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Yoga Therapy
by Robin Monro
from the Journal of Bodywork and Movement Therapies


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Abstract: Yoga therapy in its present form is a new discipline, created by the marriage of traditional yoga with modern medicine. It is a specialization of yoga, which tailors yoga practices to the individual needs of people with health problems. It employs simple postural, breathing, relaxation and meditation practices, taking into account medical diagnoses and holistic factors. It emphasizes mind–body integration, extended awareness and the cultivation of a sense of harmony with the rest of life. It is applicable to many chronic conditions and can be used in conjunction with other complementary therapies. Prior experience of yoga is not required.




Yoga therapy is the adaptation of yoga to a particular set of people – those with health problems.


Although general yoga classes can often help resolve mild health problems, they may be ineffective (or even harmful) for serious conditions. Yoga therapy tailors yoga to individuals, taking into account the nature of their medical condition, constitution and life situation. Despite being specialized, yoga therapy retains the basic principles and aims of yoga. Even though people may come in order to solve their health problems, they often benefit in larger ways as well. Indeed, yoga therapy is relatively ineffective unless a holistic approach is taken. Every yoga therapy session should include a balanced set of practices that calm and vitalize the mind and body, as well as acting specifically on diseased parts.


Origins of yoga therapy


Yoga and ayurveda (traditional Indian medicine) grew up together on the Indian subcontinent over thousands of years and they have close links with one another. The rich body of knowledge underlying them extends to physical, mental and spiritual levels of existence. While ayurveda included various aspects of yoga, modern yoga therapy is a distinct discipline, created by the marriage of traditional yoga with Western medicine.


Swami Kuvalayananda pioneered this new application of yoga in India, starting in the 1920s. He and his colleagues applied the methods of modern medical science to study physiological effects of yoga and to develop therapeutic applications of yoga. In the following decades research in this field was also taken up at the All India Institute of Medical Science, Delhi, and various Indian universities and yoga centres. The practice of yoga therapy spread to many parts of India, often in association with hospitals.


In the West, relaxation techniques, deriving from yoga, have come to be widely prescribed for anxiety by psychologists and doctors. However, yoga therapy for medical conditions is only just beginning to be established.


As yoga therapy comes to be accepted, we should always bear in mind that it has its roots in traditional yoga and that the ultimate aim of yoga is the ‘realization of life’ (not just the curing of physical and mental ailments). Each person takes from yoga what he or she is ready for. Some seek only physical and mental health, others seek something more.




Yoga therapy relies on modern medicine for diagnostic information, together with its own more intuitive and holistic methods of diagnosis based on posture, breathing patterns, physical and psychological states, energy distributions, mental attitudes, nutritional status and lifestyle. This information provides the basis (including contraindications) for the design, monitoring and periodic revision of yoga regimens to suit each individual. Yoga therapy often leads to improvements as judged by both medical and yogic diagnostic criteria.


Integral approach


Yoga therapy is thought to work simultaneously on physical, mental and spiritual levels. The interrelating of these different levels, through direct experience, distinguishes it from both traditional Western physiotherapy and psychotherapy. An interpretation of the different levels on which yoga works is provided elsewhere (Nagarathna et al 1990, pp. 1–14). Asanas (postures) act primarily at the physical level, while deep relaxation and meditation work at the mental and spiritual levels. Pranayama (breathing exercises) helps to interlink and harmonize the physical, mental and spiritual levels by consciously modulating ‘energy’ flows. Every yoga therapy session should include work at all these levels, including a consideration of their bearing on life style.


Yoga practices


Yoga therapy uses graded sets of exercises, including very simple ones, so that all students can practise on their own, even after the first lesson, whether or not they have done yoga before. Commencing with gentle stretching and breathing exercises, the student progresses to a range of classical asanas and pranayama practices.


