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Yoga as Therapy: When Is It Helpful?

Clinician Reviews. 2014 September;24(9):E1-E6

References

1. Yoga Journal. Yoga in America study 2012 [press release]. Santa Cruz, CA: Santa Cruz Bay Publishing; 2008. Available at: http://www. yogajournal.com/press/yoga_in_america. Accessed August 19, 2014.

2. Broad WJ. The Science of Yoga: The Risks and Rewards. New York, New York: Simon & Schuster; 2012.

3. Lamb T. Health Benefits of Yoga. International Association of Yoga Therapists Web site. Available at: http://www.iayt.org/?page=HealthBenefitsofYoga. Accessed August 21, 2014.

4. Yoga Alliance. 200-hour standards for yoga teacher trainings. Yoga Alliance Web site. Available at: http://yogaalliance.org/content/200-hour-standards. Accessed August 19, 2014.

5. Wren AA, Wright MA, Carson JW, et al. Yoga for persistent pain: New findings and directions for an ancient practice. Pain. 2011;152:477-480.

6. Chou R, Huffman LH; American Pain Society; American College of Physicians. Nonpharmacologic therapies for acute and chronic low back pain: a review of the evidence for an American Pain Society/American College of Physicians clinical practice guideline. Ann Intern Med. 2007;147:492-504.

7. Sherman KJ, Cherkin DC, Erro J, et al. Comparing yoga, exercise, and a self-care book for chronic low back pain: a randomized, controlled trial. Ann Intern Med. 2005;143:849-856.

8. Posadzki P, Ernst E. Yoga for low back pain: a systematic review of randomized clinical trials. Clin Rheumatol. 2011;30:1257-1262.

9. Graves N, Krepcho M, Mayo HG, et al. Does yoga speed healing for patients with low back pain? J Fam Pract. 2004;53:661-662.

10. Cramer H, Lauche R, Haller H, et al. A systematic review and meta-analysis of yoga for low back pain. Clin J Pain. 2013;29:450-460.

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How useful is the research on yoga therapy?

Yoga has been a subject of Western scientific inquiry for more than 100 years. It has been deemed effective for treating conditions from hypertension to epilepsy,³ but many claims are poorly substantiated. Most studies report on a single case or series. The few investigational studies are mainly very small, of short duration, and lacking in appropriate blinding.

Moreover, yoga practices used in the interventions vary markedly, making comparison of results difficult. Interventions range from a single 1-hour session to weekly sessions over several months to inpatient treatment that includes many lifestyle modifications. Some studies required subjects to practice physically demanding asanas, while others focused on pranayama or practices similar to guided relaxation.

Helping patients navigate  the yoga domain

 The variability in practices described as “yoga” and the lack of a standardized credentialing for yoga teachers make it challenging for patients to find a source suitable for their particular needs. Although choosing a style of yoga appropriate to one’s fitness level and finding an experienced instructor are not straightforward undertakings, physicians familiar with the styles, risks, and benefits of yoga can help direct patients seeking this type of therapy.

The Yoga Alliance is the best-known credentialing organization; it offers a 200-hour and 500-hour curriculum covering anatomy, yoga philosophy, and hands-on practice, and grants credit for years of experience in teaching.⁴However, the Yoga Alliance began its current credentialing project just 7 years ago, and it is far from ubiquitous in the industry. Some types of yoga, such as Iyengar and Bikram, have their own certification systems that teachers may preferentially use.

Therapy credentialing. The International Association of Yoga Therapists (IAYT) was founded in 1989 to define yoga therapy and to organize practitioners attempting to use yoga to treat health conditions. As of July 2012, it had published suggested curricula for yoga therapists requiring 800 hours of study.⁴ Clearly, it will take time for these standards to become disseminated through the industry. At this point, IAYT membership does not require any certification or credentials.⁴ Moreover, the broad and decentralized nature of yoga practice means that any type of teacher and therapist credentialing or licensure will be controversial and not universally accepted among practitioners. Because of the relative newness of teacher and therapist licensing programs, many experienced and well-respected instructors may lack formal credentials or certifications.

Patients should do extensive research before choosing a type of yoga and an instructor (see “Finding a yoga instructor”). They should choose a type of yoga suited to their fitness level and general health (TABLE^1,2) to avoid serious injury, which can include fractures, neuralgia, and arterial dissection.²

Finding a yoga instructor

Two organizations may be useful in helping your patient locate a yoga instructor or therapist in your area. The International Association of Yoga Therapists (IAYT) and the Yoga Alliance both offer online search tools: http://iayt.site-ym.com/search/custom.asp?id=1156 IA (IAYT) and https://www.yogaalliance.org/yogaregistry (Yoga Alliance). Important areas of questioning for potential therapists include length of teaching experience, training programs completed, and the amount of experience the instructor or therapist has had in working with individuals with a specific medical condition. It may be prudent in certain situations to refer patients to a physical therapist for evaluation before beginning yoga study.

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