Yoga in Medicine: An Ancient Solution for Modern Illness

April 18, 2013 By Leave a Comment

yoga meditationYoga in Medicine:  An Ancient Solution for Modern Illness

More than 2000 years old, yoga is just beginning to gain respect in conventional medicine and practice. It is being used in medicine, and is now receiving much attention as a 21st century ‘ancient solution’ for modern illness. The ancient lifestyle practice of yoga predates written history, and in many ways, as one the oldest forms of medicine – it is the last to be (re)discovered.

Using yoga for your patients and yourself can:

  • Improve patient outcomes over standard therapeutic exercise (Ebnezer 2012)

  • Increase patient satisfaction (Vadiraja et al 2009)

  • Improve practitioner health and well-being (Hartfield et al 2011)

  • Diminishing inflammation and managing stress (Yadav et al 2012)

However, using yoga in medicine necessitates a close look at the latest research in order to make it safe and effective.  The fifteen precepts of the medical therapeutic yoga program and Professional Yoga Therapist certification offered through Medbridge Education and Professional Yoga Therapy Studies provides a systems approach biopsychosocial model for rehabilitation and wellness programming.  The post-graduate certification covers lumbopelvic and scapulothoracic biomechanics, psychoneuroimmunology, neurovascular mechanics, neurophysiology, behavioral cardiology, and neuroendocrinology as part of its comprehensive yoga training program for medical professionals.

Read and watch more about combining yoga with medicine in my past blogs:

Earn integrative medicine CE’s with Ginger through Medical Therapeutic Yoga Part A and B, offered as part of the Medical Therapeutic Yoga Certification in partnership with Medbridge Education and Professional Yoga Therapy Studies.

 

 

Sources

  1. Ebnezar J, Nagarathna R, Yogitha B, and Nagendra HR. Effects of an Integrated Approach of Hatha Yoga Therapy on Functional Disability, Pain, and Flexibility in Osteoarthritis of the Knee Joint: A Randomized Controlled Study. The Journal of Alternative and Complementary Medicine. May 2012, 18(5): 463-472. doi:10.1089/acm.2010.0320.
  2. Yadav RK, Magan D, Mehta N, Sharma R, and Mahapatra SH. Efficacy of a Short-Term Yoga-Based Lifestyle Intervention in Reducing Stress and Inflammation: Preliminary Results.  The Journal of Alternative and Complementary Medicine. July 2012, 18(7): 662-667. doi:10.1089/acm.2011.0265.
  3. Hartfiel N, Havenhand J, Khalsa SB, Clarke G, Krayer A The effectiveness of yoga for the improvement of well-being and resilience to stress in the workplace Scand J Work Environ Health 2011;37(1):70-76
  4. Vadiraja HS, Raghavendra RM, Nagarathna R, Nagendra HR, Rekha M, Vanitha N, Gopinath KS, Srinath BS, Vishweshwara MS, Madhavi YS, Ajaikumar BS, Ramesh BS, Nalini R, Kumar V. Effects of a yoga program on cortisol rhythm and mood states in early breast cancer patients undergoing adjuvant radiotherapy: a randomized controlled trial. Integr Cancer Ther. 2009 Mar;8(1):37-46. Epub 2009 Feb 3.
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Why Yogic Breathing & Mindful Meditation are Powerful Rehab Tools (VIDEO)

April 12, 2013 By Leave a Comment

Breathing and MeditationWhy Yogic Breathing & Mindful Meditation are Powerful Rehab Tools (VIDEO)

Integration of yoga-based practices, like yogic breathing and meditation, can be effective in the treatment of a broad array of disorders exacerbated by stress, according to researchers at Boston University’s School of Medicine.  Two studies support the effectiveness of yoga in correcting parasympathetic nervous system and GABA (gamma amino-butyric acid) system underactivity, in part through stimulation of the vagus nerves in order to reduce allostatic load.

A randomized controlled trial (RCT) support yoga’s effectiveness over walking, in improving mood, reducing anxiety, and increasing brain GABA levels.  Yoga’s ability to affect neuroendocrine homeostasis has enormous implications for treating chronic pain, post-traumatic-stress-disorder (PTSD), depression, and even epilepsy.

Yogic Breathing

Vagus nerve stimulation via long, deep breathing is the first breath technique learned in practicing yoga. There are other ways to accomplish vagus nerve stimulation in yoga, but primary to mastering breathing and meditation is learning to identify, and eliminate, abnormal breathing patterns. See progression of yogic breathing

Watch Ginger merge the evidence-base with yoga in Medical Therapeutic Yoga Part A and B, offered as part of the Medical Therapeutic Yoga Certification in partnership with Medbridge Education and Professional Yoga Therapy Studies.

VIDEO: Recognizing Abnormal Breathing Patterns

 

Sources:

  1. Streeter CC et al. Effects of yoga on the autonomic nervous system, gamma-aminobutyric-acid, and allostasis in epilepsy, depression, and post-traumatic stress disorder.  Med Hypotheses. 2012 May;78(5):571-9.
  2. Streeter CC et al. Effects of yoga versus walking on mood, anxiety, and brain GABA levels: a randomized controlled MRS study.  J Altern Complement Med. 2010 Nov;16(11):1145-52

 

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The Minimalist Physical Therapist: Using Yoga as Medicine?

February 15, 2013 By 2 Comments

 

Teaching the Professional Yoga Therapy Certificate Program for Health Care Providers - Class of 2008

Teaching Level IV of the Professional Yoga Therapy Certificate Program for Health Care Providers – Winter 2008

The Minimalist Physical Therapist: Using Yoga as Medicine?

