Ginger Garner, Guest Writer
This is the second part to Can Yoga Be Used as Medicine? that discusses how you can talk with your doctor or therapist about yoga as medicine.
Year after year, I hear the same story when new patients come to me: “I got hurt doing yoga at a studio or at home.” The other phrase I commonly hear is, “My doctor/therapist told me not to do yoga.”
I have even had my own doctor and multiple colleagues in the field of therapy tell me not to do yoga.
After lengthy conversations and over a decade of educating health care professionals about how yoga can heal orthopaedic (and other types of) injuries, health care professionals are slowly starting to shift away from the common misconception that yoga is only about flexibility. However, this doesn’t change that only 6.5% of health care professionals in a 2008 Yoga Journal Market Study were reported to recommend yoga to their patients.
Two reasons health care providers in orthopaedics aren’t currently recommending yoga to their patients:
1. They are scared their patients will get hurt, and they will be held responsible (and rightfully so).
As licensed health care providers we are legally bound to our patients. We take the Hippocratic oath to “first do no harm.” We are held liable for what we prescribe and the treatments we administer.
In contrast, yoga is not currently regulated in the United States. Anyone can teach yoga. As a result, there is no way of knowing if someone is qualified to teach the subject matter of which they claim expertise. This is especially true when it comes to teaching movement, which has historically been the domain of the scope of practice of physical therapy, a board licensed allied health care field whose entry-level competence now requires a doctorate degree.
For example –
In my recent past I had a new patient come to me for healing because a yoga teacher had instructed her to perform axial loading (standing on her head) during full cervical extension (leaning your head all the way back) so that (in the words of the teacher) “she could prepare to do backbends.” This dangerous movement, by the way, has nothing to do with bending the spine backward, which is also called spinal extension.
Ultimately and because the instruction from the yoga teacher, my patient suffered a tear in the dura mater of her spinal cord which resulted in cerebrospinal fluid (CSF) leakage. This condition creates severe headaches and can contribute to severe injuries, such as paralysis or death. In the case of this patient, I taught her the “red flags” to identify unsafe yoga instruction, and strongly suggested she not return to the class/teacher where she was injured. Instead, I referred her to a licensed therapist who has been trained to use evidence-based yoga as medicine.
In another case, I had a veteran yoga teacher (30 years +) come to me with chronic instability and pain in both shoulders. She had been taught downward facing dog in its traditional alignment and had performed chataranga pose (think push up) repeatedly over the years with poor form. However in traditional yoga she was considered to be performing these two postures in relatively “perfect” form.
2. They believe yoga means “stretching.”
Actually, not only do health care providers misconstrue the orthopaedic purpose of the yoga postures, yoga teachers and yoga therapists do as well. There are many conditions for which “stretching” is actually contraindicated (will do harm instead of good). These can include joint instability (which I commonly see in traditionally taught yoga postures), joint degeneration, myofascial restriction, neural tension, and most all acute injuries (meaning injuries of less than 2-6 weeks duration), just to name a few.
For example, more than 80% of Americans will experience low back pain at some point in their lives. However, most yoga to treat low back pain is focused on “stretching,” “broadening,” or “opening.” These terms usually involve a movement associated with stretching or mobilizing of some type.
However, orthopaedic physical therapists treating low back pain know that you cannot just “stretch” your way out of low back pain. Treating low back pain involves intricate evaluation and diagnostic techniques, which measure neurophysiogical function, musculoskeletal integrity, stability, myofascial involvement, as well as neurovascular function, just for starters. Yoga – in my humble “integrative orthopaedic physical therapist yoga teacher” viewpoint – should be applied to attain stability in the individual.
Safer Yoga for Longevity and Better Quality of Life
Yoga affects our health directly, through practices which span far greater than just the physical poses. However, “American” yoga mostly relies on physical poses, coupled with breathing and some meditation. Because of so much focus on movement, (it) can actually end up closely resembling physical therapy.
Becoming a physical therapist requires a doctorate degree, and years of clinical study and experience. Contrast that with becoming a yoga teacher or “therapist,” which is something you can do with no background in medicine.
As a physical therapist I also took the time to earn a second degree and license in athletic training (sports medicine). In addition, I have studied yoga for almost 20 years now. It is in my own experiential practice, combined with my training in physical therapy and sports medicine, that allowed me to realize that even with all my training, I have much more to learn about prescribing safe yoga.
How much more then do we need to realize as yoga teachers and “therapists” that what we are teaching is, often, unsafe. We need to challenge the accepted “norms of yoga posture alignment” and scrutinize them against the science and practice of physical therapy.
I realize that yoga, in its ancient form, which teaches full and sometimes extreme range of motion in the wrist, shoulders, hips, spine, knees, and ankles, must be reminded to practice what is preaches: non-violence (ahimsa). Until yoga and all of its complex movements, commonly called postures, are applied with an evidence base, I believe we will continue to see yoga injuries on the rise.
Yoga is a beautiful method for improving one’s health, well-being, and even one’s lifespan. Yes, longevity and high quality of life are two terms often synonymous with long-term yoga practitioners.
You can continue to strive toward excellence and excel in nurturing your longevity through a yoga practice. It doesn’t have to be costly or complicated. Learn how yoga can help you recover from or prevent injury. Learn how yoga can be your secret anti-aging weapon.
About the Author
Ginger Garner PT, MPT, ATC, PYT
Ginger Garner is an integrative physical therapist and founder of Professional Yoga Therapy, an evidence based method for using yoga as medicine. Ginger advocates for her patients to receive holistic and integrative medical care in order to improve health care in the US today. Ginger has been teaching, writing, and lecturing across the United States on how to put the “care” back in health care since 2000. Her medical yoga post-graduate program, Professional Yoga Therapy, which teaches non-dogmatic, evidence-based care through fostering an east/west multi-disciplinary team approach, is a first of its kind in the United States. Ginger can be contacted at www.gingergarner.com and www.professionalyogatherapy.org.
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