Doing Yoga Therapy Safely, Part I

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Ahimsa, the principle of nonharming, is the first of Patanjali's yamas (moral injunctions) and is the foundation of both yoga and yoga therapy. It is aligned with Hippocrates's advice to physicians to "First do no harm." If people are coming to you seeking yoga therapy for relief from health conditions, the last thing you want to do is to make things worse. In this column and the next, I'll outline strategies for maximizing the benefits of yoga therapy while minimizing the risk of harm.

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Slow and Steady

While it may be tempting to try to jump-start a student's path into yoga therapy, in general, patience is the best policy. Yoga is powerful medicine, but it is slow medicine. It's generally better to progress mindfully, erring on the side of doing less and sticking with safe practices until you are sure the student is ready to move on to more challenging ones. Look to increase the student's abilities in small steps, slowly building on what they achieve.

Home practice is the key to success in yoga therapy, and since students will usually be practicing without any supervision, you need to be sure to recommend a program that won't cause problems. It might be better, for example, to give your students just a few practices at first, such as poses and breathing techniques you are convinced they'll be able to do safely, rather than giving them a longer program that they feel less sure of.

Ironically, students who are the most enthusiastic about what yoga can do may be at the greatest risk, simply from doing more than their bodies or nervous systems are prepared for. If you sense a student is too eager, be sure to counsel moderation and to work on building up stamina slowly. Be particularly careful with students who seem drawn to fancy-looking asanas or advanced Pranayama techniques that they aren't yet ready to safely tackle.

In the Yoga Sutra, Patanjali suggests that the key to success in yoga is to practice regularly over a long period of time. It's the steadiness and longevity of practice—as well as the mindset you bring to it—that determine how successful it's likely to be. A few basic practices, done consistently with finer and finer precision over time, are likely to yield real benefits with little risk of causing harm.

Adjusting the Approach to the Student's Current Situation

While much of what you'll read about yoga therapy is geared toward addressing specific problems, keep in mind that every student is unique. Two students may have the same diagnosis of back pain or breast cancer, for example, but their situations might otherwise be very different. One-size-fits-all prescriptions are unlikely to be optimal. Students tend to come in with different levels of fitness, motivation, yoga experience, time to devote to their practice, and a host of other factors that could affect what you recommend to them.

You will, of course, want to factor in any contraindications based on your students' diagnoses—for example, shunning inversions (even partial ones like Downward-Facing Dog) for a student with a history of retinal detachments. In addition to the problems for which they are seeking help, students often have other conditions that could affect what you'd recommend. For example, Sun Salutations and backbends are often useful for students who are depressed (particularly if their depression is a more tamasic or lethargic type, as opposed to a rajasic or agitated depression), but if they've got wrist problems, those practices will need to be modified.

Even if you've developed a program that seems to be working well, you may need to modify it temporarily if the student develops a bad cold or has slept poorly the night before, perhaps emphasizing restorative practices instead. Eventually, you are going to want your students to learn to adjust their home practices in accordance with how they are feeling on any particular day, and provide them alternatives. You want to teach your students to honor what's happening at any given time, listening to the feedback their bodies, minds, and breath give them, so they don't force themselves to complete a predetermined plan in spite of how they feel.

Perhaps the best way to ensure that the practices you're recommending will be safe and effective is to watch your students do them. As they practice, closely monitor their breathing, the looks in their eyes, their skin color, and their ability to concentrate. Ask them how they are feeling. Along the way, you can offer suggestions about safe alignment or point out if their breathing is becoming strained. In general, don't have students start practices at home without first watching them do them to your satisfaction. This doesn't mean they have to do the asana and other practices well from the beginning, but you should be confident they are not going to injure themselves.

In Part II, we'll discuss how to adjust your yoga therapy recommendations in light of any medications your students are taking, and to avoid problems by recognizing your limits.

Dr. Timothy McCall is a board-certified internist, Yoga Journal's Medical Editor, and the author of the forthcoming book Yoga as Medicine (Bantam Dell, summer 2007). He can be found on the Web at www.DrMcCall.com.