A minimalist pares away all unnecessary things “in order to expose the essence or identity of a subject.”

Twelve years ago I decided to try that path.  I had been raised with a “Depression Era” ethic, that is, collect and keep everything you can, because you “just never know what may happen.”

Instead of clinging to things (which we can’t keep anyway) – I decided to opt-out.

What started as a personal transformation quickly led to a professional one.  I got rid of all the things I didn’t need:  unhealthy, processed, antibiotic and chemically spiked food, junk TV, a dead-end job, and plenty of material possessions I had accumulated over the years.

Once I did that, I realized that my life had long been hurt by more than just “things”:  but also people.  Ouch.

Clearing your life of destructive relationships isn’t easy, because sometimes those harmful people – are in your own family.

My journey to become a minimalist happened in slow, often painful, stages.

Being a minimalist demanded a  new way of thinking. I wanted health. I thought I’d “been healthy” throughout my 20′s, but in retrospect, I realized how poor my health and well-being had been. First, I had to believe in myself and my abilities.  That was difficult, especially in a culture where women still make $.77 cents (at most) to every man’s $1.00. Second, I had to make hard decisions about destructive relationships.

Ultimately though, I went from being a passive victim of abuse to an emboldened woman who stood her ground.

I am not saying simplifying your life is easy.  Despite my progress it still isn’t easy for me, especially operating as a mother-of-three-CEO-physical-therapist-educator in an outdated patriarchal economic model. 

But the health and happiness transformation brings, is worth the effort. YOU are worth it.

This is where my journey in helping others begins. Once I realized I was strong enough, I wanted to help others realize they were strong enough too…through the medicine of yoga.

Advocating for Better Medicine

The concept is simple. I am a physical therapist.  In 1998 I was a new physical therapist but had already spent years studying yoga and working in the athletic training and sports medicine professions.

I frequently used yoga in physical therapy and sports medicine for people in the greatest need – those with chronic pain.  And gradually, I ended up with all the “difficult” chronic pain patients on my caseload.

The overwhelming majority of these people were women, but next in line, were those who had served or were currently in the military.  The bottom line is – yoga was helping these patients MORE than just physical therapy alone.

I am a better therapist when I use yoga as athletic training, with manual therapy, and with physical therapy.  But also – yoga works better when it is combined with western therapies and medicine.

Medicine AND yoga can both be better, if they would embrace each other.  If the two join hands, health care can improve in America – because medical providers would be advocating for their patients to receive holistic, compassionate care – a tenet of using yoga as medicine.

Does Yoga Work?

Let me share my story with you, albeit the very brief version.

One day over 10 years ago I looked up, literally, in the middle of a treatment session with a patient and said to myself,

“I am doing yoga – with the most complicated patients – as physical therapy – and it is working BETTER than physical therapy alone.  This is a gift, this yoga as medicine.  I must share its healing power with everyone.”

It wasn’t very long after that “aha” moment that I quit my job. Yes, quit.  But not physical therapy altogether; instead, I walked away from my “safe” position in conventional medicine.

This new path of pursuing yoga as medicine was and is still, risky.  I was the primary breadwinner in my home at the time and now I no longer had my salary or benefits.  What’s more, I also terminated my insurance contracts so that I could give patients what they needed, not what insurance mandated.

Then, I set out on my own.  Yes, it was risky and yes, I was scared.

However, I have learned that you cannot embrace the future if you are still clinging to the past.  There was no way that I could take hold of any blessings that were to come my way – if I was still hanging onto dusty old relics.

And so, I let it go and walked away.

Why? Because I knew that yoga worked. I didn’t need any research to tell me so (although there is plenty to support yoga); I had seen it with my own two eyes.

For years I “kept my head down and worked hard.”  I didn’t complain about insurance limits or caps – but on that “aha” day – I looked up.

And my world changed.

I saw that if health care was going to change in this country, then I needed to, as Gandhi said, “be that change.”  Change had to start somewhere, and if patients were driving as far as 3 hours, one way, to see me, then I must be doing something right.

Yes, I could be that change.

That moment I knew that stepping out of the safety of a conventional practice was not only optional, it was necessary.  Insurance companies often prove unreliable for people, especially if they in suffering from chronic pain.  An insurance company may deny patients needed treatment, and I knew it was up to me to figure out how to make using yoga affordable and accessible as a physical therapist. It doesn’t mean that all therapists should abandon conventional practices though, it just means that for my type of practice, it was the better move.

One of the Best Decisions

The good news is taking that risk turned out to be one of the best decisions I ever made.  Taking the risk of being an “integrative physical therapist,” or as I like to call it, a “minimalist physical therapist,” has allowed me to reach more people and be a more effective physical therapist.

Taking that risk also inspired me to start the first post-graduate program in using yoga as medicine in America, to try and give health care professionals a template for using yoga successfully in their practice and life.

In my humble opinion, yoga does work.

Yoga has massive implications for improving health care and its delivery in the US today.  Especially given that health care has lost its moral compass, according to a recent poignant post by physician, Dr. Lissa Rankin, and that prominent physician Dr. Andrew Weil states in the documentary film Escape Fire, “We don’t have a health care system. We have a disease care system,” I would say the time is long overdue for embracing conservative methods of caring for one’s health.  Use of integrative medicine in health care, like yoga, is a prime example.

In Part Two, I will visit how yoga works in and as medicine, and how that affects your life and health.

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Lady Gaga’s Hip Labral Tear: Are You At Risk for One?

