Eight Limbs of Yoga Practice
Path / DescriptionYamas / Moral precepts: non-harming, truthfulness, non-stealing, chastity, greedlessness
Niyamas / Qualities to nourish: purity, contentment, austerity (exercise), self-study, devotion to their higher power
Asana / Postures/movements: A calm, firm steady stance in relation to life
Pranayama / Breathing exercises: The ability to channel and direct breathing and life energy (prana)
Pratyahara / Decreased reactivity to sensation: Focusing senses inward; non-reactivity to stimuli; quelling central nervous system hypervigilance.
Dharana / Concentration; unwavering attention, commitment
Dhyana / Meditation; mindfulness, being attuned to the present moment
Samadhi / Ecstatic union; flow; “in the zone”; spiritual support/connection
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Biopsychosocial Clinical Translations of Koshas.
Sanskrit / Common Name / DescriptionAnna-maya-kosha / Food Sheath
(Physical) / Comprised of the physical, solid aspect of a human (i.e. cells, organs, bones, joints, etc.).
Prana-maya-kosha / Life Force Sheath
(Vital or Bioenergetic) / The bioelectric forces and breath are a portion of prana. Similar to "Chi" or "Qi" concepts in Chinese medicine.
Mano-maya-kosha / Thought/Primitive Mind Sheath
(Emotional/Reactive) / Includes emotions, reactive thinking, reflexes or subcortical function; is largely shared with the rest of the animal kingdom.
Vijnana-maya-kosha / Wisdom/Higher Mind Sheath
(Creative/relational) / Includes the higher cortical functions of reflection, intuition, planning and creativity; not as developed in animals.
Ananda-maya-kosha / Bliss Sheath
(Spirit) / Sometimes equated to the soul or spirit of the patient.
Practical Therapeutic Yoga Applications
Technique / Rationale and DescriptionBreath Assessment/Instruction
Pranayama / Optimize autonomic nervous system through the relaxation response.
Guided imagery and
Restorative yoga
Meditation & Samadhi / Capture Herbert Benson, MD’s “remembered wellness” for motor patterns.5
Pre-Post Body Scan Asana / Embody proprioceptive sensory cortices baseline and intervention effects.
ADL Instruction Asana / Create moment to moment conscious movement awareness.
Journaling Niyamas: Self-study / Explore, reflect, analyze, and deal with psycho-emotional/stress issues.
Clinic Environment
Niyamas: Purity / Facilitate a mindful, introspective and stress reduced environment.
Home Programs Asana / Create movement sequences that are whole body, core integrated for subtle awareness and increased compliance.
Group Instruction Yamas & Niyamas / Economical, socially-emotionally rewarding to address chronic needs.
Therapeutic Exercise Asana / Synchronized with breath, whole body, core integrated with emotional awareness/non-reactivity to movement.
Didactic Education Self-study / Offering validated and new perspectives of mind~body science.
Styles of Yoga
Type of Yoga / Orthopedic ImplicationsHatha / A generic term which generally ranges from simple to moderately difficult postures, some breathwork, and a wide range of training variance. Frequently the Y or hospital course offered. Supervision: varies widely.
Iyengar / The most widely recognized approach to Hatha yoga. Focuses on precise performance, which can both protect the joint alignment, but also lead to cumulative microtrauma and hypermobility by attempting a prescribed form that is not accessible because of an individual’s unique morphology. Supervision: ranges from very specific with quality support/props for students with orthopedic limitations to an almost militaristic, authoritarian approach where students are literally pushed into proper alignment.
Ashtanga / A very athletic, intense physical practice that moves rapidly between postures. Demands a high level of motor integration and prone to generating overuse microtrauma/hypermobility. Supervision: varies, limited knowledge of closed chain kinematics, and tends toward a competitive mode.
Power / Marketed by various schools. A very athletic, aerobic type of practice with high speed components including jumps, difficult balance poses and rapid motor progression sequences. Supervision: varies more widely than Ashtanga, limited knowledge of closed chain kinematics, and tends toward a competitive mode.
Bikram / Also known as “hot” yoga. Physical practice of a standard sequence in a room heated to 100-110 degrees Fahrenheit. Overuse patterns due to the use of the same sequence and overstretching due to both temperature and instructor encouragement. Can be very demanding and take on a zealous dedication. Supervision: Varies greatly, but usually verbally pushing for greater range of motion and holding of positions beyond fatigue.
Viniyoga / Allows for individual variance of form of the postures and trained in identifying and correcting faulty movement patterns. Supervision: extensive training, more tolerant of orthopedic anomalies, and stresses personal non-violence in practice.
Kripalu / A “softer” Hatha yoga practice with gently progressions. Supervision: varies, but tends to stress establishing a personal knowledge with students and avoiding extremes of motion.
Integrative / A Hatha yoga style that trains and emphasizes modification for individuals with medical challenges. Instructor’s medical background varies widely. Supervision: Stresses medical screening and program modification; encouraged to refer problems out to medical professionals.
Restorative / A very gentle practice of sustained, supported postures emphasizing relaxation and minimal force. Can be very beneficial for a wide range of medical problems. Supervision: varies and can be a portion of many of the above styles.
Components of a typical yoga class
Session Component / DescriptionWarm-up / Varies widely to include a question/answer period, light stretching, chanting, guided imagery, casual conversation or silent focusing.