The asanas have a variety of effects, including:


* relaxation, strengthening and balancing of muscles
* mobilization of joints
* improvement of posture
* action on pressure points
* improvement of breathing
* calming of nervous system
* promotion of homoeostasis in cardiovascular, digestive, endocrine and other systems.


Asanas relax muscles through holding them in gently stretched positions. This feeds back to the mind, thus also relaxing mental tensions. Mental relaxation techniques promote relaxation at all levels (muscles, autonomic system and mind), through body awareness, visualizations, etc.


Pranayama harmonizes and links the mind and body. Breathing is controlled by both conscious and unconscious neural pathways, providing a bridge between mind and body. This is a key bridge because breathing constantly affects the muscles, joints and internal organs, throughout the torso. Breathing patterns closely reflect mental states, and are nearly always disturbed in illness. Improving the breathing patterns promotes health and can help in the management of many chronic ailments. From the first yoga lesson, every student can begin to practise simple breathing-with-movement exercises. Many people can also begin at this stage to separate diaphragmatic breathing, lower chest breathing and upper chest breathing. These practices, alone, often bring substantial benefits, especially for people who hyperventilate. More advanced pranayama practices bring further benefits for a wide range of chronic conditions.


Simple forms of meditation are also a vital component of yoga therapy. These emphasize awareness, positive emotions, and a sense of unity with the rest of life. Many conditions affecting the musculoskeletal system have psychological components, and can therefore be helped by therapy at mental and spiritual levels (Fig. 3).


Yoga therapy for chronic conditions


Controlled trials indicate that yoga therapy can help in the management or cure of many chronic conditions, including asthma (Nagarathna & Nagendra 1985), diabetes (Monro et al 1992), heart conditions (Ornish et al 1990), hypertension (Patel & Marmot 1988) and rheumatoid arthritis (Haslock et al 1994)


Surveys, case studies and anecdotal reports suggest that yoga therapy can also help many other chronic conditions, including back pain, menstrual conditions, migraine, multiple sclerosis and osteoarthritis.


Low back pain


Back pain provides an interesting area of overlap between yoga therapy and other body-and-movement therapies. General yoga can often resolve mild back pain caused by stress and tense muscles. However, it can exacerbate conditions involving joint problems, such as prolapsed disc, facet joint strain and severe spondylosis.


The skilled yoga therapist can work safely with nearly all types of back condition, helping them in the following ways:


* releasing tense muscles
* strengthening postural muscles
* improving posture
* increasing flexibility and range of movement
* improving breathing
* improving circulation to damaged joints
* managing pain.


In severe cases (e.g. acute prolapsed disc) relaxation, pranayama and meditation can still be used and can help manage pain and stress.


There are of course limits to the range of applicability of yoga therapy, and other therapies can sometimes be more appropriate. For instance, we recently found osteopathy greatly to help a severe case of scoliosis in the mid-thoracic region, where yoga therapy had failed. Equally, we have had cases who have responded to yoga but not osteopathy.


Yoga therapy can often complement other therapies. For instance, after osteopathic treatment, a yoga therapist can provide exercises to strengthen the back and help prevent recurrence of the pain.


Yoga therapists


The Yoga Biomedical Trust runs a training course for yoga therapists. This is a part-time, 2-year course with both theoretical and practical components. The course provides a grounding in anatomy, physiology and pathology, clinical assessment, and application of yoga practices to a range of chronic conditions. For those who are not already yoga teachers, there is a foundation course in yoga teaching, which runs concurrently with the yoga therapy course.


Have a comment or question? Visit our Yoga Forum to start or join a conversation.



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About the Author

Dr. Robin Monro is Founder and Director of the Yoga Biomedical Trust and the Yoga Therapy Center in London. He started his career as a research biochemist, then shifted to the philosophical aspects of science and eventually to yoga therapy. He has been practicing yoga for 40 years and is currently involved with yoga therapy research, clinical work and training yoga therapists. He is co-author of Yoga for Common Ailments (GAIA books) and several articles on yoga and science.


Visit his website at: www.yogatherapy.org




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