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Iyengar Yoga and the Use of Props for Pediatric Chronic Pain: A Case Study
Abstract
Iyengar yoga uses postures and props to support the body so that practitioners can engage in poses that would otherwise be more difficult. This type of yoga may be useful in treating children and adolescents who have chronic pain and disability. In this case study, the authors discuss a 14-y-old girl who had two surgeries for gastro-esophageal reflux disease (GERD) and who had continued chest and abdominal pain, as well as vomiting, difficulty eating, weight loss, and anxiety. Having significantly impaired functioning, she was unable to attend school, sleep, socialize, or eat, and she had become wheelchair-bound. Despite evaluations and treatments by specialists over an extended period of time, her symptoms had not improved. This case history describes how the authors used a 4-mo treatment of Iyengar yoga to help the adolescent resume activities and re-engage with her environment. The authors intend this report to stimulate scientific study of this form of treatment for children and adolescents with chronic pain.
... This style of yoga involves the use of "props" (e.g. mats, blankets, blocks) that allow for a slow and safe practice of the postures [13]. Instructions are given throughout classes, and are focused on awareness of muscle and joint activity [13]. ...
... mats, blankets, blocks) that allow for a slow and safe practice of the postures [13]. Instructions are given throughout classes, and are focused on awareness of muscle and joint activity [13]. Importantly, poses can be tailored to the individual needs of the participant, including painrelated needs [13,14]. ...
... Instructions are given throughout classes, and are focused on awareness of muscle and joint activity [13]. Importantly, poses can be tailored to the individual needs of the participant, including painrelated needs [13,14]. ...
Objective: Little is known about the benefits of yoga for pediatric obesity, and no studies have examined the
benefits of yoga for physical activity in either adults or children. The purpose of this pilot study was to examine
whether Hatha yoga would improve overall, physical and psychosocial functioning in youth with severe obesity. We also sought to determine whether participants would increase the vigor of, and time spent in, physical activity.
Methods: This study utilized a pre-test/post-test design. Sixteen youth with severe obesity completed an 8 week Hatha yoga intervention involving fifteen, 60-minute classes. Physical and psychosocial functioning, fitness and state-anxiety were assessed at baseline and post-intervention; parents completed proxy-reports of physical and psychosocial functioning at both time points. To assess physical activity, participants wore an Actical Accelerometer for 7 days pre and post-yoga.
Results: Significant improvements were found in: Overall, Physical and Psychosocial functioning, back and
hamstring flexibility, and state-anxiety. Changes in the proportion of time spent in both light and moderate levels of physical activity were marginally significant. Although 3 tests of fitness, and time spent in physical activity did not improve significantly, trends were in the expected direction.
Conclusions: Youth with severe obesity may benefit from a Hatha yoga intervention. Yoga may also offer a way to engage in physical activity that is not precluded by bodily pain.
... While many types of yoga exist, the Iyengar style has distinct benefits for youth with obesity, particularly for those with co-morbid pain conditions. The Iyengar style is characterized by the use of "props" (e.g., mats, blankets, blocks) that increase stabilization and allow for a slow and safe practice of the postures [35]. This style is also characterized by " . . . the emphasis on ( . . . ) protecting the joints, promoting circulation, and compensating for limitations in strength, flexibility, and mobility" [36] (p. ...
... The intervention was designed and classes were taught by an experienced yoga practitioner (BM), a certified toga teacher (CYT), expert-registered yoga teacher (E-RYT), and Kripa Foundation Iyengar Yoga (KFIY) practitioner with 26 years of teaching experience. The core of the intervention involved yoga poses (asanas) and controlled breathing (pranayama) consistent with the Iyengar style of yoga, and based on the principles of B.K.S. Iyengar [35,39]. Participants were given all equipment needed for the yoga classes to use free of charge during the intervention. ...
Obesity negatively impacts the kinematics and kinetics of the lower extremities in children and adolescents. Although yoga has the potential to provide several distinct benefits for children with obesity, this is the first study to examine the benefits of yoga for gait (primary outcome) in youths with obesity. Secondary outcomes included health-related quality of life (HRQoL), physical activity, and pain. Feasibility and acceptability were also assessed. Nine youths (11–17 years) participated in an eight-week Iyengar yoga intervention (bi-weekly 1-h classes). Gait, HRQOL (self and parent-proxy reports), and physical activity were assessed at baseline and post-yoga. Pain was self-reported at the beginning of each class. Significant improvements were found in multiple gait parameters, including hip, knee, and ankle motion and moments. Self-reported and parent-proxy reports of emotional functioning significantly improved. Time spent in physical activity and weight did not change. This study demonstrates that a relatively brief, non-invasive Iyengar yoga intervention can result in improved malalignment of the lower extremities during ambulation, as well as in clinically meaningful improvements in emotional functioning. This study extends current evidence that supports a role for yoga in pediatric obesity.
