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  1. 1. P a g e | 1 Dr. Nithin Ravindran Nair (PT) YOGA AND PHYSIOTHERAPY Introduction: (Ref: Principles and Practice of Physical Rehabilitation – Megha Sheth, Neeta Vyas et al., Sengupta P. et al., 2012) ▪ The word “Yoga” is derived from the Sanskrit word “Yuj” which means “to unite”, “to harness. It also means “to direct”, “to concentrate” (the mind and thoughts, etc.) ▪ WHO has classified yoga as a mind-body practice (muscular activity + internally directed mindful focus on awareness of the self, the breath, and energy). ▪ Yoga teaches us the means by which jeevatma (human spirit) can be in communion with parmatma (god) and so secure liberation (moksha). Yoga Styles: YOGA STYLES Asthanga Sivananda Bikram Yin Hatha Iyengar Kripalu Kundalini Vinyasa Anusara
  2. 2. P a g e | 2 Dr. Nithin Ravindran Nair (PT) YOGA AND MIND: (Ref: Principles and Practice of Physical Rehabilitation – Megha Sheth, Neeta Vyas et. al.) ▪ Patanjali defines yoga as “chitta vritti nirodaha” (Calm the fluctuations of the mind) ▪ Five chitta vritti are as follows Pramana (correct knowledge or valid cognition): ✓ The experiences an individual has using the 5 senses of human body to determine the validity of knowledge. ✓ Aquiring knowledge requires the following: 1) Pratayksha (direct experience) 2) Anumana (logical reasoning / inference) 3) Agamah (trustworthy testimony) 4) Anubhava (experience) Viparyaya (misconception or wrong knowledge): ✓ False knowledge or misconception occurs due to the deceptive look of an object. ✓ The goal of yoga is to make the mind calm, so that the person can see things for what they are, without appreciating them to be something else. CHITTA VRITTI PRAMANA VIPARYAYA VIKALPANIDRA SMRITI
  3. 3. P a g e | 3 Dr. Nithin Ravindran Nair (PT) Vikalpa (Imagination): ✓ Works in a more subtle way than Pramana and Viparyaya ✓ It has a strong impact on individual’s personality – positive thoughts lead to positive personality, negative thoughts lead to negative personality ✓ Yoga → positive state of mind → positive environment → lead a good life. Nidra (Sleep): ✓ During sleep – mind diverted to oneself and it provides relaxation and refreshment ✓ Inadequate or loss of sleep – reduces ability to concentrate → negatively impacts mood → poor functioning ✓ Yoga involves various meditation techniques that help regain the state of deep sleep. Smriti (Memory) ✓ Memory is mental retention of experience gained through consciousness ✓ Memory affects mood (pleasant memories → pleasant mood, bad memories → bad mood) Patanjali enumerates 5 causes of chitta vritti klesha (creating pain) and 9 chitta vikshepa (distractions and obstacles) Chitta Vritti Klesha ✓ Avidya: Ignorance or nescience ✓ Asmita: Feeling of individuality (physical, mental, intellectual or emotional) → limits the person. ✓ Raga: Attachment or passion ✓ Dvesha: Aversion or revulsion ✓ Abhinivesha: Love or thirst for life Chitta Vikshepa ✓ Vyadhi: Sickness ✓ Styana: Mental laziness ✓ Samasya: Doubt or indecision ✓ Alasya: Physical Laziness
