How to prescribe yoga for overuse injuries

DOs unfamiliar with yoga should know that it shares many parallels with osteopathic medicine, said Stacey Pierce-Talsma, DO, during an OMED workshop Monday.

“There’s really a beautiful comparison between osteopathic medicine and yoga,” she said, noting that both disciplines focus on the mind, body and spirit, and that both follow the belief that structure and function are very much related.

As commonly practiced in the U.S., yoga is a set of exercise postures designed to help practitioners relax and calm their minds while improving their strength and flexibility. Traditional yoga includes additional practices such as meditation and a commitment to nonviolence and honesty, Dr. Pierce-Talsma noted.

Preliminary studies suggest regular yoga practice can reduce cortisol and back pain.

In recent years, yoga has become more popular across the nation. More than 20 million Americans, or about 9% of U.S. adults, practiced yoga in 2012, an increase of 29% from 2008, according to Yoga Journal.

Overuse injuries

Yoga can be particularly useful for patients with overuse injuries, said Dr. Pierce-Talsma, the program director for the Neuromusculoskeletal Medicine-Osteopathic Manipulative Medicine Plus One program at the University of New England College of Osteopathic Medicine in Biddeford, Maine.

Overuse injuries can be the result of poor posture, repetitive movements from spending the day sitting at a computer, or participation in sports. DOs typically treat overuse injuries by instructing patients to modify the offending activity and by prescribing stretches and heavy-load exercises designed to stimulate tissue remodeling and normalization of tendon structures.

Yoga addresses overuse injuries in part by helping the patient become more aware of alignment and proper posture, Dr. Pierce-Talsma said. Once patients become accustomed to the various yoga poses, they will be able to better ascertain areas of tightness and fatigue, physically and otherwise.

“The lessons that I have taken from yoga translate off the mat,” she said. “So when I’m doing my practice, I start to notice, ‘Where am I weak? Where am I tight?’ That translates into my life and in my mind. ‘Where is my mind tight? What things can I let go of? What do I need to let go of in order to better serve my patients and my community?’ “

With greater awareness of muscle tension and fatigue in their bodies, patients can recognize poor posture and behaviors causing overuse injuries while they are at work, at home or playing sports.

When patients use yoga to address overuse injuries, they receive added benefits such as stress relief, Dr. Pierce-Talsma said. Deep breathing, in particular, is a component of yoga postures that helps calm patients and has other advantages, she said.

“As osteopathic physicians, we know how important breath is,” she said. “It’s important to move our diaphragms, to have these lymph pumps, to move the venous blood through. Breath is critically important to our patients.

“Breath is intimately connected with our thoughts. It’s proven that if we breathe really fast, we’re going to have increased sympathetic tone. And if we slow our breath down, that actually decreases sympathetic tone and we can have more of a parasympathetic response.”

The emphasis on breath distinguishes yoga from other exercise activities, Dr. Pierce-Talsma said.

Prescribing yoga

DOs can learn some yoga poses and hand them out prescriptively for patients to do at home, Dr. Pierce-Talsma suggested. DOs’ knowledge of anatomy and disease processes will help them understand which postures are preferable or may be dangerous for certain patients.

As an example, Dr. Pierce-Talsma asked the audience to consider how they would treat a patient with carpal tunnel syndrome.

Members of the audience said they would examine the patient’s shoulders, forearms, wrists, elbows, thoracic inlet and cervical spine.

Dr. Pierce-Talsma then cited a 1998 JAMA study, which found that carpal tunnel patients who did yoga had improved grip strength and reduced pain after eight weeks, while patients in a control group, some of whom used a wrist splint, had no change in their grip strength or pain.

In the study, patients followed a sequence of 11 poses, which Dr. Pierce-Talsma went over with the audience. She noted that almost all of the poses are easy, which makes them safe to prescribe to patients. They included prayer pose, in which the palms and fingers are pressed together over the heart; standing mountain pose, in which practitioners align their ankles, knees, hips and shoulders; chair twists, in which one sits sideways and turns the body toward the back of the chair; and final relaxation, in which practitioners lie on their backs, relax their arms and legs, and focus on their breathing.

After discovering yoga, Dr. Pierce-Talsma said she now often prescribes yoga poses instead of exercise. She also instructs patients on performing diaphragmatic breathing with the poses.

Presentation attendee David G. Patterson, DO, said he was excited to hear more about yoga and breath work.

“It’s very fascinating how yoga uses breathing to regain control of your autonomic nervous system,” said Dr. Patterson, a family physician from Flat Rock, Michigan. “A lot of times, we’re controlled by our subconscious mind, and our autonomic nervous system can kind of take control back. It’s important in the healing process.”

Amid presentations on hypertension and diabetes at OMED, learning more about yoga was a refreshing change of pace, Dr. Patterson said.

“After you’ve been in practice for so many years, you’re ready to have something else in your armamentarium to help your patients,” he said. “Or even when a patient brings it up. ‘I’ve been doing yoga, do you think it will help for this?’ It’s good to have an awareness of it.”