EXERCISE
July 18, 2012

Yoga: Finding Your Way, Safely

Yoga has some proven benefits and unproven claims. What you can, and can't, expect it to do for you.

More major medical centers are offering non-conventional therapies to their patients. But many people may still be wondering, how effective are they?

From acupuncture to yoga, there are a wide variety of methods available and the medical conditions that drive people to seek alternative medical practices are equally varied. Research into how these practices actually work on our bodies physiologically is still in its infancy – and the findings we do have are not always conclusive.

In this final segment of our series exploring CAM or Complementary and Alternative Medicine, we consider the health benefits of yoga.

As yoga becomes more mainstream in this country – both recreationally and therapeutically – many people may wonder what the measurable benefits actually are. There are a variety of current therapies involving yoga: there’s yoga for stress, depression, addiction, weight loss, building muscle, bone maintenance, and to help cancer patients with symptoms associated with treatment, particularly pain. But what has the science actually shown to be true for yoga?

There are a variety of current therapies involving yoga: there’s yoga for stress, depression, addiction, weight loss, building muscle, bone maintenance, and to help cancer patients with symptoms associated with treatment, particularly pain.

Here we dissect some of the research studies on the practice, highlighting some of the medical benefits that one might really gain from a yoga-based therapy. We’ll also offer some pointers for finding a medical professional who specializes in complementary and alternative medicine (CAM), and for doing your own research when it comes to exploring any area of CAM – yoga, meditation, or other alternative practices. Taking part in the best-researched methods and going to professionals who are the top of their game is the best advice for getting the most out of CAM, and staying safe in the process.

Yoga to Build Bones and Heal Muscles

One of the more popular reasons for doing yoga is an athletic one: it undeniably strengthens the body. But a promising application for yoga is that it also appears to help build bone density in people at risk of or already suffering from osteoporosis. It’s known that osteoporosis and its precursor, osteopenia, can be addressed in part by engaging in weight-bearing exercises to strengthen the bone.

Working from the observation that yoga practitioners tend to live “long and fracture-free” lives, one group of researchers found that engaging in just 10 minutes of yoga per day for two years helped increase bone density in the spine and hips. People who did not engage in yoga lost bone density over this time.

Practices that address both our bodies and minds are clearly of great use when we are battling health problems that are physically and emotionally painful.

Yoga can also strengthen the shoulders, helping people recover from rotator cuff injuries. The rotator cuff includes the muscles and ligaments that connect the arm bone to the shoulder blade. Injury occurs frequently in baseball players or others who frequently raise the arm above the head. The conventional method of correcting rotator cuff injuries involves surgery to repair the muscle, which may or may not correct the problem.

Dr. Loren Fishman, MD, a specialist in rehabilitative medicine at New York-Presbyterian/Columbia has found that a variation of a yoga headstand can help alleviate rotator cuff problems by training the surrounding muscle to take over for the torn muscle. In one study, participants who were taught the headstand variation, which can be done with the assistance of a chair, had significantly better movement of the affected arm along with greatly reduced pain, both immediately after and in the six-week follow-up period.

Older patients with rotator cuff syndrome were helped considerably by learning how to do a movement called a triangular forearm support, in which one places the forearms against the wall and the hands behind the head.

In Dr. Fishman’s opinion, yoga's main value as a medical therapy is to address bone and muscle problems, such as those mentioned above. He also uses yoga to help patients recover from back pain, arthritis, and even bunions. There’s less evidence, he says, that it works on the stress response system, but he believes strongly in its ability to help treat the more mechanical problems of muscles and bones.

Yoga for Pain Management

Because the yogic tradition aims at mental resilience as well as strengthening the body, it has been studied as a way to help people in chronic pain reduce their pain by controlling their perception of it, like acupuncture. And here, the picture is encouraging:

  • A study involving a 16-week yoga session helped significantly reduce mild, chronic back pain and it reduced patients' reliance on pain medications.
  • Another study found that 12 week sessions of yoga significantly improved back function in people who suffered from chronic lower back pain, compared to people who engaged in conventional exercise programs or who were given a book on self-care.

The strengths of these types of studies is that they are randomized controlled trials, in which participants are assigned at random to take part in either the treatment group (yoga) or a control group.

  • A review study of randomized clinical trials looked at the role of yoga in addressing varieties of pain ranging from labor to osteoarthritis to irritable bowel syndrome to carpal tunnel syndrome. It found that in 9 out of the 10 studies included, yoga was associated with significantly better pain management than conventional treatments (the exception was irritable bowel syndrome pain). Since methods varied, however, as did the varieties of yoga used in the studies, the authors urge caution in the interpretation of the results and suggest that future studies continue to evaluate yoga using the gold standard that is the randomized clinical trial.
Can Yoga Improve the Body’s Biochemistry?

Fishman says he is somewhat skeptical that yoga can affect the chemicals of the body and produce changes in the biochemistry of the body. As usual, the findings present a somewhat mixed picture.

Yoga may affect the body’s inflammatory response, which, if supported by additional studies, could be used in a variety of therapeutic applications.

Yoga is often promoted as helping to balance the body, but can it help reduce the inflammation that is linked to disease states? There is some interesting evidence that it may actually reduce certain markers of inflammation in heart failure patients. After an eight-week yoga course, heart patients had significantly better physical functioning during an exercise test – and they had lower inflammatory markers like interleukin-6 (IL-6) and c-reactive protein (CRP) than participants in the standard medical care groups. The results suggest that yoga may affect the body’s inflammatory response, which, if supported by additional studies, could be used in a variety of therapeutic applications.

