PYT Students Advocate for the Advance of Professional Yoga Therapy

Advocating for the Advance of Professional Yoga Therapy
Recently I had the opportunity to assist Ginger Garner, MPT, ATC, ERYT500, founder and executive director of Professional/Medical Yoga Therapy Studies (PYTS) at this year’s National Athletic Trainers’ Association (NATA) Symposium in Philadelphia, PA on Thursday, June 24, 2010.  I had a wonderful first time experience at the NATA symposium as a lab assistant during Ginger’s dynamite 7 - 9 am presentation on Complementary & Alternative Medicine in Practice:  Using Evidenced Based Yoga to Evaluate the Athlete.  There were nearly 200 athletic trainers present and interested in providing yoga to their clients.  That must mean that their clients are interested in learning about and practicing yoga, right?

With over a hundred different styles of yoga and yoga training programs for yoga teachers and yoga therapists it can be mind boggling to decide which program is the best one?  There are many factors to consider professionally and personally.   

Mission of Professional Yoga Therapy (PYT) 
Professional/Medical Yoga Therapy exists to train licensed healthcare clinicians to be professional yoga therapists and teachers.  Equally important it exists to protect the public.  It is a unique non-dogmatic method that adheres to traditional yoga philosophy.  It is our intention that PYT becomes a model for standardization in medical yoga therapist training.  Each PYT trainee follows a code of ethics (like all yoga teachers of accredited schools are expected); however, PYT graduates also follow their respective profession’s scope of practice.

Scope of Practice and the PYT
A scope of practice is a set of distinct guidelines outlining legal parameters that the healthcare professional follows.  The duties of a nurse, therapist (PT/OT/ST/massage), athletic trainer (ATC), dentist, doctor, or chiropractor etc. vary, yet there is often overlap with some disciplines.  Each has distinct specialties and advanced knowledge that they bring to professional yoga therapy.  At a minimum each licensed healthcare worker brings to the patient or client years of experience and an understanding of anatomy and physiology. 

What the Public May Not Know
What the consumer of yoga therapy may not know is that at present any yoga teacher at the 200 hour level with little to no medical background can call themselves a yoga therapist.  Clearly the public is not protected.  Ultimately it is for the protection of our patients/clients that we seek standardization and a future board of licensing for yoga therapists.  The quality and quantity of evidenced based research presented in PYTS is phenomenal!  I wholeheartedly recommend this program to all licensed healthcare workers who have a passion and lifelong yearning to study yoga.

Yoga Therapy:  An Unregulated Field 
As an occupational therapist with 20 years of experience, I didn’t feel I should call myself a yoga therapist until completing the certification for yoga therapy.  Clearly not everyone thinks this way.  It is an unregulated field at present.  I did feel that as a yoga teacher and an occupational therapist that I could incorporate yoga as a modality into my OT treatments when appropriate. 

Having gone through a traditional yoga teacher training and loving it immensely, I saw how basic the 200 hour level is as far as how much anatomy could be covered.  Very little time was devoted to the disease process and adapting yoga to meet the needs of the individual.  New yoga teachers were advised by Swamiji to continue to learn all one could about the body and to never stop learning.  There is a distinct difference between a yoga teacher training and a yoga therapist training and then there is Professional Yoga Therapy Studies.

I chose to study with PYTS because Ginger sets the bar high and demands that each graduate complete a research project to promote evidenced based therapeutic benefits of yoga.  Traditionally, within yoga, one finds a guru in which to study under and learn from.  I have not heard Ginger use the “guru” word, or any other PYT student, however, it is with much respect and admiration that I think of her as my western guru.  I have often thought that she must have more than 24 hours in her day to accomplish all that she has. 

The Power Point Presentation
The power point presentation was thorough, concise, and I believe, would have made the ancient yogis very pleased to see the evolution of yoga in America.  After all, this is groundbreaking territory to merge western rehabilitative practices with ancient yogic practices.  I was thrilled to see so many athletic trainers interested in yoga as a modality; however, it is a lifestyle.  One must practice it in order to effectively use it as therapy; otherwise, it becomes another form of physical activity.  The mental discipline that one gains from yoga is the secret to healing with it.  It isn’t just a physical practice.    As an OT, yoga seems the perfect fit with rehab because OT’s have been taught to consider the whole person and their many facets of being, not merely the physical aspects of injury or illness.