February 14, 2013 By 2 Comments

right-hip-labral-tearLady Gaga’s Hip Labral Tear: Are You At Risk for One?

Also see the full post featured on Modern Mom

Lady Gaga’s tour operators, Live Nation, announced February 14, 2013 that she would be cancelling the remainder of her tour due to a hip injury.  You may not know one single song that Lady Gaga sings (I don’t), so why, you are thinking, should I be interested in this news?

As a physical therapist for women’s health, the headline immediately got my attention.  And because hip labral injury diagnosis is on the increase, you should be interested too.

Farther down in the CNN article the tour company clarifies Lady Gaga’s injury as a right hip labral tear.  This injury may sound like a routine orthopaedic diagnosis and surgery, but it is anything but routine.

Diagnosis of a hip labral tear is a relatively new  ability in the medical field. Suzuki (1986) described acetabular labrum tear arthroscopically for first time in 1986.  However, a paucity of studies exists on hip disorders, and as late as 2011 (Plante et al) there is no clear consensus on diagnosis or terminology.

Lady Gaga obviously has a high energy routine that requires specific high intensity repetitive movements.  Unfortunately those movements are what commonly lead to hip labral injuries.

She is fortunate that her labral tear was caught early.  Most athletes are not that lucky.

The average length of time from injury to diagnosis of a hip labral tear is 2 ½ years (Groh and Herrera 2009).  By that time, much more damage, including permanent damage to cartilage and bone, could occur.

 

Dancers at Swansboro Dance Studio

Photo compliments of Swansboro Dance Studio

Athletes of any age are at risk for labral tears, but specifically those who participate in ballet or dance or at highest risk (44%).  Soccer players, runners, golfers, gymnasts, and martial arts and yoga enthusiasts are also at risk. Not often discussed is the possibility of damage to the hip labrum during childbirth, due to extreme positioning of the hips and legs during birth.

Movements such as twisting, rotation, and extreme range of motion in any direction can cause labral tears.  However, girls and women are at particularly high risk if they have pre-existing conditions like femoral torsion,  hip laxity (instability), femoral-acetabular impingement, or hip dysplasia.  W-sitting in children can contribute to femoral torsion, and so should be discouraged in pre-school and school aged children.  Aging hips can be at higher risk as well, although generally these labral injuries are non-symptomatic and do not interfere with quality of life.

As with Lady Gaga’s case though, hip labral injuries in the young and athletic are devastating and painful.  Diagnosing Lady Gaga’s injury is particularly complex, since her doctor must consider a host of other possible injuries, including loose bodies in the hip, hip snapping, tears of the ligamentum teres, and a many possibilities for  extra-articular (outside the hip joint) injuries.

 

How Do I Know If I Have A Hip Labral Tear?

Diagnosis of a hip labral tear is often a diagnosis of exclusion. Meaning, many other injuries and problems have to be ruled out first.  A few of those were mentioned above, however multiple researchers have identified approximately 17 other hip diagnoses that must be considered before diagnosing a hip labral tear.  A physical therapist or orthopedist specializing in the hip will be able to evaluate you to determine if you could have a possible labral tear.

Symptoms you will have with a labral tear can include (Plante et al 2011):

Ginger Garner Dancer's Pose

Me, photographed in Dancer’s Pose in 2003

  • Pain with crossing legs
  • Pain with end ranges of motion
  • Pinching, catching, or grating feeling inside hip
  • Pain with combined flexion, adduction, and internal rotation (knee across chest)
  • Pain with combined flexion, abduction, and external rotation (knee bent and resting out to side)
  • Pain with resisted straight leg raise (raising leg against resistance)

 

What If I Am a Dancer, Gymnast, or other high level athlete at risk for labral tears?

If you fall under one of those “high-risk” athletes, there are some important things you can do to prevent injury to your hip.  First, a physical therapist can screen  your hip and pelvis for common bony and soft tissue malformations and weaknesses that can contribute to hip injuries, specifically labral tears.  A physical therapist is an expert trained in musculoskeleltal and neuromuscular evaluation and management. They will look at hip stability, control, and mobility, as well as any genetic or developmental predisposition.  If they identify any problems, they can design a program to help prevent injury and put you in your best physical form possible.

As a physical therapist specializing in integrative medicine, I help patients aspire to not only their best physical shape, but also their best energetic and emotional state as well.  I do this through combining yoga with physical therapy, in a method called Medical Therapeutic Yoga.

 

What Would Happen If I Just Keep on Dancing?

If Lada Gaga ignored her hip pain, as she claimed she originally did, then she is at risk of damaging her hip beyond repair.   If a labral tear is present, forces through the hip joint increase by up to 92% (Ferguson et al 2000).  Hip instability occurs, and bursitis and tendonitis can also increase pain and disability.

If a hip injury, like a labral tear, is left untreated, it can cause the patient to damage their hip joint to the point that  they end up needing a hip replacement.  Hip replacements are not a substitute for early intervention, since recipients cannot fully return to activity or sport after having one.  The earlier you seek treatment for hip pain, the better chance you have of preserving your hip joint.

In Lady Gaga’s case, she is lucky her labral tear was diagnosed early.  The best outcome for Lady Gaga is that her injury is limited to a hip labral tear  – with no evidence of chondral (bony) damage.  When any osteoarthritis or bony damage has set in, the likelihood of a good outcome is drastically reduced.

 

The Take Home Message 

If you think you may have a labral tear or hip injury, or if you just have hip pain and want to know what you can do to make it better, see your local physical therapist and orthopaedist.  Working together, they make a great team to get you back on your feet, back to work, or back to activity or sport.

