Sharing the evidence base that supports the effectiveness of yoga can be an important in-road into getting therapeutic yoga & yoga therapy into healthcare systems. Here’s how to discern which research to share!
The database of yogic practices used in the Yoga for Better Health and Yoga for Better Health Pro apps was initially developed by Ann Marie Johnston (Director of Yoga for Better Health) for her own personal knowledge, as she was completing her first 500 hour yoga teacher training program.
Ann Marie pulled information from various books and websites, but the more research she did, the more she noticed some discrepancies and contradictions in the information she was pulling from different sources.
Have you also seen these inconsistencies when searching for information about a yoga pose?
Wanting to ensure that Yoga for Better Health’s content was scientifically qualified, Ann Marie reached out to her Panel of Advisors, to seek guidance in reviewing and editing her data.
Steffany Moonaz, PhD (one of Yoga for Better Health’s Panel of Advisors) who had agreed to be a top level reviewer; asked me to review and edit the content with the intent of making sure it was both safe and accurately representative of the most current science and research in the field.
I started by searching the internet to see what kind of health claims and contraindications for potentially harmful poses were offered. What I found was a lack of integrity throughout the yoga industry.
Mainstream websites and magazines made outrageous claims such as “Heal Thyroid Cancer with This Yoga Pose,” or “Cure your Arthritis with These 5 Yoga Poses.” In an article called “Yoga for Osteoporosis,” a major publication pictured a woman doing a very rounded standing forward fold, which is often actually a contraindicated pose for osteoporosis due to risk of fracture. I also saw a lot of simplistic claims such as “abc pose” is good for all people with “xyz” health condition. We simply don’t have the science to support such claims. Plus, everybody is different.
In comparison, Yoga for Better Health provides suggestions for adapting practices to be better suited for every body, by considering options for different health conditions. It also provides many hundreds of images showing how to modify and vary the poses to better suit your needs.
The brilliance of Yoga for Better Health is that no one person wrote everything. The top experts in the world were consulted to contribute for their area of expertise.
I believe in the inspired vision of Yoga for Better Health, so I decided to take on the (rather large) task of editing the content, under the advisement of several other yoga therapists and experts. As a professor of anatomy and physiology at a college level and teacher of anatomy in yoga teacher training programs, I naturally applied science to the content of the website. This meant staring at an Excel spreadsheet for many (hundred) hours crossing off misunderstood health claims and adding safety tips. (Don’t worry, I took many yoga breaks away from sitting at the computer screen!)
Logic was applied. A variety of resources were consulted, including my own physiology text books, along with many yoga books, including “Key Poses of Yoga” by Ray Long, MD, and “A Physiological Handbook for Teachers of Yogasana” by Mel Robins, PhD. The research search engine PubMed was constantly open to consider the most recent research in yoga and related fields like physical therapy and exercise science. Many, many hundreds of hours later, Yoga for Better Health’s database was ready to be added to the apps!
Yoga for Better Health’s library of practices is evidence-informed. This means that we took into account relevant research when writing the practice descriptions, benefits, and contraindications. The content is provided to you as a starting point and a general suggestion that should be adapted for each individual.
For yoga professionals, Yoga for Better Health’s library of practices acts as a tool to inform clinical reasoning.
It can also be a tool to help yoga students be safely guided in their home practice. However, I recommend students consider finding an expert to for advisement. Yoga for Better Health’s directory (found the in the free app and on the website) can connect you with local professionals with the expertise needed, or you can search for teachers who work with their clients via telehealth options, like I do.
Article Written by: Ann Swanson
Ann is a mind-body science educator, yoga therapist, and author of SCIENCE OF YOGA. She supports people in living happier, healthier lives, by making wellness non-intimidating and accessible to everybody. With a Master of Science in yoga therapy and roots studying yoga in India and qi gong in China, she uniquely applies cutting-edge research to mind-body practices while maintaining the heart of the traditions. Her practical tips and online classes help busy people worldwide relieve pain, manage stress, and find ease.
Join us for an inspiring 3-day virtual conference with stimulating global keynotes, rousing experiential community sessions, engaging interactive panel discussions and plenty of opportunities to network with colleagues.