Occupational therapists have always been taught to look at the psycho-social and emotional aspects of a person’s being, as well as, consider cultural differences and educational levels when working with and teaching our patients.  The beauty of yoga as therapy is that it can be applied to any setting or population:  pediatrics, geriatrics, orthopedics, injured workers, schools, homecare, or with athletes.  It works solo, one on one or in groups.  It addressed the physical as well as the mind (psycho-social-emotional-spiritual realms).  Yoga offers lifestyle guidance for optimal and proper living in this world. 

When Ginger introduced the yogic concept of koshas and put it in the Pentagon of Wellness Frame of Reference it made total sense to me.  The analogy of an onion is often used to describe the koshas because of the multiple layers.  One layer doesn’t make an onion but together the many layers do make an onion.  The same is true for humans.  We are so much more than we think we are.

 The Pentagon of Wellness Frame of Reference

Physical Body or Annamayakosha  - This includes but is not limited to the medical history, pain level, ROM, postural assessment, MMT, and diet.

Energy Body or Pranamayakosha - This includes the breath, is it rhythmic, shallow, labored?  Are secondary muscles of respiration being called in?  What is the person’s energy level throughout the day and their sleep patterns like?  It also includes subtle energy, chakra system.

Psychological Body or Manomayakosha - Look at the person’s actions toward themselves and to others.  Are they limiting themselves with negative thoughts?  Are they overworked or overwhelmed? 

Intellectual Body or Vijanamayakosha  - What type of learner is she or he?  Does the patient or athlete understand their condition?  This includes self-awareness and self-discipline.

Spiritual Body or Anandamayakosha - Are they in touch with their passion or direction in life?  Do they feel joy and contentment in this life?  Do they live by a set of core values?

Why is this important?  In order for true health and healing to be fostered, we as healthcare workers must (I believe) become more like “healers”.  We must be centered, compassionate and tuned in to our clients or patients to help them recognize the big picture.  After listening to my patients I am often able to see a clear correlation between their emotional state of being and their physical manifestation.  I help my patients to use “eagle-eyes” to see themselves and their situation with more objectivity.  I talk about self-responsibility while helping my patients get through their current injury or illness.  I believe this empowers the individual to take a look at their lifestyle choices.

Everything that we do and think makes us who we are.  Our daily lives are busy.  We often operate in rush mode.  We juggle the needs of family, work, friends, continuing education, emergencies and the occasional difficult co-worker and office politics.  Yoga’s teachings remind us to live authentically, to be mindful of not only our actions but our thoughts too.  Thoughts have vibrations that reverberate out into the world and come back to us.  This is why positive affirmations or setting a clear intention are often part of a yoga class or session.  With thoughts and words of love and kindness, everything that I think and speak comes back to me.  The “cure” is not “out there” per se, yoga teaches it is “within”. 

Learning Lab Portion of NATA Presentation
During the lab portion of the presentation we taught several foundation precepts held in the PYT method of yoga therapy such as the TATD breath or the transversus abdominis assisted thoraco-diaphragmatic breath.  We explained that patients must master of the breath before postures are introduced.  In fact, we teach deep abdominal breathing and the three part breath prior to TATD, however, these were athletic trainers so we started with the TATD breath that is unique to PYT.  Participants were instructed to gently bring the navel toward the spine and hold it taut while continuing to inhale and exhale.  While presenting the TATD breath, at least two athletic trainers in the group wanted to learn how to evaluate the athlete using yoga.  Obviously or not so obviously one must practice yoga before being able to use it as a therapeutic modality.  We proceeded to teach TATD in supine, sitting and 4 point. 

We then spoke of the PYT precept #7 (there are 15 total) that teaches lumbopelvic stabilization should be emphasized first in postures while scapulohumeral rhythm and stabilization should follow second.  From there we introduced spinal neutral, cat/cow asana with verbal cues to check TATD, was it maintained or lost, and if lost to re-engage it with assurance that this is common even amongst seasoned practitioners.  From there we introduced “The Arm Spiral” and “The Arm Float”, a specific PYT technique used to facilitate scapulohumeral rhythm and scapular stabilization, while simultaneously nurturing glenohumeral external rotation, scapular depression, medial rotation, retraction, and forearm pronation (see power point presentation or learn more by attending PYT I).  

We proceeded to down dog prep (another PYT I specific posture), downward facing dog and some got to plank all while staying conscious of the breath.  Ironically someone said, “It wasn’t much but it was a lot”.  How often have you heard, “less is more”.  We should remember this and not bombard our clients or patients with too much information all at once.

