By Patricia Staszak, PT
As a physical therapist, it’s my job and my passion to examine, analyze and teach movement. I was first drawn to yoga because its slower movements and focus on mindfulness made it a perfect place to work on strength and alignment. I loved it – it felt calming and right for me. I also recognized what so many people across the world are experiencing – yoga’s wonderful healing potential.
The medical community in the United States has slowly begun to embrace the subtle and holistic healing power that yoga has to offer. A growing number of studies and clinical evidence showing the positive effects of yoga will likely accelerate this trend. Yoga has been credited with improving sleep, reducing dependence on sedatives and helping cancer patients return to their normal routines. Yoga has also been an effective treatment for chronic neck and back pain, high blood pressure and cardiac disease, and to decrease stress, anxiety and depression. Some proponents even argue that the powerful results in current yoga research will propel health insurance carriers to cover yoga.
But even with mounting evidence on the benefits of practicing yoga and its growth in popularity, I don’t believe the healing potential has been fully realized by Western medicine. As a physical therapist and budding yogi, my concern is how each of us can get the most out of our yoga practice while ensuring that it is both safe and effective.
Fortunately, I'm not alone in this interest. Last month, I attended a course created by Ginger Garner, MPT, OCS, ATC. Garner, a physical therapist and professional yoga therapist, has contributed an impressive body of work that incorporates current research, rehabilitation principles, and biomechanics with influences from Ashtanga, Iyengar, Prana Flow, and Ayurveda to create the Professional Yoga Therapy Program.
Garner's Professional Yoga Therapy Program is a certification program for licensed medical practitioners. It emphasizes the evidence-based principles of neutral joint position and stabilization with posture and movement that are commonly used in physical therapy and rehabilitation. Physical therapists and researchers have long identified the benefits of neutral joint position and stabilization to reduce abnormal wearing on joints – which we know leads to early degeneration, pain and loss of function.
As orthopedic rehabilitation specialists, we teach people to apply these PT concepts to their daily activities so they can continue to do what they do – whether it's walking, running, playing sports or practicing asanas — while minimizing self-harm and maximizing the benefits these activities offer. Garner has systematically applied these same concepts to yoga in a way that honors the essence and evolution of yoga while also honoring and applying the work of scientific researchers and rehabilitation specialists. We have found her approach consistent with what we find works best at our clinic – a gentle flow that is guided by the breath, poses that are modified to meet the needs of the individual and the use of props to help create support and stability.
You can apply Garner’s approach to therapeutic pranayama to your practice by understanding the three different types of therapeutic breath.
Abdominal breath – Abdominal breathing (belly, or diaphragmatic) stimulates the vagus nerve, the cranial nerve that controls the parasympathetic nervous system (PNS). Research has shown that stimulation of the PNS with abdominal breathing increases vagal tone, which has been correlated with the body and brain’s increased resilience under stress.
Abdominal breathing is performed by inhaling into the belly so it expands outward and exhaling gently so the navel draws back toward the spine. Abdominal breathing downshifts the nervous system to transition from the sympathetic (flight or fight) to the parasympathetic (rest and digest) state, which is the first step in the process of healing chronic pain and disease. This tool is incredibly useful to people who are experiencing pain.
The second breath type is what Garner calls Transversus Abdominis Thoraco-Diaphragmatic (TATD) breath. This modified diaphragmatic breathing type can be used during all active asanas to provide more support for the spine and pelvis. TATD breathing uses principles supported by research to activite the core, is commonly used by physical therapists and other rehabilitation specialists to teach spinal stabilization.
In TATD breath, the transverse abdominis is drawn in and the respiratory diaphragm descends, which causes the lower ribs to expand laterally. This activation of core muscles to stabilize the spine and pelvis also improves mobility of restrictions in the rib cage and thoracic spine.
Focus on this breath type during every movement of the practice makes for a moving meditation, which is also beneficial for rehabilitation, as meditation alone has a large body of research to support its use in reducing chronic pain.
Garner also introduces and coins a third breath type, Therapeutic Pranayamic Breath, which is used in restorative poses. In this breath type, the emphasis is on filling the upper lobes of the lungs to get full rib cage movement. Trunk muscle activation is similar to that used in the TATD breath — the deep core stabilizers are engaged and working as stabilizers, but it is a deeper breath and more focused on upper rib cage mobilization.
As Garner suggests, we really need a healthy dialogue between East and West to further progress the power of yoga as medicine and for yoga to be fully embraced in our healthcare system. And we need healthcare practitioners who are trained in therapeutic yoga. The good news is, Garner’s concepts are starting to get a foothold. Two physical therapy programs in the United States and one in Canada have recently added the PYT curriculum. Imagine if this became the norm. We’d have a body of healthcare practitioners embracing Eastern and holistic philosophies while deploying the best that modern science and medicine has to offer.
We apply therapeutic yoga in my physical therapy practice with this goal in mind, and it’s been exciting to see the benefits in our patients. We focus on deep breathing; slow, controlled movements; the activation of the deep stabilizing muscles; and the overall feeling of moving meditation. All of this creates a more balanced muscular system, helps stabilize joints and calms down the nervous system.
Pat Staszak is a licensed physical therapist and certified yoga therapist. Currently studying in the Medical Therapeutic Yoga program with Ginger Garner, she opened Andersonville Physical Therapy in 1999 to provide one-on-one care and a more holistic approach for her patients. She and other yoga certified PTs offer yoga workshops, group yoga and Pilates classes;, individual yoga therapy wellness sessions, and physical therapy that incorporates yoga healing practices. Learn more at www.andersonvillept.com.
Catherine Lewan, PT, DPT, CYT, and STOTT Pilates instructor also contributed to this article
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