Physical Therapy CE, Jobs, and News at TodayinPT.com

Rather than have a patient perform different exercises for stretching, strengthening, balance, and breathing, Matthew J. Taylor, PT, PhD, RYT (registered yoga teacher) might have a patient get into a traditional yoga pose and talk that patient through physical and mental awareness and breathing elements of yoga.

It’s a patient’s one-stop shop, Taylor says — an efficient way to provide care to a spectrum of physical therapy clients, including older patients with balance issues. In his book, “Balance: Constructing a Firm Foundation,” Taylor uses yoga as part of an integrative and scientific approach to fall prevention and writes about an eight-week fall prevention program focused on the elements of yoga that he administered to 18 seniors.

“We measured their balance before and after, and all had improved balance and two no longer needed to use their canes,” he says.

Yoga Defined

Taylor, who is president of the International Association of Yoga Therapists, defines yoga as what it’s not, or “neti,” which means “not that” in Sanskrit.

“Yoga doesn’t equal stretching,” Taylor says. “There are eight classical practices in yoga, one of which is the stretches, or asana.” The other seven practices, called the limbs of yoga, include moral and ethical precepts (concepts of nonviolence, vegetarianism, and more), breathing, withdrawal of senses, concentration, meditation, and deep connection, also known as flow or peak experience. “So yoga, by definition, is apsycho-spiritual practice that uses the physical body to develop our ability to control the stabilization of the mind,” he clarifies.

Taylor, who has a private PT practice in Scottsdale, Ariz., says the traditional PT approach is to identify muscle imbalances and stretch those, identify the muscle weaknesses and strengthen those, and to correct balance deficiencies with specific exercises.

“[Then] if you’re stressed, do these breathing exercises. Yoga merely says why don’t we all do them at the same time?” Taylor says. “Because yoga is a mind-body science, you study what you’re thinking about, how you’re breathing, and how you’re moving. When you do that, we know it creates a relaxation response. We know it increases flexibility. We know it increases strength, and it increases balance.”

Balancing Approaches

Although PTs who practice yoga say it is an ideal approach for improving balance, most studies looking at yoga are on orthopedic cases, such as subjects with low back pain, says Mary Lou Galantino, PT, MS, PhD, MSCE, a yoga instructor and professor of physical therapy at Richard Stockton College of New Jersey, in Pomona.

However, Galantino insists that yoga and balance training go hand in hand. “If we look at the basic neurophysiology of balance and take postures that challenge balance … we can work a progression and further challenge balance,” she says.

Research proving the point is starting to emerge. A new study in the Journal of Strength Training and Conditioning Research showed that for young adults, a short-term yoga program improved balance substantially, producing modest improvements in leg strength and leg muscle control.

Another recent study in the Journal of Nursing Research suggests that a yoga exercise program for female seniors promoted good health, including balance and range of motion.

“We have a Cochrane database systematic review [published in 2003] that includes yoga. [The authors] looked at exercise in general and found that exercise appears to have statistically significant benefits on balance ability in the short term, but strength of the evidence is limited, which means that — back to my original statement — even when it comes to generalized exercise programs, we still need more data,” Galantino says.

Yoga, claims Galantino, not only helps with the physical aspects of balance, but also the mental. “If you have a patient that fears falling, and we can get them to attend to the body through the breath, and we can get them to decrease their fear of falling, then we can decrease the number of potential falls. We know that fear of falling is a predictor of falling,” she says.

Practice Precautions

Sara Meeks, PT, MS, GCS, KYT (Kripalu yoga teacher), is a proponent of using yoga in PT practice but says there are precautions. She travels around the world teaching health professionals and others how to use yoga in the specific management of people with osteoporosis.

“Statistics now show that over half of the U.S. population over the age of 50, both men and women, already have low bone mass and/or osteoporosis; so, we have to look at bone health or the effect of exercise on the bone when we’re working specifically with people over age 50,” Meeks says. “What that means in terms of the literature and also my teaching is that when we’re teaching exercise or yoga, we have to limit or avoid movement of … spinal flexion, rotation, and side bending because these kinds of movements, particularly the forward bending, put people at increased risk for compression fracture.” Still, yoga helps people with osteoporosis on several levels, including their anxiety and need for weight-bearing exercise, she says.

“For osteoporosis, in particular, one of the things recommended is weight-bearing exercise … and there are many yoga postures that incorporate weight-bearing through the bones and through the body, and with an emphasis on alignment,” she says. “The other is there are many postures also that would bring into the exercises site-specific exercises … with osteoporosis, that means the back, back extensors, and hip muscles would be probably the largest group.”

Other precautions that should be considered before participating in yoga include hypertension and cardiac disease. “Therapists want to make sure that if patients have uncontrolled hypertension, they really shouldn’t be doing any poses with their legs up higher than the head,” Taylor says.

It’s also important that therapists understand the modifications they might have to make with patients who have balance or orthopedic problems. “You really need to be particularly mindful of how we can best accommodate them with various props, using chairs [or other] mechanisms that will allow for greater awareness of the body,” says Galantino, who just moments before her interview with Today in PT treated a patient who had hurt her back in a yoga class.

Active Teaching

Taylor says that PTs who incorporate yoga into their practices or recommend yoga for patients should take yoga themselves to learn about their own bodies.

“My experience in teaching PTs for over 10 years is very few of them know how to move well in their own bodies, yet we’re full of head and book information,” Taylor says. “One of the best ways to learn that is to go inside yourself and discover how your mind’s breath and thoughts modify your quality of movement and balance.”

Meeks recommends that PTs who want to incorporate yoga into their practices get formal training. “When I took my first yoga class, I began to wonder how I could do it [for my patients], but it wasn’t until I took the training that I could really see how that could be accomplished in a PT practice,” she says.

“There is yoga teacher training and there are other courses that are taught specifically for PTs to help them become familiar with yoga. They wouldn’t necessarily have to become a certified yoga teacher, but I think it would have to be a little more than just taking a yoga class or two,” Meeks adds.

In essence, yoga can be a useful tool for PTs and the patients they treat. “Yoga is very much about body awareness — being aware of what we are doing with our body on a daily basis as we wash dishes, go grocery shopping, whatever we’re doing. That kind of awareness helps people be safer in their daily lives,” Meeks says.