... While many types of yoga exist, the Iyengar style has distinct benefits for youth with obesity, particularly for those with co-morbid pain conditions. The Iyengar style is characterized by the use of "props" (e.g., mats, blankets, blocks) that increase stabilization and allow for a slow and safe practice of the postures [35]. This style is also characterized by " . . . the emphasis on ( . . . ) protecting the joints, promoting circulation, and compensating for limitations in strength, flexibility, and mobility" [36] (p. ...
... The intervention was designed and classes were taught by an experienced yoga practitioner (BM), a certified toga teacher (CYT), expert-registered yoga teacher (E-RYT), and Kripa Foundation Iyengar Yoga (KFIY) practitioner with 26 years of teaching experience. The core of the intervention involved yoga poses (asanas) and controlled breathing (pranayama) consistent with the Iyengar style of yoga, and based on the principles of B.K.S. Iyengar [35,39]. Participants were given all equipment needed for the yoga classes to use free of charge during the intervention. ...
Childhood obesity in the United States has more than tripled in the past three decades. Differences in lower extremity kinematics between obese and nonobese children during walking have been investigated, but the validity of using the gait deviation index (GDI) for measuring gait in obese children has not been explored. Nine obese children (13.9 ± 2.4 years old) with a body mass index of 33.3 ± 3.5 participated in the study. Reflective markers were placed on all children in a widely used standard lower extremity marker configuration. All participants walked along a 20-foot walkway at a self-selected speed. The kinematic and kinetic measurements for all children were taken, and the GDI for each subject was calculated. The mean ± standard deviation (SD) GDI of the nine obese children was 88.5 ± 12, which was significantly lower than the GDI of the typically developing children (100 ± 10, p < 0.002). There were no statistically significant correlations between the GDI and the Pediatric Quality of Life (PedsQL) Total score or PedsQL Physical Functioning score. Obese children had a significantly increased anterior pelvic tilt, hip flexion, hip adduction, hip adduction moment, knee flexion, knee valgus, and plantar flexion in stance phase (p < 0.05). While in swing phase, obese children had increased hip adduction and knee varus. The kinematic differences may reveal lower limb mal-alignment in obese children during walking. Overall, the GDI can play a major role in evaluating gait pathology in obese children. Future studies will increase the sample size to further evaluate the correlation between the GDI and functional outcomes.
... There is strong scientific evidence demonstrating its beneficial effects on improvement of physical fitness including lower back/hamstring flexibility [7][8][9], handgrip strength [10][11][12][13], vital capacity [14,15] and psychological [6,16] variables in both healthy and non-healthy subjects. Furthermore, recent controlled studies of yoga for particular populations have used modified hatha yoga, with some poses modified by using props to support body regions, performed in seated positions or selected based on therapeutics' purpose, to meet the specific needs of subjects who are limited in their physical and functional abilities [10,11,[17][18][19]. As yoga therapy grows in popularity, an increasing number of rehabilitation teams, including physical and occupational therapy are modifying therapeutic yoga into their practice. ...
... Yoga postures were selected based on capabilities of participant to ensure safety and minimize risk of re-injury. Taking into account the physical disability of the individuals in the groups, postures were modified when necessary using props to support body regions in order for the selected postures to be performed correctly by the individuals without impairing body mechanics [17]. In addition, the program included only basic sitting, kneeling and lying yoga poses. ...
Purpose:
The purpose of this study was to assess the effects of 8 weeks of modified hatha yoga training on physical fitness and stress level in injured workers.
Methods:
Eighteen male and female injured workers, age between 18 and 55 years, participated in this study. They were divided into two groups: an additive hatha yoga training to routine industrial rehabilitation program group (HYG: n = 9) and a control group with no yoga training (CG: n = 9). A modified hatha yoga protocol was designed for this population by two certified yoga instructors, approved by a physical therapist, and conducted for 1 h, three times weekly for 8 weeks. Physical fitness variables including flexibility of lower back and hamstrings, hand grip strength and lung capacity and scores of sensitivity to stress were evaluated at the time of recruitment and after 8 weeks of intervention.
Results:
The values of all physical fitness variables and stress scores were no significant difference between the two groups at baseline. Significant post-yoga improvements for HYG group were noted in flexibility, hand grip strength, and vital capacity (p < 0.05). In contrast, there was no significant change in the CG group. Stress scores did not change as a result of hatha yoga training.
Conclusion:
An 8-week modified hatha yoga training experience exerted therapeutic effects on physical fitness variables including flexibility of lower back and hamstrings, hand grip strength and vital capacity, but not on stress level in injured workers. These findings indicate that hatha yoga can be a beneficial adjunct to routine physical therapy treatment in industrial rehabilitation programs.