Keynotes include: Dr Dean Ornish, Sat Bir Khalsa, Alison Whitehead, Yogacharya Dr. Ananda Balayogi Bhavanani, and Göran Boll
Day one: ‘Integrating Yoga Therapy into Healthcare’
Day two: ‘Creating Optimal Health at All Ages; Self-Care and Managing Pain’
Keynotes include Sara Lazar, PhD; Holger Cramer, PhD; Gary Kraftsow, C-IAYT, Michelle Fury, C-IAYT, and Shirley Telles, PhD
Day three ends with ‘Healing Our World With Yoga; Safe, Therapeutic, Effective’
Keynotes include Priya Verma and Charlene Muhammad, Catherine Justice, Dr. Ingrid Yang, Saraswathi Vasudevan and Stanford Dunsmuir and Colin Wang.
The conference is for healthcare professionals, yoga professionals and individuals interested in how yoga & yoga therapy holistically helps create better health and well-being.
Each day kicks off at noon (EST US) (Aug 13, 14, 15).
Learn more and register for the conference at www.globalyogatherapyday.com
Viewing the Whole of You
I like to tell people who have been through standard treatment for neck pain without success that sometimes looking “south” holds a key for resolving the problem. By south I mean lower in the body and in fact all the way to the toes.
You see between your head and your toes lay three diaphragms of muscular and dynamic control. Think of them as a musical trio and for you to enjoy their music, the three must be in harmony. In medicine we call these the thoracic outlet (glottis/shoulders/neck/upper chest), the respiratory diaphragm (covers the entire bottom of the rib cage), and the pelvic floor (the part of your body that rests on the saddle of a horse). In Yoga these areas have been described for centuries as important places of balance and awareness, known as the bandhas.
An imbalance or tightness in anyone of these areas throws the other two off and can generate discomfort and pain in any one or more of the other areas as well. A good yoga therapist will help you discover which if any may be affected and prescribe techniques to resolve the imbalance. The causes can be from:
- Poor postural support and ergonomics
- Bad sleeping habits
- Repetitive oral habits (clenching, chewing, etc.)
- Diet and use of stimulants
- Faulty breathing patterns
- Physical inactivity (couch potato-it is)
But be prepared, as often more subtle aspects of our human experience are the cause, such as emotional distress, fear, spiritual isolation or anger that may be fueling the imbalance.
Failure to explore and address these states will keep you on the merry-go-round of pain. A missing ingredient in many students prescription for relief is often that there is no joy in their life. I ask, “What do you do for fun?” and there’s a long awkward silence, often followed by an admission they don’t have much fun and certainly not every day. If that includes you the reader, then start scheduling some at least once a day…and triple your out loud laughter while you are at it. It’s free and non-allergenic, though it can be infectious!
Postures and Breathing
These postures, or asana, and breathing (pranayama) will be prescribed based on the evaluation by the yoga therapist. Typically they include grounding the feet and toes as the foundation, then opening both the hips and chest. By performing these in conjunction with your awareness around the above-mentioned subtle issues, you increase your sensitivity and consciousness in that moment and later moments to moments in your daily life. We call those moments “Off the Mat” yoga because what you discover in the formal practice should transform what you do away from the mat. As you explore relationships between how you hold yourself during life and your response to life, you can return to work together with the yoga therapist to address those intertwined relationships that may have gone unnoticed or weren’t addressed in your earlier treatment attempts. Be assured, you will discover the need to change, but then stimulating change is a primary function of pain anyway so the pain is doing its job well.
Surrender and Action
As you continue to learn and change, hopefully you will experience the “art” of yoga in your life. It is a beautiful dance of action and surrender. Accepting what is and acting to change what will be.
When we lose our balance and become stuck, often the head throbs, the neck stiffens and the heart collapses in despair.
Restoring that dance we become light and free in our actions, vanishing pain and suffering, and becoming an inspiration to others to wake up and engage the moment with sweetness and calm.
Words of Caution
Not all of the tools and technologies of yoga are benign. Knowing when and what to avoid are probably as important as what to do. Here’s a checklist of things I have observed in yoga injuries that would be good to keep in mind.
