When many people in the West think of yoga, what first comes to mind are asanas, the physical postures such as Lotus (Padmasana) or Triangle Pose (Trikonasana). And indeed, the practice of asana can be a powerful therapeutic tool, improving strength, flexibility, and balance and helping to reduce stress levels. But for teachers and students open to a broader approach, yogic tools ranging from breathing techniques (Pranayama) to selfless service (karma yoga) can be useful, either to supplement the postures or—in cases where asana may not be appropriate due to injuries, weakness, or other problems—to provide an alternative.
Almost all styles of yoga in the West emphasize some degree of breath awareness in asana. In styles such as Ashtanga, students are taught to breathe using Ujjayi technique throughout their asana practice. Other styles, such as Iyengar, don't place as much emphasis on breathing during asana but do encourage dedicated students to develop a regular pranayama practice. In both these styles, students are encouraged to begin pranayama only after they have achieved some degree of facility with the postures, which may take a few years.
Other styles, such as Viniyoga, Kripalu, and Integral, may introduce simple breathing exercises in your very first class or private session. In my experience, it's safe to include pranayama from the beginning as long as the practices are kept simple, students are warned against pushing or doing techniques they aren't ready for, and there is no emphasis on fancy ratio breathing or long retentions of breath. Alternate-nostril breathing, or Nadi Shodhana, for example, is a practice that almost anyone can do and benefit from.
There is actually far more scientific evidence for the healing potential of meditation than there is for asana and other yogic tools, yet many dedicated yoga practitioners do not have a sitting practice. The ancient sages, however, viewed meditation as the most important tool for transformation, and it is clearly a powerful way to reduce stress, a contributor to so many health problems. Meditation appears to be particularly beneficial for chronic pain, in part by helping practitioners learn to differentiate the pain, which may be bad, from their thoughts, worries, and fears about it, which may be awful.
A simple way to begin a meditation practice is to add a minute or two of sitting immediately following Savasana (Corpse Pose) at the end of an asana session. Even better, do a couple of minutes of alternate-nostril breathing after asanas, and then meditate. The ancient yogis believed, and modern practitioners confirm, that it's natural to shift into meditation right after finishing Nadi Shodhana. Aim to slowly (over months) build up your time meditating to 20 minutes once or twice a day.
Not everyone can meditate. Some people only get agitated if they try. Others, however, give up too easily, believing it isn't working because when they sit they become aware of how busy their minds are and how much difficulty they have trying to stay focused. Seeing how busy your mind is, however, is a crucial step on the path to self-knowledge, and eventually to deeper and more satisfying meditation.
Visualization and Imagery
Visualization and imagery are ancient yogic tools that can facilitate healing. One particularly useful therapeutic method (though scientific study of it is just beginning) is the guided imagery technique of Yoga Nidra, literally "yogic sleep." In Yoga Nidra, a teacher (or a recording of one) guides you through a series of visualizations while you lie in Savasana. It's particularly useful for people with anxiety, either as a primary condition or as a feature of another medical condition, such as cancer. Such people may not be able to relax in Savasana or in restorative poses because their minds are so busy. With the teacher's voice is guiding them throughout Yoga Nidra, however, they tend to be less distracted by their internal voices, and they typically can drop into deeper relaxation than is usually available to them.
Chanting can be useful for people with a variety of health conditions. Some people are drawn to the devotional nature of chanting and prayer. Others who suffer from anxiety and depression find that chanting is a useful tool to get them out of their heads. Because chanting typically involves lengthening the exhalation relative to the inhalation, it also tends to relax the nervous system, shifting the balance away from the sympathetic side (the fight-or-flight system) to the more restorative parasympathetic branch—precisely what most people in the modern world, and most people seeking yoga therapy, need.
Other Yogic Tools
There are many other yogic tools with potential therapeutic utility. One of the most valuable is service. Counter to what you might think, when you volunteer to help others or take other selfless actions, you tend to be the biggest beneficiary (not that this goal should be your primary motivation). When you see, for example, what others must cope with, your problems may seem small in comparison. Doing something for others also tends to instill the sense that you are doing something meaningful with your life.
In addition, yoga philosophy is full of insights that can help your students as they work with health problems. One of the most important concepts, articulated in the Bhagavad Gita, is the idea of giving your best effort and letting go of results. You can (more or less) control your actions, but not what happens as a result. Focusing on what you want to have happen, instead of on what you will do to try to establish the necessary conditions to allow it to happen, can be a huge source of suffering—and one that undermines health and healing by keeping your stress-response system constantly turned on.
The more yogic tools at your disposal, the more flexibility you'll have in adapting to the unique circumstances and predilections of each of your students. One of the greatest benefits of using a varied approach, however, is the potential for healing synergy. For example, the hip opening you gain through asana and the sensitivity to the breath you cultivate in pranayama can make your sitting meditation practice deeper and more subtle, and in all likelihood more therapeutic. Regular use of another yogic tool, jala neti&mash;rinsing the nasal passages with salt water, using a neti pot or similar device—can relieve nasal congestion and, in my experience, facilitate even subtler pranayama and meditation.
This is yoga, after all, and the whole is always more than the sum of the parts.
Dr. Timothy McCall is a board-certified internist, Yoga Journal's Medical Editor, and the author of the forthcoming book Yoga as Medicine: The Yogic Prescription for Health and Healing (Bantam Dell, summer 2007). He can be found on the Web at www.DrMcCall.com.