The benefits of practicing yoga include reduced stress and increased flexibility

By Terri Swan

Amy, an otherwise healthy 34-year-old suburban Philadelphian, had had a painful muscle spasm in her left shoulder for 15 years. Sometimes the pain would subside, only to return even worse later. She had been embarrassed because the spasm was so noticeable—she couldn't turn her head to the left, and her clothes didn't fit correctly, since bra straps and bathing suits fell off her opposite shoulder.

Amy had tried chiropractic, pain creams and even physical therapy. Nothing had helped. Then Amy began attending yoga classes twice a week, and after just three or four classes, her pain vanished.

After enduring a decade and a half of pain, she said, "I wasn't lopsided anymore." Amy also found that her blood pressure, once borderline high, now was lower than it ever had been. And as a bonus, she could finally touch her toes.

All these benefits, plus a newfound love of yoga, came to a woman who describes herself as "absolutely not athletic at all."

Yoga Basics

The word yoga comes from the Sanskrit word meaning to yoke or bind; it is interpreted as "union," or a method of discipline. The goal of yoga is to bring the body and mind together.

"The whole system is designed to help quiet the noise in your body, the noise in your breath and the noise in your mind until you can finally listen to yourself, listen to your conscience," said Blair Lewis, PA-C, creator and spiritual director of the Alive and Healthy Foundation in Madison, WI, and the co-founder of the Blue Sky Educational Foundation.

It is believed that an Indian sage named Patanjali produced the Yoga Sutra an estimated 2,000 years ago from an oral tradition passed through the years from teacher to student. This text contains 195 statements, which together form a philosophical guidebook for yoga (see the sidebar for the eight limbs of yoga, which are explained in the Yoga Sutra).

"Yoga is an ancient system of meditation and it encompasses several arms, not just the postures," said Anna-leila Williams, PA-C, MPH, a research scientist at Yale Prevention Research Center in Derby, CT. "There's a whole philosophical foundation to it that encompasses, basically, a way of living. It focuses on nonviolence, both in speech and through behavior, and also as a means of connecting to a higher consciousness or a higher power."

Today many people in the United States practicing what is known as yoga focus on the third limb, asana, performing a routine of physical poses that are held to strengthen the body. In a report on complementary and alternative medicine use among U.S. adults, the Centers for Disease Control and Prevention estimated that in 2002, 7.5 percent of adults in the country had ever practiced yoga.

The many yoga postures include Tadasana (mountain pose), Bhujangasana (cobra pose) and Adho Mukha Svanasana (downward-facing dog).

Types of Yoga

Generally, the type of yoga practiced today is what's known as Hatha yoga, which stresses physical movement. Yoga instructors say that the postures open channels of the body so that energy can flow.

"Hatha is to be a series of coordinated exercises that balances both the sympathetic and parasympathetic nervous system, leading to improved health and improved relaxation," Lewis said.

Ha means sun and tha means moon, referring to the balance of masculine and feminine within the body. Therefore, Hatha yoga works toward creating balance by uniting opposites.

Many different branches of yoga exist today in addition to Hatha. "All of them pretty much stem from the same yogic philosophy," Williams said. "It's just a matter of how they've been translated to a Western audience."

Some types of yoga practiced in the United States include Ashtanga, a series of postures with a particular flow pattern; Iyengar, which focuses intensely on each posture and uses props, such as belts or blocks; power yoga, designed to create heat and energy flow; Kripalu, which is practiced from a mindfulness-based state; and Bikram, which is practiced in a room heated to 100 degrees or more.

Yoga Benefits

Reduced stress and increased flexibility seem to be the most widely recognized benefits of yoga.

"What's been documented is, initially, people are found to have a lowering of blood pressure, a lowering of pulse and a calming of the mind, and those three obviously are connected," Williams said. "And then, over time, what can happen is that people's balance improves, flexibility improves, and while this balance and flexibility is happening to the body, it's also happening to the mind."