As for Lady Gaga, she will be on the mend for quite some time, whether she has a labral repair or excision.  Any hip surgery does require “strict down time,” as stated by her tour operator, which may even include time where walking is not even allowed.

In addition to Lady Gaga’s down time, post-surgical plans should include dance medicine specialized physical therapy in order  to get back on the stage – and in top form.  It is unfortunate that Lady Gaga has sustained an injury from repetitive stress motions such as dance, but her condition can help others. Her high profile story is raising awareness of hip labral injury – what they are, and who is at risk.

Hip labral tear injury and diagnosis is new in sport and dance medicine.  Being aware of it can help prevent injury and intervene in hip injuries early – which is good for everyone.

 

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Anti-Cancer Living 101: Avoid Pesticides

February 5, 2013 By Leave a Comment
Anti-Cancer Tip 101: Avoid Pesticide Consumption. Here's How

Anti-Cancer Tip 101: Avoid Pesticide Consumption. Here’s How

Anti-Cancer 101: Avoid Pesticides

Here’s How:

  1. Eat Seasonally
  2. Learn about the ways veggies (and fruits) are grown
  3. Eat Organic
  4. Try Cleaning

Here are some other helpful links for your family’s health:

Avoiding Cancer & Chronic Disease

Clean Food

Resources – If buying organic is expensive where you live, then make sure you at least follow the Dirty Dozen List, buy organic milk and yogurt, and avoid GMO’s (namely wheat, corn, soy, & canola as of 2013)

Respected Authors in the “Clean Food” field

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Helping Yourself Means This

January 23, 2013 By Leave a Comment

Helping Yourself Means This

Ginger and her son, Michael, just before his lifesaving cardiothoracic surgery in 2008

Ginger and her son, Michael, just before his lifesaving cardiothoracic surgery in 2008

Self-Help Tip of the Week:

That which remains when there is no more grasping, is the Self. ~ Panchardasi

 

This picture was taken circa 2008.  I was about the business of “letting go” while my 2 year old cheered me on, not knowing he was in the biggest battle of his little life.

Heeding this proverb, or mantra, or whatever you want to call it, is a daily challenge for me.

And on the day this picture was taken, in the dimming of the day on a Virginia mountainside that gingerly nestles the mystery miles of pitch black caves beneath its surface (that is why we were there actually, to go caving), I was in the midst of the biggest challenge of my life in letting go.

 

It was a bittersweet moment for me. This picture was taken in the last weekend that remained before Michael (in photo), my oldest son, went in for urgent cardiothoracic surgery. That moment in time was very poignant for me – because we knew that practicing letting go could mean losing Michael – the little baby we had waited our whole lives for…

After more than a decade of struggling with infertility, Michael came to us.  And yet it only took a moment, when the cardiologist delivered the news to us, to realize that it could all be gone in an instant.
I had experienced tragic loss and death in my family, multiple times over, and I knew what it was like to lose a child. My aunt had lost her only child, a daughter, and a “sister” to me, to a drunk driver at just 16 years old.

I was forced to let go early on in my life, and in some way, those tragedies prepared me to “let go and let God,” when Michael was diagnosed with a severe heart defect in the spring of 2008.

It is said that a picture is worth a thousand words, and here, it is true.  Friends who have seen this picture and know its story say there “is so much captured there – the photographer’s sensitivity, you and your son’s gestures, and the connections, visible and invisible, between all 3 of you.”

There is nothing though that can capture the vulnerability, angst, concern, inability to cry or grieve because my fierce “maternal instinct” kicked into “let’s fix this now” mode, or the many, many prayers that went up, hoping that we would not have to give Michael up so soon.

After all, when I learned I was pregnant with Michael, I promised him to God. You don’t have to believe in God to understand what this means.  To me, I was so thankful that God, the Universe, the Divine, had blessed me with this baby, that I knew the greatest thing I could do would be to present him back to that Power.  If the Universe conspires to help you succeed, in the words of Paulo Coelho’s The Alchemist, and if God does in fact have your best life in mind (which I believe), then I knew it was the right thing to do.

I made that pledge on an ordinary day that I just happened to be at the extraordinary National Cathedral in Washington D.C. In the children’s chapel, before he had even arrived in my arms, I gave Michael back.

And now I was at a crossroads thinking, “be careful what you ask for…”

The moment this photo was taken, and the mere days before when we learned of his dire condition, were filled with one thing: Letting. Go.

And so, I did.

I practiced yoga and I let go.
I played music to help let the grief out, and I let go.
I prayed, and I let go.
I opened my hands and emptied myself out, and I let go.

Life Began Again

 

Michael just before moving from intensive care to the pediatric unitIn setting our attachments, all attachments free, even to life itself, I got life back. Two fold. My life and Michael’s life.

And it was new. It was unlike any experience I had ever or will ever felt.

The breath I seized as I saw his tiny pediatric bed being wheeled down a corridor that I just happened to glimpse as I looked out a window, down a hallway, through an outside park, and into the window of a corridor some 20 yards away, felt like my first.

I knew it was his bed because it was surrounded by a surgical team and one of them was carrying his Snoopy that he had clutched as the team carried him into surgery.
I knew it was his bed, that it was him, but it was draped in a white sheet. A white sheet.
My heart dropped.
But my panic was quickly sucked out of the air when I saw a plethora of lines and tubes being rolled with the bed. I’ve never been more happy to see the 15 or so lines connected to a child I love so dear.

