What is Yoga Therapy?

Yoga therapy is the process of empowering individuals to progress toward improved health and well-being through the application of the teachings and practices of Yoga.

                                                     -International Association of Yoga Therapists definition

As yoga has gained in popularity it is too often given as a generalized prescription, such as, “Yoga is good for back pain.” Yoga could also be very bad for back pain. Yoga could even cause back pain where there was none before. One of the hardest things for long time yogis to discover is that the way they’re practicing yoga is causing their pain. While yoga can have many benefits it is not a panacea.

How do yoga and yoga therapy differ? While it’s possible to provide modifications to allow students of all abilities to participate in a group class, it’s nearly impossible to provide the type of personalized instruction that can help each student truly progress while in a yoga class. A yoga therapist takes an individualized approach, considering a client’s whole being, including their present state (such as calm, wired, or tired), constitution, lifestyle, environment, motivation, and personal goals. A yoga therapist uses the therapeutic application of yoga through movement, breath, and stillness to help educate and empower the client to see her own patterns and solve her own problems.

Principles of Yoga Therapy

While illness or injury may be what initially brings a client to seek out a yoga therapist, therapeutic yoga can serve a much broader range of clientele, including an athlete who wants to increase her performance or an artist who wants to move through a creative block. In essence, it is about helping clients become more of who they are. There are as many approaches to yoga therapy as there are schools of yoga. For this author/therapist, the physical body is the entry point because, as yoga therapist Susi Hately states, “The body is a barometer of the mind. What the mind suppresses, the body expresses.” The way we hold our bodies affects our mood and our mood affects the way we hold our body.

The Sanskrit word for yoga pose is “Asana”, which means to be seated comfortably and still. In a class, generalized cues help us to form the shape of the pose. Rather than “holding a pose,” yoga therapy involves moving into asana, being in asana, moving out of asana, comfortably and still. Throughout sessions, clients are observing and discovering - where is the interference? What is working well? We begin by nourishing what is underworking and quieting what is overworking. An initial session might mean nourishing underworked deep, stabilizing muscles while quieting overworked, external, power muscles. This initial physical exploration often leads to another layer, the discovery that it is the mind that is the overworked “muscle” while the body has been left behind. The mind deciding what a pose should look like or what life should be like, and the effect that has on a client’s well-being.

“Pure movement” is when one part of the body moves in relationship to another part in a smooth, coordinated range of motion without compensation. For example, movement at the hip joint occurs when the leg bone moves on the pelvis. If the pelvis wobbles, the breath is held, or the shoulders brace, there is compensation. When the leg bone moves smoothly, the pelvis stays stable, the jaw is relaxed, and the breath moves with ease, we have pure movement at the hip joint. (1)

A client begins by developing awareness of their patterns of movement, of body and mind, while on the mat. Soon they become aware of patterns that are happening all day long. One client noticed that she grips her toes while standing to do the dishes, another that he uses momentum rather than the strength of his legs to get up from a chair. Many clients experience a shift in tension simply from noticing that they’re holding their breath 95% of the time. The first step is developing awareness, because we cannot change a pattern if we’re not aware that it’s happening.

As clients become aware of and shift away from compensation that leads to pain it’s imperative that they learn new, more functional ways of moving. Compensation patterns exist for a reason; if they’re taken away without building more functional patterns they will simply move to another place. Improved movement may include moving from the hips and feeling the strength of the legs, sensing the full 3-dimensional volume of the breath, experiencing relaxed shoulders or a settled mind. These small, subtle shifts in movement can lead to powerful change. Clients gain a better ability to feel where their body is in space. Increased proprioception results in pattern shift and postural change. There is no need to “hold” one’s posture or self in place.

Case Studies: Corinne and Pam

Corinne, a 70 year-old woman who describes herself as “very active,” loves to work out and travel. Initial complaints included back pain, limited range of motion in her hips, and poor balance, stating she is “terrified of falling.” Corinne stated that she was not interested in meditation and didn’t like to relax, but she was impressed with how her friends who did yoga could move, and she thought it might benefit her. In her first session, I identified she needed a physical challenge. She attempted a pure movement lunge, moving into asana without overuse of force, devoid of breath holding or other compensations often utilized when moving without awareness.

“Oh My God, I’m fake fit!”  she exclaimed.

