Yoga Goes to the Doctor?
By Felicia M.Tomasko
You are sitting across from your doctor’s desk, after yet another sleepless night. No matter how much you tossed and turned, you couldn’t seem to get comfortable. Your low back pain just wasn’t eased by the painkillers or heating pad, and the racing thoughts from your stressful day at work wouldn’t slow down so you could enter dreamland. Just when you thought he might offer you a sleeping pill this doctor writes a prescription for yoga. Yoga?
First there is the Law of Divine Compensation, which purports that no matter what the darkness, God's light is larger. Yet where is the light within such a horrible tragedy as a tidal wave killing over a hundred thousand people? That light emerges from the incredible outpour of love that followed.
As yoga spills out of the studio and the health club into the medical facility, people who are not necessarily looking for enlightenment, but whose health is compromised, who are struggling with chronic illnesses, or unable to complete a standard class are taking up yoga. They are in search of improved health, better physical or musculoskeletal control and an increased sense of well being.
It is becoming increasingly common for a physician or primary health provider to write out a prescription that includes a directive to take up yoga. Even providers who have never flowed through a sun salutation or pressed up into a downward facing dog are scribbling “yoga” on prescription pads.
Doctors in a wide range of settings suggest yoga. In San Diego, family physician and regional physician coordinator for preventative care and health promotion at Kaiser Permanente, Dr. Albert Rey, prescribes yoga for conditions ranging from headaches, musculoskeletal disorders, asthma, heart disease, high blood pressure, stress, anxiety, mood disorders, depression, and just about anything else that he thinks will help people benefit from learning how to be in touch with their body.
Los Angeles yoga therapist Larry Payne, PhD, alone receives referrals from more than 100 area doctors. Throughout the country, in fact, people who call themselves “yoga therapists” are busy seeing people in hospitals, physical therapy clinics, doctor’s offices and various types of medical centers.
The Yoga Therapist
Who is this person your doctor is sending you to see? University degrees comparable to degrees in physical therapy or psychology, for example, just don’t exist. Yet, yoga therapy is emerging as a specialty within yoga, and western medicine seems to be embracing it.
As would be expected, because there are no educational standards or licensing requirements, yoga therapists have varied backgrounds and train in a range of programs with different approaches. Some are yoga teachers with years or even decades of experience adapting yoga. Others are medical professionals who have studied yoga in a program that focuses on training yoga teachers and health professionals in the fundamentals of adapting yoga for people with health conditions, as a method of self-inquiry and self-discovery, and as an adjunct to promoting health and wellness.
The programs vary too. Some instruct teachers and medical professionals how to teach students with heart disease or other chronic illnesses, like Nischala Joy Devi’s Yoga of the Heart program. There are focused therapeutic trainings like Integrative Yoga Therapy. Phoenix Rising emphasizes self-inquiry while the practitioner leads the student though a supported practice. Ashram-based programs like those at Kripalu and Satchidananda Ashram Yogaville have participants working with a number of teachers and methodologies. Then there are the extended training programs of study under the mentorship of well known yoga teachers like yoga therapist Gary Kraftsow, Mukunda Stiles, the Desikachars or Larry Payne.
The graduates of these yoga therapy programs - or teachers with extensive therapeutic experience - teach specialized and general classes in a host of medical environments. These yoga therapists can be found in hospitals, clinics, medical schools, colleges, cancer centers and doctor’s offices. Or they may teach adaptive classes at yoga studios. And, some simply hang a shingle for their own private yoga therapy practice.
As a profession, yoga therapy is clearly still emerging. Formulating a set of agreed-upon education standards is only at the beginning stages. The International Association of Yoga Therapists is spearheading an effort to create a definition for the practice and set training standards for the training of yoga therapists. Since there is no current central certification, licensing board, or regulating body and the holistic nature of yoga does not lend itself well to these definitions, we should be diligent in asking for credentials.
Your yoga therapist may be a medical professional who combines the art and science of yoga with their other training and experience. Los Angeles yoga therapist Jamie Shaw is not only a master degreed physical therapist with years of experience, she also studied yoga at Kripalu. Many of the people she sees on a one-on-one basis need more individual attention than they can receive in a class because they may have back pain, or even acute injuries or chronic medical illnesses.
You may also come across someone like Los Angeles teacher Phyllis Solomon, an art therapist who completed the Phoenix Rising training. Then there’s experience with trainings completed at Yogaville in Yoga for the Special Child and Phoenix Rising.
An integrative physical therapy office is another place to look for yoga therapy. One example is Dynamic System Rehabilitation, in Scottsdale, Arizona where physical therapist Matt Taylor practices what he labels integrative or mindful physical therapy. Rather than applying the five magic asanas (yoga poses) to cure carpal tunnel syndrome, Taylor states that through using the principles of yoga, “we are able to start to address people’s complex conditions.”
