The Yoga Therapist Will See You Now

[Guest guest]

The Yoga Therapist Will See You Now

http://www.nytimes.com/2007/05/10/fashion/10Fitness.html?ref=health

By Nora Isaacs

FOR three years after a car crash left her with chronic pain, Deanna

searched high and low for relief. Mrs. , 41, a stay-at-

home mother in West Palm Beach, Fla., consulted a physical

therapist, a chiropractor, two doctors (a pain specialist and a

neurologist) and an acupuncturist — to no avail.

She also went to basic yoga, hoping asanas would ease the

debilitating back pain, neck spasms and migraines that plagued her.

After each class at LA Fitness, Mrs. felt better for a few

hours, but her symptoms inevitably returned.

It was only after her first yoga therapy session with Large,

who runs Living Large Therapeutics, that she realized why group yoga

left her cold. " When you go to a yoga class, everybody is doing the

same thing, " Mrs. said. " If you have a neck or back injury,

the instructor doesn't know. "

Yoga therapy — one-on-one visits which take place in medical

clinics, physical therapist offices and yoga studios — takes into

account pain and injuries for a customized experience.

As her client did yoga postures she had handpicked, Mrs. Large, a

yoga therapist with a physical therapy license, lightly touched her

to sense where Mrs. was tense or weak. Then she designed a

sequence of poses to target those areas, including a lying twist

with the knees bent and a repetitive variation of triangle pose. As

Mrs. grew stronger and more flexible doing poses at home, her

routine was updated, and after three months, her pain has largely

subsided.

People often turn to yoga when they are injured because they want

gentle exercise that's easy on the joints. But, most yoga teachers

don't have time to address individual problems, nor do they

regularly deal with special needs.

Enter yoga therapy, an emerging field in the United States, although

commonplace in India. Therapists work in small groups or privately,

adapting poses for musculoskeletal problems that have been diagnosed

by doctors. Other therapists help people deal with the anxiety of

living with illnesses as varied as cancer and chronic fatigue.

" We recognize that not every pose is for everybody, " said Robin

Rothenberg, a yoga therapist who runs the Yoga Barn studios outside

of Seattle. " If you are a 20-something dancer, that is one thing and

if you are a 50-year-old computer programmer, that's a different

thing. "

Yoga therapy is nowhere near as popular as one-pose-fits-all

classes. Still, in the last three years, membership in the

International Association of Yoga Therapists, a trade group based in

Prescott, Ariz., has almost tripled to 2,060, from 760.

But experts inside and outside the industry say yoga therapy should

be approached with caution. In general, a person can practice as a

yoga therapist after 200 hours of yoga teacher training, which might

include basic training in anatomy, breathing, meditation and giving

adjustments.

" Anybody can hang their shingle and say they are a yoga therapist, "

said Gudmestad, a physical therapist who also practices yoga

therapy in Portland, Ore. " Buyer beware. I've seen some strange

things done in the name of yoga therapy. "

Most reputable yoga therapists have additional credentials. Some are

physical therapists or nurses or have completed two years of

training in Iyengar yoga, which emphasizes anatomy and kinesiology.

Others have been certified as therapists by schools like Integrative

Yoga Therapy or American Viniyoga Institute. The institute is run by

Kraftsow; applicants must have completed 500 hours of his

teacher training. His course teaches the clinical applications of

yoga for spine, joint and muscle problems.

There is no national credentialing system, and the lack of industry-

wide standards worries doctors. " You need some core set of

certification that allows a patient to know that they are going to

someone from whom they can reliably get appropriate treatment, " Dr.

Weinstein, chairman of the department of orthopedic surgery at

Dartmouth-Hitchcock Medical Center in Lebanon, N.H., and the editor

of the medical journal Spine. " I have certainly seen patients asked

to do positions that have made them worse. "

Just as certain conditions can be helped by extension, flexion,

twisting or side bending, they can also be aggravated, said

Forster, a physical therapist in Santa , Calif.

Some doctors advocate its use, however. " I deeply believe in yoga

and know the therapeutic value of yoga for health care, " said Dr.

Sinel, an assistant professor of physical medicine and

rehabilitation at the University of California, Los Angeles, who has

a private practice in Santa . In the next six months, he plans

to start YogaMed, a company that will offer medical care and

therapeutic yoga within the Yoga Works chain of studios.

There is some evidence that certain yoga poses help alleviate

chronic back pain. A randomized, controlled study published in the

ls of Internal Medicine in 2005 found that participants who

followed a pose sequence designed by a yoga therapist improved

function more than those given a self-care book or sent to exercise

class. (The 101 participants did not include patients with sciatica,

previous back surgery or pregnant women.) Now, the National

Institutes of Health has allocated $1.2 million for a second study

to see, in part, if the results can be replicated on a larger scale.

Yoga therapists are not qualified to diagnose injuries, although

some do, said Bogart, a yoga therapist in Santa , who

has worked as a nurse. " Everybody should be seen by a medical person

first, without question, " Ms. Bogart said. " Yoga should be an

adjunct to " treatment, not " a replacement. "

A handful of doctor's offices already offer therapeutic yoga. Dr.

Loren Fishman, who runs a physical medicine and rehabilitation

practice in Manhattan, studied Iyengar yoga in India before medical

school, and now recommends poses to patients like Sharon .

Ms. , 46, a development director at Dance Theater of Harlem,

suffered from chronic shoulder pain. An M.R.I. revealed a torn

rotator cuff, for which Dr. Fishman prescribed, among other things,

a variation of a headstand using a chair. This pose can help relieve

pain and restore range of motion, yoga therapists say, because of a

method called muscular substitution — training the body to avoid

aggravating an existing problem by using other muscles.

This is plausible, said Dr. J. Hearst Welborn, an orthopedic surgeon

in San Pablo, Calif. He added that actively trying to recover

helps: " Mind over matter has a huge effect on people's pain. "

Longtime yoga therapists say the next step for them is learning to

work with doctors. Larry Payne, who has practiced since 1982 and is

the founding president of the yoga therapist association, said

therapists need to learn to read medical reports and to work in

clinical settings. " The doctors aren't interested in Sanskrit, they

just want to be sure that yoga therapists they work with are

properly trained, " he said.

To that end, Dr. Payne created a yoga therapy teacher training

course at Loyola mount University in Los Angeles, where students

learn yoga therapy for both systemic and muscular ailments.

Dr. Payne and Dr. P. Usatine also started yoga classes for

medical students at the Geffen School of Medicine at

U.C.L.A. " Once they understand and can feel the value of yoga

personally, they can then suggest and prescribe it for their

patients, " said Dr. Usatine, a professor of family medicine at the

University of Texas Health Science Center at San .

Nationwide, yoga is provided at 93 percent of 755 integrative

medical centers, facilities offering under one roof both traditional

medicine and other approaches to health and wellness. But it's

unclear how many offer yoga therapy, said Cary Wing, the executive

director of the Medical Fitness Association, a nonprofit group.

Starting Monday, Donna Karan, the designer, is sponsoring a 10-day

Well-Being Forum in Manhattan to bring together doctors, yoga

therapists and yoga teachers. The hope is to integrate alternatives

like yoga into patient care, Ms. Karan wrote in an e-mail message.