Corinne came to discover that she had been moving through her fitness routine, and daily life, by using force rather than strength. She learned how cues such as “tuck your tailbone” or “draw the navel to the spine” were actually compensations that work against the core. In reality she was doing all of her “core strengthening” by holding her breath, bracing with her back, shoulders, neck, and jaw, and actually leaving her true core far behind and contributing to her pain patterns. When we truly have core strength, there is a feeling of lightness and ease rather than bracing and strain. Corinne’s ‘aha’ was uncovered in how she had been using fitness as a way to control her life, and that she had been mistaking the feeling of tension for strength. She conducted everything in her life with that same pattern - bracing as soon as she got out of bed, while running errands, and even while relaxing at the end of the day.

Pam, age 66, is a long time yoga teacher who had neck, back, shoulder, and hip pain. Through her yoga therapy sessions she discovered that her approach to yoga, and life, was one of “getting it right” and her body was paying the price. She unconsciously believed that when she could master the pose, sit long enough in meditation, or just get all her ducks in a row, all would be well.

After initial consults and as sessions progressed, Pam’s greatest shifts involved bringing awareness to her body’s sensations. Anxiety became a tingling in the chest and a tightening of the breath. Joy, a warmth in the belly and fear a stiffening of the back. She felt how sensations alone might shift in minutes but if she attached a thought or judgment to them they could stay fixed for hours or days. She loved learning that thoughts are nerve impulses that tighten tissue and she could see the correlation between this and her patterns of pain. As Pam learned to approach sensation with curiosity rather than fear her movement improved. She gained the confidence to move from the inside out rather than compress her body into the external form of the pose that she thought was “right.” When Pam began to soften, both in her tissues and her beliefs, her pain diminished. “One of the clearest lessons from contemporary neuroscience is that our sense of ourselves is anchored in a vital connection with our bodies.” (Damasio, 1999, as cited in van der Kolk, 2015).

Through yoga therapy, Pam came to discover that it was the way she was practicing that was causing her pain. Her practice had become a pursuit of perfection; sitting meditation was ultimately self-punishing tolerance, holding alignment was an attempt at holding it all together.

Conclusion: Life As It Is

While Corinne and Pam’s stories are similar, these contrasting case studies highlight the individualized nature of yoga therapy. Corinne needed a physical challenge as a way in. Pam needed a more subtle approach, greater awareness of sensation and the effect that her thoughts were having on her body. There was not one generalized prescription to help Corinne and Pam shift the patterns that were causing their pain.

So much of our muscular tension comes from holding ourselves together. Through yoga therapy a pose becomes a pathway rather than a goal. Awareness along the path allows us to have choices and identify alternative routes. It is not about being perfect, it’s about being whole. The yoga therapist meets the client where they are at, holds the space, and offers a variety of stimuli in the form of breath, movement, and stillness. The insights come from within and clients gain a better ability to be with Life As It Is.

1. Hately, S. (2004, 2006). Anatomy and Asana: Preventing Yoga Injuries. Seattle, WA: Eastland Press
2. van der Kolk, B. (2014). The Body Keeps the Score. New York, NY: Penguin Books

Hips

What’s going on down there? The hip joint is where the leg bone meets the pelvis. Normal movement at the hip joint consists of the leg bone moving on the pelvis in the following directions; forward and backward, side to side, and rotating out and in.

When we move in the same way all the time, such as sitting at the computer, driving home from work, then sitting in front of the TV, our tissues become tight and rigid. Our bodies freeze into a shape. Our hips become like a stiff pair of shorts, the leg bone loses it's ability to move well in all its directions and as a result we can’t move our legs as smoothly or as far as we once could.

This increase in stiffness shows up in little ways at first. We may find we have to get off the couch by using momentum, hurling our body forward rather than using the strength of our legs. We may need a grunt or a push of the arms to rise up from a chair. Eventually, we'll bend at the waist rather than the hip joint when we feed the cat or get in the car.

Over time, this stiffness at the hip joint may lead to back, knee, or shoulder pain. When the leg bone can't move efficiently in the hip socket there will be compensation somewhere else. That means some other joint will take up the slack by doing work it was not designed to do. Eventually it becomes overworked which leads to pain, either in that joint or somewhere further along the chain of compensation.