... The exercises significantly reduced pain intensity and frequency in children with functional abdominal pain (FAP) and irritable bowel syndrome (IBS) [24]. The beneficial effects of yoga exercises have also been observed in other clinical cases and review studies [31,32]. ...
... Props such as blocks, straps, and bolsters are commonly used in yoga to assist practitioners in achieving proper alignment and deepening their practices. [10] These props can be particularly beneficial in rehabilitation settings, allowing individuals to perform poses safely and effectively regardless of their physical limitations. For example, straps can help patients with limited range of motion stretch more effectively, whereas bolsters provide support to those who are unable to fully perform certain postures. ...
... Furthermore, normally tennis elbow, shoulder and knee pain are usually caused by tennis (Pluim et al., 2006). Asana-like handstands, dog pose, including the upward dog, and balancing poses help for relieving shoulder and elbow pain (Evans, 2013). Vitrita karani followed by Sputa virasana is useful to give the whole neuro-endocrine system that should rest and recover (Govindaraj et al., 2016). ...
One of India's spiritual systems, yoga, emphasizes the value of working with the human body to develop good thoughts and behaviours. Additionally, yoga assists in balancing our physical and mental conditions. However, lack of understanding about the impact of yoga in sports seems to have led to a decline in yoga practise specifically among sportsmen and sportswomen. Thus, this narrative review is designed for sportsmen and sportswomen, physical education students, teachers, yoga students, health professionals, and those who are inclined to study yoga. This review identifies a leaner relationship between the systems of yoga and sports, and provides information on the value of yoga in physical education and sports. All the data in this article were collected using search terms including "yoga", "physical education", "asana" and "sports". Various beneficial yoga factors influence sport performance, and these important factors are outlined with appropriate evidence. All the findings included in this review paper highlight the importance of yoga in physical education and sports, and warrant the need of special awareness of the system of yoga in health, physical and sports education.
... Due to this large pain burden and risk profile for opioid therapy, new programs are needed that target increasing active lifestyles and engagement in non-pharmacological means for chronic pain management. Although limited in the literature, the non-opiate related treatment approaches that show the most promise take a rehabilitative approach (Claus et al., 2022) and include cognitive behavioral therapy (Noel et al., 2012), yoga (Evans et al., 2013), physical activity (Ostelo & Vlaeyen, 2008) mindfulness activities (Jastrowski Mano et al., 2013), cognitive behavioral programs for both the youth and caregiver (Carter et al., 2013), and include a family program component (Harris et al., 2013). ...
Patients with chronic pain utilize health care services up to five times the rate of the general population while pediatric chronic pain admissions from 2004-2010 increased by 831% (Coffelt et al., 2013; Reddy, 2006). Further complicating this public health epidemic are co-morbid conditions resulting in poor sleep, depression, and anxiety as well as psycho-social problems related to school truancy and poor social networks. Caregiver attitude towards pain may also negatively contribute to the illness, i.e., caregivers may increase chronic pain and functional disability by promoting sedentary lifestyles due to fear avoidance behaviors (Palermo et al., 2014). Interventions are needed to assist adolescents that experience chronic pain. The following is a detailed overview of the Kids B.E.A.R. Pain intervention protocol, a support program for pediatric patients experiencing chronic pain and their caregivers.
Background
In primigravidas, childbirth, although physiological can be a frightening event. Two factors that accompany labor are anxiety and pain. This study aims to investigate the benefits of Iyengar yoga for anxiety and labor pain in primigravida women.
Material and methods
The study involved 59 female primigravida subjects, which were divided into 29 controls (without the provision of yoga exercises) and 30 people who received Iyengar yoga exercise. Anxiety and the degree of labor pain will be measured using the Hamilton Scale Rating for Anxiety (HSRA) and visual analog scale (VAS), respectively.
Results
Iyengar yoga significantly reduced VAS and HARS values compared to controls (p < 0.05).
Conclusion
It was concluded that Iyengar yoga in primigravida women was beneficial in reducing labor pain and anxiety. Thus, the Iyengar yoga technique can be a method for supporting the success and safety of labor.
Background
Abdominal pain-related functional gastrointestinal disorder (AP-FGID) comprises of 4 main conditions: functional dyspepsia, irritable bowel syndrome, abdominal migraine and functional abdominal pain. AP-FGIDs are diagnosed clinically based on the Rome IV criteria for FGIDs of childhood. There is limited evidence for pharmacological therapies.
Data sources
This review article discusses non-pharmacological management of AP-FGID based on the current literature including systematic reviews, randomized controlled trials, cohort and case control studies. We aim to provide a comprehensive overview on the available evidence for the pediatricians and pediatric gastroenterologists involved in managing children with AP-FGID.