We are homo erectus, not homo invertus… if you have issues with your neck, there is no reason to do headstand, shoulderstand, plow or any other postures where you bear weight on your neck and shoulders. Just don’t.
- No teacher should push you into a posture with their hands. If they have your permission, a light touch to give you a sense of direction is helpful, but no firm or hard adjustments.
- The nerves in your arms arise from your neck. Use caution moving into and out of any stretches of the arms and shoulders as it could ignite your neck symptoms if not done slowly and with awareness.
- Use props liberally. Belts, blocks and furniture extend your reach, allowing you to not grip in the neck and to move in safety and ease.
The first Yama in yoga is that of non-violence or non-harming. Following the above guidelines will keep you from harm and keep you safe. With some attention to the whole of you and honoring your limits, yoga has many positive ways of easing your neck pain. Stand up for yourself and know your and the teacher’s limits. Have fun, be safe and look deeply…your neck pain is beckoning you to change.
Article by Matthew Taylor, C-IAYT. Article originally published of YogaMate
Arthritis and rheumatic conditions is an umbrella category that consists of over 100 different disease diagnoses. Some of these include rheumatoid arthritis, lupus, ankylosing spondylitis, gout and fibromyalgia. What these diseases have in common is that they are often accompanied by pain, can interfere with activities of daily living, and can result in reduced quality of life. In addition, many people living with these conditions experience fatigue, trouble sleeping, depressive symptoms, and even social isolation. Some of these conditions are autoimmune in nature, some are more mechanical, and some are closely associated with central nervous system dysregulation.
Regardless of which rheumatic disease is involved, the tools of yoga can help individuals to balance activity and rest, improve mood, find social connection, and reframe life with chronic disease.
Physical activity is recommended for general health, and certainly that applies to people with rheumatic conditions also. Unfortunately, it is more challenging to exercise in the face of pain, fatigue, stiffness and swelling. While people with arthritis should exercise for all of the same reasons as the general public (cardiovascular health, weight maintenance, improved energy and mood, bone density, etc), there are some unique considerations for this population. Physical activity can help to maintain joint mobility, which can decrease over time. Some diseases can involve rheumatoid cachexia, or muscle wasting, which can be reduced with strengthening exercises. Strong skeletal muscles can help keep joints stable with the loss of connective tissue. Therefore, it is imperative to find safe, accessible, and sustainable ways for this population to balance physical activity and rest.
Unlike physical activities such as running or swimming, yoga is infinitely modifiable. The physical poses of yoga can be adapted with props, such as blocks, straps, and blankets. Poses can also be moved to a chair or a wall, and can be flipped around to change the impact of gravity. What must be maintained is the essence of the pose, and the intention of the pose, but this can take many forms.
Adaptation of a yoga practice for someone with joint limitations is best done with the guidance of a yoga teacher or yoga therapist with specialized training and experience. Yoga professionals who have worked with limitations have an extensive set of tools at their fingertips, and a creativity about how to find new modifications on the spot.
This is best done while working one-on-one in a private session, or in a small group where the professional can provide individualized attention. A fast-paced class is not ideal for the process of learning and creating individually tailored poses, but a more fluid practice might be available after the individual gets comfortable with how to adapt a practice for the fluctuations that come with disease flares and/or disease progression.
When many Westerners think of yoga, the focus is on the physical practice of static poses and moving pose sequences. However, these are relatively new compared to the more ancient practices of meditation, mindfulness, attention, and breathwork. In fact, the physical postures were initially used as a tool to bring the body into balance for greater comfort, balance and attention in seated meditation. While the physical practice of yoga offers potential for many benefits to those living with arthritis, it is perhaps the other practices that help yoga to stand out from other activities in addressing both mind and body simultaneously.
Alteration of the breath can be used to engage parasympathetic nervous system engagement, which counters the stress response. Since stress can trigger flares and exacerbate symptoms, tools for stress management are important for stable disease.
Mindfulness and meditation have long been associated with better mental health, and even measurable changes in brain activity and pain response. Many people initially pursue yoga for the physical practice, which can be an introduction to the other practices that can confer an important impact. Furthermore, tools such as deep breathing and mindfulness can be easily practiced without an instructor and can be seamlessly incorporated into daily life.