This loss of range of motion and stiffness at the hips is not inevitable. Making small movements of the leg bones in their sockets in all directions, while keeping the pelvis still and breathing with ease, is one step we can take toward keeping our hips stable and our legs moving freely so we can walk, bend and stand back up again.

Immobilized

Recently, at the beginning of a session, one of my clients said she felt "immobilized." She said it felt like her whole middle was in a plaster cast and her arms were just dangling out on the sides. Another client described a similar feeling, as if her middle felt "like a stack of tires." 

That mysterious middle consists of the pelvis, spine, rib cage, shoulder blades, and organs.​ There are also muscles and nerves and a few other important things that keep us alive and every one of those things is wrapped in connective tissue. That "plaster cast" feeling starts to happen when the connective tissue becomes dehydrated and compressed and instead of operating as an orchestration of individual parts, those parts get stuck together like masking tape and move as one solid unit.

This might feel like tightness or tension, or we may lose the ability to feel those individual parts of our body altogether. The ribs and pelvis were designed to rotate separately when we walk and when they get stuck together we begin to shuffle. The shoulder blades were designed to slide along the back when we move our arms up, when they get stuck to the rib cage it becomes hard to lift our arms to put our shirt overhead or to comb the back of our hair.

What helps? Movement, but particularly movement with awareness. As we work together my clients begin to discover muscles that are working way too hard and some that are not working at all.​ They become more aware of parts of their body that should be moving, parts that shouldn't be moving, and parts that aren't moving but ought to be. As they increase their ability to feel and sense and move they can begin to identify what is causing their tension and what brings relief.

In his book "Somatics," Thomas Hanna, Ph.D writes: It is a wonderful neurological fact that increasing bodily awareness means increasing neurological sensory awareness, and that this sensory awareness of the muscles goes hand in hand with voluntary motor control of the muscles. This is because the sensory-motor system is a "feedback loop": in other words, if you cannot sense it, you cannot move it, and the more you can move it, the more you will sense it.

Breathing

When I first started practicing yoga I would hear my teachers say things like, "It's all about the breath." I just didn't understand what the big deal was. I figured breathing was something I would get to later, when I had extra time. And anyway, If we weren't already breathing, wouldn't we be dead?

Years later, in "The Breathing Book," yoga teacher Donna Farhi answered my question simply,  most of us breathe enough to survive but not to thrive.

For years I wrangled myself into poses, and through my daily life, with the cue "Don't forget to breathe" added on at the end like icing on a cake. I've since discovered that breathing well is the most important ingredient of the cake, it keeps the whole thing from falling apart. It turns out that we actually hold our breath 95% of the time, while we work and drive and do the dishes and even when we're trying to fall asleep.

One of the ways the therapy I offer is different is by considering breathing as the foundation. When we breathe well we feel at ease. From a place of ease we can begin to move purely and then we can strengthen that pure movement. In traditional rehab the focus is on using strength to create movement and then the breath comes more like a gasp at the end. The problem with working this way is we often end up strengthening tension patterns and never really get to the heart of unwinding patterns that are causing pain.

Occupational therapist Bonnie Bainbridge Cohen sums up the importance of beginning with breathing, here,

Pre-vertebrate patterns underly the vertebrate patterns and provide the process of movement. Breathing, the first pattern, lays the foundation for all other succeeding patterns. Wherever the breathing is blocked in the body, future patterns will be blocked; wherever the breathing is free, the future patterns will develop efficiently. 

Arise Rises

I'm thrilled to announce the opening of Arise Therapeutics! As an occupational therapist, I'm excited to be able to offer solutions that really work to help people get out of pain and back into life. I named my business "Arise" in honor of the many patients and clients I've worked with who felt down for the count but were able to rise back up again.

I love this image of a grandmother setting forth with her grandson on her back in Chinatown, NYC. To me, it captures the spirit of Arise, getting out there and engaging in life. With simple, pure, and effective movements I help clients release tension and pain, and I help them connect those movements to the activities they want and need to do in daily life. I've worked with a drummer who not only found relief from neck and shoulder pain, but can now drum with a faster tempo and better coordination. A hiker who is hiking further without shortness of breath and fatigue. My clients are getting amazing results, find out what they're saying on the "About" page of my website.

I'll be posting here periodically, sharing client success stories, observations and insights about anatomy and movement and how it relates to daily life, and tips to help you move and feel better.

Thank you for joining me on this journey!

Anne