The popularity of yoga continues to rise with over 36 million yogis living in the United States of America and over 300 million practitioners worldwide. Yoga has several therapeutic effects that make it a beneficial addition to home exercise programs for practitioners and personal practice.
Dustienne Miller discussed some of the benefits of yoga in her March blog (March 8, 2022 - A yoga practice can change your neuroanatomy!). These benefits extend beyond the musculoskeletal system and include improved mood and depression, changes in pain perception, improved mindfulness and associated improved pain tolerance, and the ability to observe situations with emotional detachment.
The physical benefits are well documented in several research studies and include improved flexibility, strength, and stability as well as enhanced respiratory and cardiovascular function. Supporting documentation also shows that yoga can help alleviate the symptoms of chronic pain. Dustienne Miller shared that in a study by Villemure et al, they determined “that the insula-related interoceptive awareness strategies of the yoga practitioners being used during the experiment correlated with the greater intra-insular connectivity...concluding that the insular cortex can act as a pain mediator for yoga practitioners.”
Restorative yoga shares the many benefits seen in other styles of yoga and can also be a great addition to home programs for pelvic rehab practitioners. Kate Bailey shared in her interview with The Pelvic Rehab Report (August 31, 2021 – Faculty Interview: Kate Bailey) that restorative yoga “focuses on the lesser-known aspects of the yoga platform: breath, restorative practice, and a bit of meditation. I have clients all the time who struggle with meditation because their nervous systems aren’t ready for it. So we look at breathing and restorative yoga both as independent alternatives, but also as a way to get closer to meditation.. giving the clinicians another skill for their own rest practice can be useful when feeling tired, overwhelmed, or burned out. “
But what does this mean? Let’s look at some of these aspects a bit closer:
Improving mood and sleep: This includes depression, anxiety, and even stress or other mood disorders. Consistent yoga practice can lead to significant increases in serotonin levels coupled with decreases in the levels of monoamine oxidase, an enzyme that breaks down neurotransmitters and cortisol(1). Yoga can inhibit the areas in the brain responsible for fear, aggressiveness, and rage (posterior or sympathetic area of the hypothalamus) – while simultaneously stimulating the rewarding pleasure centers in the median forebrain and other areas leading to a state of bliss and pleasure. This inhibition results in lower anxiety, heart rate, respiratory rate, blood pressure, and cardiac output (2).
Think about it. Deep breathing calms the nervous system. This promotes relaxation. The more relaxed you are then the better the chance of having a good night’s sleep. Consistent yoga practice can also assist sleep quality by increasing melatonin and reducing hyperarousal (3). Pratyahara, or a turning inward of the senses, allows downtime for the nervous system and can be encouraged by yoga poses such as savasana (corpse pose) and pranayama (breathing exercises/control.
Reduced Chronic Pain: Asana and meditation have been shown to reduce chronic pain including reduced pain from arthritis, back pain, and other chronic conditions while also improving balance and increasing proprioception(1). Yoga sessions can take our joints through a full range of motion. This squeezes and soaks areas of cartilage not often used and provides fresh nutrients, oxygen, and blook to the joints. Otherwise neglected areas of cartilage in the joints would wear out, exposing bone, which can lead to arthritis and chronic pain. At the same time, yoga is gentle on the body and consistent practice can strengthen the connective tissues that surround the bones and joints.
Effects on Cancer Patients: Yoga cannot cure cancer, but it can reduce stress and improve physical, emotional, and spiritual wellness. There is supporting research that the growth of cancerous tumors can be exacerbated by stress(4). This same study found that consistent yoga practice could decrease post-chemotherapy-induced frequency and intensity of nausea and the intensity of anticipatory nausea and vomiting. In 2018 Lin et al provided new research showing that restorative yoga can decrease depression in cancer survivors; improve symptoms of anxiety, depression, and pain symptoms in cancer patients; and help patients manage the toxicity of cancer treatments (5). In addition, yoga has a fundamental emphasis placed on mindfulness and acceptance of your body and its limitations.
Kate Bailey likes to joke about lying on the floor, but really, it is not a joke at all. Lying on the floor for 15 minutes is savasana. She shares that “Savasana is a wakeful resting and a practice of relaxation response. It seems easy: you always have access to a floor. You don’t need anything fancy. Aside from the neuroregulatory benefits of rest, savasana also gives the postural muscles a break. It allows the hip flexors to re-lengthen and the cervicothoracic junction to realign.”