  4. 4. P a g e | 4 Dr. Nithin Ravindran Nair (PT) ✓ Pramada: carelessness, negligence ✓ Avirati: sensuality, craving ✓ Bhranti Darshana: False or distorted perception ✓ Alabdha Bhumikatva: Failure to attain yogic states, stability, goal ✓ Anavasthitattva: Instability to maintain (hold on) Limbs or Stages of Yoga: Patanjali has enumerated eight limbs or stages of yoga for the quest of the soul YOGA Bahiranga Sadhana (Outward Quest) Antaranga Sadhana (Inner Quest) Antaratma Sadhana (The Quest of the Soul) YAMA PRANAYAMA DHARANA NIYAMA PRATYAHARA DHYANA ASANA SAMADHI Yama: ▪ Universal Moral Commandments ▪ These commandments are – o Ahimsa (non – violence) o Satya (truth) o Asteya (non – stealing) o Brahmacharya (celibacy) o Aparigraha (non – greed / generosity) Niyama: ▪ Self – Purification by Discipline ▪ Sage Patanjali has listed 5 niyama – o Shaucha (purification) o Santosha (contentment) o Tapas (austerity) o Swadhyaya (self – study) o Ishwara Pranidhana (surrender)
  5. 5. P a g e | 5 Dr. Nithin Ravindran Nair (PT) Asana: ▪ Postures ▪ Easy comfortable positions of the body, connecting the mind and the spirit to experience stillness and infinity Pranayama: ▪ Rhythmic control of Breath ▪ Prana means – breath, life, vitality, or energy ▪ Ayama means – length or expansion ▪ Inhalation or inspiration - Puraka ▪ Exhalation or expiration – Rechaka ▪ Retention or holding the breath – Kumbhaka ▪ 2 states of Kumbhaka – o Breathing suspended after full inhalation (before exhalation) – Antara Kumbhaka o Breathing suspended after full exhalation (before inhalation) – Bahya Kumbhaka Pratyahara: ▪ Withdrawal and emancipation of the mind from the domination of the senses and exterior objects ▪ In Pratyahara, the extrovert senses are filtered out (turned inward) – there by providing alternate “inner point of attraction” Dharana: ▪ Concentration ▪ Dharana is the art of maintaining focus uninterrupted by distraction – both internal and external Dhyana: ▪ Meditation ▪ Meditation is the subjective experience which releases all tensions ▪ In meditation, the flow of energy is continuous and stable whereas the awareness of time and space is lost.
  6. 6. P a g e | 6 Dr. Nithin Ravindran Nair (PT) Samadhi: ▪ State of super-consciousness brought about by profound meditation ▪ When an uninterrupted flow of the individual’s awareness gets absorbed in the object of meditation, their consciousness loses its identity and becomes one with the object. Benefits of Yoga: (Ref: Principles and Practice of Physical Rehabilitation – Megha Sheth, Neeta Vyas et al; Yoga and Rehabilitation – Nilima Patel, Effect of Yogasana on Circulatory and Respiratory System, Sarma AS, 2018) ▪ Yoga as an adjunctive therapy and a way of promoting and maintaining wellness, has diverse clinical and non-clinical applications in physiotherapeutic process. ▪ Yoga is one of the most efficient and an integrated technique for mind-body management and can be used as a tool for health promotion (Moharana S. et. al., 2017) Asanas used in various pathologies and conditions Pathology/Symptom Asanas Obesity Pawanmuktasana, Ardhachandrasana, Garudasana, Gomukhasana, Suryanamaskar Diabetes Janu Sirasana, Supta Virasana, Paschimottanasana, Nadi Sodhana Pranayama, Pawanmuktasana Hypertension Janu Sirasana, Nadi Sodhana Pranayama, Supta Baddha konasana, Dhyana Arthritis, Low Back Pain Supta Baddha konasana, Supta Virasana, Bhujangasana, Salbhasana, Garudasana Respiratory Disorders Supta Baddha konasana, Supta Virasana, Bhujangasana, Ujjayi Pranayama, Nadi Sodhana Pranayama, Janu Sirasana Gynecological Problems Sarpasana, Malasana, modified Pawanmuktasana, Supta Baddha konasana, Supta Virasana Musculoskeletal Improvements and Posture Control: ▪ Yoga as a set of “static dynamic procedures” can be considered as a means of self-mobilization of the nervous system and the joints of spine and limbs.
