“Yoga helps the joints move through their various ranges of motion,” says Eden G. Fromberg, DO, the director of a yoga studio in Manhattan. (Photo by Mila Radulovic)
The patient, an editor, had suffered from years of unexplained sciatic back pain and leg pain. After visits to physicians and physical therapists proved unsuccessful, he ended up in the Manhattan office of Lillie M. Rosenthal, DO.
“Nothing really helped,” she says. “And he came to see me, and about two months after seeing me he was maybe 50% better.”
Dr. Rosenthal, who is board certified in physical medicine and rehabilitation, was helping the patient by providing osteopathic manipulative treatment. After a few months, she suggested that the patient add yoga to his therapeutic regimen. He hired a private instructor and his condition rapidly improved. After just a month of OMT and yoga—one session per week for each—he said he was 90% better.
“It’s really dramatic because the chronicity of his problem was so frustrating for him and me,” she says. “We just really wanted to get him going. So the combination of OMT and yoga is great.”
Yoga as a physical activity has become increasingly popular in the U.S. Roughly 20 million Amerians practice yoga, an increase of 29% from 2008,according to a 2012 study released by Yoga Journal. Some of these yoga practitioners also receive OMT. Major studies examining yoga practice and its impact on OMT patients have not been conducted, but Dr. Rosenthal and other DOs say yoga can provide many benefits to them.
Because many yoga poses work the muscles in a fashion similar to OMT, Dr. Rosenthal refers to yoga as self-OMT.
“There are several fascia-release techniques that mimic some yoga poses,” she says.
Yoga practitioner Jim Preddy, DO, also describes the practice as self-OMT.
“Yoga focuses on breathing and manipulation of the ribs and spine. These things are very central to all of our OMT theories,” says Dr. Preddy, an emergency physician in Las Vegas who also teaches anatomy to yoga instructors.
Patients may preserve the effects of OMT for longer by doing Locusts, Rabbits and other yoga poses, he says.
“Doing yoga might change how often you need to receive OMT,” Dr. Preddy says. “It might prolong the benefits that you’re getting.”
Dr. Rosenthal agrees. OMT patients can build on the progress they make by using yoga to keep the body in good structural alignment, she says, and yoga helps to strengthen the muscles, improve flexibility and unwind the fascia.
Yoga may be of particular help to patients with back pain, says Eden G. Fromberg, DO, who is AOA board certified in obstetrics-gynecology and the director of Lila Yoga, Dharma & Wellness, a yoga studio in Manhattan.
“When I was in college I had a book called Yoga and Medicine,” she says. “I remember clearly where it said what would help you the most for back pain. They did various studies, and they said yoga helps more than anything else on the list. Osteopathic manipulation was not on the list, but chiropractic was.
“Yoga won hands down above everything else as helping back pain. I was aware early on that you can’t just put your hands on people and then say, ‘OK, you’re fixed.’ They’re going to slide back into their old patterns if they keep moving in the same way. Changing their movement patterns is essential, and there are different ways to do it. But I always did it through yoga, so of course I saw the connection and would often steer people in that direction.”
Yoga styles explained
Wondering which yoga style promotes relaxation and which focuses on flexibility? Here’s a brief overview of some of the most popular styles.
Hatha yoga: Many yoga styles fall under the umbrella of Hatha yoga, which is described by Yoga Journal as a physical discipline focusing on sequences of poses and breathwork.
Iyengar yoga: Developed by B.K.S. Iyengar, an influential nonagenarian yogi, this style focuses on alignment. Classes tend to be more slow-moving; practitioners hold poses for longer times. Students are encouraged to use props such as blocks and straps for assistance with poses.
Vinyasa yoga: A faster-paced style in which students transition from pose to pose quickly and focus on flowing postures and rhythmic breathing. This style provides more of an aerobic workout and encompasses other fast styles such as Ashtanga yoga and Power yoga.
Ashtanga yoga: Emphasis is placed on breathing and nonstop transition from pose to pose in this faster style. Students work through six different sequences of poses, each more difficult than the last. When a student masters the first, or easiest, sequence, he or she graduates to the next one. This system allows students to progress at their own pace.
Power yoga: This style is Ashtanga yoga’s Western cousin. Power yoga teachers focus on the “workout” aspect of yoga; students rapidly progress through pose sequences designed to strengthen the upper body and improve flexibility and balance.
Bikram yoga: The brainchild of yogi Bikram Choudhury, Bikram yoga is characterized by a 100-plus-degree practice space and a set sequence of 26 poses designed to work the muscles and cleanse the organs. The room is heated for the purpose of releasing the body’s toxins.
