YOGA AND PHYSIOTHERAPY
Yoga
Yoga is a supreme harmonization of physical, vital, mental, psy- chological and spiritual aspects of an individual. The basic aim of genuine yoga is to acquire intelligent and absolute control of the mind through self-development of physical and mental fac- ulties. This absolute harmony and coordination of mind and body, though based upon physical exercises, breath and mind control, is primarily a spiritual process. Thus, attainment of physical fitness through yoga asanas and pranayama is just the initial two steps towards the path of yoga sadhana.
Yoga is very ancient and the time of origin of its practice and doctrine cannot be dated with accuracy. The word 'yoga' is men- tioned in the Rigveda and some of its methods are found in Vedic literature, which dates back to thousands of years before Christ. One description of yoga and its definition is found in the ancient Hindu epic, Bhagwat Gita, which defines yoga as follows:
1. Samatvam yoga uchhayate - meaning, yoga is balance and harmony of the mind and body skill in work
2. Yoga karmasu kaushalam - meaning, yoga is skill in work.
Physiotherapy
Physiotherapy is the treatment of disease or its aftereffects by means of various physical modalities like remedial exercises, heat (thermotherapy), cold (cryotherapy), various modes of electri- cal currents, water (hydrotherapy) and wax (wax therapy). The basic aim of physiotherapy is to provide maximum possible physical independence within the limits of the disease and dis- ability. Of all the modalities at hand, exercise forms the basis of physiotherapy for the relief of symptoms and improvement of functions or functioning capacity of the body.
The word exercise originated from the word 'ex' meaning out the word 'ere' derived from 'arcere' meaning to lock. Thus exercise means to unlock or to free a part to move. The origin of exercise as a therapeutic measure dates back to the prehistoric period. The earliest writing on therapeutic exercises using various postures and movements of the body is traced back to about 1000 years before Christ in Cong Fou of Ancient China (Mac Auliffe, 1904). The fourth volume of Atharvaveda of ancient India called Ayurveda recommended remedial exercise and massage about 800 years before Christ (Guthrie, 1945).
In ancient Greece, interestingly enough, there existed a class of gymnasts, besides philosophers and priest-physicians, who prac- tised medicine. They also studied the effects of diet and exercises (Littre, 1839).
The knowledge about the relationship between body movements and muscles is found in a book on articulations by Hippocrates. In his text, he also very often used the word exercise (Adams, 1849; Littre, 1839).
THERAPEUTIC BENEFITS OF YOGA
Hypertension
Reduction of systolic blood pressure from 150 to 140 mm Hg, and reduction of diastolic blood pressure from 94 to 88 mm Hg was reported in 22 hypertensive patients after TM.
The practice of shavasana also resulted in a significant reduction of hypertension (Datey & Bhagat, 1975).
Exercise Tolerance
Patients of coronary artery disease (CAD) with stable angina showed improvement in exercise tolerance. Increase in the dura- tion of exercise, increase in maximum work load and delay in ST depression in the ECG were reported in 10%, 15% and 15% of patients, respectively.
Bronchial Asthma
Spontaneous reduction in the rate of breathing from 13 to 10 and reduction in the airway resistance were found in about 50% of patients with bronchial asthma. The severity of symptoms was reduced in as many as 75% patients (Wallace 1970; Wallace and Benson, 1972).
Swami Anandananda and associates (1975) reported an improve- ment in the lung function, pattern of breathing and even har- monal homeostasis just by practising simple muscular exercises (shukshma vyayam) with certain asanas in patients with mild-to- moderate bronchial asthma. However, they concluded that yoga cannot substitute drugs for emergencies like status asthmaticus.
Diabetes
Adult onset type diabetes, of less than 10 years' duration, with a fasting blood sugar of less than 250 mg%, and patients requiring less than 40 units of insulin daily for control of their diabetes responded favourably (Rugmini, 1975).
Low Backache
Practising Konasana, Supta-vajrasana, Bhujangasana, Shalab- hasana and Chakrasana showed favourable response in patients suffering from low back pain with improved functional capacity (Udupa, Singh & Shettiwar, 1975).
Squatting posture gives excellent stretch for lower spine while strengthening the muscles of legs and hips. It helps to open the lower spine. People who squat often get less backache problems. However, squatting should not be done for long periods.
Tachycardia, Palpitation, Nervousness, Insomnia
All these symptoms and signs responded favourably to the regular practice of asanas (Udupa, Singh & Shettiwar, 1975).
