An Overview of Joga

Published on January 9, 2012 by Melanie A. Greenberg, Ph.D. in The Mindful Self-Express

Yoga is an ancient Indian discipline with the ultimate goals of uniting mind, body,and spirit, and of transcending the boundaries of the self to become one with the universal consciousness. It began in India thousands of years ago, taught by swamis to their students. The mind-body benefits of Yoga have been widely touted by health magazines and celebrities, yet some experts have warned that there are risks in practicing complicated Yoga poses without correct mental preparation and spiritualmindset. The New York Times has added fuel to the fire by publishing an article describing serious injuries resulting from Yoga, such as spinal stenosis, stroke, or nerve compression. Yoga loyalists retort that these stories of injury are anecdotal and not based on controlled studies. It is the opinion of this author that we shouldn't be hanging up our Yoga mats just yet, although some precautions are in order.  Here 's why...

What is Yoga?

The most prevalent form of yoga in the West is Hatha Yoga. Hatha, meaning literally "sun-moon" Yoga is thought of as a way of uniting opposite energies, such as "masculine and feminine" or "hot and cold." Traditional Hatha Yoga encompasses not only physical poses (asanas), but also breath-work (pranayama), mudras (energy locks), meditation, and contemplative practice. In the West, 90 percent of the Yoga practiced consists of asanas (poses), and it is more likely to be pursued for body toning and weight loss benefits than for spiritual transcendence.  What distinguishes Yoga from other types of exercise is the focus on "non-violence," not forcing or straining,  "non-competitiveness," focusing on improving oneself at one's own pace, achieving "balance and inner calm" and "listening to the body."  However, it would be virtually impossible to assess all the Yoga studios and gyms in the world to see if teachers actually follow these principles. Gyms may be unaware of these tenets when they make hiring decisions. Also, if you have an injury or chronic medical condition, it is not clear what percentage of teachers would be qualified to tailor the poses for you.  The Yoga Alliance certifies Yoga teachers who have undergone a fairly rigorous training curriculum, including instruction in anatomy, yet universal standards do not currently exist for therapeutic work (although I hear from good sources that they are in the works).

History of Yoga in the West

Hatha Yoga was brought to the West in the 1920's by three students of T. Krishnamacharya (a prominent Indian yogi) namely, B.K.S. Iyengar, T.K.V. Desikachar , and Sri Pattabhi Jois. These three gurus founded the schools of Iyengar Yoga, ViniYoga, and Ashtanga, respectively. Compared to the first two, Ashtanga is more vigorous, continuous. and aerobic and was originally designed to help adolescent boys calm their excess energy. In 1947, Indira Devi opened her Yoga studio in Hollywood, which led to a steady migration of celebrities to the discipline. Where celebrities go, the public eventually follows; today, there are thousands of yoga studios and millions of devotees throughout the Western world. In the last decade, the growth of Yoga has been exponential. The New York Times cites a 5-fold increase in Yoga practitioners from 4 million in 2001 to 20 million in 2011.

Who Practices Yoga?

According to national surveys, the typical Yoga practitioner is an educated woman in her mid-30's with above-average income, living in an urban setting and perceiving herself as being in better physical shape than the average person (sounds like the Real Housewives!). Typical reasons for pursuing Yoga include stress and lifestyle factors, weight-management or pain.  Only a small minority of Yogis abandon traditional medicine; most continue to see regular doctors as well. Most practitioners believe that Yoga works for their physical or mental symptoms and also identify with the mind-body and self-care philosophy. With the typical doctor's appointment now only 14-18 minutes, they may need a bit more mind-body love (know what I'm saying?).

Benefits of Yoga

The last decade has also seen an increase in studies using Yoga to treat ailments such as cancer, pain, or diabetes.  Studies support the benefits of Yoga for a variety of health outcomes, including pain, functional ability, blood pressure, sleep, depression, anxiety, immune function, andcognitive function.  Most studies in medical samples have, however, used small samples of subjects, so participants may not be typical or representative of the average person in the real world. Also, many studies compared Yoga to being on a waiting list for treatment. As we all know, just about any treatment will make patients feel happier and better than being on a waiting list. Therefore, it's not clear if the results were due to something special about the Yoga, or because Yoga group participants were given more attention and therefore expected they would improve (the placebo effect). Also, if patients did improve, was this because they exercised and became stronger and more flexible, or because of the psychological and spiritual aspects?

Risks of Yoga

Practicing Yoga is not without risks, however.  As research results on Yoga's benefits reach the public via the internet, older and less healthy people are trying it out. At home Yoga tapes can be bought relatively cheaply and are widely available at discount stores and on a plethora of expert websites. Gyms and health clubs without a holistic focus are also meeting demands from consumers by offering Yoga classes.  Sites like Groupon offer discounts for a series of Yoga classes as well. Because there are many different styles of Yoga and participants may not be aware of the difference in style, they are likely to choose the most affordable. This may lead novices into vigorous classes, such as Ashtanga or Bikram (heated) Yoga, with increased injury potential unless you know what you are doing. Even classical Yoga poses, such as shoulder or headstands, may pose risks for neck compression injuries. Extreme backbends may lead to hyperflexion, and those with high blood pressure may have increased risk for stroke when doing inverted poses.  According to The New York Times, emergency room visits due to Yoga injuries increased from 13 in 2000 to 20 in 2001.  Considering that millions of people actually practice Yoga, this does not seem like a particularly troubling number. Any serious adverse effects, potentially resulting in potentially permanent disability, should not be taken lightly, however.

