Yoga and Physical Therapy

Physical Therapists and Yoga Teachers Collaboration.

Dalia Zwick, PT, PhD

Change in the health care arena is not the only reason for the recent scarcity of physical therapy consumers. There's a hidden competition in the treatment of people with health conditions, particularly cases of neck and back pain and chronic disabilities. Part of this competition comes from yoga teachers and dedicated yoga practitioners, who often specialize in therapeutic exercise.

But rather than competition, the expertise of these practitioners should be viewed as a positive. It should drive physical therapists to improve their skills. Since well-informed consumers are now searching for quality in their treatment, only the best and most qualified practitioners will survive. Rather than resist their input, we should ask ourselves: Why are non-medical providers being sought by consumers?

Why Collaborate?

Having studied with several different yoga disciplines over the years, I've discovered a fascinating world of knowledge that allows me to integrate yoga postures, breathing and other principles with my physical therapy treatment modalities. Through yoga studies, I've met dedicated people who use a different language to describe the same movements we deal with in physical therapy.

Many yoga teachers are able to instruct therapeutic exercises that are at times more beneficial, interesting and effective than the options physical therapists can offer. Physical therapists can learn from this group, and adapt and accommodate this knowledge to benefit patients under their care. Sharing our professional knowledge in anatomy, physiology and biomechanics can benefit both groups and the public at large.

Most experienced yoga teachers understand movement and movement dysfunction from experiential aspects. I've found that as a result, their level of understanding of posture and movement is often deeper than those of most PTs.

The collaborative model is not a new idea. Many physical therapists are already sharing their knowledge with yoga teachers and practitioners. Others are teaching yoga themselves, while still others strongly integrate their treatment philosophy with yoga principles.

Thanks to these thoughtful practitioners, an open forum for knowledge exchange and collaborative studies of yoga movements is at hand. Many issues are ripe for exploration, such as analyzing which muscles are working during yoga practice, which joints are stretched, and the rationale for using a particular exercise for a particular pathology or disease.

Yoga and the Western World

In light of my awe for renowned yoga teacher BKS Iyengar and his inspirational approach to therapeutics, I recently traveled to his institute in Pune, India, to learn more about this philosophy and why it's become so popular.

Even after 40 years in the physical therapy profession, I'm amazed by Iyengar's profound respect for the human body's innate wisdom, as well as his confidence in the way it can be guided to its limits. Given Iyengar's unique attention to meticulous alignment in Hatha yoga postures and his particular focus on yogic breathing practice, Iyengar Yoga (as it's known in the West) has attracted the greatest number of yoga practitioners in the United States.

Contextually speaking, Hatha yoga is the physical yoga exercise, while prana is the force of life, and ayama is an expansion of the breath. Deep-breathing exercises are one of the most widely accepted alternative medicine modalities in the Western world.

By extension, BKS Iyengar yoga highlights body symmetry and elongation, advocating a longer duration in poses, as well as the use of props such as straps, blankets, and blocks that enable people with physical ailments to reap some of yoga's benefits. of props such as straps, blankets, and blocks that enable people with physical ailments to reap some of yoga's benefits.

Yoga's ability to relieve pain and restore movement are clear and well established. But how can this knowledge be distilled into usable clinical applications that Western therapists can incorporate in hospitals, clinics and other professional health care venues?

Clinical Applications

One illustration of yoga's potential to enhance contemporary Western rehab methods may be found in the realm of cardiopulmonary rehabilitation. BKS Iyengar himself often claims that modern allopathic medicine is lacking in this area, and to an extent I share his disdain for the widespread lack of understanding surrounding the breathing mechanism and the workings of the diaphragm.

In Western medicine, the typical cardiopulmonary rehabilitation approach involves endurance and strength training of the extremities using exercise equipment. Little attention is paid to the thoracic region's limited mobility, the tightness of muscles and tendons (particularly the diaphragm's central tendon), or to deep-breathing practices.

Iyengar yoga poses allow for expansion of the chest to improve joint range of motion while elongating the diaphragm-a primary breathing apparatus-thus facilitating personal ventilation. Capacity and control require improved mobility of the chest and upper body.

Often, Western medicine fails to universally recognize that extension of the thoracic region with backbends facilitates expansion of the lungs, muscles, joints and ligaments. This chest-opening posture can be modified, supported or otherwise accommodated in order for health care professionals working with people who have had cardiac surgery or who have breathing difficulties to adopt this key principle.

It's important to grasp the connection between back-bending postures and breathing to appreciate the importance of adapting these principles to suit people post-cardiac surgery, even while they're still in the hospital. With research and clinical study, this principle can begin to be modified and applied more universally.

Bridging the Gap

Some physical therapists are already sharing their knowledge of body movement, mechanics and pathology with yoga teachers and practitioners. Rather than pointless efforts to block other professionals from treating people properly, working together benefits everyone. The reality is that many yoga practitioners are already working with people who have a variety of ailments.

I often recommend that health care providers study and practice yoga to understand its possibilities. In addition to the cardiopulmonary example outlined above, there are at least two yoga disciplines that incorporate special sequences of exercises suitable for back care, neck pain, carpal tunnel syndrome and other pathologies we see in the clinic every day. Some offer claims that are worth serious scientific investigation. Let's enlighten these teachers about our expertise, while we learn from theirs.

Dalia Zwick is senior rehabilitation supervisor and coordinator of the Program for People with Physical Disability at Premier

HealthCare in New York City.

This article appeared in the Advance for Physical Therapy Jan 11, 2010