Many local hospitals have been offering yoga for quite a while (whether it’s yoga therapy, or not, is another question, one which will only be answered when the definition of and standards for yoga therapy have been determined). One hospital-based integrative medical facility that includes yoga is the California Pacific Medical Center’s Institute for Health and Healing in San Francisco. According to Medical Director Dr. William Stewart, the center offers individual yoga sessions and group classes for general health, people with cancer, HIV/AIDS, chronic illness, and yoga for seniors. Dr. Stewart states that the yoga offered is not used as a treatment for a specific disease, but as a wisdom practice focused on participants enhancing their overall well-being. The UCSF Osher Center for Integrative Medicine in San Francisco features therapeutically-based classes for people with cancer, classes that focus on stress reduction and individual sessions.
Throughout Southern California yoga is quite visible in the medical community. In Los Angeles, Cedars-Sinai Medical Center offers a hatha yoga class for people with cardiac disease. Vivian Richmond has been teaching classes to people with cancer for four years at the cancer center at the USC Norris Hospital. At Santa Barbara Cancer Center, a therapeutic yoga program for people with cancer has been in place for five years.
Yoga therapy is off the mat, in a bed and perhaps even at the threshold of a hospital operating room. If you’re in for surgery, you may encounter someone like registered nurse Deborah Matza. Matza uses yoga in assisting women with breast cancer to prepare for surgery. She uses restorative yoga poses, hands-on touch therapy, guided relaxation and imagery at Beth Israel and at the Roosevelt campus of St Luke’s-Roosevelt Hospitals in New York City.
Doctor Knows Best?
You may be thinking “does my doctor even know anything about yoga? How will they know that yoga could possibly help my insomnia, stress, backache?”
Evidence (and reimbursement) drives medical practice. The highly publicized studies done by Dr. Dean Ornish investigating the efficacy of lifestyle programs that included yoga-based stress reduction techniques thrust the therapeutic applications of yoga into the public eye. Expanding research projects are continuing in the therapeutic potential of yoga. For example, yoga therapist and teacher Gary Kraftsow is involved in research conducted at Harvard, in Seattle and at the University of Colorado.
Medical schools nationwide are teaching yoga. Payne initially taught the country’s first yoga class to medical students at UCLA more than four years ago. In UCLA’s newly integrated curriculum, yoga is even more deeply incorporated. Professor of Psychiatry Dr. Margaret Stuber explains three curricular areas that include yoga. First and second year students choose an experiential selective, or required elective; choices include meditation, yoga and integrative East/West medicine. Yogic techniques of stress reduction, mind/body medicine and meditation are incorporated into students’ study of the cardiovascular system, psychiatry, neuroscience and neurology. Summer research electives are also available to medical students to assist in yoga research.
Other universities provide yoga education in their medical health departments. At Metropolitan State University in Denver, Colorado, Patricia Hansen teaches a course in Yoga Therapy and Ayurveda. Registered nurses, physician assistants and other health professions attend the class which doesn’t qualify them to be practitioners, but introduces them to the philosophical tradition and experiential practice. Therefore, it is possible that the person sitting across the desk from you may have more than just a passing knowledge of yoga.
Who Pays the Bills?
Most likely, you will be writing your own check for your therapeutic yoga class or individual session, even if your doctor writes a prescription, although there are some exceptions. If you are referred to a physical therapist like Taylor, or visit an office where the doctor or physical therapist has a yoga therapist on staff, your sessions may fall under a physical therapy insurance code and receive coverage.
If you are eligible for workmen’s compensation, you may be referred to yoga. Ammidown and Payne have both received reimbursement through workmen’s compensation for providing yoga therapy sessions prescribed by a physician. You may also be able to reimburse yourself for prescription pad yoga, through individual health savings or flexible spending accounts.
This may someday change, as Medicare is currently reviewing the evidence for Dr. Dean Ornish’s Lifestyle program for the reversal of heart disease. So far, expert panels have determined that the program is worth reviewing. Dr. Ornish states, this “encompasses any program with scientific evidence that it affects coronary heart disease.” And if Medicare decides to cover the program, other insurance companies are likely to follow their lead. A primary determinant of medical practice and education in medicine is not only science, but reimbursement, too, states Dr. Ornish.
The new term “Yoga Therapy” seems to be appearing with increasing frequency, and you may not be the only one with this type of prescription. As you gaze at yours, it is important to remember yoga therapy is not a medical system in itself. Both medical professionals and yoga specialists caution against a reductionistic approach that identifies specific asanas or practices as “cures” for your insomnia or back pain. If you decide to fill that prescription, the approach taken will be individual, examining the causes of your condition and providing techniques that work with the entirety of your physical, mental and spiritual condition. Yoga is an individual practice and the exact nature of your therapeutic yoga is based on your own unique situation. Yoga, after all, is our own individual transformation, whether it’s called yoga therapy or just plain old yoga.
Felicia M. Tomasko is a writer, yoga teacher, and Ayurvedic practictioner in Santa Barbara. FeliciaTomasko@yahoo.com