Marie Bensulock, MS, PA-C, a professor at Philadelphia College of Osteopathic Medicine, has basic training in Hatha yoga and has experienced these benefits firsthand. She started practicing yoga in 1977 because she thought it seemed like a nice way to exercise. Subsequently, Bensulock recalls, she gradually overcame her headaches and stress and became quite relaxed. She's found that the breathing patterns in yoga are a genuine benefit for everyone, but may be of particular benefit for people who are anxious and stressed, people who hyperventilate and people who are hypertensive.

According to Lewis, yoga is appropriate for every type of emotional concern, including anxiety, sadness, loneliness, impulse problems and obsessive-compulsive disorder. He also lists heart palpitations, high blood pressure, attention deficit disorder and fibromyalgia as physical ailments that may benefit from yoga.

"I just don't think there's any diagnostic category where improving both the nourishing and cleansing functions of the body would not be helpful," he said.

Another benefit of yoga is that it is widely regarded to help the body become aligned. Improved postural alignment adds to the strengthening of the body. In addition, Bensulock said, muscles become toned without a bulked-up appearance.

A Sense of Peacefulness

ADVANCE visited the Stillpoint Yoga Studio in King of Prussia, PA, and spoke with owner and teacher Jack Forgosh and teacher Kris Hanvey, RN, about the benefits of yoga. The two have noticed that yoga seems to help with digestion and constipation issues, anxiety and stress-related illnesses, headache, back issues, repetitive stress and range-of-motion issues.

And yoga even may help with weight loss. "The practice of yoga—which helps you pay attention–can help you distinguish between real hunger and emotional hunger," said Linda L. Smith, PA-C, a certified Kripalu yoga teacher and director of programs and operations at the Duke Center for Integrative Medicine in Durham, NC.

Some yoga teachers have training in specific conditions. Instructors might have training in prenatal yoga, yoga for osteoporosis or yoga for arthritis. For example, the Stillpoint Yoga Studio offers classes specifically for full-figured women and for menopausal women. Yoga instructors also might have health care training—they might be PAs like Smith or nurses like Hanvey.

Yoga should be practiced regularly in order to experience the benefits. Smith suggests that her patients practice yoga for at least 20 to 30 minutes at least three times per week to really make a difference in the body. If time is an issue, a person can even do short stretching exercises based on yoga for five minutes in the middle of the day.

Importantly, yoga should provide a sense of peacefulness, where the body is at one with the mind. Hanvey finishes her yoga class by reading a passage about spiritual being and with a greeting of "namaste"—an acknowledgement of souls that means, "I bow to you."

Getting Started

Anybody can do some yoga, even if it's limited to simple breathing exercises, Bensulock said.

But how should a person choose how to practice yoga? With all the available classes, books and videos, decisions could become overwhelming.

Experts agree that at first, taking a class is best. Instructors often allow first-time students to take a class for free to see whether they like it.

"I think for a beginner, it's necessary to take a class, just to get some of the fundamentals down," Williams said. "Ideally, a practice becomes one's own, but I think that takes time. Just like adopting any behavior, it's hard to make it a part of one's life at first, and in order to do that, often having the support of a class can be very helpful. But being able to learn the postures so that one doesn't get injured is important as well, and that's where a teacher can be very helpful."

Bensulock recommends a hands-on instructor in the beginning, because people new to yoga will not necessarily get their bodies into the proper positions. For example, she said, many people do not know where their true pelvis is and bend at the waist for postures that require bending from the pelvis. A yoga teacher is able to place a person in the correct posture.

Your patient also will need to find a yoga style that best matches his needs, Lewis said. "Yoga classes are very different based on who's teaching the class and what style of yoga is being taught," he said. "There is no one style that is considered better than another style."

Finally, don't just settle for any teacher, Bensulock said. Since many different varieties of yoga, practice settings and types of instructors are available, tell your patients to shop around for an instructor and an atmosphere they like and where they feel comfortable.

Although yoga instructors can become individually certified by organizations in their yoga branch, yoga instructors as a whole have no national certification process. The Yoga Alliance, an organization designed to, in its words, "set standards, foster integrity, provide resources and uphold the teachings of yoga," registers yoga instructors and yoga teacher training programs that meet the organization's minimum educational standards. But the registration is voluntary, and instructors are not required to become certified.