A skilled yoga teacher or therapist uses not only the practices of yoga, but also incorporates the underlying philosophy. The yogic philosophy can provide perspective that can support ways to think differently about life with chronic disease. The yamas and niyamas, or ethical principles, can also help to guide individuals in safe execution of the physical practice. For example, the first principle is “ahimsa” or “non-harming.” This is, of course, aligned with the medical profession’s aim to “first, do no harm.” While this applies to the yoga professional, it also applies to the individual student. It is important to do no harm to others, but also to do no harm to self. This may mean a more gentle physical practice on some days, or a reminder to not judge oneself on days that are physically more limited. Other principles encourage practitioners to avoid envy of their previous ability or the abilities of others, to be honest with themselves and their instructor about limitations and pain, to listen and honor bodily cues, and to foster contentment and equanimity in any situation. While it cannot be suggested that these are easy concepts to understand or master, these concepts are where the practice of yoga can become transformative, not just physically, but mentally, emotionally, socially, and even spiritually. While yoga is not a religion, it may encourage an inner quiet that could foster connection to an individual’s sense of spirituality, whatever form that may take.
In working with hundreds of students and clients who live with arthritis or other rheumatic conditions, I have seen the potential for many types of benefits and growth. For some people, finding a way to become physically fit and to feel capable in a body that has provided challenges is euphoric. For others, yoga provides a way to become quiet and pay more attention to the need for balance in one’s life. And in a few rare cases, I have seen individuals come to find gratitude for the very disease that brings them pain, limitations, and daily uncertainty. In a process of true transformation, it is possible to find gratitude in the most unlikely places. Yoga practice is unique in its ability to meet anyone where they are on their journey- physically, mentally, emotionally, socially, or spiritually. It is universally accessible when modified appropriately, and can be practiced for a lifetime with no limit to the lessons and skills that can continue to be utilized, both on the mat and out in the world.
Shelly Prosko, PT, C-IAYT, is a physiotherapist, yoga therapist, educator and pioneer of PhysioYoga, a combination of physiotherapy and yoga therapy. With over 20 years of training and experience, Shelly advocates for the integration of yoga into modern healthcare and rehabilitation. She teaches at medical colleges and yoga therapy schools, presents at international conferences, contributes to academic research, provides mentorship to health professionals and offers onsite and online continuing education courses for yoga and healthcare professionals on topics surrounding pelvic health, chronic pain, compassion and professional burnout. Shelly is co-editor and co-author of the book Yoga and Science in Pain Care: Treating the Person in Pain and is a Pain Care Yoga Trainer with Pain Care U. She maintains a clinical practice in Sylvan Lake, Canada and considers herself a lifelong student and believes that meaningful connections, spending time in nature, sharing joy and compassion can be powerful contributors to recovery and well-being.
Please visit www.physioyoga.ca for more info.
Breath Awareness MINDFUL BREATHING IS POWERFUL. Listen to the short audio recording on breath awareness – this is one of the most effective ways for you to change your nervous systems and decrease their sensitization. Becoming skilled at this technique is vital for so much more than pain relief. Become a ‘pro’ at calm breathing as a step towards recovering ease of moment. Practice this 3-5 times each day, at first while in your most comfortable positions. More practice sessions are better for learning. Expect to get better at this when you practice consistently. Becoming more skillful may require 3-6 weeks. Do not be discouraged if it takes time for your pain to decrease – this is a skill that you can master. If your pain does change quickly, imagine how much more it will change when you practice consistently for 6 weeks.
Integrating yoga therapy more fully into health care settings and structures is considered by many to be the path forward for the profession, leading the way to sustainable careers and the mainstreaming of the use of yoga therapy among the population.
It’s been a tough nut to crack. Lack of awareness and understanding of yoga therapy on the part of health-care professionals, structural rigidity within health-care structures and lack of insurance reimbursement for yoga therapy have been major obstacles.
But there is progress to report and more opportunities today than ever before to make inroads, according to several global leaders in the field of yoga therapy.