THERAPEUTIC BENEFITS OF PHYSIOTHERAPY
Modern physiotherapy has a wide variety of specialized exercise techniques, evolved and established through scientific research. The specific technique of therapeutic exercises is planned after a thorough clinical examination and investigations indicating the nature, degree of involvement, and the prognosis of the disorder. It may be directed toward the following:
1. To improve strength, endurance and flexibility of muscles
2. To facilitate neuromuscular coordination
3. To restore function or to provide maximum functional independence within the limits of the disease and disability (rehabilitation of physically handicapped patient)
4. To build up vicarious movements or trick movements to compensate for the permanent loss of movements
5. To facilitate neuromuscular re-education through biofeed- back or synchronization of electrical stimulation with voluntary efforts and specialized exercise techniques
6. To achieve cardiopulmonary conditioning to prevent as well as control risk factors for CAD, hypertension, diabetes, obesity, etc.
7. To improve body balance and gait
8. To promote performance by leading to optimal physical fitness through increase in functional capacity (VO2 max)
9. To prevent common sports injuries by conditioning of an athlete
10. To prepare for and facilitate child birth
11. To relieve pain and inflammation and to augment healing
12. To provide ergonomic advice with specific exercises, to prevent common musculoskeletal ailments
13. To prevent postsurgical complications
14. To promote physical fitness for overall positive health benefits
15. To improve psychological status leading to positive thinking, greater self-confidence, feeling of relaxation and wellness following a session of exercise
RATIONALE OF YOGA AND PHYSIOTHERAPY
The basic postures of the body known as fundamental or starting positions for initiating therapeutic exercise are same as the starting postures or asanas in yoga, e.g., tadasana corresponding to standing.
Figure: in yoga : tadasana. In Physiotherapy: fundamental standing position
In yoga:Pawan Muktasana in Physiotherapy : low back stretch
However, the basic difference is obvious when it comes to the methodology of performance of the therapeutic exercise and yoga asana.
In yoga asana, one assumes a definite posture of a particular asana and holds that posture for a brief period and then returns back to the starting position. Thus, the sequence of yoga asana is a slow, rhythmic dynamic movement of the body progressing to a static state of holding and again returning to the starting posture (dynamic-static hold-dynamic), whereas in therapeutic exercise, the sequence, speed, groove of the movement and arc of joint range vary as per the required effect of exercise. Although the maximum emphasis is on dynamic exercises, static exercises are used in physiotherapy to prevent painful joint compression and disuse atrophy, to improve strength, endurance, posture and to induce relaxation.
Similarly, exercises could be passive, assisted, active or even resistive as against only dynamic and static in yoga. Thus, the mode of therapeutic exercise is extremely variable and as such. there is no generalization of exercises, rather the mode of exer cise is planned on an individual basis. The exercises are modified or progressed as per the requirements of the patient's condition.
This is not true with Hatha yoga. Although the asanas are more or less based on scientific experimentation, they are limited to certain body movements, postures and breathing and cleansing techniques (kriyas). This has resulted in providing excellent general exercises with flexibility to the whole body.
Yoga asanas, without integration of astangas or all the eight ele- ments of yoga, are excellent means of promoting flexibility to the joints and soft tissues. They also help improve muscular strength, endurance, controlled muscular actions, controlled breathing and relaxation. This limits their application in patients with spinal cord injuries, polyarthritis, severe physical handicap and neurological disorders.
The efficacy of exercising the whole body through asanas in a specific localized disorder or dysfunction is not without doubt, whereas advanced exercise techniques like proprioceptive neu- romuscular facilitation (PNF), biofeedback and self-controlled movements in combination with a suitable electrotherapeutic modality help to re-educate neuromusculoskeletal function.
Pranayama and yoga kriyas (or shat karmas), the procedures for systemic purification, are, no doubt, excellent techniques to promote respiratory and gastrointestinal systems on the whole. But various methods of chest physiotherapy and postural drainage to eliminate secretions from a diseased area of the lung are much more specific.
The slow, smooth and rhythmic movements of yoga asana on leading to a static relaxed posture aim at conservation of energy nd (prana). As against this, in physiotherapy, the movements, although smooth and rhythmic, are aimed at overloading or excessive expenditure of energy (e.g.. cardiorespiratory condi- tioning). The nature of movements in restorative or re-educative the therapies is not so vigorous but is dynamic and repetitive.
