Stretch toward healing
As a way to treat illness, yoga's role in U.S. medicine is growing.

Meeting Eric Small, shaking his hand and looking into his eyes, one would never know he was diagnosed with multiple sclerosis about 50 years ago. Photographs in his yoga studio show him in complex poses, the kind that take years of study to perfect.

Small's almost lifelong dedication to yoga has given him the stamina, strength and confidence, he says, to live medication-free. Now in his early 70s, he has symptoms of relapsing-remitting MS, including loss of vision, fatigue and occasional numbness. But he's also able to sustain a daily two-hour practice in addition to teaching -- most notably others with MS, even some who must use wheelchairs.

This yoga niche, called therapeutic yoga, is not limited to people with MS. Such therapy incorporates poses (asanas), breathing (pranayama) and meditation techniques to improve quality of life and manage symptoms of various diseases, chronic conditions and illnesses -- including asthma, back pain, fibromyalgia, depression and cancer.

Although conventional exercise -- walking, bicycling -- is recommended for many people with health problems, yoga goes a step further, say its proponents. The mind-body connection that yoga can create serves to heal the mind and spirit as well as the body, they say.

In India, the roots of therapeutic yoga go back thousands of years, but the mainstream medical community in the U.S. has been slow to embrace it, considering the practice little more than good exercise. Now researchers have studied its effects on carpal tunnel syndrome, asthma and heart disease, and health professionals have incorporated it into medical programs that offer other alternative therapies, such as acupuncture and massage therapy.

A study in 1998 showed that yoga, more than conventional treatment, helped reduce pain and improve hand strength for people with carpal tunnel syndrome. That same year, yoga was shown to be effective in improving the quality of life for people with asthma.

A study in the June issue of the journal Neurology showed that MS patients who practiced yoga for six months had significantly less fatigue than those who didn't practice it. Current studies are evaluating yoga's effectiveness in treating symptoms of chronic obstructive pulmonary disease, depression and breast cancer.

Most yoga therapists and some physicians believe yoga's strengths come from its ability to decrease stress, battle fatigue and increase flexibility and muscle strength, as well as improve one's quality of life. But some believers claim that therapeutic yoga, sometimes done in conjunction with other alternative therapies, can actually cure diseases and conditions.

Although Small needs no convincing of therapeutic yoga's positive effects, he stops short of seeing it as more. "It is a really good management tool for something that medical science doesn't know that much about," he says. "I don't ever proclaim that this is a cure." He urges students to confer with their doctors before deciding to stop medications.

Overcoming fatigue

One of yoga's greatest benefits is an increase in stamina, often needed by patients recovering from surgery or dealing with chronic conditions.

Pam Bridger had a successful recovery after quadruple bypass surgery two years ago but a year later found herself with persistent fatigue. The 55-year-old medical transcriptionist from Richmond, Texas, walked regularly but showed no signs of making physical progress. Her doctor recommended the For Your Whole Life integrated medicine program at Memorial Hermann Hospital in Houston, which has a cardiac rehab program that includes aerobics, nutrition counseling and yoga.

"I think the one thing you learn," she says, "is body awareness. They showed us how to slow down and take the time to pay attention to the moves you're making -- what you feel when you do something. That was quite new for me." Bridger says yoga has made it easier to do things that most people take for granted, such as getting up from the floor. She also feels stronger and better equipped to deal with stress. "At this point," she adds, "I have more hope about my condition."

Soraya Vaghefi, a nurse who oversees the yoga program, says its philosophy "is to provide stress management, and that includes yoga and meditation. If they find ways to manage their stress better, they're not going to experience as many relapses."

Students are told yoga is an excellent stretching exercise, but "it also quiets your mind," says Vaghefi, "and patients learn to know themselves. When they come to us, they've had the quick fix with the surgery, but there are a lot of unanswered questions, such as, 'Why am I here? Why did this happen to me?' Through yoga, hopefully, people will experience a sense of harmony and calmness."

The six-month study on yoga's effect on MS patients' fatigue was done by doctors at the Oregon Health & Science University in Portland last year. Coauthor Dr. Dennis Bourdette says yoga was chosen because of its acceptance among MS patients; a survey of Oregonians with MS showed that 30% practiced yoga and 60% of those found it beneficial.

The study also attempted to evaluate yoga's effect on cognitive function, because memory loss is another common symptom of MS. No improvements were seen, however.

Bourdette believes more research is needed to determine whether yoga has therapeutic benefits: "Do I think that yoga as an isolated therapy for cancer is going to be curative? No. But I do see that it could be used for serious ailments as complementary therapy in addition to whatever the doctors have to offer in terms of medication."

He cautions fellow physicians not to diminish the value of using yoga to simply improve a patient's quality of life. "With any condition, we want to have a favorable impact on a person's quality of life. For many chronic illnesses, we aren't hitting home runs in curing people, and to really maximize the chances of improving the quality of life, it's going to take more than a prescription pad."