  7. 7. P a g e | 7 Dr. Nithin Ravindran Nair (PT) ▪ With regards to therapeutic process, Yoga helps in releasing somatic dysfunctions and improves flexibility and range of motion. ▪ Yoga practice may decrease anterior pelvic tilt, improve hip extension, increase stride length – thereby preventing or reducing age-related changes in gait function. ▪ Weight bearing asanas usually helps to prevent osteoporosis. ▪ Other benefits include – scoliosis prevention, passive correction of multidimensional pelvic distortion, postural re-education. Neurological Benefits of Yoga: ▪ Yoga techniques seems to stimulate the right hemisphere of the brain and increases alpha wave frequencies. ▪ Yoga Practioner may also show a significant reduction in the number of mistakes during static motor performance as well as improvement in sensory-motor performance. ▪ Enhanced processing ability of the CNS and hand-eye coordination. ▪ Physiotherapists can utilize yoga to promote the recovery process and improve functions among stroke patients. Physiological Benefits of Yoga: ▪ Yoga exercises leads to stimulation of the autonomic nerve plexus and the endocrine system by an increased pressure in abdominal wall. ▪ Yoga asanas enhance lung function and improves performance of cardio- respiratory systems - ↑ strength and endurance of respiratory muscles, ↑VC and breath volume, normalizes BP, ↓ HR, RR, breath rate. ▪ Yoga enhances circulation of blood and body fluids throughout the body. ▪ Different poses and posture in Yoga are advantages in influencing a healthy circulatory system in the body – o Standing Postures – Improves flow of blood along the walls of the heart – prevent heart diseases
  8. 8. P a g e | 8 Dr. Nithin Ravindran Nair (PT) o Inverted Postures – Prevents muscles and cell tissue degeneration, effective blood circulation to the brain, lymphatic system - properly rested. o Horizontal Postures – BP brought under control – resting and rejuvenating heart and lung. o Bending Postures – improved blood supply to cardiac muscles – toning up of myocardium. ▪ Yoga intervention increases regression of coronary lesions and coronary atherosclerosis and improves myocardial perfusion. ▪ Yoga also improves risk factor profile, symptomatic status and functional class. ▪ Regular yoga practice speeds up sluggish digestion – create space between the visceral organs and releases adhesions. Benefits of Yoga: Psychological and Spiritual Wellness: ▪ Yogasanas have shown considerable reduction in symptoms of depression and anxiety. ▪ ↓ oxidative stress and relieves tension leading to better concentration and relaxation. ▪ The work of Shannahoff-Khalsa demonstrated – Yogasanas increases serotonin and dopamine and decreases cortisol secretion. ▪ Yoga improves cognitive functions – memory and vigilance levels. ▪ Yoga is effective in psychological disorders – OCD, phobias, major depressive disorder. ▪ It’s also effective in insomnia and post-traumatic stress disorder. ▪ Yoga offers new path for positive mental health by opening door to self- realization and creation of union of the mind, body and the spirit– free individuals from drug dependency, enhances wellbeing, mood, stress tolerance and mental focus. ▪ Overall improvement in quality of life scores are observed in yoga practitioners.
  9. 9. P a g e | 9 Dr. Nithin Ravindran Nair (PT) Overview of Health Benefits of Yoga: (Ref: ACSM’s Health and Fitness Journal) Cardiovascular and related diseases • Reduced sympathetic dominance • Increased parasympathetic activation • Reduced BP • Reduced cholesterol • Reduced blood glucose level • Improved lipid profile • Inproved endothelial function • Decrease in inflammatory markers • Decreased body weight • Reduced weight – hip ratio Cancer • Decreased nausea • Decreased physical distress • Increased feeling of well-being • Positive shift in locust of control • Improved coping • Improved immune system function Mental Health • Reduced anxiety • Reduced depression • Improved mood Fibromyalgia • Reduction in chronic pain Infertility • Reduced stress and improved hormonal function • Increased blood flow to pelvis and reproductive organs Pregnancy • Reduced anxiety and negative effect • Higher birth weights Headaches • Reduced stress • Increased blood flow to tensed muscles – relaxation • Increased body awareness • Improved control of muscle tension Back Pain • Increased muscle relaxation
  10. 10. P a g e | 10 Dr. Nithin Ravindran Nair (PT) • Improved muscle balance • Increased spinal flexibility Insomnia • Reduced muscle tension • Increased parasympathetic activation • Increased CO2 from breathing techniques – sedative effect • Increased ability to let go of obsessive, worrisome thoughts • Reduced stress and sleep disturbances REFERENCES: ❖ Principles and Practice of Physical Rehabilitation – Neeta Vyas et. al. ❖ Yoga and Rehabilitation – Nilima Patel. ❖ Textbook of Prevention Practice and Community Physiotherapy – Dr. Bharati Vijay Bellare et. al. ❖ ACSM’s Health and Fitness Journal.