Here are their takeaways on what is working and how to build on those successes:
Four success stories
Heather Mason, director of the Yoga in Healthcare Alliance in the United Kingdom and the secretariat for the British Parliamentary Group on Yoga in Society, mentioned four programs that are finding success around the world. All of the programs, she said, do a good job of targeting a stated goal of the health-care organization involved, a key to their success.
The Mediyoga program in Sweden developed by Goran Boll (who will present on this topic in the upcoming Global Yoga Therapy Day Conference) is a great example of a yoga therapy program that has flourished because it has shown healthcare policymakers that it meets their benchmarks, Mason said. More than 20 percent of hospitals and clinics in Sweden offer the Mediyoga program, and it is being increasingly copied.
In the U.K., Mason and her partner at the Yoga in Healthcare Alliance, Paul Fox, have developed a yoga therapy program designed for the country’s social prescribing initiative. Under the social prescribing plan, individuals can be referred to community group activities, such as yoga, by a primary health professional. “It’s really quite ingenious,” Mason said. “It’s based on the philosophy that poor health outcomes are associated with isolation, because of poor health behaviors but also cardiological neurological health dysfunction.”
Like the Mediyoga program in Sweden, the yoga therapy program developed by Mason and Fox promotes the program’s usefulness in targeting specific health goals identified by the National Health Service, including improving heart health and reducing stress and anxiety. The program is upscaling in the U.K. and being exported, said Mason, who is also the founder of The Minded Institute, which offers yoga therapy training.
Other yoga-in-health-care success stories include the AYUSH program in India, which brings traditional Indian therapies, including yoga and ayurveda, to underserved rural areas, and the Dean Ornish program for reversing heart disease, which includes yoga therapy. The program, which was promoted as a way to keep health care costs down, an overarching goal of health-care organizations, is now reimbursed by Medicare and several big private insurers.
Covid-19 brings opportunity
Matthew Taylor, a former IAYT board president who has held national yoga therapy leadership roles for more than 20 years, told the forum that the pandemic has both brought great uncertainty as well as great opportunity.
To the question of what insurer reimbursement will look like in the future, Taylor said the state of reimbursement is in flux literally around the world as both state and private insurers grapple with the effects of the pandemic.
But amid the pandemic uncertainty lie a lot of opportunities for yoga therapy, said Taylor, who is currently working with UnitedHealthcare, the world’s largest health insurer, on research and clinical applications.
Big insurers like UnitedHealthcare are not only looking at patient outcomes, but are increasingly looking at employee health, and actively seeking ways to prevent employee burnout.
“When you look at replacing a nurse or doctor, that’s tens of thousands of dollars, if not six figures,” Taylor said. If yoga therapy programs can demonstrate that they enhance quality of life and job satisfaction in a way that retains employees, that’s a pocketful of money saved for them,” he said.
As for addressing the needs of Covid-19 sufferers themselves, there are millions of people who are likely to become long-haulers. That creates a new chronic long-term health condition that will need to be addressed, Taylor said. Yoga therapy has all the tools and is ideally suited to provide such individuals with the holistic tools and sense of safety that are needed for healing.
For a deeper dive into the challenges, and opportunities, of addressing wellness in the Covid era, the Yoga in Healthcare Alliance and Give Back Yoga Foundation are sponsoring a virtual “Wellness After Covid” virtual symposium from May 28-30.
A yoga therapy pilot program for healthcare employee burnout
One organization acting on these opportunities is Yoga for Better Health, which will deliver starting in June a six-week customized therapeutic yoga program to healthcare employees of the VA’s Tennessee Valley Healthcare System.
> Assess the impact a six-week customized therapeutic yoga program has on employee health, resilience, stress and burnout
The purpose of the program will be to
> Measure the demand for delivering real-time therapeutic group yoga online vs. pre-recorded content
> Measure the impact of an employer-mandated yoga program vs. waitlist control
> Better understand employee sentiment, adherence and efficacy of the program
> Assess the health economic impact of the program, with a view to expanding research and rollout of further trials
Individuals or groups that are seeking to offer a yoga therapy pilot program to health care organizations should first make sure they have the time and have secured the resources to host such a program and that the project fits with their own professional strategic objectives. The aims and purpose of pilot programs, such as to measure the efficacy of a protocol or publish research, should be clearly defined and stated.
