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Yoga Therapy

A definition: Yoga Therapy is the adaptation of yoga to a particular set of people – those with health problems.

By Robin Monro, Ph.D. (Cantab)

    Although general yoga classes can often help people resolve mild health problems, they may be ineffective, or even harmful, for those with more serious conditions. With yoga therapy the individual and their circumstances, as well as the nature of their condition, can be taken into account and the yoga tailored to their particular needs.
     Yoga therapy retains the basic principles and aims of yoga. Even though people may come with the specific intention of solving their health problems, they will benefit in larger ways as well, if guided properly. Indeed, yoga therapy will be relatively ineffective if a holistic approach is not taken. Every yoga therapy session should include a balanced set of practices that calm and vitalise the whole system, as well as those which act specifically on its diseased parts.

The author in conversation with Dr Shrikrishna, Head
of the Kaivalyadhama Yoga Institute, Bombay –
one of the world's most experienced yoga therapists.
Photo by Lindy Gillam

Its source and how it has developed
    Yoga practices have been used in traditional Indian medicine for thousands of years, and yoga therapy springs from the same rich, age-old tradition, which ranges in scope through every level of existence, from the mental to the spiritual.
     Yoga therapy in its present form is a new discipline, created by the marriage of traditional yoga with modern medicine. It was pioneered by Swami Kuvalayananda in the early 1920s, when he founded Kaivalyadhama, a yoga centre in Lonavla (near Bombay). It was there that he and his colleagues started to use the methods of modern medical science to study physiological effects and therapeutic applications of yoga. In the following decades yoga therapy spread to other parts of India, so that now there are yoga therapy clinics in many parts of the country, often associated with hospitals.
     In the West, psychologists and doctors now use relaxation techniques quite widely for the treatment of anxiety and stress. These techniques are, as we know, derived from yoga, but Western medicine is only just beginning to recognise the value of yoga therapy, as a discipline in its own right, for the treatment of a much wider range of conditions.
     In all our work, we must remember, however, that the ultimate aim of yoga is the realisation of life, not just the curing of physical ailments. Each person takes from this tradition what they are ready for. Some seek only physical and mental health, others seek something more.
     Swami Kuvalayananda appreciated these differences and distinguished two types of yoga practice – one as a form of physical culture, the other as a spiritual path. He saw both as legitimate. Yoga therapy likewise can tend towards one or other of these two types, according to the predispositions of those practising it.

Diagnosis
     Traditionally used within the framework of Ayurvedic medicine, yoga therapy in the 20th Century, and as practised, for instance, by the Yoga Biomedical Trust, relies primarily on Western medicine for diagnosis. Nevertheless, yoga does in a sense have a system of diagnosis (largely intuitive) which picks up disorders in breathing patterns, physical and psychological tensions, energy distributions, mental attitudes, etc. By correcting these, yoga therapy often improves, or even cures, conditions diagnosed by modern medical methods. The combination of yoga with modern medical knowledge can therefore have remarkable results, especially in treating stress-related, chronic ailments (for which modern medical treatments may be relatively ineffective).
     There is one condition where yoga is being used particularly effectively in combination with the methods of Western medical diagnosis, and that is the treatment of low back pain. All patients who come to the Trust's London Centre with back problems are seen individually for 90 minutes, in order to assess their condition so that yoga can be appropriately tailored. There are several different kinds of low back pain, requiring different modifications to the yoga sequence. The method of assessment were taught to our yoga therapists by Professor D Dongaonkar, a spinal surgeon who recently conducted research in the UK on yoga as a treatment for back problems, and this has proved to be very effective.
     For instance, a patient came to us recently who was suffering from severe pain in the right hip. His GP had sent him for X-rays which had shown wear in both hips. But following a subsequent MRI scan at his local hospital, he was informed by the orthopaedic surgeon to whom he had been referred that the problem was not in the hip but in the spine, and that spinal surgery (decompression) was urgently needed.
     The thorough examination he received at our London Yoga Therapy Centre showed that although there was some deterioration in the spine, it was asymptomatic (not causing pain) and not in need of surgery at present. The main trouble was in the hip. And this was confirmed by one of the country's leading experts on the spine, who was asked for a second opinion, and later by a different consultant at his own hospital.
     Within eight weeks of the subsequent hip replacement, he was driving, had no pain and was taking no medication at all. He admitted in a letter to me that without our diagnosis he would have undergone a spinal operation, "which at best would have been pointless and at worst would have left [him] in a wheelchair". He is now doing meditation and some gentle exercises for the spine to help prevent further deterioration and avoid future problems.

Integral approach
     Yoga therapy works simultaneously on physical, mental and spiritual levels. The interrelating of these different levels, through direct experience, distinguishes yoga therapy both from traditional Western physiotherapy and psychotherapy.
     An interpretation of these different levels is provided in the book, Yoga for Common Ailments (R Nagarathna, H R Naghendra and Robin Monro, pp 10-14, 1990. GAIA Books). In very simple terms, asanas act primarily through the physical level, while relaxation, rational analysis, emotion culturing and meditation work through the mental and spiritual levels. Pranayama helps to harmonise and link the physical and mental levels by controlling "energy" flows.
     We see yoga and yoga therapy as working simultaneously on all these levels and we aim to consider lifestyle and attitudes, along with asanas, Pranayama and meditation, at every yoga therapy session.

