Merging Yoga and Occupational Therapy program and develop the Merging Yoga and Occupational Therapy for Parkinson's disease (MY-OT for PD) program, designed to target fall risk management. Creating a new program involved the targeted development of Stage 1 manuals. Methods: Researchers employed a pragmatic qualitative design to focus on meeting the purpose of the study. Stage 1 manuals were created following a literature review, a focus group of participants with PD, and individual interviews with experts in practice or research. Visual familiarization with data, generation of conclusions, and results verification were used to translate participant feedback into manual revisions. Results: Themes included revisions to model, content, and delivery. Revisions were incorporated into Stage 1 manuals to create a PD-specific program to improve fall risk management. Conclusion: A structured process is necessary to create Stage 1 manuals in a novel population prior to feasibility and pilot testing.

• Matthew Jerome Taylor

: Yoga therapeutics may have the potential to complement neurologic physical therapy. In this paper, the principles of the yogic health model and yoga therapeutics are described. Fundamental themes of yoga therapeutics that are germane to clinical interventions, a list of resources, and some practical elements for immediate clinical implementation are offered for consideration. A case study involving a patient with Parkinson's disease illustrates the clinical thought process used in applying yoga therapeutics to examination, intervention, evaluation, and outcomes. (C) 2001 Neurology Section, APTA

The mood benefits of Hatha yoga and swimming, two activities that differ greatly in aerobic training benefits, were examined. College students (N = 87) in two swimming classes, a yoga class, and a lecture-control class completed mood and personality inventories before and after class on three occasions. A multivariate analysis of variance indicated that both yoga participants (n = 22) and swimmers (n = 37) reported greater decreases in scores on Anget, Confusion, Tension, and Depression than did the control students (n = 28). The consistent mood benefits of yoga supported our earlier observation that the exercise need not be aerobic to be associated with mood enhancement. However, underlying and causal mechanisms remain uncertain. Among the men, the acute decreases in Tension, Fatigue, and Anger after yoga were significantly greater than those after swimming. Yoga may be even more beneficial than swimming for men who personally select to participate. The women reported fairly similar mood benefits after swimming and yoga. It seems that aerobic exercise may not be necessary to facilitate the mood benefits. Also, students with greater mood changes attended class more regularly than those who reported fewer psychological benefits. Maximizing the immediate psychological benefits of exercise might be one way to encourage adults to be physically active.

• Matthew Jerome Taylor
• M. Majundmar

This article describes yoga and the yogic health model and reviews the physiologic principles of yoga and yoga therapeutics. A summary of published research applicable to orthopaedic physical therapy is included, with suggestions for future study. The article concludes with practical steps for incorporating these findings into a traditional practice and addressing the business challenges of providing tangible application to a topic often perceived as metaphysical.

• Matthew Jerome Taylor

: Yoga therapeutics may have the potential to complement neurologic physical therapy. In this paper, the principles of the yogic health model and yoga therapeutics are described. Fundamental themes of yoga therapeutics that are germane to clinical interventions, a list of resources, and some practical elements for immediate clinical implementation are offered for consideration. A case study involving a patient with Parkinson's disease illustrates the clinical thought process used in applying yoga therapeutics to examination, intervention, evaluation, and outcomes.

• Marcus M. McKinney

Reviews the book, Timeless healing: The power and biology of belief by Herbert Benson, with Marg Stark (1996). In Herbert Benson's latest volume, he addresses the often neglected area of the "meaning of life that makes people thirst for health and longevity", and he proposes a balanced treatment that integrates faith and medicine. The center of Benson's book is what he calls remembered wellness--a process of activating human beliefs. This book will touch a great number of our patients and families, and it presents a growing area of research that will assist us as healthcare providers to address the spiritual dimension of healing. Benson also includes practical suggestions for tapes that highlight exercises in meditation, and descriptions of basic principles in self-care relative to beliefs. (PsycINFO Database Record (c) 2012 APA, all rights reserved)

• S. S. Khumar
• Paramjit Kaur
• Sarabjit Kaur

Examined the effectiveness of Shavasana (a type of yoga exercise) as a therapeutic technique to alleviate depression. 50 female university students were diagnosed with severe depression; 25 were subjected to 30 sessions of Shavasana, and 25 served as controls. Results reveal that (1) Shavasana was an effective technique for alleviating depression and (2) continuation of the treatment for a longer period resulted in a significantly increased positive change in the Ss. (PsycINFO Database Record (c) 2012 APA, all rights reserved)

• Zach Savich

Merging the spirits of Don Quixote, Shakespearean fools, Theodore Roethke, Frank O’Hara, James Merrill, and the Marx Brothers, Zach Savich’s first book does more than showcase the innovative fluency of its roving forms and moods: these poetic hybrids are not hothouse blossoms but minotaurs. With ebullient intelligence and high-stakes insistence on the panic, lust, and suffering of the sensual world, Full Catastrophe Living uses the self as an instrument to investigate art, love, and the hardest honesty. In meditations, songs, slapstick sequences, sonnets, narratives, and tightly carved fragments, Savich explores the conflicts between romance and reality, between inventing a new world and staying true to this one. Relishing both traditional and experimental poetics, he takes refreshing, ecumenical risks to show the “strange grace / of bells that ring with a rag’s polishing.” Like a Fourth of July band conductor guiding planes to land, his poetic wit alters what’s real. This book will change the ways that readers think about poetry, language’s expressive capacity, and the robust world around us.

• J M Mennell

The therapeutic use of cold for pain in the musculoskeletal system is sporadic, although remarkable success has been reported in the relief of pain syndromes of long duration. The recognition of the trigger point as a cause of pain has been slow, although pain patterns from trigger points and their response to treatment are predictable. Understanding of the physiologic basis for the effect of cold and its proper application are keys to success in its use. The role of the sensory receptor organs in muscle, tendon, and synovial capsule must be understood, and the myofascial component of visceral pain and its treatment must be kept in mind. The dangers of home use of cold in treatment of undiagnosed pain must be considered.

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Source: https://www.researchgate.net/publication/232241438_Yoga_Therapeutics_An_Ancient_Dynamic_Systems_Theory