Results
Managing AP-FGIDs can be challenging. This should follow a stepwise approach with focused history, identification of "red flag" signs and symptoms, physical examination and investigations done following initial consultation. Family needs explaining that there is nothing seriously wrong with the child’s abdomen. This explanation and reassurance can achieve symptom control in large number of cases. Non-pharmacological interventions are delivered through lifestyle and dietary changes and bio-psychosocial therapies. Dietary interventions vary depending on the type of AP-FGID. Bio-psychosocial therapies such as hypnotherapy, cognitive behavioral therapy and yoga aim at stress reduction.
Conclusion
There is increasing evidence for use of non-pharmacological interventions in children with APFGID.
Cognitive–behavioral and biobehavioral skills are the cornerstones of an effective pediatric psychology pain management plan, and routine practice of these skills is essential for mastery. Integrating engaging technology into clinical care has the potential to enhance outcomes by fostering practice and by making the home-based acquisition of empirically supported skills an easy and accessible process. The present study systematically reviewed 57 Apple applications (“apps”) targeting pediatric chronic pain and pain-related difficulties. Each app was independently rated in 4 different categories. The reading level of each app was then systematically assessed via software to determine the grade-level at which a child could be expected to understand instructions and applicability of the app. Apps were also coded into categories based on main function or utility. Nineteen apps were recommended based on a composite rating of “very good” or “excellent” in this systematic review. Although the majority of the apps in this review were developed by lay-professionals, target adult populations, and have not been subject to clinical research, a significant number of these apps appear to be well designed for adjunctive reinforcement of pediatric pain management skills. This study highlights 19 apps that may be clinically useful in pediatric chronic pain populations, but also notes the need for further research and the importance of exercising caution when using apps with pediatric patients. Additionally, this review found that many apps included a complex level of written content. Thus, providers may need to provide developmentally targeted instruction to pediatric patients to ensure comprehension.
Purpose of review:
Although many diagnostic terms are used for pediatric chronic pain, evidence suggests a common thread of signal amplification, leading to the unifying term 'amplified pain syndromes'. Ongoing research provides new insights into biopsychosocial contributors and treatments for pediatric amplified pain syndromes.
Recent findings:
Basic science indicates a complex interplay of genetic, epigenetic, neurochemical, endocrine, and inflammatory contributors, along with environmental and psychological factors. Although medications and interventions remain common approaches to children with chronic pain, their evidence is limited. Preliminary evidence exists for mindfulness-based therapies, yoga, and other complementary/alternative medicine approaches. The strongest evidence is for exercise-based and cognitive-behavioral treatments, in particular, when combined in a multidisciplinary format. Intensive approaches (pain rehabilitation) have the potential to effectively and efficiently treat those most disabled by amplified pain syndromes, and lead to sustained improvement in pain, functioning, and medical utilization.
Summary:
Although understanding of the mechanisms underlying pediatric amplified pain syndromes evolves, standard of care is multidisciplinary emphasizing exercise therapy, cognitive-behavioral treatment, and self-regulation. Treatment should target full return to physical function, which leads to subsequent improvement or resolution of pain. Multidisciplinary care can be coordinated by a rheumatologist or other physician with appropriate referrals, or through a multidisciplinary team.
Approximately one-third of breast cancer survivors experiences persistent fatigue for months or years after successful treatment completion. There is a lack of evidence-based treatments for cancer-related fatigue, particularly among cancer survivors. This single-arm pilot study evaluated the feasibility and preliminary efficacy of a yoga intervention for fatigued breast cancer survivors based on the Iyengar tradition. Iyengar yoga prescribes specific poses for individuals with specific medical problems and conditions; this trial emphasized postures believed to be effective for reducing fatigue among breast cancer survivors, including inversions and backbends performed with the support of props. Twelve women were enrolled in the trial, and 11 completed the full 12-week course of treatment. There was a significant improvement in fatigue scores from pre- to post-intervention that was maintained at the 3-month post-intervention followup. Significant improvements were also observed in measures of physical function, depressed mood, and quality of life. These results support the acceptability of this intervention and suggest that it may have beneficial effects on persistent post-treatment fatigue. However, results require replication in a larger randomized controlled trial.
The effectiveness and efficacy of Iyengar yoga for chronic low back pain (CLBP) were assessed with intention-to-treat and per-protocol analysis. Ninety subjects were randomized to a yoga (n = 43) or control group (n = 47) receiving standard medical care. Participants were followed 6 months after completion of the intervention.
This study aimed to evaluate Iyengar yoga therapy on chronic low back pain. Yoga subjects were hypothesized to report greater reductions in functional disability, pain intensity, depression, and pain medication usage than controls.