Simplicity
     Yoga therapy starts with very simple exercises. People can begin to practise and benefit from these right away, even if they have done no yoga before. Commencing with gentle stretching and breathing exercises, the patient gradually progresses to a range of classical asanas and Pranayama practices.
     YBT considers Pranayama to be a key part of yoga therapy, and find that simple forms of sectional breathing, kapalabhati and slow breathing can be learned within a few weeks by most people. Taught in the right way, these often bring striking benefits and present virtually no risks. We also find simple forms of meditation and emotion culturing to be of great value, with the emphasis on awareness, positive emotions, and a sense of unity with the rest of life.

Yoga therapy for chronic conditions
     Asthma, diabetes, anxiety, ME – all these chronic conditions respond to yoga therapy. It was, indeed, my own dramatic recovery from asthma following treatment from an Indian yoga therapist, that spurred me on to set up an organisation which could provide the expertise (medical, scientific and yogic) to bring the benefits of yoga therapy into the Western hemisphere.
     The successful treatment of asthma at YBT's London Centre continues. Patients have described not only the changes in their physical symptoms, but in their attitude to life. This is summed up well by one of them: "The aim from now on will be [to go] slower, deeper, more gently. You are restoring the breath of life to me, the best of all gifts."
     Another good example of a chronic, debilitating condition that can be helped by yoga therapy is ME (Myalgic encephalomyelitis).
     A patient who came to the Trust for help with this disease described as "a miraculous break" her discovery of yoga therapy in a history of failure with conventional medicine. Yoga, she said, "gradually produced the beginnings of awareness and mental balance to a point where the needs of the body began to emerge". These were: to be able to take appropriate exercise; to learn to breath properly, and, above all, to be able to rest on demand. For the first time for years, in fact, she felt she had access, through deep relaxation and the "amazing power of the outbreath", to that "different kind of rest" that ME patients so crucially need.
     She also pointed out that ME sufferers, with their unpredictable swings in energy levels, find regular classes difficult to attend. Yoga therapy can be organised on a flexible basis over a relatively short period of time – often only a few weeks will be enough to learn the individually-tailored sequence – and the one-to-one tuition can accommodate the changing patterns of the disease (ie the sudden dominance of one symptom over the others, or even the appearance of a new one). Individual sessions also provide opportunity for personal discussion which can be so helpful in understanding how to approach long-term illness.

Relations to doctors
     There are several possible ways in which the practice of yoga therapy can be related to the practice of medicine.
     In India it is quite common for medical doctors, familiar with yoga, to be associated with yoga therapy centres. They see all patients when they first attend, and at intervals thereafter to monitor their progress. They prescribe the yoga to be practised, and this is taught by yoga instructors under their direction.
     At other Indian yoga therapy centres, yoga therapists have more responsibility. They take patients directly, only referring them to doctors if they feel it is called for. The Yoga Biomedical Trust has followed this path.
     Our approach is to train yoga teachers to have sufficient grounding in anatomy, physiology and pathology to be able to understand the nature of the conditions they are likely to meet, the medical treatments normally applied, and the bearing of these on the application of yoga therapy. They should be able to judge when to consult a medical doctor, and to brief doctors about their cases and discuss them intelligently.
     There is also a place for physiotherapists, occupational therapists and nurses to take up yoga therapy. In contrast to yoga teachers, the emphasis of their further training will have to be on yoga and yoga teacher training, rather than medical topics.
     There are some yoga teachers with a talent for yoga therapy of a more intuitive sort, who are not inclined to undertake medical training to the extent described above. We believe there is a place for such yoga therapists, and are exploring ways to incorporate them – probably by having them work in collaboration with sympathetic doctors or with more medically-trained yoga therapists who would carry out the patient assessments.
     There is also much scope, of course, for yoga teachers in general classes to practise yoga therapy – as they already do. Here the need is to improve their knowledge and skills in relation to ailments they are likely to meet so that they can deal with them safely and effectively. A good example is low back pain. YBT already runs workshops to inform general yoga teachers on which kinds of low back pain can be helped in a general class, which should be assessed by a professional yoga therapist, and which should only be referred to a medical doctor.

Discussion
     Yoga therapy is a new, emerging discipline. We believe it can find its own place among the complementary medical professions, as well as being applicable in the context of general yoga classes.
     The most distinctive feature of yoga therapy is its emphasis on mind-body integration, extended awareness and the cultivation of a sense of harmony with the rest of life.
     There are many challenges facing the development of yoga therapy, but the greatest of these is how to maintain this spirit of yoga intact, and yet achieve excellence at technical and professional levels.