Let’s take a moment to close with a savasana (did you know that a 5-minute savasana is recommended for every 30 minutes of yoga?). This pose can calm the central nervous system, aid the digestive and immune systems, reduce headaches, fatigue, and anxiety while lowering blood pressure and calming the mind, and reducing stress.
Take a moment and lay on the floor with your arms and legs open wide and relaxed (starfish style), supported by a bolster, or you may want to place your hands gently over your chest or your stomach. Now gently still your body. Release your breath and be present. Be completely aware of the moment. Let your mind and body go for a few moments.
Restorative Yoga for Physical Therapists with instructor Kate Bailey
This course will provide the basis for experiencing and integrating restorative yoga into physical therapy practice. Restorative yoga is an accessible practice that can teach patients (and practitioners) how to rest systematically, for short periods of time, on a regular basis to encourage the parasympathetic nervous system to balance with the sympathetic nervous system for improved neuroregulation. Topics include the difference between meditation and restorative yoga, and how they can support each other in order to support the ability to drop into relaxation. Restorative postures, each taking 20-30 minutes are offered prior to the live meeting so that participants can experience what a patient might experience when restorative yoga is a component of their home program. Then in the live course participant experiences, questions, and strategies on how to reduce barriers to relaxation so that patients can integrate this practice into their lifestyle will be discussed. There will also be live labs for breathing techniques and specific meditations that may be helpful to patients working with an unregulated nervous system.
Yoga for Pelvic Pain with instructor Dustienne Miller
This course offers an evidence-based perspective on the value of yoga for patients with chronic pelvic pain by focusing on two of the eight limbs of Patanjali’s eightfold path: pranayama (breathing) and asana (postures) - and how they can be applied for patients who have hip, back and pelvic pain. A variety of pelvic conditions will be discussed including interstitial cystitis/painful bladder syndrome, vulvar pain, coccydynia, hip pain, and pudendal neuralgia. Lecture topics include the role of yoga within the medical model, contraindicated postures, and how to incorporate yoga home programs as therapeutic exercise and neuromuscular re-education both between visits and after discharge.
Dustienne Miller, CYT, PT, MS, WCS instructed the H&W remote course Yoga for Pelvic Pain. Dustienne passionately believes in the integration of physical therapy and yoga in a holistic model of care, helping individuals navigate through pelvic pain and incontinence to live a healthy and pain-free life. You can find Dustienne Miller on Instagram at @yourpaceyoga
Research demonstrates multiple benefits of a yoga practice that extend beyond the musculoskeletal system. These benefits include improved mood and depression, changes in pain perception, improved mindfulness and associated improved pain tolerance, and the ability to observe situations with emotional detachment.
Do the brains of yoga practitioners vs non-practitioners look different?
A study by Villemure et al looked at the role the insular cortex plays in mediating pain in the brains of yoga practitioners. They included various styles of yoga to capture the essence of yoga across multiple styles - Vinyasa, Ashtanga, Kripalu, Sivananda, and Iyengar.
Rewind back to neuroanatomy class - remember the insular cortex? The insular cortex is responsible for sensory processing, decision-making, and motor control by communicating between the cortical and subcortical aspects of the brain. The outside inputs include auditory, somatosensory, olfactory, gustatory, and visual. The internal inputs are interoceptive (Gogolla).
Villemure et al found several interesting objective differences. The practitioners had increased grey matter volume in several areas of the brain. This increase in grey matter specifically in the insula correlated with increased pain tolerance. The length of time practiced correlated with increased grey matter volume of the left insular cortex. Additionally, white matter in the left intrainsular region demonstrated more connectivity in the yoga group.
Other differences were seen in strategies utilized to manage pain. Most folks in the yoga group expected their practice would decrease reactivity to pain, which it did. The yoga group used parasympathetic nervous system accessing strategies and interoceptive awareness. These strategies were breathwork, noticing and being with the sensation, encouraging the mind and body to relax, and acceptance of the pain. The control group strategies were distraction techniques and ignoring the pain.
The authors determine that the insula-related interoceptive awareness strategies of the yoga practitioners being used during the experiment correlated with the greater intra-insular connectivity. Therefore, the authors conclude that the insular cortex can act as a pain mediator for yoga practitioners.
