Could Yoga Help You Get Better?

Hatha Yoga as a Therapeutic Approach

Timothy B. McCall, M.D.

Seventeen years ago, Jo Zukovich of San Diego developed carpal tunnel syndrome (CTS), a neurological condition affecting the hands. It started with numbness and tingling in the fingers of both hands at night. When Zukovich carried her young child, the way she bent her wrist caused similar numbness in whichever hand she used.

At the time, Zukovich was working as a weaver, spending hours every day leaning over a big floor loom to make fabrics that were later turned into fashionable women’s clothes. Describing the sideways wrist action she employed to throw the shuttle across the 36 inch width of the loom, she says it was "the same movement, over and over and over again."

This kind of repeated motion is commonly seen in patients with CTS and other forms of so-called "repetitive strain injury." CTS--in which narrowing of the tunnel formed by bones and ligaments in the wrist compresses the median nerve to the hand--has become a near epidemic among computer users.

Zukovich consulted her family doctor who told her she would have to stop weaving. He gave her wrist splints to wear at night which brought some relief. Still the problem persisted.

Yoga to the Rescue

Zukovich mentioned her condition to her yoga teacher, Mary Dunn. Dunn, who now teaches at the Iyengar Yoga Institute in New York City, suggested that she try various yoga postures to see if they would help. She also suggested that Zukovich temporarily give up weaving.

While the medical profession tends to view carpal tunnel syndrome as primarily a problem involving the wrists, Dunn believes the situation is more complex. "Posture has a huge impact on this condition," she says. "It’s not just the position of the wrists. It’s the position of the head on the shoulders, whether the chest is sunken, how tense the person is."

"Concentration doesn’t have to include tension," Dunn says, "but for many people it does." As an example of unnecessary strain, she cites people hunching their shoulders and leaning forward while working on a computer. Yoga, she believes, helps people learn that they can concentrate while being relaxed and aware of their bodies.

With a little more than six months of regular practice, Zukovich’s symptoms went away entirely. She went back to full time weaving without problems--though she did modify her routine. Instead of working continuously for hours, she started to take breaks and to even do a few yoga stretches between sessions at the loom.

The JAMA Article

While Zukovich’s story may be interesting, most doctors would dismiss it as nothing more than anecdotal evidence. They want to see scientific studies that prove a therapy works before recommending it to patients. The first evidence came in a 1998 article in the Journal of the American Medical Association (JAMA).

In a randomized trial of 42 patients, conducted at the Medical College of Pennsylvania, half of the patients took part in an 8 week program of Iyengar yoga while the control group received wrist splints. The subjects in the yoga group practiced 11 yoga postures designed to strengthen and stretch each joint in the upper body along with a yoga relaxation technique (described below). After the intervention, the people who had done yoga had less pain and a significant improvement in grip strength. While the group studied was small and a longer-range study might be more revealing, the results were encouraging.

Marian S. Garfinkel, EdD, the study’s lead author and a senior teacher of the Iyengar method of yoga, stresses that the postures must be done "with care and precision" if the students are to achieve maximum benefit. She recommends that anyone contemplating using yoga for carpal tunnel consult an experienced teacher trained in the Iyengar method.

Other Therapeutic Uses For Yoga

Another area where yoga may be of benefit is in treating arthritis. In fact, Garfinkel’s doctoral dissertation, later published in the Journal of Rheumatology, was a small randomized controlled study of patients with garden-variety degenerative arthritis (osteoarthritis) of the hands. She found that a program of Iyengar yoga and relaxation resulted in reduced pain, increased grip strength and less bony deformation of the knuckles (known medically as Heberden’s nodes). Once again, these results seem promising but Garfinkel cautions that further studies are needed to compare yoga with other treatments and to examine long-term effects.

Perhaps one of the best known examples of yoga therapy is Dr. Dean Ornish’s work on heart disease prevention. He found that a program that included Integral style hatha yoga, along with a low-fat diet, smoking cessation and aerobic exercise, resulted in a reduction in LDL "bad" cholesterol, less chest pain and a shrinkage in the fatty deposits in the coronary arteries that can lead to heart attacks. While it’s impossible to say from his studies how big a contribution yoga played in the patients’ improvement, Ornish himself believes its role was important.

A 1998 study, published in the prestigious British medical journal the Lancet, found that a yoga breathing technique helped patients with congestive heart failure (CHF) to breathe better. After a month of training, subjects taught yoga breathing were getting more oxygen into their systems and doing it with fewer breaths per minute than controls. They were also able to exercise more. The authors state that they can’t rule out that awareness of the aim of the study might have affected the breathing patterns of participants but they believe the yoga breathing could be additive in its benefits to other treatments for CHF.

Studies from India suggest yoga may help a wide range of other conditions from epilepsy to asthma to obsessive compulsive disorder. Some western scientists, however, including Garfinkel, question the methodology of these studies and are unwilling to draw conclusions based on them. These studies may point to areas that seem promising for future research but according to the Lancet, few studies examining the effectiveness of yoga are currently underway. Unfortunately, patients may have to wait years for better scientific evidence.

Anecdotal Evidence

There are several problems where anecdotal evidence suggests yoga may be helpful. Judith Lasater, PT, PhD, author of Relax and Renew: Restful Yoga for Stressful Times, believes yoga can be a tremendous help with any problem that is stress-related. She includes headaches, insomnia, back pain, digestive troubles and anxiety on that list.

"Yoga is not a panacea," Lasater says, but based on her years of experience in the field, she believes it’s one of the most powerful therapeutic modalities available. She is particularly impressed with the results of the yoga relaxation posture, in which you lie on your back with your arms and legs splayed to the side and follow your breathing. "Fifteen minutes of relaxation a day," she says, "will change your life."

Richard Miller PhD, a clinical psychologist whose diverse training includes yoga therapy based on the viniyoga system, has used yoga to help several students suffering from such problems as sciatica and incontinence. He has found yoga breathing techniques to be particularly helpful with depression but cautions they should be learned under the guidance of an experienced teacher. For help finding a qualified yoga therapist, he suggests contacting the Yoga Research and Education Center (see below).

Anecdotal evidence can be unreliable and given the lack of more scientific data, it would be unwise to forsake proven remedies to try yoga therapy. If your physician approves it, however, yoga might be a sensible complement to your current regimen. As the Lancet puts it, “Yoga is not a quick fix for health, but it may hold surprises for those who are willing to make the effort.”

Anecdotal though it may have been, Jo Zukovich was so impressed with what yoga did for her carpal tunnel syndrome that four years later she became a yoga teacher. She now runs an Iyengar studio in San Diego. And she’s thrilled that doctors finally seem to be catching on to what she learned about yoga therapy a long time ago.

Further Resources

• B.K.S. Iyengar Yoga National Association of the United States: Site includes lists of certified Iyengar teachers in the US and internationally.
• Mary Dunn / Iyengar Yoga Association of Greater New York: Information on yoga classes offered by Mary Dunn and other Iyengar teachers in the New York city area.
• Judith Lasater
• Richard Miller: Information on workshops and yoga classes offered by Richard Miller.
• Viniyoga: Information on viniyoga philosophy and teachers.
• Yoga Research and Education Center (YREC): This comprehensive site includes information on yoga therapy
• Yoga-Based Intervention for Carpal Tunnel Syndrome: A Randomized Trial by Marian S. Garfinkel, EdD et. al, JAMA 1998 Nov 11;280(18):1601-3. Abstract available here

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