I knew it was Michael. And in that moment I knew he was coming back to us.

So today, almost 5 years later, I remind myself of this small but earth-shifting quote: That which remains when there is no more grasping, is the Self. ~ Panchardasi

And just like all our lives, the battle that ends isn’t necessarily over.  Michael still has other congenital defects and will require lifelong cardiology attention. There will be more tragedy and loss and hurt in my life, in his life. But if I recite this proverb and keep my faith, I know I can find my full potential and take on whatever life fast pitches my way.  I will teach Michael that too. In the adversity of his heart conditions, he can find great strength, great inspiration, and great power.

Helping yourself means this: Letting go is a lesson that must be relearned – daily.

If you would like to donate to the American Heart Association, Michael is participating in the “Jump Rope for Heart” fundraiser to help other children like himself who have heart disease.  No amount is too small. Even $1 can help save a child’s life. Donate here.

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Influencing Health Care Policy: Can Medical Providers Do That?

December 10, 2012 By Leave a Comment

Influencing Health Care Policy: Can Medical Providers Do That?

How can health care professionals/pain management specialists become more involved in shaping health care policy?

Rehabilitation specialists are instrumental medical providers in the management of chronic pain. As a physical therapist I have been specializing in chronic pain for close to 15 years, and doing so, through the use of Complementary and Integrative Medicine methods, namely yoga.

As health care providers, the focus we choose for our clinical work is very important.  As therapists we have the power to directly impact healthcare policy in the US.

How can we influence the future of health care?

We can start by changing the way we deliver therapy services.

When I started out in physical therapy I made a conscious effort to do just that. With deliberation and much thought, during my first year of the Master of Physical Therapy program at The University of North Carolina at Chapel Hill, I sat down and created a mission which I felt would direct and determine the impact of the rest of my career.

Think Outside of the Box

At the time I was in PT school, I was concerned that there were no courses in integrative medicine, prevention, or business, much less alternative business models.  That led me to venture outside the School of Medicine and into the School of Public Health.

After obtaining special acceptance to do graduate work at The University of North Carolina at Chapel Hill School of Public Health, I worked on special projects that would eventually lead me to become a community organizer in eastern North Carolina.  There I was able to create some of the first integrative medicine programs in yoga and Pilates in the US.

Now 15 years later, my clinical focus continues to target public health education and injury prevention through writing and education in evidence based yoga.  My career and work in yoga as medicine stands as a humble offering for anecdotal evidence that as health care professionals, we can improve health care delivery through fostering a paradigm shift toward holistic and preventive therapy care.

In a recent excerpt from Becker Spine Review I gave the following answer when interviewed about influencing health care policy as pain management health care providers:

My mission in PT and chronic management has been to improve health care and health care delivery in the US, for the past 15 years.

My activism to shape health care policy through being a health care provider – led me to integrate a holistic biopsychosocial model of assessment, which I dub the “Pentagon of Wellness,” into my PT practice.  It is the foundation of a method of evidence based medical therapeutic yoga practice called Professional Yoga Therapy.  That model has allowed me to shift pain management and health care from its current medical model, curative based, to a more preventive or wellness based model. The results are very positive.

The model operates on the notion that CAM, a multi-billion dollar industry in the US, can be effective at both preventing and managing disease. The vehicles I use for shifting the health care paradigm include yoga, Pilates, Ayurveda, Native American medicine, Feng Shui, chromotherapy, and music as medicine. I combine all of these modalities with my licenses and experience in physical therapy, manual therapy and soft tissue work, women’s health, and sports medicine.

In less than 10 years, and working outside the current insurance model in order to lower health care costs (and since insurance can routinely deny or cap treatment for those in chronic pain) – I have been able to work with patients of all types – from pediatrics to geriatrics, from low back pain to cancer – and see them for a drastically lower cost through group physical therapy using the PYT model.

Professional Yoga Therapy, Yoga as Medicine Part 1, Module 8 on Emerald Isle, NC

Professional Yoga Therapy, Yoga as Medicine Part 1, Module 8 on Emerald Isle, NC

You Can Be A Change Agent – Build A Better Practice, Lower Your Stress, and Improve Patient Outcomes

My story is a small contribution toward the collectively massive potential we have available to us as medical professionals to create lasting transformation in health care today.  We have a clear and decidedly urgent responsibility as health care professionals to influence health care policy change, particularly in pain management.  The insurance based system, as it stands, frequently denies patients therapy services when the words “chronic pain” are involved.  I have repeatedly empathized and felt the despair and depression that patients bring to me because they felt they had no advocate in their previous health care experiences.  In fact, it is the most common story I hear, other than the shared variable of the pain experience.

But the positive news is we can change. We can improve health care today.  We can empower our patients to take control of their health care, to be an advocate for themselves, to educate them as to their options and rights in receiving therapy services, and finally, to begin to incorporate evidence based methods of Complementary and Integrative Medicine in alternative business models.

One of the many ways you can start to be a change agent today is to start by taking the Medical Therapeutic Yoga series that HomeCEUConnection.com currently offers in partnership with Professional Yoga Therapy.  The entire premise of the program is built upon empowering the patient and managing stress and inflammation in both the patient and therapist in order to reduce health care costs and improve health care in the US. I believe holistic self-care techniques, steeped in prevention and compassion, can truly change the landscape of American health care today.

More Resources

The methodology of the biopsychosocial model used in the Medical Therapeutic Yoga coursework is both evidence based and fiscally responsible. It offers an affordable business model which has enormous potential to reduce overhead costs in medical practice, health care, improve patient outcomes in therapy, and reduce health care provider burnout. Read patient testimonials here and read student reviews of the program here.