CLBP is a musculoskeletal disorder with public health and economic impact. Pilot studies of yoga and back pain have reported significant changes in clinically important outcomes.
Subjects were recruited through self-referral and health professional referrals according to explicit inclusion/exclusion criteria. Yoga subjects participated in 24 weeks of biweekly yoga classes designed for CLBP. Outcomes were assessed at 12 (midway), 24 (immediately after), and 48 weeks (6-month follow-up) after the start of the intervention using the Oswestry Disability Questionnaire, a Visual Analog Scale, the Beck Depression Inventory, and a pain medication-usage questionnaire.
Using intention-to-treat analysis with repeated measures ANOVA (group x time), significantly greater reductions in functional disability and pain intensity were observed in the yoga group when compared to the control group at 24 weeks. A significantly greater proportion of yoga subjects also reported clinical improvements at both 12 and 24 weeks. In addition, depression was significantly lower in yoga subjects. Furthermore, while a reduction in pain medication occurred, this was comparable in both groups. When results were analyzed using per-protocol analysis, improvements were observed for all outcomes in the yoga group, including agreater trend for reduced pain medication usage. Although slightly less than at 24 weeks, the yoga group had statistically significant reductions in functional disability, pain intensity, and depression compared to standard medical care 6-months postintervention.
Yoga improves functional disability, pain intensity, and depression in adults with CLBP. There was also a clinically important trend for the yoga group to reduce their pain medication usage compared to the control group.
To determine the effect of yoga and of aerobic exercise on cognitive function, fatigue, mood, and quality of life in multiple sclerosis (MS).
Subjects with clinically definite MS and Expanded Disability Status Score less than or equal to 6.0 were randomly assigned to one of three groups lasting 6 months: weekly Iyengar yoga class along with home practice, weekly exercise class using a stationary bicycle along with home exercise, or a waiting-list control group. Outcome assessments performed at baseline and at the end of the 6-month period included a battery of cognitive measures focused on attention, physiologic measures of alertness, Profile of Mood States, State-Trait Anxiety Inventory, Multi-Dimensional Fatigue Inventory (MFI), and Short Form (SF)-36 health-related quality of life.
Sixty-nine subjects were recruited and randomized. Twelve subjects did not finish the 6-month intervention. There were no adverse events related to the intervention. There were no effects from either of the active interventions on either of the primary outcome measures of attention or alertness. Both active interventions produced improvement in secondary measures of fatigue compared to the control group: Energy and Fatigue (Vitality) on the SF-36 and general fatigue on the MFI. There were no clear changes in mood related to yoga or exercise.
Subjects with MS participating in either a 6-month yoga class or exercise class showed significant improvement in measures of fatigue compared to a waiting-list control group. There was no relative improvement of cognitive function in either of the intervention groups.
In recent years, the use of complementary and alternative medicine (CAM) in pediatric populations has increased considerably, especially for chronic conditions such as cancer, rheumatoid arthritis and cystic fibrosis in which pain may be a significant problem. Despite the growing popularity of CAM approaches for pediatric pain, questions regarding the efficacy of these interventions remain. This review critically evaluates the existing empirical evidence for the efficacy of CAM interventions for pain symptoms in children. CAM modalities that possess a published literature, including controlled trials and/or multiple baseline studies, that focused on either chronic or acute, procedural pain were included in this review. The efficacy of the CAM interventions was evaluated according to the framework developed by the American Psychological Association (APA) Division 12 Task Force on Promotion and Dissemination of Psychological Procedures. According to these criteria, only one CAM approach reviewed herein (self-hypnosis/guided imagery/relaxation for recurrent pediatric headache) qualified as an empirically supported therapy (EST), although many may be considered possibly efficacious or promising treatments for pediatric pain. Several methodological limitations of the existing literature on CAM interventions for pain problems in children are highlighted and future avenues for research are outlined.
Emotional distress is an increasing public health problem and Hatha yoga has been claimed to induce stress reduction and empowerment in practicing subjects. We aimed to evaluate potential effects of Iyengar Hatha yoga on perceived stress and associated psychological outcomes in mentally distressed women.
A controlled prospective non-randomized study was conducted in 24 self-referred female subjects (mean age 37.9+/-7.3 years) who perceived themselves as emotionally distressed. Subjects were offered participation in one of two subsequential 3-months yoga programs. Group 1 (n=16) participated in the first class, group 2 (n=8) served as a waiting list control. During the yoga course, subjects attended two-weekly 90-min Iyengar yoga classes. Outcome was assessed on entry and after 3 months by Cohen Perceived Stress Scale, State-Trait Anxiety Inventory, Profile of Mood States, CESD-Depression Scale, Bf-S/Bf-S' Well-Being Scales, Freiburg Complaint List and ratings of physical well-being. Salivary cortisol levels were measured before and after an evening yoga class in a second sample.
