Dr. Loren Fishman is Medical Director at Manhattan Physical Medicine and Rehabilitation in New York City, on the staff at Columbia University College of Physicians and Surgeons, and has practiced and studied yoga with BKS Iyengar since 1973. He is a pioneer in the use of yoga as therapy for a number of health conditions, including rotator cuff syndrome, lower back pain, osteoporosis, arthritis, scoliosis, and more. In this interview, he shares his insights into the use of yoga as therapy and the challenges that lie ahead for the teaching of yoga as a profession.
You have used yoga as therapy for a range of physical conditions for more than 40 years. What is the typical reaction from your patients when you introduce yoga postures as part of their treatment?
Well, when I started using yoga postures to treat patients with scoliosis and rotator cuff tears back in the 1970s and 80s, you couldn’t really say, “This is a yoga pose.” People were frightened by that.
Today, people come to me and say, “I want yoga.” They don’t want medicine. They certainly don’t want surgery, nor physical therapy; yoga is what they want. So the demand for skilled yoga therapists is growing.
Which are some of the conditions you’ve seen good results with?
I’ve seen yoga help a wide range of issues: rotator cuff tears, piriformis syndrome, scoliosis, you name it. With scoliosis, irrespective of age, in three months of doing the proper pose—provided they do it every day and the right way, we have seen 38 percent improvement. No braces, no meds, no surgery. I even have a pretty good yoga cure for the lowly bunion.
You have an ongoing study on the effects of yoga on osteoporosis?
Yes, we have been looking at the effects of yoga on bone strength in more than 450 people worldwide, measuring the effects of two years of practice. By now, we’ve heard back from 26 people, who have gone through the study for two years, and have given us their second bone density scan. For 21 of them, the second bone density has improved their bone mineral density. Four of the five others are either stable, or have lost less bone than previously. That’s quite promising.
There has been much debate about yoga injuries. Are there some people who shouldn’t be practicing yoga?
Well, in the same way that not all types of exercise are suitable for everyone, not all styles of yoga are suitable for everyone. Many people think that yoga is one size fits all. It’s not. There’s a wide range in how demanding different styles of yoga are.
If you use common sense, yoga is perfectly safe. You wouldn’t run a ten-mile marathon if you’re out of shape. In the same way, if you’re not that fit, and are new to yoga, a fast-paced Vinyasa Power Yoga class is probably not your best bet.
But, the media debate on any issue tends to exaggerate it. In fact, I’m participating in an online telesummit on Yoga Injuries: Facts and Fiction on YogaUOnline.com at the end of the month. We are a group of yoga teachers and medical experts who will do our best to set the record straight and clear up some of the confusion.
Some of the health benefits of yoga have been widely publicized, and more doctors are referring patients to try yoga for e.g. back pain. Are yoga teachers really trained to deal with such situations?
Well, someone with a preexisting medical condition who’s interested in starting yoga is better off looking for a yoga therapist or a very experienced yoga teacher, who does individual sessions and specializes in working with people with their problem. So, it’s important to seek out those experts with more specialized yoga training and learn from them. And, it’s important for yoga teachers to know what they know, and in particular, what they don’t know.
What would you say to someone who is already a yoga teacher, and is considering pursuing yoga therapy as a career path?
To those who are thinking of becoming a yoga therapist, I say this: When you’re a yoga therapist, you’re entering the medical world. The more you know about the human body and what resources are available in Medicine, the better.
Essentially, yoga can be practiced safely by anyone, as long as the practice is modified to take into account any preexisting conditions. The question is how do you do it? What is the adaptation for this person? To answer that question, you need to know the anatomy, physiology and kinesiology that are relevant to the condition. You need to do your homework.
Yoga teachers teaching general classes may have ten or 15 students coming to class, and some may be older and/or have physical limitations. How can yoga instructors, particularly those teaching people who are older than fifty, make sure that students don’t have a medical condition that could be a contraindication for some postures?
They must ask new students about pre-existing health conditions. Ask them to fill out a form, and talk to them before class. It’s usually bad business to admit more than one or two or at most three new students to your class at any given time. You’ve just got too much to take care of that way. But, if you admit one or two a week, you have a revolving roster of people that come, but you know them. One or two new ones, that’s probably enough. Ask and limit.
And then, of course, know the contraindications. If one of your clients has a hernia, then they probably shouldn’t do Locust pose because the pressure in the abdomen might pop out the hernia, which is very painful. If another has severe osteoarthritis of the knee, have them use a chair when doing Warrior III. If glaucoma is an issue, it probably isn't a sound idea to tackle Headstand.
Dr. Fishman is the author of seven books, including Yoga for Arthritis and Yoga for Osteoporosis with Ellen Saltonstall. Learn more about Dr. Fishman at his website, sciatica.org.
Join Dr. Fishman for a free online telesummit, August 25: Yoga Injuries: Facts and Fiction