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REVIEW
Yoga and Physiotherapy: A Speculative Review and
Conceptual Synthesis
Paul Posadzki1 and Sheetal Parekh2
ABSTRACT This article presents the potential integration of yoga and physiotherapy when considering
the essence of their underlying concepts. Within the scope of this article the existence of several similarities
between these two 'concepts' has been suggested. Researchers, physiotherapists and their patients as
well as yoga practitioners can obtain valuable and additional arguments through the cross-fertilization of
ideas across presented studies united by shared, underlying concepts. The practice of yoga is based on
the following assumptions: complexity and multidimensionality, various positive influences on an individual's
wholeness through the mind, body, and the relationships between them. These assumptions may have the
potential to contribute towards the practice of physiotherapy and its underlying principles. The essence of
physiotherapy as a multifaceted process requires teamwork and efforts of various specialists like psychologists,
sociologists, occupational therapists and nurses if patients are to benefit. Ideally, the physiotherapist should
possess knowledge from these areas of science in order to professionally care about patients. Therefore, it
can be suggested that basic similarities exist between yoga and physiotherapy in terms of mutidisciplinarity
and complexity of holistic care. Such conceptual enrichment may be a useful source of inspiration for
physiotherapists concerned about their patients' overall health on a daily basis. The authors emphasize the
usefulness of yoga practice in clinical units and explain how the essence of Ayurvedic knowledge might be
extrapolated and incorporated into theoretical principles of physiotherapy process. The justification of the studies
included is also presented.
KEY WORDS yoga, physiotherapy, review, concept formation
Yoga, as adjunctive therapy and a way of In this review, the authors' aim is to present
promoting and maintaining wellness, offers an the results from various researches on yoga and
excellent example of the mind-body connection (1). combine them with the core, theoretical component
It has been suggested that yoga has diverse of physiotherapeutic processes. The rationale for
clinical and non-clinical applications in the this combination is that yoga's philosophy and
physiotherapeutic process. This is mainly attributed physical exercises (asanas) share a number of
to the degree of complexity and multidimensionality basic underlying principles of the physiotherapeutic
of influences that is apparent in both yoga exercises process. The principles of yoga resonate with the
and physiotherapy as continuous processes. principles of the physiotherapeutic process as in their
The similarities between yoga and physiotherapy holistic approach towards health and well-being of
on the conceptual level include physiological, an individual. Therefore, the aim of this study is to
psychological, spiritual, social and educational present yoga's potential role in terms of the whole
dimensions of human health (2) . Yoga exercises physiotherapeutic process. The theoretical cross-
combined with physiotherapeutic processes, both fertilization of their mutual assumptions would lead
in clinical and non-clinical settings, can affect to various benefits in terms of the patient mind-body
various body structures and systems such as the relationship and general wellness. Consequently, this
musculoskeletal, nervous, visceral, endocrine would imply the possible integration of yoga with the
and immune system. This would be beneficial for physiotherapeutic process at the conceptual level.
patients with neurological, orthopedic, metabolic
and psychosomatic disorders. Nevertheless, the 1. School of Medicine, Health Policy and Practice, University of
main strength of this form of activity is that all the East Anglia, Norwich NR4 7TJ, UK; 2. School of Allied Health
Professions, University of East Anglia, Norwich NR4 7TJ, UK
body's dimensions (i.e. cells, tissues, organs) can Correspondence to: Dr. Paul Posadzki, Tel: 44-01603591223,
be influenced simultaneously within one entire E-mail: P.Posadzki@uea.ac.uk
system. DOI: 10.1007/s11655-009-0066-0
Chin J Integr Med 2009 Feb;15(1):66-72 • 67 •
It can be suggested that physiotherapists could The authors hypothesize that during yoga
utilise yoga to facilitate the recovery processes among exercises the same psychological and spiritual
stroke patients and improve their function. resources are utilized by practitioners as used by
physiotherapists in order to improve the patients'
Benefits of Yoga: Psychological and Spiritual return to function. If verified, this hypothesis may be
Wellness a useful adjunct both to patients intended to develop
Yoga asanas have shown significant reduction in their psychological or spiritual features as well as
the symptoms of anxiety and depression(27-31). They can to physiotherapists who might consider expanding
also decrease oxidative stress(32) and relieve tensions their holistic approach as therapists using yoga's
leading to better relaxation and concentration (33-35). This essence. Furthermore, physiotherapist, osteopaths,
may be partially explained by the work of Shannahoff- chiropractors or manual therapists could consider
Khalsa, who demonstrated that yoga asanas increase yoga as a way of "mental mobilization" insofar as the
dopamine and serotonin and decrease cortisol individual performs postures that comprise elements
secretion(3,36). of enhanced self-efficacy, self-development or positive
mind states such as optimism.
