YOGA AND PHYSICAL THERAPY

By Terri Sullivan DPT, OCS

Yoga can have many physiological benefits as long as it’s practiced safely, intentionally, and with proper breathing techniques. Physical therapy can also have the similar benefit to help increase ROM (range of motion), strength, and flexibility after injury to improve function. The research combining the two has been limited until more recently.

A recent systematic review revealed some studies that combined both physical therapy and yoga for treatment of joint pain along with many other medical conditions (4).  A study on knee arthritis found that Hatha yoga along with physical therapy helped improve walking pain, knee disability, knee flexion ROM, tenderness, swelling and walking time.1 Also, yoga, with it’s breathing, postures, and meditation adds mindfulness to therapy which helps to reduce pain and stiffness associated with arthritis by working on re-alignment, strengthening, and stretching around the joints (2).  In a recent study regarding the cardiorespiratory system, it was found that yoga produces physiological changes that change the pain experience: decreasing sympathetic nervous system activity, reducing inflammatory (interleukin 1, CRP, etc) and stress (cortisol) markers, increasing strength and flexibility, improving circulation and cardiorespiratory capacity (3).  In patients who have a history of stroke, those who participate in yoga have better fine motor function. In Kundalini yoga, the focus of this type of yoga practice is to increase the awareness of the body, nervous system, and mind for increased activity. This increased whole body connection practiced over several months can help improve fine motor coordination over time (5).

Incontinence is a problem for many women over the age of 40 and there are many different exercises that can be prescribed by a physical therapist. In a recent study, a group of women over the age of 40 who had stress incontinence started participating in a group yoga class, which also involved performing poses at home for 6 weeks. The women who were in the yoga therapy group had a 50% or more improvement in total and stress incontinence compared to women who only read a pamphlet on self treatment of incontinence (6).

Depression and anxiety are common in western cultures and many people take anti-depressants to help treat the condition. Many studies over the years have shown that yoga can help depression, but a recent study compared subjects who were depressed and those who were on medication and how they responded to yoga. All individuals who participated in yoga, with and without antidepressants, had a decrease in the depression score in comparison to those who had no yoga therapy and took antidepressants alone (7).

Balance, gait speed, and risk of falls are all issues for the geriatric population. In a study performed in 2014, researchers had a group of community-dwelling older adults participate in a 12 week yoga program. After 12 weeks of a bi-weekly yoga class, there was improvement in mobility, postural control, and gait speed based on the timed up and go test and the mini-BESTest, which tests balance and postural control (8.)
Contrary to using physical therapy as a primary intervention for chronic back pain, a recent randomized controlled trial compared 80 patients, males and females, half of whom performed 7 days of yoga and the other group perform physical therapy exercises for the back. The results showed that those in the week long yoga intensive had less pain, anxiety, and depression along with improved spinal mobility (9). Granted this was at a retreat and the 2 therapies were not combined, so it would be interesting to see the outcomes with both physical therapy and yoga.

Yoga may not be the activity of choice for many people, but it is helpful to know that yoga along with physical therapy can be helpful in the treatment of many physical aliments, injuries, and conditions.

1. Ebnezar J, Yogitha Bali M, John R, Gupta O. Role of integrated approach of yoga therapy in a failed post-total knee replacement of bilateral knees. International Journal of Yoga. 2014;7(2):160-164
2. Garfinkel M, Schumacher HR (2000) Jr Yoga. Rheum Dis Clin North Am 26:125-132.
3. Wren AA, Wright MA, Carson JW, Keefe FJ. Yoga for Persistent Pain: New Findings and Directions for an Ancient Practice. Pain. 2011;152(3):477-480.
4. Ravi, S. Physiotherapy and Yoga for Joint Pain Treatment: A Review. J Yoga Phys Ther 2016, 6: 234
5. Lynton, Holly, Benjamin Kligler, and Samuel Shiflett. “Yoga in stroke rehabilitation: a systematic review and results of a pilot study.” Topics in stroke rehabilitation (2014).
6. Huang, Alison J., et al. “A group-based yoga therapy intervention for urinary incontinence in women: a pilot randomized trial.” Female pelvic medicine & reconstructive surgery 20.3 (2014): 147.
7. Naveen, G. H., et al. “Positive therapeutic and neurotropic effects of yoga in depression: A comparative study.” Indian journal of psychiatry 55.7 (2013): 400.
8. Kelley KK, Aaron D, Hynds K, Machado E, Wolff M. The Effects of a Therapeutic Yoga Program on Postural Control, Mobility, and Gait Speed in Community-Dwelling Older Adults. Journal of Alternative and Complementary Medicine. 2014;20(12):949-954
9. Tekur, P., et al. “A comprehensive yoga programs improves pain, anxiety and depression in chronic low back pain patients more than exercise: an RCT.” Complementary therapies in medicine 20.3 (2012): 107-118.