Breathing Regulation (Pranayama) / Ranges from none to long periods of practicing a variety of breathing exercise, normally in a seated position. Generally 5-10 minutes.
Postures (Asanas) / Hundreds of variations, done in supine, prone, sitting, standing or inverted positions. Ranges from a few held for a long period of time to many done for 1-2 minutes. Can be static or strung together in flowing sequences (vinyasas). Intensity varies with the posture, the duration and recovery periods allowed.
Relaxation/Guided Imagery / Usually done supine for 5-20 minutes toward the end of class.
Mudras/Mantras/Chants / Various hand positions for interoceptive awareness and repeated sounds for CNS quieting/integration
Meditation / Varies; sometimes not included, other styles can range from 5 – 30 minutes or more. Generally done in a seated position.
Closing / Varies; ranges from a simple salutation, to open discussion or quiet socializing after class.
Guide for assisting patients in finding a yoga teacher
Suggestion / Limitations/CautionsEstablished referral relationships / Presumes existing relationships; personalities may conflict.
Local hospital wellness programs / Quality of instruction varies as such programs tend to underpay instructors or allow too large of class size.
Check registry / No competency testing, only indicates certain minimal training hours. For yoga therapy, is presently developing standards for school and individual teachers.
Yellow pages / Need to interview instructor, ask for references, insure they do an intake medical screen, and observe classes to monitor teacher style and ask about supervision/corrections.
Check with affiliate rehabilitation professionals. / Wide variance in direct relationships with yoga teachers, past experiences and concerns regarding professional “turf” infringement by studios.
Smart medical history questions to ask yoga practitioners
Question / Orthopedic ImplicationsWhat type of yoga do you practice? / Styles of Yoga.
How do you feel the day after class? / There should be no pain or stiffness. Recovery should be minimal if they are under biomechanical control.
Would you describe the tempo as “fast”? / Takes a high level of motor integration to maintain good biomechanical alignment in a “fast” class.
How does your instructor respond when a student reports feeling pain? / Postures should be modified, supported with props, or abandoned after direct observation by the teacher. Warning if no direct observation or assessment.
Does your instructor ever push you into a position as a correction? / There are some instructors that forcefully manipulate student’s positions, while others offer gentle correction or subtle realignment alternatives.
Have you had constant aches and pains since beginning yoga? / Surprisingly a number of students “expect” to hurt after yoga. They should be more comfortable and move with greater ease.
Can you show me what postures seem to help or hurt the most? / Often seeing the movement or position will spotlight the offending mechanical dysfunction or in the case of relief, identify the corrective mechanical input.
Clinical applications and risk management considerations when prescribing yoga
Condition / Specific Requests / Precautions/RisksConcomitant conditions / “Adhere to standard contraindications.” / These include diabetes, hypertension, cardiac disease, detached retinas, hernias, and glaucoma; for which there are standard prohibitions of certain practices of yoga, but can be safely practiced within those limitations.
Rheumatoid Arthritis / “Headstands/Shoulderstands prohibited…call with questions.” / Upper cervical laxity; monitoring of flare ups and excess fatigue. Emphasize joint alignment and protection throughout the body.
Osteoporosis/Osteopenia / “Neutral spine forward bends; minimal twisting; emphasize back bends and chest openers.” / Probably the most worrisome of all the conditions. A phone interview ascertaining the instructor’s knowledge base is warranted. Properly instructed though the response can be dramatic. for teacher handout to follow from the National Osteoporosis Foundation.
Osteoarthritis / “Use props/supports for comfort and alignment; modify postures per limitations.” / Specify any unstable joints or interarticular degeneration limiting motion.
Joint Arthroplasties / “List range of motion limitations; no jumping or twisting through involved joint(s).” / Determine whether the instructor understands range of motion terminology.
Chronic Spine Pain / “List imaging findings, weakness or sensory deficits; and, contraindications for lifting/spinal movements.” / Caution the patient to proceed slowly, report back any peripheralization of symptoms, and invite back questions from the instructor.
Amputees / “Any stump limitations or circulation precautions.” / Minimal precautions. Instructor must be familiar with asanas adaptations.
Ligamentous/Tendon Repairs / “List range of motion and strength precautions.” / Invite dialog between physical therapist and instructor to insure protection of the repair.
Post-fracture / “List range of motion and strength precautions.” / Issue guidance regarding endurance or maximum sustainable stretch sensation.
Repetitive stress syndromes; Fibromyalgia/Chronic Fatigue Syndrome / “Restorative yoga; open chest (upper extremity) and hips (lower extremity); utilize a “cooling” practice for this “hot” condition.” / Instructor should provide close monitoring of symptom response. It is alright to proceed with a general diffuse parathesia sensation, but avoid symptom exacerbation promptly.
Patellofemoral Dysfunction / “Open the hips; emphasize prone strengthening and balance postures; maintain neutral knee alignment in all postures.” / Avoiding symptom production and emphasizing proximal chain mobility and stability is a key.
Rotator Cuff Dysfunction / “Chest openers; no sharp shoulder pain; optimize alignment of arms on weight bearing postures.” / Emphasis on proximal mobility and stability rather than shoulder range of motion is important. Ice after practice.
Hip Pain and Impingement / “Hip openers; no sharp hip pain; optimize alignment of legs on weight bearing postures.” / Once flexibility improves, insure stability is integrated through standing and balance postures.