Compared to waiting-list, women who participated in the yoga-training demonstrated pronounced and significant improvements in perceived stress (P<0.02), State and Trait Anxiety (P<0.02 and P<0.01, respectively), well-being (P<0.01), vigor (P<0.02), fatigue (P<0.02) and depression (P<0.05). Physical well-being also increased (P<0.01), and those subjects suffering from headache or back pain reported marked pain relief. Salivary cortisol decreased significantly after participation in a yoga class (P<0.05).
Women suffering from mental distress participating in a 3-month Iyengar yoga class show significant improvements on measures of stress and psychological outcomes. Further investigation of yoga with respect to prevention and treatment of stress-related disease and of underlying mechanism is warranted.
Patient expectations regarding complementary and alternative medicine (CAM) interventions have important implications for treatment adherence, attrition and clinical outcome. Little is known, however, about parent and child treatment expectations regarding CAM approaches for pediatric chronic pain problems. The present study examined ratings of the expected benefits of CAM (i.e. hypnosis, massage, acupuncture, yoga and relaxation) and conventional medicine (i.e. medications, surgery) interventions in 45 children (32 girls; mean age = 13.8 years +/- 2.5) and parents (39 mothers) presenting for treatment at a specialty clinic for chronic pediatric pain. Among children, medications and relaxation were expected to be significantly more helpful than the remaining approaches (P < 0.01). However, children expected the three lowest rated interventions, acupuncture, surgery and hypnosis, to be of equal benefit. Results among parents were similar to those found in children but there were fewer significant differences between ratings of the various interventions. Only surgery was expected by parents to be significantly less helpful than the other approaches (P < 0.01). When parent and child perceptions were compared, parents expected hypnosis, acupuncture and yoga, to be more beneficial than did children, whereas children expected surgery to be more helpful than did parents (P < 0.01). Overall, children expected the benefits of CAM to be fairly low with parents' expectations only somewhat more positive. The current findings suggest that educational efforts directed at enhancing treatment expectations regarding CAM, particularly among children with chronic pain, are warranted.
Adolescents with irritable bowel syndrome (IBS) frequently experience interference with everyday activities. Mind-body approaches such as yoga have been recommended as interventions for patients with IBS. Despite promising results among adult samples, there have been limited studies exploring the efficacy of yoga with pediatric patients.
To conduct a preliminary randomized study of yoga as treatment for adolescents with IBS.
Twenty-five adolescents aged 11 to 18 years with IBS were randomly assigned to either a yoga or wait list control group. Before the intervention, both groups completed questionnaires assessing gastrointestinal symptoms, pain, functional disability, coping, anxiety and depression. The yoga intervention consisted of a 1 h instructional session, demonstration and practice, followed by four weeks of daily home practice guided by a video. After four weeks, adolescents repeated the baseline questionnaires. The wait list control group then received the yoga intervention and four weeks later completed an additional set of questionnaires.
Adolescents in the yoga group reported lower levels of functional disability, less use of emotion-focused avoidance and lower anxiety following the intervention than adolescents in the control group. When the pre- and postintervention data for the two groups were combined, adolescents had significantly lower scores for gastrointestinal symptoms and emotion-focused avoidance following the yoga intervention. Adolescents found the yoga to be helpful and indicated they would continue to use it to manage their IBS.
Yoga holds promise as an intervention for adolescents with IBS.
Preliminary findings support the potential of yoga as a complementary treatment of depressed patients who are taking anti-depressant medications but who are only in partial remission. The purpose of this article is to present further data on the intervention, focusing on individual differences in psychological, emotional and biological processes affecting treatment outcome. Twenty-seven women and 10 men were enrolled in the study, of whom 17 completed the intervention and pre- and post-intervention assessment data. The intervention consisted of 20 classes led by senior Iyengar yoga teachers, in three courses of 20 yoga classes each. All participants were diagnosed with unipolar major depression in partial remission. Psychological and biological characteristics were assessed pre- and post-intervention, and participants rated their mood states before and after each class. Significant reductions were shown for depression, anger, anxiety, neurotic symptoms and low frequency heart rate variability in the 17 completers. Eleven out of these completers achieved remission levels post-intervention. Participants who remitted differed from the non-remitters at intake on several traits and on physiological measures indicative of a greater capacity for emotional regulation. Moods improved from before to after the yoga classes. Yoga appears to be a promising intervention for depression; it is cost-effective and easy to implement. It produces many beneficial emotional, psychological and biological effects, as supported by observations in this study. The physiological methods are especially useful as they provide objective markers of the processes and effectiveness of treatment. These observations may help guide further clinical application of yoga in depression and other mental health disorders, and future research on the processes and mechanisms.
