When reflecting upon what exactly makes yoga a yoga therapy, a few primary requirements arise. Following these requirements is necessary for the practice to really become therapeutic.
The first requirement that yoga therapy must fulfill is safety. Let’s remember the first commandment of any doctor: “Do no harm”. Unfortunately, sometimes we get to observe how instead of improving a person’s well-being, yoga practice does the opposite: aggravates and amplifies his or her health problems. If a person started a yoga practice and during the process nothing got worse – that alone means that considerable success has already been achieved. That is why when building a practice, it is advisable to exclude some techniques that would be negatively influencing the course of a disease. For example, in cases of herniated nucleus pulposus there is a high degree of probability that forward bends may cause nucleus bulging and increase the protrusion degree with all its following consequences. For the same reason being, in the event of lumbar hernia asanas that include forward bends to straight legs should not be practiced (as paschimottanasana, uttanasana etc.). If suffering from cervical disc herniation one should not apply jalandhara bandha, and should refrain from practicing asanas in which it is normally included. Thus, all aspects of the practice must be analyzed in terms of their potential dangers and, if necessary, excluded from the sequence.
The second requirement that yoga therapy practice must meet is efficiency. It is desirable that a positive outcome is achieved in short term. For that, the elements that are implemented into practice must have a particular therapeutic characteristic that is necessary in each specific case. For instance, abdominal manipulation techniques such as uddiyana bandha and nauli, are powerful vacuum methods and therefore encourage the process of venous outflow. Hence these techniques are beneficial in preventing varicosity. However, in Iyengar yoga beginner’s class, abdominal manipulations are not offered during the first year of practice (even though this tradition holds an enormous amount of information on yoga therapy); meanwhile, these techniques play an important role in attaining rapid therapeutic results. In this manner, after cutting off potentially dangerous techniques, we have to include the ones bearing a distinctive therapeutic orientation. Here there is no escape – a yoga therapist must understand exactly how the techniques that he or she is planning to apply are operating.
The third requirement that must be met in yoga therapy is accessibility. Very often a person begins his practice specifically with yoga therapy. Someone, upon resolving his health issues, goes deeper into the practice and moves forward in yoga; someone decides to stay on the level achieved and uses yoga as a tool solely to maintain present health. But very often a patient whom a yoga therapist gets to work with is an ordinary person, a passer-by without any prior experience. He is looking for a way to heal, and it is very important that from the very first day he is able to perform the advised exercises. For that, the practice has to be simple and easily repeated. There is no use to recommend exercises which will take months or years to master. We suggest that a patient reaches at least a certain level of relief quite quickly (otherwise his enthusiasm may burn out quickly). In order to do so, his practice must be safe, effective and accessible.
When the core of practice is built, there are a few main rules that should be followed.
Firstly, the whole practice should be undertaken in comfort. If a movement or a body posture results in pain or discomfort, the amplitude must be reduced, pace or intensity decreased (if we are talking about dynamic practices). If the element is done in a static position, the depth of asana might have to be less intense. There are a few rare exceptions to the rule, for example when practicing yoga therapy with pleurisy. Breathing exercises and vyayama may cause painful sensations, but these techniques help against formation of fibrinous exudate. In this case, these practices can be used despite the presence of pain. In general, pain always is a sign of microtrauma, cell and tissue destruction; a sign that a movement or a position is having an unfavorable effect on the patient. Also, some undesirable symptoms include heart palpitations, dyspnea, dizziness, weakness during or after exercising. Overall, the practice has to be done within the body’s comfortable boundaries.
Secondly, it is always desirable to practice from basics to a more advanced level, gradually finding the most appropriate range for each particular case. For example, when doing vyayama we have to start the movement with the most minimum effort – tilting the head one centimeter forward and then one centimeter backward; continuing the movement and increasing the amplitude with each cycle, while carefully observing the sensations. If pain or unpleasant sensations arise, the intensity of the movement has to be lessened, returning to the comfort zone. In this manner we choose the right amplitude for all dynamic practices: as if defining the correct dosage, slowly increasing and stopping where it feels appropriate. Another example is with practicing kapalabhati: it is advisable to start with a minimum number of breaths in one cycle, breathing softly and at a slow pace, carefully observing yourself after each cycle. Gently increasing the intensity and number of breaths in one cycle, we can safely choose the right option for a person with a specific pathology.
Thirdly, it is highly important to have a mindset focused on general muscle relaxation. During the practice the muscles which are not involved in maintaining a posture or performing a movement have to be relaxed. In general, this principle has to be relative not only to yoga therapy, but to any kind of yogic practice. One might say that the art of conscious muscle relaxation and the ability to manage your own muscle tone is one of the cornerstones of hatha yoga. In yoga therapy this has a special value because muscular tensions often support pathological interconnections within the central nervous system, musculoskeletal system and many other body systems. Unnecessary tension in any muscle group leads to creation of unwanted “interference” in proprioceptive sense; schematically speaking, each asana is reflected in central nervous system as a distinctive pattern or image. So, excess muscle tensions create interference, distort and pollute this scheme.
Fourthly, we cannot emphasize enough how important it is for the respiratory center to function in its most natural regime. In cases when movement is coordinated with breath, the rhythm of practice has to be led by the rhythm of breath. Whenever the breath is not connected with the movement, the breath must remain normal and should not be blocked.
Finally, the state of consciousness and concentration play an important role in yoga therapy. The exercises should not be approached mechanically. When a person practices, he should pay attention to movement, body position, sensations which arise, and breath. During practice, the instructor has to constantly remind his student of this, helping him to maintain attention to the body and its working zones. When following this principle, the practitioner receives a psycho-emotional release which brings his practice closer to a variation of a body-oriented psychotherapy. Improving a patient’s psycho-emotional tone is a crucial aspect of healing, that is why working with attention during the practice is not of lesser importance than other aspects.
Original article is here