As therapists today, I believe we have overlooked our potential to be powerhouse agents of change. The health care provider as legislative change agent starts now – one patient at a time. If we as health care providers begin to embrace proven and safe holistic and integrative therapies then I strongly believe we can incite massive change in US health care and improve not just the health of our patients, but our health as well.

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Labor & Delivery Yoga: Better Birth is Only a Breath Away

October 25, 2012 By 15 Comments
Ginger Garner PT, MPT, ATC, PYT, ERYT500

Ginger Garner, in her first pregnancy, practicing yogic breathing

Labor & Delivery Yoga: Better Birth is Only a Breath Away

I have had the absolute joy of giving birth three times. Although I have other secret weapons for labor and delivery, I believe this one is the most important for managing pain, preventing panic or anxiety, and maintaining adequate oxygenation, no matter what type of birth you are planning.

The secret weapon is simple: Your breath.

Over my almost 20 years of practice in physical therapy and women’s health, I have found that the breath is the first line of defense in promoting women’s well-being. Female well-being is perhaps most important during birth. The best vehicle I have found for helping moms harness the grit to give birth (because girls, you ALREADY have the grit, you just need to fully develop it) is yogic breathing.

First: Practice and know Yogic breathing for labor & delivery.

In my own clinical practice I teach expectant (and veteran) moms a concise ‘breathing through birth practice’. It focuses on alveolar ventilation, which is crucial during labor to prevent oxygen deprivation to you and your baby. It also minimizes the “fight or flight” reaction which can cause a mother to panic or have such anxiety that it interferes with healthy birth outcomes. Plus, good breathing will give you a laser-like focus and resolve during the most intense moments (that is also good for later, when your sweet little one gets into trouble).

During labor, I encourage moms to focus on the rate and rhythm of the breath. Slow down your respiration’s per minute (which is typically around 12 per minute).

Second: Your birth coach should also know the breathing routine.

Even though I teach labor and delivery coaching, I still needed support from my husband (and fantastic birth coach) during my sons’ births. Practice your breath routine for the moments where you may forget or lose focus during hard labor or transition (which we all do). This means your husband, doula, and anyone else supporting you during birth. You don’t want them to give you different cues for breathing at critical moments.

Although I cannot teach you the complete breathing program, here are a few tips to remember in practicing breathing for labor and delivery. Remember, the breath not only affects your health, it directly influences your unborn baby’s health as well. Good breathing habits during labor can be one of the key determinants in having the birth you imagine.

Tips for a Better Birth through Breath

1. To learn how to breath, you first must know what improper breathing looks like.

Your belly gets big in the last trimester, and it gets tough to breathe. During my first pregnancy I thought belly breathing might be impossible as I journeyed into my third trimester. And here I was, a breathing “expert!” However, I soon found out that it was a myth.

You CAN belly breath all the way through pregnancy. It just takes practice.

A belly breath is also called a diaphragmatic or abdominal breath. Abdominal breathing is not only possible, it is absolutely necessary. Abdominal breathing helps you maintain your focus and prevent hypoventilation (too little oxygen to you and baby), especially during the most difficult parts, like transition (right before pushing begins).

Poor breathing, also called, shallow, thoracic, chest, or clavicular breathing, “looks” like this:

  • On inhale, the chest will heave upwards and expand with little or even reverse (pulling in) expansion in the belly area. A poor breather will breathe through the mouth instead of the nose. The muscles of the neck may pop or stand out when she inhales. The inhale will be short and not very long.
  • On exhale, the belly will expand instead of relaxing in a passive drawing in action.

This type of breath does not allow for proper oxygen exchange because it only utilizes the upper portions of the lungs and does not allow for use of the respiratory diaphragm.

2. Know what a proper breath looks like.

The gold standard breath needed during labor and delivery is the belly breath, also called the abdominal or diaphragmatic breath.

  • On inhale, the belly expands naturally and without force. This is because the diaphragm must descend and therefore must push the abdominal contents outward. No muscles in the neck, face, or shoulders need to be used to take a breath.
  • On exhale, the belly naturally and passively retracts as the diaphragm returns to its original position.

A 2011 review of randomized studies in the International Journal of Obstetrics and Gynecology discourages the use of valsalva (breathing holding) during the pushing phase, citing reduced maternal satisfaction and increased urodynamic (bladder) problems. This means you want to avoid holding the breath at any time during labor and delivery, especially the pushing phase.

During the abdominal breath, primarily breathe through the nose. Avoid adding mouth breathing until an abdominal breath is perfected. Mouth breathing alone can increase anxiety and chest breathing by causing a sympathetic nervous system response. This puts the nervous system in a “fight or flight” condition and can cause hyperventilation, an imbalance of O2 and CO2 in the mother and baby.

After perfecting abdominal breathing, a mom can learn how to breathe through both the nose and mouth at the same time.

More Tips for Best Breathing:

  • Watch a baby breathe. Mimic their gentle abdominal expansion during inhale and passive relaxation during exhale. Repeat.
  • Slow down your breaths per minute. Try to reduce it to below 12 respirations per minute.
  • Equalize your inhale to your exhale. Start with a 3-6 second inhale and a 3-6 second exhale. During my own births, I focused on a long (up to 12 seconds for each inhale and 12 seconds for each exhale), rhythmic (often synchronizing my breath to the music I brought to the birth room) breath.

