Yoga as therapy

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Therapeutic yoga workshop, Jakarta, 2016

Yoga as therapy is the use of yoga as exercise, consisting mainly of postures called asanas, as a gentle form of exercise and relaxation applied specifically with the intention of improving health. This form of yoga is widely practised in classes, and may involve meditation, imagery, breath work (pranayama) and calming music as well as postural yoga.[1]

At least three types of health claims have been made for yoga:

organ
systems from the practice of asanas; and more or less well supported claims of specific medical and psychological benefits from studies of differing sizes using a wide variety of methodologies.

Systematic reviews have found beneficial effects of yoga on low back pain[2] and depression,[3] but despite much investigation, little or no evidence of benefit for specific medical conditions.[3][4] The study of trauma-sensitive yoga has been hampered by weak methodology.[5]

Context

haṭha yoga
) may teach any combination of these.

haṭha yoga tradition, but they were not widely practiced in India before the early 20th century.[8]

The number of

Sivananda Yoga focuses more on spiritual practice, with 12 basic poses, chanting in Sanskrit, pranayama breathing exercises, meditation, and relaxation in each class, and importance is placed on a vegetarian diet.[6][9]

Types of claims

At least three different types of claims of therapeutic benefit have been made for yoga from medieval times onwards, not counting the more general claims of good health made throughout this period: magical powers, biomedical claims for marketing purposes, and specific medical claims. Neither of the first two are supported by reliable evidence. The medical claims are supported by evidence of varying quality, from case studies to controlled trials and ultimately systematic review of multiple trials.[10][11]

Magical powers

Medieval authors asserted that

Haṭha yoga brought physical (as well as spiritual) benefits, and provided magical powers, including of healing. The Hatha Yoga Pradipika (HYP) states that asanas in general, described as the first auxiliary of haṭha yoga, give "steadiness, good health, and lightness of limb." (HYP 1.17)[10] Specific asanas, it claims, bring additional benefits; for example, Matsyendrasana awakens Kundalini and helps to prevent semen from being shed involuntarily; (HYP 1.27) Paschimottanasana "stokes up the digestive fire, slims the belly and gives good health"; (HYP 1.29) Shavasana "takes away fatigue and relaxes the mind"; (HYP 1.32) while Padmasana "destroys all diseases" (HYP 1.47).[12] These claims lie within a tradition across all forms of yoga that practitioners can gain supernatural powers.[13] Hemachandra's Yogashastra (1.8–9) lists the magical powers, which include healing and the destruction of poisons.[14]

Biomedical claims for marketing purposes

Twentieth century advocates of some schools of yoga, such as B. K. S. Iyengar, have for various reasons made claims for the effects of yoga on specific organs, without citing any evidence. The yoga scholar Suzanne Newcombe argues that this was one of several visions of yoga as in some sense therapeutic, ranging from medical to a more popular offer of health and well-being.[15] The yoga scholar

Eka Pada Sirsasana cycle[18]

...tone up the muscular, nervous and circulatory systems of the entire body. The spine receives a rich supply of blood, which increases the nervous energy in the chakras (the various nerve plexuses situated in the spine), the flywheels in the human body machine. These poses develop the chest and make the breathing fuller and the body firmer; they stop nervous trembling of the body and prevent the diseases which cause it; they also help to eliminate toxins by supplying pure blood to every part of the body and bringing the congested blood back to the heart and lungs for purification.[18]

The history of such claims was reviewed by

Hindu nationalist posturing, it turns out that there is ironically[11] "a wealth of real benefits".[11]

Types of activity

Remedial yoga

The

International Association of Yoga Therapists offers a definition of yoga therapy that can encompass a wide range of activities and practices, calling it "the process of empowering individuals to progress toward improved health and well-being through the application of the teachings and practices of Yoga".[19]

The history of remedial yoga goes back to the pioneers of modern yoga,

knee cartilage problems, pregnancy, sciatica, scoliosis and varicose veins in the Mehtas' 1990 book Yoga the Iyengar Way.[25] However, Iyengar was deferential to Western medicine and its assessments, so in Newcombe's view Iyengar Yoga is "positioned as complementary to standard medical treatment rather than as an alternative".[26]