Viniyoga: This is a gentler style of yoga that focuses on breathing and relaxation. Sequences and classes are often tailored to meet individual needs; for instance, children are prescribed different poses than adults.
Sources: Yoga Journal, WebMD.com
Dr. Rosenthal talks about another patient, a new patient with recurrent intermittent low back pain. She had been to many physicians over the years, but the patient says yoga helped her the most.
“It’s pretty amazing,” Dr. Rosenthal says. “We always think, ‘The doctor’s going to fix me,’ but that’s not necessarily always true. We can help and direct people, but that was her experience.”
How yoga helps
Just how does yoga bring these benefits to patients? Like OMT, yoga focuses on movement and structure, DOs say.
“Yoga helps the joints move through their various ranges of motion and can also coordinate the activity of the respiratory diaphragm and the deep neuromuscular core,” says Dr. Fromberg.
Although the delivery methods vary, yoga and OMT both affect the body’s structure to improve function, Dr. Rosenthal says.
“Yoga almost cements what OMT can do,” she says. “It’s a beautiful adjunct of something active and something passive, which reminds the body and the mind of the same thing, which is keeping flexible, being in your body, releasing tension and really changing the postural habit.”
Darcy G. Thomas, DO, says she thinks of yoga as a tool she can give patients so they can more actively work on their recovery. Dr. Thomas, a family physician who specializes in osteopathic manipulative medicine in Arlington, Mass., and teaches yoga, encouraged a patient with back problems to try yoga, and he was elated to find an activity he could do on his own.
“This had been a recurring event in his life, pulling out his back,” she says. “He had started yoga classes and was really seeing the benefits, and he felt for the first time that he had a tool to deal with this problem that had continually been happening.”
Consider style, teacher
For all its virtues, yoga as a fitness tool does have drawbacks—mainly that inexperienced practitioners can hurt themselves by straining their muscles, says John Kepner, the executive director of the International Association of Yoga Therapists in Prescott, Ariz. For instance, more older people now attend yoga classes, but they might not be suited to the fast-paced yoga that is popular in many gyms.
“So you get into a Power yoga class, and it’s a gym, so they can encourage people to practice too hard,” he says. “That’s how people get hurt in yoga. They push too hard. The key is to go to a class that’s appropriate for you.”
It’s not uncommon, Dr. Fromberg says, for yoga students to suffer tendon and ligament strains. She suggests students pay attention to signals of pain or fear coming from their body during yoga practice and check in with an instructor to make sure proceeding won’t cause injury.
“A good teacher can help a student learn what proper alignment is,” she says. “But the student also has to cultivate a degree of self-perception and inner awareness.”
Jim Preddy, DO, gives yoga teachers an anatomy lesson. (Photo courtesy of Dr. Preddy)
Although none of the physicians interviewed for this article said OMT patients would necessarily need to be more cautious than the general public when practicing yoga, several noted that it’s good for all yoga practitioners, OMT patients included, to be aware of different yoga styles and the varying experience levels of teachers.
“You know when you get a DO, you have someone who’s had at least four years of medical school, who has a license to practice in his or her state,” says Ronald V. Marino, DO, MPH, who teaches yoga in Babylon, N.Y. “Yoga teachers are not credentialed and certified in the same way. So you can have someone who’s had a two-day course in yoga teaching, and then you can get people who spend their lives immersed in yoga. You need to be aware of your teacher’s expertise and skills.”
There are the different styles of yoga to consider as well, says Dr. Fromberg. For instance, Vinyasa yoga and Ashtanga yoga are generally faster and more aerobic, while Iyengar yoga is more focused on alignment.
“Because Iyengar is more methodical and alignment-oriented than Vinyasa-oriented styles, it’s often safer and more accessible for a novice,” she says.
Smaller classes, where students can receive more individualized training from teachers, are also ideal, Dr. Fromberg says, and she has recommended private instructors for patients with severe injuries.
Some patients may not be able to afford private lessons. Dr. Rosenthal notes that an advantage of yoga is it can be done at home.
“You don’t need fancy equipment, you don’t necessarily need a gym,” she says. “You can get a video from the library for free and do it at home.”
It’s also beneficial for physicians to learn some of the yoga poses in order to better understand patients, Dr. Rosenthal says.
“It would be valuable for doctors to educate themselves on a couple of basic poses so when patients say, ‘I’m in yoga, and I’m doing a Downward-Facing Dog,’ you know that there is weight bearing on the feet and the hands,” she says. “Or simply ask the patient to demonstrate it.”
And Dr. Preddy suggests DOs try yoga themselves before recommending it as a therapeutic option for their patients.
“You can really only evaluate what’s going to go on with your patients by trying it out,” he says. “Not everybody can run, but everybody can swim and everybody can do yoga.”