Johnston agreed with other yoga therapy leaders that the objective of any pilot program should be proposed as a partnership with the healthcare organization to help and meet their objectivesn and gain buy-in.
Building the evidence base for yoga therapy in health care
Marlysa Sullivan, a leading yoga therapy educator and researcher, said it is important to consider how proposed programs can build the case, and the evidence base, for yoga therapy in health care. She said there are many ways a program can add to the body of published research, in the form of theoretical or perspective pieces, case reports, papers that discuss a study protocol, and program evaluations.
Program evaluations, she said, have the particular benefit of reflecting real world conditions and clinical experience vs. what happens in controlled environments such as randomized trials, which often do not reflect what actually happens in clinical settings.
Sullivan said that outcome measurements should be considered carefully when designing yoga therapy programs and research. Outcome measures should demonstrate the uniqueness and importance of yoga therapy and should also reflect what is meaningful for the funders of the study and the society at large.
What the IAYT is doing to help
Getting yoga therapy into health care will require continued career development and marketing support from national and international yoga therapy associations.
Alyssa Wostrel, the executive director of the International Association of Yoga Therapists, said the IAYT was moving ahead with a Yoga Therapy certification exam, which will serve to amplify the visibility and credibility of the profession, as well as to ensure the safety of and standardize the work that yoga therapists do.
In addition, Wostrel said the IAYT was looking to enhance its career development efforts to include outreach efforts to promote yoga therapy to HR managers in hospital systems. She said the association was also looking to collaborate with other organizations, including the Social Workers Association, in an effort to expand career opportunities for the yoga therapist.
Keys to success
For those frustrated by today’s barriers to entry into healthcare settings, Taylor counsels persistence, patience and a dose of humility. “We didn’t even have yoga therapy defined 14 years ago. The fact is that it’s not fully integrated into the health care system where we live is not a surprise.”
The more a yoga therapist speaks the language of the healthcare industry and looks to partner with, and not replace, healthcare professionals, the sooner they will get a seat at the table, the yoga therapy experts agreed.
Taylor counsels against proposing yoga therapy programs that replicate services that other health-care professionals, such as physical therapists or respiratory therapists, are trained to do. The value of yoga therapy, he said, goes beyond individual symptoms and conditions.
“Don’t be the expert in all. Be an expert in some things and refer out” to other professionals for others, said Wendy Landry, a certified yoga therapist and owner of Om Prana Yoga in Parkville, Mo. “There’s a space for all.”
Landry, the community manager for the upcoming Global Yoga Therapy Day (GYTD), also informs of the networking and marketing opportunities available for yoga therapists to connect and share their knowledge through the community sessions of the upcoming GYTD conference. “This is an opportunity for you to get in front of a global audience of healthcare employees and organizations interested in how yoga is therapeutically used to enhance health and well-being; we hope to feature 100+ yoga therapists around the world interested in bringing yoga into health care.”
Above all, the yoga therapy experts agree, when you reach out, propose partnerships that meet the objectives of the health-care institution or system involved. These may include programs that deliver on public health priorities, such as non-pharmacological care on chronic pain, community giveback and outreach and innovative wellness programs for employees and patients.
The fact that yoga therapy is still emerging is actually a plus, Taylor said. “We are small and can move quickly.” “If we can show up in various venues and deliver value, then that is going to bring us to the table much more quickly and effectively.”
Want to learn more? Make sure to join us at the Global Yoga Therapy Day Conference, Aug 13-15. The conference is particularly focused on the integration of yoga into healthcare and features global experts including Sat Bir Khalsa, Alison Whitehead, Saraswathi Vasudevan. To stay up to date with Global Yoga Therapy Day announcements make sure to be on the mailing list!
Article written by Kelly Couturier
Kelly Couturier, MS, C-IAYT, is a yoga therapist at the Addiction Institute of Mount Sinai in New York City. She also teaches yoga and meditation, with both corporate and individual clients.