By Rachel Krentzman, RPT, RYT, CPI
I remember the moment well–the moment where the shooting pain hit me in my back and sent me to my knees, unable to breathe. I remember the numbness and tingling I felt in my right foot, and no matter how much I commanded, my foot would not obey. As a physical therapist, I knew exactly what was happening. I just couldn’t believe it was happening to me.
I was young, healthy, active and a dedicated yoga practitioner. How could it be that I had herniated a disc in my lower back? The fear surrounding any significant injury began to surface. The main question in my mind was, “would I be able to stay active and do the things I love doing, the activities that fulfill my soul and inspire me daily?”
The doctor took one look at my MRI (which revealed a significant disc herniation at L5-S1 with nerve root impingement) and told me I would have to modify my activities for the rest of my life. I said “thank you very much” and hung up the phone. Three weeks later, I was pain-free. Five years later, I am working with others to help them overcome their physical injuries and chronic pain using what worked for me–yoga.
Yoga Meets Physical Therapy
Yoga therapy is a long-established and recognized healing modality in India and is now an emerging field in the West. A recent study in the Annals of Internal Medicine concluded that yoga was the most effective treatment for chronic lower back pain when compared to conventional exercise. Yoga also was found to significantly reduce pain and improve grip strength in individuals suffering from carpal-tunnel syndrome.
The marriage of physical therapy to yoga is a natural one. With a clear understanding of anatomy and movement science, it became obvious to me that one asana (pose) could accomplish many different things in the body at one time.
Yoga asanas provide a unique method of creating balance in the body and mind where conventional stretching exercises fall short. There is a strong emphasis on alignment and focus on subtle actions that create lasting change from the inside out.
For example, downward facing dog pose (adho mukha svanasana) lengthens the spine, stretches the hamstrings, strengthens the upper body and opens the chest simultaneously. In a traditional physical therapy setting, we tend to focus on one muscle at a time. Yoga can accomplish more with one pose than five separate physical therapy exercises.
The most striking difference between yoga and conventional physical therapy is the attention to breath. Breath is the one thing that connects our minds to our bodies for more conscious movement and awareness. Yoga shifts the body into a more relaxed state by switching from the fight or flight of regular exercise into the parasympathetic nervous system, which is the only environment in which the body can heal. For years, I taught patients with back pain “cat/cow” exercises, which gently stretch the spine, and never felt that it provided great relief. Now when I teach the same pose intimately connecting the breath with movement, healing comes naturally.
Treatment for Athletes
After evaluating many individuals using both physical therapy and yoga postures as diagnostic tools, it has become apparent that there are common areas of tightness and weakness among athletes. These areas may not cause pain immediately, but over time they contribute to most lower back, knee and neck pain.
At rest, most runners and cyclists stand with the feet turned outward. This posture has little to do with the feet but rather is a telltale sign of tightness in the hip external rotators (including the piriformis, iliotibial band and gluteus maximus, to name a few). In addition to this tightness, there is often weakness in the hip adductors and deep abdominals, also known as the “core” of the body and sometimes a limited range of motion in hip internal rotation.
It is also very common to see shortened hamstrings and hip flexors in endurance athletes, especially in cyclists who sit with the hips and lumbar spine in flexion for hours. Since all of these muscles attach to the pelvis and/or lumbar spine, the combined effect of this posture is compression in the lower back and abnormal tracking in the knee joint.
Fortunately, these problems are completely reversible and many long-term injuries and chronic pain can be healed and kept at bay. Once the areas of tightness and weakness are determined, yoga therapy techniques are applied to realign the body, creating length in the tight areas and strengthening the weak areas simultaneously. The result is increased space in areas that are normally compressed and a change in movement patterns to prevent reoccurrence. Most clients are able to return to their previous level of activity without the need for pills or surgery.
Restoring Your Balance With Yoga Therapy
The yoga therapy approach is about restoring balance to each individual so they can find freedom from pain. The system works in five stages:
- Re-Align: Identify what is tight and weak. Correct it.
- Create Space: Open up tight structures and surrounding connective tissue to reduce joint and nerve compression.
- Re-educate: Identify faulty movement patterns that contribute to the imbalances and learn how to move in a different way.
- Stabilize: Once the structure is aligned, stabilize the core.
- Practice: Be consistent for long-term results and transformation.
It is important to note that yoga is not simply a physical practice. Yoga means “to join” and works to unite the body, mind and spirit. Yoga is not about becoming more fit but rather about learning more about yourself and your true nature.
With this in mind, it is a wonderful vehicle for self-discovery and true healing. Yoga therapy not only addresses the physical through poses, but looks at emotions and belief systems as well. Meditation practices are taught as a way to quiet the mind and help work with the psychological components of injury and disease.
When looking for a yoga therapist it is important to realize that there are many different levels of training and expertise. There are yoga teacher trainings that will certify you in a weekend while others take years to finish. Many basic teacher trainings do not teach about injuries and pathology, which is why a health care professional who is also a certified yoga instructor is your best bet.
Working privately with a trained yoga therapist is recommended so you can get the personal attention needed to work with your specific injury and body type. While general yoga classes can be beneficial to relieve pain, supplementing them with one-on-one time with a professional helps the healing process.
Through dealing with my own injury, I learned a great deal about myself and found a new way to be in my body with mindfulness, patience and a little more acceptance.