As contributing medical editor for Yoga Journal magazine, Dr. Timothy McCall finds himself in the dual role of cheerleader for therapeutic yoga and skeptic about some claims.

"I firmly believe that yoga is strong medicine, but it's slow medicine," he says. "If you stick with it for years, it can be absolutely transformational. A skilled yoga teacher can look at someone with back pain and see how the failure in the way they use the muscles on the outside of their calf contributes to it."

Yet he's critical of yoga teachers and therapists who make what he believes are unsubstantiated claims: "There are teachers who see that what they do works and are trying to legitimize it by coming up with scientific-sounding language to explain it," he says. "It may well be true that a backbend can stimulate the adrenal gland, but as far as I know no one's stuck a catheter up there and measured it. I really try to get yoga teachers to stop doing that."

But McCall does have faith in published scientific data showing that yoga can have positive benefits, and he is happy to see more studies funded by such organizations as the National Institutes of Health. Therapeutic-yoga studies are relatively new phenomena, he believes, because funding is costly and yoga has no industry to support them.

Yoga also doesn't always fit into standard protocols for research studies, especially short-term ones. Advocates say that since the practice deepens and improves with time, even a six-month study may not adequately demonstrate yoga's value.

Yoga's believers

At the Massachusetts-based Kripalu Center for Yoga & Health, considered by some the country's foremost nonprofit yoga educational center, no convincing of yoga's curative powers is needed. The center offers classes and teacher training in such areas as medical yoga, massage therapy and meditation.

Dr. Jeffrey Migdow, who teaches and has a holistic medical practice at the center, believes that illnesses -- even serious ones -- can be cured though yoga, sometimes in conjunction with other natural methods.

"In India and Tibet," he says, "they cured sicknesses with herbs and pranayama, and they had cultures that flourished, and they had exactly the same diseases we do. They healed through natural means, but we fell away from that."

Migdow believes there's been a separation from yoga's spiritual elements. Often in therapeutic yoga, especially classes taught through medical programs, emphasis is placed primarily on the physical, the stretches and poses. Some program directors fear that students, especially older ones, may distrust yoga, believing that it will conflict with their religious beliefs.

"We do yoga more like exercise in the West," says Migdow. "In India, yoga was developed to open the flow of healing energy into the body. That part was diminished when it came to America, where it was made more physiological."

Yet he remains optimistic about yoga's further acceptance in Western medical practices: "Things are much better than they were 10 years ago."

One major change that could push yoga therapy further into the mainstream is the development of industrywide standards for yoga therapists that could include establishing minimum hours of study and teacher training, plus requiring internships and more study of anatomy and physiology.

"In order for it to be a respected profession, we have to be credible to the medical community," says Trisha Lamb, associate director of the Arizona-based International Assn. of Yoga Therapists, which is looking into developing criteria. By being self- regulating, the organization hopes to avoid government regulation. "We have to educate people," she says. "We have people who call us who want to train as yoga therapists without having taken a yoga course."

As the popularity of therapeutic yoga increases, it may eventually move out of the realm of integrated medicine programs and into more mainstream health systems. With more patients asking about it and more physicians taking yoga classes, the process could be hastened.

A bad car accident years ago prompted Dr. Mary Hardy to seek yoga for help with serious musculoskeletal problems. The medical director of the Integrative Medicine Program at Cedars-Sinai in Los Angles combined Western and Eastern therapies, and her experience with yoga convinced her that it had medical benefits.

"One of the constant challenges," she says, "is that we want to leave the widest possible room for a miracle while at the same time being responsible. At the very least, we're going to get decreased pain and increased strength and endurance and deeper relaxation."

Hardy stops short of offering yoga as a cure but adds, "I think therapeutic yoga is part of the landscape, and the joke will be on all of us if those guys figure out something we can't."

[Illustration Photo Credit]
PHOTO 1: TEACHER: Yoga adherent and MS patient Eric Small teaches an adaptive yoga class at UCLA for others with multiple sclerosis.; PHOTOGRAPHER: Ricardo DeAratanha Los Angeles Times;

PHOTO 2: POWERFUL POSE: Small, who has multiple sclerosis, describes yoga therapy as "a really good management tool."; PHOTOGRAPHER: Ricardo DeAratanha Los Angeles Times;

PHOTO 3: STRETCH: Maria Casas, foreground, is among participants. Fans stress yoga's ability to battle fatigue and increase strength.; PHOTOGRAPHER: Ricardo DeAratanha Los Angeles Times;

PHOTO 4: THE PRACTICE: Instructor Eric Small helps John Spagon stretch into a pose during a class at UCLA. Small is an avid proponent of yoga, but he stops short of declaring it a cure-all.; PHOTOGRAPHER: Ricardo DeAratanha Los Angeles Times

Credit: Times Staff Writer