People often say they do yoga to reduce stress, but its role in modulating the stress response on a physiological level is unclear. One study did find that people who had practiced yoga for at least three years had lower levels of the stress hormone cortisol, and higher scores on a test of sleep quality. But this was not a randomized trial, so there could be many other lifestyle factors associated with the practice of yoga, which could affect both sleep and stress.

In the same way, another study found that when women suffering from the pain disorder fibromyalgia were assigned to take an eight-week yoga course, their pain and mindfulness scores improved, but their cortisol levels were higher at the end of the study. The authors suggest some theories for this counterintuitive finding, but the exact reason remains unclear.

The most promising applications of yoga seem to be in pain management and as a form of physical therapy for problems involving muscle and bone. Research has not painted a full picture of how and whether yoga could alter the body’s biochemistry.

Yoga can be intense exercise. Before beginning any type of exercise routine, it is a good idea to talk to your doctor about whether it’s right for you, and which type of yoga would be the best fit, since there are many varieties.

Safety Tips for Choosing A Practitioner

We’ve seen a lot of research suggesting the effectiveness of CAM for certain conditions, particularly for pain, attention, well-being, addiction, and muscle and bone health. Whichever practice you choose to try, and to whichever end, it is important to practice safely.

Stick to Reputable Institutions

Dr. Aaron Katz heads the Center for Holistic Urology at New York-Presbyterian/Columbia University Medical Center. As a CAM practitioner, his best advice for people hoping to start yoga, meditation or acupuncture is to seek out people who practice at research institutions, such as universities or medical school-affiliated hospitals. “A lot of smaller centers know that patients are interested in ‘alternative’ practices,” he says, “so they advertise that they offer these methods, but their expertise may really be lacking.”

Don’t be drawn in by enticing advertising: Spend some time on the institutions’ websites to learn about which researchers are involved and the type of research they’re doing. Sticking with academic centers or those that have a long history of offering complementary or integrative medicine will give you the best odds of finding a skilled practitioner with high-quality medical and research expertise.

Look for Practitioners with Plaques
Another rule of thumb is to verify that your expert is really an expert. Dr. Allan Magaziner, who has a private integrative health care practice in New Jersey, advises patients to check the credentials of their prospective practitioners. If you’re trying acupuncture, make sure your acupuncturist is certified, uses aseptic techniques, and has a clean office environment. With yoga and meditation, the distinction is a little less clear-cut.

Spend some time on the institutions’ websites to learn about which researchers are involved and the type of research they’re doing. Sticking with academic centers or those that have a long history of offering complementary or integrative medicine will give you the best odds of finding a skilled practitioner with high-quality medical and research expertise.

If you are trying yoga or meditation to address a specific health or mental health problem, go to a doctor, nurse practitioner, or teacher who specializes in your particular ailment or interest. If you’re interested in more involved or clinical areas of integrative medicine, says Dr. Magaziner, “make sure you go with an MD, OD [osteopathic doctor], or NMD [naturopathic medical doctor],” who have four-year degrees from accredited universities. If they are certified in an alternative practice, make sure the certification is up-to-date. “You don’t want a doctor who got credentialed 20 years ago and hasn’t been to a convention or kept up with his education since then.” Be sure to ask the doctor to explain how he stays abreast of the research and new techniques involved with his practice.

Do Your Own Research
Dr. Fishman, who first studied yoga in India and later went to medical school to figure out what it was really doing in the body, emphasized that it is important to become educated. “Look at the studies and look at what’s in phase III clinical trials,” which are randomized controlled trials often involving larger pools of participants. It is also important to “request techniques that are supported by major medical associations,” Fishman continues. “For example, the American College of Physicians recommends yoga for management of certain conditions.” Much of the research is available free to the public, so don’t be afraid to dig in and look at the research itself – or at the research institution’s press releases, which can be easier to digest. The NCCAM website is also a great resource for an objective look at the findings of the studies, including positive and negative results.

Conclusion: Integrative Medicine Has Undeniable Strengths

The research is still presenting a complicated picture for CAM, but researchers are making good headway in trying to sort out myths from facts. It is important to think about each method distinctly, and determine what each can and can’t be used for. As Dr. Briggs, the director of NCCAM, points out, “We shouldn’t lump all alternative practices together. Some are being integrated are because of the recognition of promise; on the other hand, a lot of things being marketed on internet in which there is no scientific basis.” She adds that “what we’re seeing is active public and research interest in certain area that look promising – in cancer centers, hospice, and in emotional support for patients.”

'We shouldn’t lump all alternative practices together. Some are being integrated are because of the recognition of promise; on the other hand, a lot of things being marketed on internet in which there is no scientific basis.'

And this – emotional or psychological support – is where CAM really flexes its muscle. Some patients may become frustrated with conventional medicine for not offering enough support during tough times. Practices that address both our bodies and minds are clearly of great use when we are battling health problems that are physically and emotionally painful.

While more research is being done, it’s probably best to be cautious but curious, since there is value in both conventional and alternative methods. As Dr. Katz says, “these practices can help people heal, but we must integrate them. They might be used instead of conventional treatments in some cases, and in others, they can delay the need for more invasive methods.” If you have questions about using alternative practices, it’s always best to speak to your health care provider before trying anything new.

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