Learning Styles
It is important to recognize that we all learn differently and one way is not better than another.   PYT reminds healthcare workers of the various learning styles in order that we do not use the same manner of presentation when explaining new information to our clients/patients.  Just as we may customize how we teach our client or patient, we also customize yoga to fit the individual rather than the reverse.  I have noticed that some people are resistant to yoga props perhaps thinking they are a stigma much like some elders are with canes and walkers.  I always say that props are our friends.  Often we don’t even know we need them or would benefit from them until we try.  There is much to be learned from a review of learning styles.  Recognizing that we and our clients and patients learn differently is a good thing and these different ways have been classified differently too.
Visual/Spatial:  pictures, images
Auditory:  sounds, music
Verbal/Linguistic:  words, speech, writing
Physical/Kinesthetic:  sense of touch, using your body and hands
Logical/Mathematics:  reasoning
Social:  group setting
Solitary:  self-study

Anthony Gregore has a model in which he describes concrete and abstract learners and goes on to further classify how we organize information either in a random or sequential way.  We can be any combination of these.  Why is this important you might ask?  We come into contact with so many different people in the healthcare field.  When you get that feeling that your client or patient just doesn’t get it, then quickly re-evaluate what you just said or did and offer the information in another manner.  Decipher how best the person you are talking with learns or better yet use a simple learning styles inventory available on the web.
Within yoga’s sister science of Ayurveda there is yet another way of understanding and knowing the Self better.  PYT teaches evaluation through the doshic lens.  Yoga offers a vast body of knowledge that will keep you stimulated, balanced, relaxed, and enjoying optimal health and well being.  You might even become a centurion yogi or yogini should you embrace the yogic lifestyle.

My Evolution in Yoga Therapy
I enrolled in the Professional Yoga Therapy Studies program in May 2009 after attending the International Association of Yoga Therapists (IAYT) Symposium in Los Angeles, CA in 2008.  At that time I knew I wanted to complete a yoga therapy certification.  I had completed my 200 hour level yoga teacher training in the Sivananda style in Oct. 2007.  As I networked at the IAYT Symposium, I was amazed at the number of yoga teachers marketing themselves as yoga therapists who didn’t have “credentials”.  My 200 hour yoga teacher certification says “teacher”, not “therapist”.  I believe there is a huge distinction.  One woman I spoke with at lunch had never even taken a college level anatomy and physiology course.  To be fair, there are many competent, self-educated yoga teachers who have studied and sought additional training (some have even written books or released DVDs) that gives them knowledge and confidence to treat someone with a medical condition.  However, they are not licensed healthcare professionals.

Since completing the PYT program I found the courage to leave my acute/outpatient/SNF hospital based position of 9 years (that I enjoyed yet was administratively limited in my ability to fully integrate yoga therapy in that practice setting) and now have control of my calendar to schedule home care visits, yoga classes, specialty yoga classes, and private sessions around a new position (two half days to start with another hospital) that seeks to offer outpatient occupational therapy at a satellite clinic that previously offered PT only, as well as, market yoga therapy.  Currently, I teach two specialty yoga classes:  yoga for breast cancer survivors and therapeutic yoga for seniors.

Conclusion
Yoga, because of its many limbs is the perfect foundation for integrative rehabilitation programs.  It allows for the exploration of the Self to understand our minds and recognize ego which helps one gain control over the senses.  It offers tried and true lifestyle guidance for optimal health and well-being.  It fosters self-discipline, as well as, offers a myriad of benefits, physically, psychologically, emotionally, intellectually, and spiritually.                                                 

About Eleanor
Eleanor graduated from Keuka College with a Bachelor’s of Science degree in Occupational Therapy in 1990.  She has practiced OT in a variety of settings and thinks of herself as an eclectic OT.  She has primarily worked in the acute hospital and nursing home setting, though also worked in the school system and in the acute mental health setting.  She has been Director of Occupational Therapy preferring direct care.  She grew up in upstate NY near Ithaca, where she continues to reside.  Besides loving yoga she loves nature and creating relaxing places to simply “be” outdoors.  She planted a 7000 square foot maze and created a large stone defined 7-circuit labyrinth on her property that borders the Finger Lakes National Forrest.  Soon ‘Amazeing Acres’ will open to the public so that field trips can be scheduled for school children, and welcome tourists and locals a fun way to walk and play (exercise).  She intends to open the Finger Lakes Hostel and Yoga Retreat in the near future.  She is a descendent of the Seneca Native American tribe and great, great, great grand-daughter of Seneca Chief Red Jacket.            

Next week: Another Student Perspective Advocate column, by Teresa Donahue PTA, PYT