In recent years, the use of complementary and alternative medicine ( CAM) in pediatric populations has increased considerably, especially for chronic conditions such as cancer, rheumatoid arthritis and cystic fibrosis in which pain may be a significant problem. Despite the growing popularity of CAM approaches for pediatric pain, questions regarding the efficacy of these interventions remain. This review critically evaluates the existing empirical evidence for the efficacy of CAM interventions for pain symptoms in children. CAM modalities that possess a published literature, including controlled trials and/or multiple baseline studies, that focused on either chronic or acute, procedural pain were included in this review. The efficacy of the CAM interventions was evaluated according to the framework developed by the American Psychological Association (APA) Division 12 Task Force on Promotion and Dissemination of Psychological Procedures. According to these criteria, only one CAM approach reviewed herein (self-hypnosis/guided imagery/relaxation for recurrent pediatric headache) qualified as an empirically supported therapy (EST), although many may be considered possibly efficacious or promising treatments for pediatric pain. Several methodological limitations of the existing literature on CAM interventions for pain problems in children are highlighted and future avenues for research are outlined.
Yoga is a popular modality of complementary and alternative medicine (CAM), and yet a relatively small body of literature examines the efficacy of yoga in addressing health problems. This review details the existing studies on yoga for chronic health conditions associated with pain in individuals across the lifespan. Overall, there is compelling preliminary evidence about the beneficial aspects of yoga in addressing a variety of pain conditions including osteoarthritis, back pain, headaches, and irritable bowel syndrome. Problematic to the literature as a body is the lack of detail offered by most researchers about the branch of yoga chosen, the specific postures employed, and the qualifications of yoga teachers in these studies. Also of issue is the typically small sample size as well as an absence of theoretical models to inform interventions and assessments. These shortcomings have conceivably impeded greater wide-scale replication and dissemination of yoga programs for health conditions. For people with chronic pain conditions, yoga offers a relatively low-cost and easily accessible CAM intervention and would likely be of public health benefit if studied more rigorously in the future.
The civilization of India has produced a great variety of systems of spiritual beliefs and practices. Ancient seers used yoga as a means to explore the exterior and interior world and, perhaps, ultimately to achieve wisdom and knowledge of the sacred Indian texts: the Vedas, Upanishads, and Shastras.6 These great teachers, or gurus, did not equate yoga with religion but more as an art of living at the highest level in attunement with the larger life–reality. The emphasis in yoga was on personal verification rather than on belief. The practice of yoga was a way to inner joy and outer harmony.The Sanskrit word “yoga” comes from the root yug (to join), or yoke (to bind together or to concentrate). Essentially, however, the word “yoga” has come to describe a means of uniting or a method of discipline: to join the body to the mind and together join to the self (soul), or the union between the individual self and the transcendental self. Yoga comes from an oral tradition in which teaching was transmitted from teacher to student. The Indian sage Patanjali, called “The Father of Yoga, ” collated this oral tradition in his classic work The Yoga Sutras, a 2000-year-old treatise on yogic philosophy. He defines yoga as “that which restrains the thought process and makes the mind serene.” Patanjali suggests that ethics (yama and niyama) is the way to cleanse the mind, body, and spirit. He emphasizes a more psychological approach to healing and self-realization. The body's organs and systems are to be cleansed first through asanas (postures) and pranayama (controlling the breath).13 The Sutras provide guidance on how to gain mastery over the mind and emotions and how to achieve spiritual growth. The code of conduct includes the practice of the highest human virtues like ahimsa (noninjury) and satya (truth), and the promotion of the noblest feelings like amity and compassion.2Initially, the discipline of hatha yoga used in the studies described later was developed as a means for meditation: preparing the body and the nervous system for stillness. Physical strength and stamina developed by asanas and pranayama allowed the mind to remain calm. The word “hatha” can be divided into two words: ha (sun) and tha (moon). The common interpretation of hatha yoga is a union of the pairs of opposites. Hatha yoga, the yoga of activity, addresses the body and mind and requires discipline and effort. It is through hatha yoga that most Westerners are introduced to the philosophy. Many people believe that this is yoga and are unaware of the totality of yoga as a philosophy of life.Along with meditation, yoga asanas and pranyama have become popular in the West, and yoga has become “westernized.” Postures are taught as ends in themselves merely to heal an illness, reduce stress, or look better. The fact that these postures are a foundation for self-realization is generally ignored. Yoga is often thought of as calisthenics, epitomized by the headstand, the lotus posture, or another pretzel-like pose. Many think of yoga as a system of meditation or religion. Yoga, however, is meant to be practiced in the larger context of conscious spiritual discipline. The Hatha Yoga Pradipika is considered to be the classic manual on hatha yoga. The first chapter reminds the student that hatha yoga