Yoga in Healthcare
By Mandy Lubas, OTR/L, RYT
Originally published on ADVANCE Magazine on March 19, 2013
[Editor’s note: This column is part II in a two-part series on yoga. Part I provided an overview of the healing priniciples of yoga and explored the author’s personal experience with yoga; called “Yoga: A Catalyst for Health & Well-Being”]
According to an article in the American Psychological Association’s publication Monitor on Psychology in Nov. 2009, “With a growing body of research supporting yoga’s mental health benefits, psychologists are weaving the practice into their work with clients.” The article references research showing that yoga targets unmanaged stress, a main component of chronic disorders such as anxiety, depression, obesity, diabetes and insomnia. It does this by reducing the stress response, which includes the activity of the sympathetic nervous system and the levels of the stress hormone cortisol. The practice of yoga enhances resilience and improves mind-body awareness, which can help people adjust their behaviors based on the feelings they’re experiencing in their bodies.
“No doctor since the beginning of time has ever cured a patient and no doctor ever will, for Nature can cure. Nature performs the miracles; doctors need only teach their patients how to tap into Nature’s wonder working. Doctors should use what they can learn of a patient’s past illnesses and present conditions to intuit future possibilities for health and establish healing strategies,” writes Dr. Robert E. Svoboda in his book, Prakriti: Your Ayurvedic Constitution.
This concept is so powerful; as a holistic occupational therapist I am only a conduit for those I teach and treat.
Health, Well-Being, and Occupational Therapy: How to Incorporate Yoga into Occupational Therapy
Occupational therapy assists people in performing everyday functions so they can be involved in meaningful occupations. It is a holistic system that facilitates healing on many levels and encompasses schools of thought from psychology, anthropology, and medicine. The ancient system of yoga guides an individual through enhanced physical, mental, emotional, and spiritual well-being through the eight limbs, or stages. Therefore, both disciplines combined create a dynamic state of well-being to maximize overall health, especially mental clarity.
After my full year of yoga training in 2011-2012, I quickly started to generalize all of the yoga principles that I have studied into the majority of my occupational therapy treatment sessions. I rapidly learned that yoga and occupational therapy are very similar in their concepts and methodologies. While yoga has an emphasis on activating the parasympathetic nervous system, occupational therapy encompasses goals and objectives toward functional independence, or living one’s life purpose. Both sciences accentuate the use of mind, body, and spirit in daily life in order to function in this “conditioned” world with a new perception while being in a calmer state.
Becoming a certified yoga instructor has enhanced my knowledge in areas that I didn’t know existed. Receiving the education I did in just a year has been invaluable and is something I could never have received in occupational therapy school. My patients and clients are reaping the benefits and soaring to their fullest potential.
As an occupational therapy practitioner I’ve combined the eight limbs of yoga in my daily treatment sessions with my clients/patients of all ages. However, in this article I will only address yoga asana and pranayama. With my yoga mindset I am able to address the whole person as I would in any occupational therapy treatment; however the difference is that by being a certified yoga teacher I’m able to add modalities and techniques to create balance and stillness in my client/patient’s life. I use my yoga background to incorporate yoga asana and deep breathing to balance out the nadis (energy centers in the body) to elicit a parasympathetic response.
Asana, or posture, is the third limb of yoga. “Asana brings steadiness, health, and lightness of limb. A steady and pleasant posture produces mental equilibrium and prevents fickleness of mind,” writes B.K.S. Iyengar in Light on Yoga. When working with a patient or client it is important to structurally assess their body mechanics and ask appropriate questions to obtain medical information (i.e. injuries, discomfort, sensory defensiveness, etc.) to avoid injuryor initiate a flight/fright response.
I incorporate yoga asana during therapy either at the beginning or the end of a treatment session, depending on the individual patient’s particular plan of care. If I’m working with a child who has tactile defensiveness and is anxious, I combine poses that are grounding and allow the crown of their heads to drop below their hearts in order to activate the parasympathetic nervous system. In addition, weighted blankets or weighted sand bags are used when the child is in a seated pose to provide proprioceptive input to the lower extremities. This increases body awareness along with providing greater freedom in the axial skeleton to lengthen the spine. Using yoga at the beginning of a treatment session prepares the child’s body for sensory challenges and visual-perceptual, fine-motor, or visual-motor activities.
When working with adults who have cognitive impairments secondary to executive functioning disorders (i.e. ADHD, learning disability, aAnxiety D/O, etc.) and traumatic brain injuries, I incorporate restorative poses to decrease anxiety, improve attention, provide overall nourishment to the body, and facilitate rest and rejuvenation. Restorative poses help to settle the mind and relax the body, allowing a patient or client to work on cognitive-behavioral retraining approaches with ease to improve occupational performance.