Groundbreaking Study of Yoga for Low Back Pain

To evaluate the benefits versus costs of Yoga more systematically, I looked at a recent, groundbreaking study by Karen Sherman and colleagues at the Group Health Cooperative in Seattle, Washington in the Archives of Internal Medicine(December, 2011). This study used rigorous methods to assess the benefits of Yoga for participants with chronic low back pain.  This is the first study of Yoga for chronic pain that has included a large number of patients (228 to be exact), used a long-term (approximately 6-month) follow-up assessment, and compared Yoga not only to a minimal treatment (self-help book), but to another intervention (Stretching) that is widely used to treat back pain. Participants were therefore assigned, on a random basis, to either get the self-help book, attend 12 weekly Yoga classes taught by an experienced Yoga instructor, or attend 12 weekly classes of stretching exercises taught by an experienced physical therapist.  Everybody in the study was assessed before treatment and at 6, 12, and 26 weeks as to how impaired they were in doing their daily activities and how bothersome their pain was.

As expected, the self-help book group fared rather poorly, compared to patients actually given an instructor-led treatment.  Both exercise groups were less bothered by pain and reported better daily functioning after the treatments, compared to the self-help group. Also, the two exercise groups decreased their medication use by 25 to 33 percent, compared to before the study, but the decrease was far less for self-help.  There were no differences between Yoga and Stretching, except that patients assigned to the Yoga group were more likely toshow up for the first class, but the Stretching group was more likely to practice exercises at home.  This study is considered state-of-the-art and demonstrates that Yoga works as well asSstretching for lower back pain. Currently, physical therapyis covered by most insurance plans, whereas Yoga is not.  The study also hints at potential cost-savings in the form of decreased medication use, which could more than compensate for the cost of the classes.

Risks for Injury

This study clearly shows substantial benefit of Yoga for this troubling health condition. Aside from the distress and suffering caused by chronic low back pain, this malady costs the nation billions of dollars each year in office visits, medications, surgeries, and lost productivity due to  work disability.  But can it hurt some patients, as The New York Times article suggests?  Luckily, for our purposes, the researchers were veryconscientious in studying any adverse effects reported by participants.  Of the 87 Yoga and 75 Stretching participants who completed the study, only 13 in each group reported mild/moderate increases in pain. One Yoga participant, however, ended up with a herniated disk. The benefits of Yoga under these pristine conditions clearly outweighed the costs (except for the one poor guy!). However, the average joe going to his local gym with a New Year's special deal would probably encounter much more variability in the skill of instruction and poses taught. Further, he/she may be more likely to force or overdo the poses in this more macho atmosphere.  Clearly, we need some well-designed studies of Yoga as practiced in the community to assess how much the risks for injury increase in real-world settings.

Suggested Precautions
The following may help those who are new to Yoga or in less than optimal state of fitness to minimize the risk of injury:
(1)  Look for Beginners' Classes.  Leave tying oneself in knots to the Swamis. If you see the word "Bikram," proceed with caution if you're a beginner.
(3)  If you have a chronic medical condition or are obese, get clearance from your doctor before starting Yoga, and let the instructor know in advance.  Ask the instructor if he/she is familiar with modifications of poses for this condition.
(4)  Respect the limits of your own body, be gentle with yourself, and leave the macho attitude at home. Every person's body is different and the idea is to extend your own limits, not outdo others.
(5)  Avoid headstands if you are a beginner and use blankets to support your shoulders during shoulder stands.
(6)  If something hurts more than a little bit, pay attention and stop. Don't let the instructor do any overly vigorous adjustments either.
With these precautions in mind, some patience and a reasonably well-trained instructor, you should be in a good shape to reap the many health and stress-reducing benefits that Yoga has to offer. Remember than any type of exercise has risks (think of head injuries in High School football) andbe aware that the risks of being chronically sedentary include obesity, diabetes, physical deconditioning, and heart disease. To reap maximum benefit from this holistic practice, bring your mind and spirit into the room along with your body.
Namaste.



Link to New York Times and related articles:
http://www.nytimes.com/2012/01/08/magazine/how-yoga-can-wreck-your-body.html?pagewanted=all
http://abcnews.go.com/blogs/health/2012/01/06/4-ways-to-practice-safe-yoga/
Link to Sherman et al. study:
http://archinte.ama-assn.org/cgi/content/short/archinternmed.2011.524
About The Author
Melanie Greenberg, Ph.D. is a clinical psychologist, life coach, and expert on life change, health psychology, integrative  & behavioral medicine,  chronic stress and pain, who has published her own research in academic journals.  Previously a Professor, she is now an influential  practicing psychologist, speaker, and media consultant.
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