The more strategies our patients have for pain management, the better! Yoga is one of several non-invasive modalities our patients can add to their healing toolbox.
Yoga for Pelvic Pain was developed by Dustienne Miller to offer participants an evidence-based perspective on the value of yoga for patients with chronic pelvic pain. This course focuses on two of the eight limbs of Patanjali’s eightfold path: pranayama (breathing) and asana (postures) and how they can be applied for patients who have hip, back, and pelvic pain.
A variety of pelvic conditions are discussed including interstitial cystitis/painful bladder syndrome, vulvar pain, coccydynia, hip pain, and pudendal neuralgia. Other lectures discuss the role of yoga within the medical model, contraindicated postures, and how to incorporate yoga home programs as therapeutic exercise and neuromuscular re-education both between visits and after discharge.
Gogolla N. The insular cortex. Current Biology. 2017; 27(12): R580-R586.
Villemure C, Ceko M, Cotton VA, Bushnell MC. Insular cortex mediates increased pain tolerance in yoga practitioners. Cereb Cortex. 2014 Oct;24(10):2732-40. doi: 10.1093/cercor/bht124. Epub 2013 May 21. PMID: 23696275; PMCID: PMC4153807.
Portions of this blog are from an interview with Dustienne Miller. Dustienne is the creator of the two-day course Yoga for Pelvic Pain. She passionately believes in the integration of physical therapy and yoga in a holistic model of care, helping individuals navigate through pelvic pain and incontinence to live a healthy and pain-free life.
Have you noticed when you are afraid or don’t want to feel something you hold your breath? Imagine what it's like to have daily pain that limits function and how that could impact rib cage, abdominal and pelvic floor expansion. Dustienne Miller discusses this in her remote course, Yoga for Pelvic Pain, upcoming on July 31 - August 1, 2021. Her course focuses on two of the eight limbs of Patanjali’s eightfold path: pranayama (breathing) and asana (postures) and how they can be applied for patients who have hip, back, and pelvic pain.
Dustienne explains "We teach our patients how breathing patterns inform our digestion, our spine, our emotional state, our pelvic floor, etc. It’s one of the most powerful tools we have to inform our system that we are safe. Despite this knowledge, we will often find ourselves holding our breath or breathing in non-optimal ways without even realizing it." Dustienne focuses her practice on introducing yoga to patients within the medical model. Yoga can be included in pelvic rehabilitation in so many ways, including incorporating yoga home programs as therapeutic exercise and neuromuscular re-education (both between visits and after discharge).
Pelvic conditions that can be positively impacted by yoga are interstitial cystitis/painful bladder syndrome, vulvar pain, coccydynia, hip pain, and pudendal neuralgia. Treatment for these conditions often involves an individualized approach that may include both pharmacologic therapies (prescription drugs, analgesics, and NSAIDs) and nonpharmacologic interventions such as exercise, muscle strength training, cognitive behavioral therapy, movement/body awareness practices, massage, acupuncture, and nutrition.
A systematic review of the 2017 clinical practice guidelines evaluated 14 randomized controlled trials and found that yoga was associated with lower pain scores (1). Similarly, in 2020 there was a review of 25 randomized controlled trials that examined the effects of yoga on back pain. Out of these trials, 20 studies reported positive outcomes in pain, psychological distress, and energy (2).
The great thing about yoga is that the asanas (postures) can be modified to accommodate your strength, experience, and health conditions. An example of this is the Downward Facing Dog pose. There are so many ways to made Downward Facing Dog work for your body. Use straps, the wall, or the plinth/countertop to provide support for your body as needed, which might look different each day.
Some folks think you need to be flexible to have a yoga practice. Dustienne stresses "What is necessary is to be flexible with understanding that every day might feel different. If you are in an active pain flare your practice will look different than on the days you are feeling better. That can be a challenging aspect of a mindful practice - embracing that every day is different. Have the courage not to judge yourself, but to celebrate that you are meeting your needs with kindness."
People have been doing yoga for thousands of years. It is a mind-body and exercise practice that combines breath control, meditation, and movements to stretch and strengthen muscles. Join Dustienne Miller in Yoga for Pelvic Pain on July 31 - August 1, 2021, to learn more about incorporating yoga into your clinical practice.
No prior experience with teaching yoga is required to attend the course. However, all participants must possess a working knowledge of pelvic pain conditions and foundational rehabilitation principles.