Studies on the effects of yoga on cognitive
functions have shown improvements in memory and Benefits of Yoga: Musculoskeletal
vigilance levels(37). Yoga techniques were found to be Improvements and Posture Control
effective in treating obsessive-compulsive disorder, Some publications imply that yoga exercises can
phobias, major depressive disorders, dyslexia, grief, influence the musculoskeletal and nervous systems
insomnia and other sleep disorders (3) and post- via mobilization or auto-mobilization of both joints
traumatic stress disorder (PTSD)(38). Yoga can also and nerves respectively (44,45). For example, one of
improve fear management through its soothing McKenzie's static procedures and the "Cobra" asana
effects in controlling anger and assisting effects in are almost the equivalent and can directly lead to
coping mental challenges by helping patients to alleviation of pain symptoms of low back and cervical
turn negative thoughts into positive ones as well as pain(46). This could suggest direct similarities between
facilitating rehabilitation of patients prone to anti-social these two approaches and the congruence of their
behaviours (39). Yoga offers a new route to positive essence. From the physiotherapeutic perspective,
mental health and helps to free individuals from somatic dysfunction can be released and flexibility
drug dependency (addictive and substance abuse and range of movement improved. With regards to
disorders) (12) and its associated problems (40). Yoga physiotherapeutic processes, yoga as a set of "static-
techniques can enhance well-being, mood, mental dynamic procedures" can be considered as a means
focus, and stress tolerance(39,41), promote personal to "self-mobilisation" of the nervous system and the
development by encouraging individual initiative and joints, spine and limbs. Other research supports
self-belief and help to bring about improvements this point of view, having demonstrated that patient
in attitude and health behaviour. Yoga asanas are conditions improved considerably after six months
observed by many as an open door to self-realization of yoga practice, with some markers of incorrect
and creation of the perfect union of the mind, body, posture completely disappearing such as head
and spirit. The results indicate a statistically significant protrusion, asymmetry of the shoulders, mamillas
improvement in various parameters such as better and hips, shortening of the musculus pectoralis and
sense of well being, self confidence, improved back extensors(16). Findings from another exploratory
effectiveness, better interpersonal relationship, study suggest that yoga practice may improve hip
increased attentiveness, lowered irritability levels and extension, increase stride length and decrease
an optimistic outlook in life as some of the beneficial anterior pelvic tilt, and that yoga programs tailored
effects enjoyed by the yoga practitioners indicated to individual needs may offer a cost-effective means
by feedback score (28). Significant improvements in of preventing or reducing age-related changes in
perceived self-efficacy may also improve coping and these indices of gait function (47). Physiotherapists
stress management among yoga practitioners (42). specialized in orthopedic manual therapy might be
Significant improvements in quality of life (QOL) particularly interested in the beneficial effects of yoga
scores are also observed(43). exercises on the musculoskeletal system(48), scoliosis
Chin J Integr Med 2009 Feb;15(1):66-72 • 69 •
precise, for example, pranic breathing patterns Physiotherapists may therefore consider that
might be useful for various groups of compromised asanas enfold the core of their normal therapeutic
patients, specifically those with cardio-pulmonary management affecting patients' physiological,
disturbances. Yoga's philosophical background is psychological and spiritual well-being by the use of
rooted in knowledge that has been accumulating tranquilizing effects on joint mobilization and pain
over several millennia and offers a route to spiritual reduction, increased sense of serenity and heightened
development for patients after serious injury-for awareness, respectively. As a result of this conceptual
example, with tetraplegia. Improved muscle strength synthesis, physiotherapists may also achieve an
may also be beneficial in orthopaedic patients who awareness of yoga's complex and multidimensional
have immobilised limb(s). It can also be suggested benefits on patient's overall health, leading to the
that yoga's "popularity" may bring positive effects on incorporation of some asanas into their regular
patient's willingness to exercise, especially among the practice. Specifically, instead of separately performing
elderly. relaxation exercises, facilitating breathing patterns
and practicing meditation in order to mobilize joints
The underlying principles of both yoga and and normalize blood pressure and central nervous
physiotherapy suggest that these are complex and system functions. Yoga offers a way of combining
continuous, covering spiritual, mental, physiological and these modalities.
social dimensions of health, well being and quality of an
individual's life. Therefore, the essential value of yoga Changes in the academic curriculum of
exercises, with their multidimensional influence and physiotherapy might be implemented and yoga
"interdisciplinary" approach to human unity and integrity courses should also be made available to students.
should be particularly useful in physiotherapy practice Physiotherapy students may consider personal and
on a routine basis. Subsequently, physiotherapists professional development by combining their current
may understand that yoga's philosophy or underlying knowledge with yoga's application in their ways of
principles can be a useful adjunct to their normal approaching patients.
therapeutic management. It may lead to their patients'
overall health and well-being as their physical, mental, Yoga exercises can also be a useful method for
spiritual and social well-being may be affected therapists who are potentially vulnerable to overload
simultaneously, i.e. holistically. Yoga exercises can their musculoskeletal system after continuous hours
be also regarded as an effective "psychological of workouts with their patients. Yoga asanas may
rehabilitation" by improving patients' emotional well- be regarded as a form of preventive medicine within
being, cognitive functions, motivational patterns and healthcare environments and society.
engagement in the recovery process.
All the same, a physiotherapist must be aware
Implications for Practice that yoga exercises bring benefits to overall health
If these similarities exist between yoga and only when performed correctly and should therefore,
physiotherapy, then there are several key issues that approach each patient individually with respect to
need to be addressed. Firstly, from a pragmatic point his or her learning abilities and resources. Potential
of view, the incorporation of yoga may be applicable and specific indications and contraindications of yoga
to clinical practice and the home, where patients applications must be also taken into account.
are instructed to perform special kinds of physical
FUTURES RESEARCH
activity to sustain the health effects obtained with their
physiotherapist. Secondly, from the psychological Future research should include potential patient
perspective yoga may also make the physiotherapeutic benefits, physiotherapists' satisfaction as well as
processes more attractive to patients, especially those cost-effectiveness of extrapolating the principles of
with low motivation, by enhancing their willingness yoga into clinical practice. Since yoga exercises have
to participate more actively in the recovery process. multidimensional effects in terms of recovery from
Thirdly, from the therapist's point of view, yoga may traumatic injuries, future research could also cover
be an effective modality in terms of work ergonomics the complexity of yoga influences on general health
and prevention of overloading their bodies. and the uniqueness of yoga's approach to each
Chin J Integr Med 2009 Feb;15(1):66-72 • 71 •
patient as a unified psycho-spiritual and physiological practice on autonomic and respiratory variables. Indian J
wholeness. Physiol Pharmacol 2003;47:34-42.
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