3. Start a yoga practice.

If you are pregnant and not already a yogini (woman who studies or practices yoga), now is the perfect time to begin. With your doctor or midwife’s approval, you can begin practicing yoga with the help of this post.

Even if you only practice the breath without the poses, yogic breath harnesses the power to prepare you for labor and delivery.

I work with moms on yogic breath practice, starting with abdominal breath during their first trimester. Each 3-4 weeks I add a new technique. By the 37th week, moms can be experts of the breath.

A yogic breathing practice can help you exercise control over their body during birth through the following:

  • Decrease fatigue (especially important for labor)
  • Increase mental focus (important for entering into the “zone” of concentration)
  • Manage pain (perhaps most important, especially since there is such a fear surrounding natural childbirth)
  • Control nervous system and hormonal/endocrine regulation (related to depression prevention and birth outcomes)
  • Help with easier pushing phase during delivery

 

Get Started with a Free Tutorial on Abdominal Breathing

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How America’s Broken Health Care System Affects Women

October 25, 2012 By Leave a Comment

Symbol of Women's Empowerment - Rosie How America’s Broken Health Care System Affects Women A post also featured on Modern Mom, November 1, 2012

The idea of women’s empowerment is a touchy issue. It has been correlated with the myth of the “male decline” and other scare tactics put forth by those who may seek to sweep women’s issues under the proverbial rug.

However, one fact stands very clear.

Our current approach on women’s health care in the US is not working. I wrote the original post on Women’s Empowerment over a year ago.  Sadly women’s health care rights are more under the gun than ever.

What’s worse are America’s rankings in maternal and infant mortality

The very future of our country depends on the willingness of women to become mothers, through giving birth; and yet, we have some of the worst birth statistics in the entire world. In 2006, the US had the second worst death rates for mothers and newborns of any industrialized nation. But by 2011, America claimed the number one shameful ranking  – giving birth in the US today means you are more likely to die than if give you birth in any other developed country in the world.

The annual State of the World’s Mothers report reports, “the United States has more neonatologists and neonatal intensive care beds per person than Australia, Canada and the United Kingdom, but its infant mortality rate is higher than any of those countries.

“Amnesty International’s executive director Larry Cox in 2010 states “this country’s extraordinary record of medical advancement makes its haphazard approach to maternal care all the more scandalous and disgraceful.”

 

Health care in America needs a mother/woman-centered approach. American mothers and women are in great need of holistic, patient centered care, rather than disease care centered around drugs and diagnostic testing.

But That’s Not All

In the US, there are more women living in poverty and suffering from chronic diseases than men. (1,2)  As a woman and mother, I am saddened but not surprised. The findings provide us with the objective evidence of what we have felt intuitively for some time – women’s health care, its delivery, and the proactivity of women in America to take (back) control of their health and health care – must improve.

We Need Change in Health Care Delivery for American Women. Now. 

Here are some of the women’s health statistics from the US Department of Health and Human Services and the American Heart Association.

The scandalous statistics on the poor state of women’s health in America:

  • The US ranks number one of all industrialized nations in maternal and infant mortality. (4)
  • Women suffer from more chronic disease and pain than men. (1,2)
  • Since 1984, more women have been dying from heart disease than men. (1)
  • More women die from stroke, heart disease, and stress related illness than men. (1,2)
  • Women suffer more from autoimmune diseases than men, at rates from 2:1 to as high as 10:1.2
  • More women than men suffer from arthritis. (2)
  • Because of the difference in sex-related cancers, women are more apt to get one of the “top 10 cancers” than men. 2
  • The leading causes of death in women are (in order): heart disease, cancer, and stroke. More than ½ of all these deaths were attributed to heart disease and cancer. (2)
  • Obesity has increased in alarming rates since the 1960’s, with over 61% of both men and women now overweight or obese. (3)
  • Stress related disorders and mental health illness like Post Traumatic Stress Disorder, attempted suicide, depression, and anxiety disorders, occur most often in women. (2)
  • Three times as many women attempt suicide as men. (2)
  • Lastly, when polled, more men (who have good reason to) report they are in excellent or very good health. (2)

Why are Women in the US Less Healthy than Men?

Could it be because…

• more women live in poverty than men? (2)
• women in families experience higher rates of poverty than men living in families? (2)
• men report higher satisfaction levels with heath care and access to health care than women? (2)
• more money is spent (per average expenditure) on men’s health care than women, despite one of the primary reasons for hospitalization and medical visits being maternity care? (2)
• because women use prescription drugs more frequently than men, and of those drugs, the common ones are taken for depression and mental health? (2)
• more women’s health care is paid for by Medicaid or out of pocket? (2)

The reasons are multi-faceted, but the bottom line is women urgently need better access to health care. Access to both conventional and integrative medicine is also an imperative. Why? Because integrative medicine techniques are less invasive, less costly, and highly effective. For an example, see my post: Why Every New Mom Needs Physical Therapy

Most importantly, in a time when women are severely underrepresented in the corporate, political, and legislative spheres, women also need and deserve the empowerment that comes with enjoying better health. And by the way, it (women’s health) isn’t “just” a woman’s issue – it is a family issue.  Or as Secretary of State Hillary Clinton puts it, “we must learn that women’s rights issues are human rights issues.” Read my past blog on A Mother’s Bill of Rights

“What’s good for women then, is good for the world.” Dr. Riane Eisler, Founder of the Caring Economy Campaign

If your wife, partner, mother, grandmother, or daughter doesn’t have access to health care when she needs it – every American is affected. Common sense might even say that investing in women’s health is investing in America health – and its future prosperity. Dr. Riane Eisler of the Caring Economics movement, launched this past summer in Washington D.C., has unequivocally shown that raising the status of women raises a country’s economic status. Well, it’s settled then, women’s empowerment is good for our country, its citizens, AND its economy. What’s good for women then, is good for everyone.