"Like many of the complementary and alternative practices, anyone can start a yoga type, and then train people in it and give certification," Smith said. A person may find a yoga instructor who is certified, but the person should find out whether the instructor went to a weekend workshop or has practiced yoga for years.

"The classic yoga teacher is a very kind, soft-spoken benevolent person who's there to help you improve your self-esteem by allowing you to become more comfortable with your physical appearance and the honest functionality of your body," Lewis said.

Yoga Contraindications

Yoga is contraindicated in people with certain medical conditions. "Patients with medical conditions should check in with their health care provider before starting any exercise program, including yoga," Smith said.

For example, people with osteoporosis, back pain or musculoskeletal pain might need to approach yoga with extreme caution. "Yoga should not be practiced in a state of pain," Smith said. "You want to be stretching, but not inducing overstretching or pain in the body."

Heat, such as the warm room of Bikram yoga, may be another contraindication for people with certain conditions. Smith cautions her patients about any yoga performed in an excessively warm room, since blood pressure sometimes can be affected in warm conditions.

Modifications

Do think twice before telling patients that they can't practice yoga at all. Yoga can be modified so that a greater portion of the population can practice it. For example, a person with physical limitations or advanced age can execute a forward bend standing, sitting or as an inverted supine pose. "You achieve the same outcome," Bensulock said. Patients with mobility issues can just perform yoga breathing patterns for the relaxation effect, she added.

Women who become pregnant can modify their yoga routine. Yoga for pregnant women is concentrated on the body areas involved with active labor, their decreasing lung capacity, overall sense of well-being and postural alignment maintenance. The postures focus on balance, lung health, breathing and the lower pelvic area involved with labor and delivery, but avoid inverted position and backward or forward bends.

"Pregnancy and yoga has caught on quite nicely, and it complements Lamaze breathing," Bensulock said. Women who are menstruating should also check with their instructor about modifying their yoga practice.

Terri Swan is on staff at ADVANCE.

The Eight Limbs of Yoga

Yama (restraint)–Ethical standards that focus on behavior and conduct in life.

Niyama (observance)–Rules for personal, spiritual observances.

Asana (posture)–The physical postures of yoga.

Pranayama (breathing)–Measuring, control and directing of the breath.

Pratyahara (withdrawal of senses)–Drawing awareness away from external world and outside stimuli and becoming self-observant.

Dharana (concentration)–Slowing down the thinking process by holding the focus of attention in one direction.

Dhyana (meditation)–The uninterrupted flow of concentration.

Samadhi (self-actualization)–Becoming absorbed in something so that the mind becomes one with it.

Pilates Primer

Once your patients have tried yoga, they might be interested in another form of exercise that provides strength and flexibility. Pilates, developed by Joseph H. Pilates, a German-born fitness innovator, may be for them.

"It's a another form of exercise that is best practiced in calm, quiet surroundings in order to concentrate on breathing, postures and movements," said Marie Bensulock, MS, PA-C, who practices Pilates and is a professor at Philadelphia College of Osteopathic Medicine. "If somebody's done yoga, a lot of the postures will seem familiar."

Joseph Pilates coupled a background in yoga, Zen meditation, martial arts and other ancient fitness techniques with success as a gymnast, diver and boxer to develop his system in the 1920s. The system includes more than 500 controlled exercises to work the mind and body.

Pilates works several muscle groups, with a focus on the "powerhouse"–the abdominal, back and pelvic girdle region. The muscle groups are worked at the same time by a smooth, continuous motion of exercises. One main difference between Pilates and yoga, though, is a person practicing Pilates does not hold the poses. Pilates focuses on the quality of the movement.

Joseph Pilates and his wife opened a Pilates studio near the New York City Ballet in 1926, and soon after many dancers were practicing his method, which creates lean muscle and a strong physique. "The only resistance is your body, so there's no bulking up," Bensulock said.

All one needs is the body to practice Pilates, although some accessories and equipment are available, such as balls, resistance bands and the Pilates Reformer–a system of springs, straps and pulleys on which one can perform more than 100 exercises.

The equipment is actually based on Joseph Pilates's experiences as an orderly in England during World War I, where he rigged springs on hospital beds to provide light resistance exercises to the patients.

–Terri Swan