Newcombe argues that in Britain, yoga "largely avoided overt conflict with the medical profession by simultaneously

research funding, and in the 1990s moved to London, focusing on training yoga teachers in yoga as therapy and providing yoga as individualised therapy, using pranayama, relaxation and asanas.[32]

Sports medicine

From the point of view of

Research

Methodology

Much of the research on the therapeutic use of yoga has been in the form of preliminary studies or clinical trials of low methodological quality, including small sample sizes, inadequate control and blinding, lack of randomization, and high risk of bias.[34][4] Further research is needed to quantify the benefits and to clarify the mechanisms involved.[35]

For example, a 2010 literature review on the use of yoga for depression stated, "although the results from these trials are encouraging, they should be viewed as very preliminary because the trials, as a group, suffered from substantial methodological limitations."[4] A 2015 systematic review on the effect of yoga on mood and the brain recommended that future clinical trials should apply more methodological rigour.[3]

Mechanisms

Supta Baddha Konasana. There is evidence that yoga relieves stress by multiple mechanisms.[36]

The practice of asanas has been claimed to improve flexibility, strength, and balance; to alleviate stress and anxiety, and to reduce the symptoms of

interleukin-6, C-reactive protein and cortisol) that might act on stress had been examined empirically, whereas many other potential mechanisms remani to be studied; four of the mechanisms (positive affect, self-compassion, inhibition of the posterior hypothalamus and salivary cortisol) were found to mediate yoga's effect on stress.[36]

Low back pain

Back pain is one reason people take up yoga, and since at least the 1960s some practitioners have claimed that it relieved their symptoms.[38]

A 2013 systematic review on the use of yoga for low back pain found strong evidence for short- and long-term effects on pain, and moderate evidence for long-term benefit in back-specific disability, with no serious adverse events. Ten randomised controlled trials were analysed, of which eight had a low risk of bias. The outcomes measured included improvements in "pain, back-specific disability, generic disability, health-related quality of life, and global improvement".[2] The review stated that yoga can be recommended as an additional therapy to chronic low back pain patients.[2] A 2022 Cochrane systematic review of yoga for chronic non-specific low back pain included 21 randomised controlled trials and found that yoga produced clinically unimportant improvements in pain and back-specific function. Improvements in back-specific function were similar to those obtained from other forms of therapeutic exercise, such as physical therapy.[39]

Mental disorders

Trauma-sensitive yoga has been developed in the US in the hope of benefiting individuals suffering from psychological trauma.

Trauma-sensitive yoga has been developed by David Emerson and others of the Trauma Center at the Justice Resource Institute in Brookline, Massachusetts. The center uses yoga alongside other treatments to support recovery from traumatic episodes and to enable healing from post-traumatic stress disorder (PTSD). Workers including Bessel van der Kolk and Richard Miller have studied how clients can "regain comfort in their bodies, counteract rumination, and improve self-regulation through yoga."[40][41]

Systematic reviews indicate that yoga offers moderate benefit in the treatment of PTSD.[42][43][44] A 2017 systematic review of PTSD in post-9/11 veterans showed that participants in studies who had received mindfulness training, mind-body therapy, and yoga "reported significant improvements in PTSD symptoms".[45] Another systematic review on veterans the same year also found improvement in PTSD symptoms.[46] Other systematic reviews postulate that designing the style and instructions to the needs of the veterans leads to better results and a larger impact on PTSD symptoms.[47]

A 2013 systematic review on the use of yoga for

randomised controlled trials were required.[49]

Cardiovascular health

A 2012 survey of yoga in Australia notes that there is "good evidence"

cardiovascular health, but that there was "little apparent uptake of yoga to address [existing] cardiovascular conditions and risk factors".[35] Yoga was cited by respondents as a cause of these lifestyle changes. The survey notes that the relative importance of the various factors had not been assessed.[35]

Other conditions

There is little reliable evidence that yoga is beneficial for specific medical conditions, and an increasing amount of evidence that it is not.

