Physiotherapy and Yoga

Written by our resident physiotherapist and yogi, Dean Tumibay

“Movement is medicine.”

edmonton yoga arm balance

At first glance, physiotherapy and yoga appear to be a perfect match. Both harness principles of alignment to safely guide individuals through postures and use exercise to improve movement and prevent injury. Both emphasize a balance between stretching and strengthening as a means of improving posture. Parallels can even be drawn between very specific yogic and physiotherapy philosophies.

edmonton yoga malasana

The notion that “movement is medicine” has spurred the growth of both practices in the western world with more and more people turning to either their local yoga instructor or physiotherapist to aid in recovery of specific musculoskeletal ailments. The yoga industry has boomed with a new studio popping up within our city limits almost yearly and dedicated practitioners flocking to studios in search of improved posture, better athletic performance, stress reduction and in some cases pain relief. Physiotherapy clinics have seen increased traffic with many turning to them as their primary care provider when confronted with a physical limitation. Though ties exist between the two practices, as movement specialists, it’s interesting to consider what the physiotherapy perspective is on individuals using yoga to remedy their aches and pains.

edmonton yeg yoga crow pose

As a newly practicing physiotherapist, and a former Yogalife Studios employee, I’ve had the opportunity to have a foot in both worlds. The understanding of bodily movement and proper alignment that I gained from physiotherapy school has enriched my yoga practice, and my understanding of yoga principles has likewise complimented the tools I use with patients as a physiotherapist. From my conversations with my peers in the physiotherapy profession, I’ve found that many physiotherapists recommend patients to yoga, but it’s important to understand the considerations that they make before deciding on whether a regular practice would be appropriate for your particular condition.

To help inform this week’s blog post, I looked to my colleagues as well as my former instructors for their opinions on yoga as a rehabilitative practice as well as the advice they give their clients before sending them to a community yoga class.

First of all, why do physiotherapists refer their clients to yoga? Do physiotherapists ever advise patients to avoid yoga?

If you ask any physiotherapist what the primary challenge of their profession is, one answer that would come to the forefront is exercise adherence. It can be a challenge to convince clients that a lifestyle change is necessary and that the daily practice of prescribed exercises is essential for optimal rehab in a population that is often looking for a quick fix. Yoga often incorporates movements and exercises that are similar to those that we prescribe to our patients, but they have the added benefit of being practiced in a community. Community settings and group programs can be strong motivators for individuals to maintain a regular exercise regime.

Andrea Bui, an Edmonton physiotherapist with Qi Creative indicates that she has referred clients to yoga in the past, especially when the client inquires about the practice. She comments, “yoga has a social acceptability with less stigma than physiotherapy. It’s more realistic that patients will continue to go to an activity program in a group setting than do a set of the same exercises at home alone.”

Aside from the appealing nature of being in a community setting, the actual practice of yoga itself addresses a number of different issues that physiotherapists encounter with clients on a daily basis. There is a lot of value to an exercise regime that has such a heavy emphasis on postural alignment compared to other more aggressive activities that may put patients at risk of further injury. However, like any activity, the appropriateness of yoga is primarily dependent on the patient.

Stephany Luu, an Edmonton physiotherapist at Lifemark Millwoods indicates that she “refers patients to yoga if their issues could be addressed by improving posture.” She also highlights the benefits of improved balance in postures that require a single-leg stance or a narrow base. “The balance aspect of yoga is great for my patients who have trouble with proprioception, or poor body awareness” but she admits “I generally avoid referring patients to yoga if they are already hypermobile, especially in their spine, and lack proper control of that area of their body”.

Judy Chepeha, an experienced Edmonton physical therapist and professor at the University of Alberta’s physiotherapy program reports “recommending yoga to almost all of her patients”, but is cognizant of the style of class the client is interested in attending. Despite being a fan of yoga for most of her clients, Judy admits she is hesitant to refer patients who, surprisingly, are already avid yogis. “My main concern is with those individuals who take more advanced classes, so I make sure I’m careful to understand what yoga means to different people.”

Despite being aesthetically pleasing, advanced postures can put our joints into compromising positions. Physiotherapists should be aware that many advanced yoga practices involve extreme ranges of motion, unconventional strengthening postures that may be stressful on the joints and repetitive movements that could exacerbate pre-existing injuries instead of aid in them.

So what advice did our panel have for those transitioning from the rehabilitative practice of physiotherapy to the community practice of yoga?

1. Make sure your physiotherapist is aware of what is involved in the yoga practice you’re interested in.

Make sure your physiotherapist has an idea of what kinds of movements are involved in the yoga practice you want to attend. If they have a general understanding of the practice, they can help determine how appropriate it is for your body and your specific condition. In some cases, physiotherapists can help inform you if modifications are necessary for certain postures so that they can be practiced safely.

2. Talk to your yoga instructor before the class. Let your instructor know of your limitations.

This includes what movements cause you pain, what movements you were told to avoid by your physiotherapists, and the nature and location of your injuries. Your yoga instructor can provide insight into which postures you can perform, and alternates for those that may not be safe at the moment.

3. If you’re new to the practice, try and book a one-on-one consultation with a yoga instructor first before committing to a regular class.

One-on-one yoga classes provide a perfect opportunity to develop a healthy dialogue between you and your yoga instructor. This allows them a full session to understand your limitations and provide personalized modifications for postures that may not be appropriate for you in their full form.

4. Keep your physiotherapist and yoga instructor in the loop.  

Let them know what postures worked well for you, and those you found were too difficult. Let them know if there have been any changes in your pain levels, or if you’re experiencing unfamiliar sensations or movement restrictions after the practice.

Ultimately, when it comes to creating a smooth transition from physiotherapy to yoga, the responsibility lies with you, the client to keep both professionals informed. Your physiotherapist should be aware of what types of yoga you’re interested in practicing, and the nature of the practice. Your yoga instructor should be aware of your limitations. By keeping a constant dialogue with yourself, and those involved in your care, the more likely you will be successful in maintaining a safe, and beneficial yoga practice for your condition.