The fourth limb of yoga is pranayama, which simply means extension of breath and control. “Prana” means breath and “ayama” means length, expansion, stretching or restraint. This control is over all functions of breathing.
At the beginning of each occupational therapy session the majority of my patients/clients will participate in a centering activity while sitting upright on a bolster or while supine on an acupressure mat to take part in breath work. During breath work, affirmations are read aloud with the intention of holding a client or patient in the present moment, allowing them to surrender (“Swaha!”) to what may be keeping them out of the present moment. Chanting is the rhythmic singing or speaking of words or sounds as a way to focus the mind and control the breath.
The wide scope of populations I treat have participated in chanting for the benefits of adjusting the chemical composition of their internal states and regulating brain-hemisphere imbalances that contribute to fears and worries. By combining sound, breath, and rhythm channels, the flow of energy through the mind-body circuit is activated. By balancing the nervous system, chanting regulates the chronic stress and tension for many people in today’s overstimulated and multitasking lifestyle. By balancing the endocrine system, chanting normalizes hormone production, which balances our moods and overall sense of well-being.
Having the mindset of a yogi combined with my medical background as an occupational therapist has allowed me to think out of the box to set-up a treatment plan. The facilities in which I work are open-minded, allowing me to combine yoga philosophy into my scope of practice. Families have been following through with all home programs, as the techniques and modalities that have been introduced are new and exciting! A child’s pose, restorative pose, breath work, and a good night chant would allow anyone to want to catch their REM sleep!
If we can facilitate our clients to select the right experiences in their lives they can actually start to perceive their lives differently, their minds can be reprogrammed from old habits, tendencies, and worries. A new bodily intellect will start to rise to the surface and signs of healing will manifest. Each positive thought creates a healing molecule and cell which may alter a disease.
When the mind is able view the world differently, true healing takes place because we go beyond our conditioned states and connect to the fullness of who we truly are, rather than our worries, insecurities, traumas, and dramas. Assisting a client in reshaping and changing their attention of mind will change how they perceive the outside world. When the mind is focused on a thought, it lessens the heightened sensory experience where we can be still and just know.
Becoming a Yoga Instructor
You may desire to become a yoga teacher or want to explore ways to enhance your knowledge to incorporate yoga into your “tool box” as an occupational therapist. There are some questions to ponder which can be found on the Yoga Alliance Website at http://www.yogaalliance.org/ya/m/Becoming_a_Teacher.aspx. As an occupational therapist you can use yoga within your treatment sessions; however, to treat your clients and patients using the eight limbs of yoga, extensive learning and certifications are required. When choosing a school, it is important to reflect on your personal yoga experience and educational needs. Knowing this ahead of time will support your individual educational process, professional training, and personal practice.
The Yoga Alliance (YA) was formed in 1999 and has established a national Yoga Teachers’ Registry to recognize and promote teachers with training that meets YA minimum standards. Teachers who meet these standards are eligible to register as Registered Yoga Teachers (RYTs). In conjunction with enhanced and revised standards for registration, YA began recognizing and registering teachers with significant teaching experience in addition to training in 2005. These teachers can register as Experienced Registered Yoga Teachers (E-RYTs).
YA also maintains a Registry of Yoga Schools to recognize yoga teacher training programs that meet the YA’s 200-hour and 500-hour standards. A school whose curriculum satisfies or exceeds the minimum training standards may apply to register as a Registered Yoga School (RYS). Once a school is registered, all graduates of a RYS are automatically eligible to register with YA as RYTs. More information can be found at www.yogaalliance.org.
To connect with other OTs interested in and practicing holistic approaches and to learn more, join us once a month for our holistic OT phone conversation. Ask to join the e-mail list at firstname.lastname@example.org to receive updates on Holistic OT. Please ‘like’ our Holistic Occupational Therapy Facebook Page and join the conversation on-line at the Holistic Occupational Therapy Group page on Facebook. We look forward to connecting with you!
Mandy Lubas, OTR/L, RYT, has been in the field of medicine for 11 years working with pediatric, adult and geriatric populations. She is certified in sensory integration and as a beginner yoga teacher. Her training has involved biodynamic craniosacral therapy, sound therapies and nutrition. She works at Braintree Rehabilitation in Lynnfield, MA, and works as a consultant for a private school. She can be reached at email@example.com or www.beyoga4life.com.
Iyengar, B.K.S. (1979). Light on Yoga. New York, NY: Schocken Books
Svoboda, Dr. Robert E. (2003). Prakriti Your Ayurvedic Constitution.Twin Lakes, WI: Lotus Press
Novotny, A. “Yoga as a practice tool.” Monitor on Psychology.Vol. 40, No. 10. Nov. 2009. Retrieved from American Psychological Association: http://www.apa.org/monitor/2009/11/yoga.aspx