Evidence for applicability to specific medical conditions
Condition Study Date Findings
rheumatic diseases Systematic review 2013 Weak support in terms of pain and disability, no evidence on safety[51]
epilepsy or menopause-related symptoms Systematic review 2015 No evidence of benefit[52][53]
Cancer American Cancer Society's opinion 2019 Can improve strength and balance; is "unlikely to cause harm", does not "interfere with cancer treatment";
randomised controlled trial of women who had had breast cancer. Measured outcomes included fatigue, depression, and sleep quality.[55][56]
Dementia Systematic review 2015 "Promising" evidence that exercise helps with activities of daily living; no evidence of benefit to cognition, neuropsychiatric symptoms, or depression; yoga was not distinguished from other forms of exercise.[57]
Attention deficit hyperactivity disorder Systematic review 2010 No effect, measured by teacher rating on the ADHD overall scale.[34]
Female urinary incompetence Systematic review 2019 Insufficient evidence[58]

Safety

Although relatively safe, yoga is not a risk-free form of exercise. Sensible precautions can usefully be taken, such as avoiding advanced moves by beginners, not combining practice with psychoactive drug use, and avoiding competitiveness.[59]

A small percentage of yoga practitioners each year suffer physical injuries analogous to

sports injuries.[60] The practice of yoga has been cited as a cause of hyperextension or rotation of the neck, which may be a precipitating factor in cervical artery dissection.[61]

See also

References

  1. ^ Feuerstein, Georg (2006). "Yogic Meditation". In Jonathan Shear (ed.). The Experience of Meditation. St. Paul, Minnesota: Paragon House. p. 90. While not every branch or school of yoga includes meditation in its technical repertoire, most do.
  2. ^
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  6. ^ a b c Anon (13 November 2012). "What's Your Style? Explore the Types of Yoga". Yoga Journal.
  7. ^ Forbes, Bo. "Yoga Therapy in Practice: Using Integrative Yoga Therapeutics in the Treatment of Comorbid Anxiety and Depression". International Journal of Yoga. 2008: 87.
  8. ^ Singleton 2010, p. 4.
  9. ^ a b c Beirne, Geraldine (10 January 2014). "Yoga: a beginner's guide to the different styles". The Guardian. Retrieved 1 February 2019.
  10. ^ a b Mallinson & Singleton 2017, p. 108.
  11. ^ a b c Broad 2012, pp. 39 and whole book.
  12. ^ Mallinson & Singleton 2017, pp. 108–111.
  13. ^ Mallinson & Singleton 2017, pp. 359–361.
  14. ^ Mallinson & Singleton 2017, pp. 385–387.
  15. ^ Newcombe 2019, pp. 203–227, Chapter "Yoga as Therapy".
  16. ^ a b c d Jain 2015, pp. 82–83.
  17. ^ Gourley, Bernie (1 June 2014). "Book Review: Light on Yoga by BKS Iyengar". The !n(tro)verted yogi. Retrieved 20 November 2018.
  18. ^ a b Iyengar 1979, p. 302, and whole book.
  19. ^ "Contemporary Definitions of Yoga Therapy". International Association of Yoga Therapists. Retrieved 10 December 2021.
  20. ^ a b Newcombe 2019, p. 215.
  21. ^ Goldberg 2016.
  22. ^ Newcombe 2019, p. 216.
  23. ^ Newcombe 2019, p. 217.
  24. ^ Newcombe 2019, p. 221.
  25. ^ Mehta, Mehta & Mehta 1990, pp. 185–187.
  26. ^ Newcombe 2019, p. 219.
  27. ^ Newcombe 2019, p. 206.
  28. ^ Newcombe 2019, p. 189.
  29. ^ Newcombe 2019, p. 209.
  30. ^ Newcombe 2019, p. 211.
  31. ^ Newcombe 2019, pp. 212–214.
  32. ^ Newcombe 2019, pp. 222–225.
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  54. ^ "The Truth About Alternative Medical Treatments". American Cancer Society. 30 January 2019. Retrieved 4 September 2019.
  55. ^ a b "Say Yes to Yoga". American Cancer Society. 23 August 2018. Retrieved 4 September 2019.
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Sources

External links