Sources
1. American Heart Association
2. US Dept. of Health and Human Services 2006. Women’s Health USA 2007 report
3. Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion. Overweight and obesity. June 2004
4. Save the Children “State of the World’s Mothers” report 2011

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Can Yoga Be Used As Medicine?

October 12, 2012 By 2 Comments

At work teaching Yoga as Medicine in an interactive lab for a community physical therapy class during a medical continuing education yoga conference for PYT. September 2012

Can Yoga Be Used as Medicine?

The short answer is yes.

The reality is yoga is not usually used as medicine. Using yoga as medicine can be tedious and laborious (trust me), requiring constant review of the scientific literature in order to make it safe and effective.  More often than not yoga is seen as a way to lose weight, compete for the trimmest bum or the buffest handstand, claim exalted enlightened status, or as is common in America with yoga teachers – to compete for yoga celebrity status and fame.

The reality also is, there are hundreds, maybe even thousands of yoga teachers who are earnestly doing their best and in the spirit of utmost integrity – teaching in their local community, giving away free classes and sessions, making a difference in their world – and they aren’t concerned about their pant or chest size or whether or not they become a famous teacher.

However in both groups – Yoga Injuries are on the Rise. 

Why?

Because as much as the term “Integrative Medicine” is tossed around, we still aren’t, in the medical profession OR in the yoga community, aware of what each other does as a profession, nor are we privy to the dangers of improperly aligned yoga postures.

For example, when is the last time your ob/gyn knew that there is a subspecialty of physical therapy that treats women’s health issues like incontinence, pelvic pain, and post-surgical complications? How about prenatal pubic symphysis or sacroiliac disorder?

For example, when was the last time your family doctor mentioned that yoga, when combined with physical therapy (aka Integrative Physical Therapy), can be beneficial for treating combinations of problems like depressive symptoms/anxiety issues plus sports injuries (since the two often go together) like rotator cuff syndrome or hip intra/extra-articular injury?  How about common systemic problems like heart disease or asthma (which are commonly treated in cardiopulmonary physical therapy or respiratory physical therapy)?

Chances are, your doctor may not clearly know what physical therapy does, much less what yoga is capable of doing when combined with physical therapy or nursing or occupational therapy or medicine.  The fact is, yoga when combined with evidence based medicine and rehabilitation, is not the yoga of ancient days. Yoga for the 21st century can be modern, fresh, and new – because it must be made safer.  Only then can it be most effective at improving health and well-being.

Why mention yoga injuries and unsafe yoga being taught in America?

As a consumer of yoga, just as a consumer of health care, you deserve safety. You deserve to know you are being taught postures that in the very least, create physical health and not harm.

Yoga is of course not just about the physical postures (asana).  However since the postures are most frequently used as the gateway to health and self-awareness we cannot ignore the paramount mantra of medicine in teaching the yoga postures – “first do no harm.”

Safe Yoga = Effective Yoga

The most common yoga injuries being seen in radiology offices (Corroller 2012) today are tendinous lesions and fibrocartilaginous tears.  The most common areas of injury include the rotator cuff of the shoulder, the Achilles tendon of the foot, and the labrums of the hip and shoulder (just for starters).

If yoga postures are unsafe then they cannot be effective.  These common postures can be considered high risk postures for many populations.  A person with any pre-existing conditions or injuries should see their physician and/or physical therapist so treatment (which can include yoga) can be prescribed specifically for their condition(s).  Yoga must be taught correctly and according to each person’s specific needs and deficits.  Here are some examples of how the above injuries are happening in yoga today:

Some high risk postures in yoga can include:

  • Child’s pose – a pose which can cause cervical spine shearing and adverse discal pressure
  • Downward facing dog – typically causes hyperflexion of the shoulder and reversal of spine curves that puts pressure in the direction of lumbar disc herniation
  • Warrior series – a series of three postures which can easily cause low back pain, sacroiliac joint dysfunction, or excessive range of motion in the hips leading to fibrocartilaginous injury
  • Crescent post (deep lunge) where the elbows are placed on the floor requiring extreme hip flexion combined with weight bearing torque/twisting and rotation in the hip joint
  • Plow pose where the feet touch the floor above the head
  • Triangle – a high risk pose for hip and spine injuries
  • Wheel and all forms of extreme backbending/spinal extension
  • Weightbearing headstands
  • Weightbearing shoulderstands where the chin is against the chest  and the cervical curves are reversed
  •  “Chataranga” – a pose that resembles a full push up from the toes and is rarely performed correctly

Yoga Can Save Your Life.

But don’t get me wrong. Yoga is valuable. Very valuable.

Yoga has saved my life multiple times over.  It has helped me recover from pregnancy and childbirth (three times), traumatic injuries like multiple cervical spine disc bulges, sacroiliac joint dysfunction, a postpartum rotator cuff tear, a hip labral tear, and numerous psycho-emotional stressors.

However the same poses that heal my injuries, when not aligned properly, can cause the same injuries.  Achieving longevity and high quality of life can be accomplished with yoga, but one must proceed with caution in what yoga you ultimately “buy into.” Not all yoga is created equal, or even safe.

In my next post, Part Two, I will discuss how to talk with your orthopedist or physical therapist about yoga and how it can work for you.

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