YOGA AND PHYSIOTHERAPY

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. 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. 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. 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. 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. 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. 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. 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. 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. 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.