is used as a vehicle in self-realization.25 This goal should be kept in sight. Yoga is proposed to be a preventive as well as curative system of the body, mind, and spirit.14Recently, large numbers of Americans are practicing yoga for its proposed health benefits. Some health professionals are referring their patients to yoga teachers for help in managing a variety of stress-related ailments. Yoga is regarded as a holistic approach to health that not only increases flexibility, strength, and stamina but also fosters self-awareness, emotional stability, and peace of mind. Yoga has become a household word in the West. Millions of men and women read books about yoga, attend classes or seminars, and do the physical exercises for which yoga is famous. Many have tried meditation or some other form of yoga on a regular basis. Clearly, yoga is alive in Western society today.There are various styles of hatha yoga, and each has specific characteristics that reflect a particular approach to the yoga asanas such as Iyengar, Kundalini, Kripalu, and Sivananda. Iyengar, a popular style in the West, is based on the teachings of living yoga master named B.K.S. Iyengar. The method is orderly and progressive. Postures are adjusted to meet the needs and physical conditions of the student. There are specific anatomic guidelines in the execution of the asanas and pranayama.12 As a therapy, yoga is a system designed to refine human physiology. Asanas, or postures, if done properly, are believed to affect every gland and organ in the body. Postures have to be adjusted so that the various organs, joints, and bones are properly positioned so that physiologic changes may occur. Distribution of body weight has to be even on the joints and muscles so that there is no injury. Therapeutic yoga is the performance of postures for treating medical disorders. A key development in this application of yoga is Iyengar's use of props (e.g., chairs, belts, blankets, blocks) to assist the patient in assuming the posture without strain. It is said that each posture has a specific shape to which the body must be adapted and not the asana to the body.23In a disease like osteoarthritis (OA) of the finger joints, asanas are proposed to realign the skeletal structure and loosen stiff joints. Effects may be the result of the geometry of the asana. Many musculoskeletal problems may be mechanical and have to be mechanically considered. Realignment of muscles is proposed to remove the altered stresses and strains and to re-establish anatomic relationships.8
To examine the effect of regular Iyengar yoga practice on measures of self-perceived psychosocial function and diurnal salivary cortisol secretion in stage II-IV breast cancer survivors (n = 18).
Women were randomly assigned to attend yoga practice for 90 min twice weekly for 8 weeks (n = 9) or to a wait-listed, noninterventional control group (n = 9). Traditional Iyengar yoga routines that progressively increased in difficulty as participants gained strength and flexibility were used. At baseline and after the 8-week study period, women completed self-report instruments to document various aspects of psychosocial and physical functioning, and collected salivary samples for cortisol analysis four times during the day for two consecutive days.
The yoga group had lower morning and 5 p.m. salivary cortisol and improved emotional well-being and fatigue scores.
Breast cancer survivors are at risk for chronic psychosocial distress that may alter activity of the hypothalamic-pituitary-adrenal axis, resulting in aberrant regulation of cortisol secretion and increased risk of immune dysfunction and cancer progression. Regular yoga practice may be a low-risk, cost-effective way to improve psychosocial functioning, fatigue, and regulation of cortisol secretion in breast cancer survivors. These findings require validation with a larger randomized study.
Currently, many clinicians treating persistent pain hear about the benefits of yoga from patients who frequent yoga centers. However, pain clinicians and researchers may not be aware of randomized controlled studies examining the efficacy of yoga for managing persistent pain. The purpose of this review is to highlight recent studies that shed light on the potential role that yoga can play in pain management for a range of conditions that can be chronically painful. The review is divided into three sections: 1) a description of the basic components of yoga-based protocols for pain, b) a review of nine of the thirteen randomized studies located that test yoga’s efficacy for persistent pain, and c) a discussion of key clinical issues and future directions for yoga-based pain research and practice.
Rheumatoid arthritis (RA) is a chronic disease that often impacts patient's quality of life. For young people with RA, there is a need for rehabilitative approaches that have been shown to be safe and to lead to improved functioning.
This pilot study investigated the feasibility of a single-arm, group-administered, six-week, biweekly Iyengar yoga (IY) program for eight young adults with RA.
IY is known for its use of props, therapeutic sequences designed for patient populations, emphasis on alignment, and a rigorous teacher training. Treatment outcomes were evaluated using a mixed-methods approach that combined quantitative results from standardized questionnaires and qualitative interviews with participants.
Initial attrition was 37% (n=3) after the first week because of scheduling conflicts and a prior non-RA related injury. However, the remaining participants (n=5) completed between 75% and 100% of treatment sessions (mean=95%). No adverse events were reported. The quantitative results indicated significant improvements in pain, pain disability, depression, mental health, vitality, and self-efficacy. Interviews demonstrated improvement in RA symptoms and functioning but uncertainty about whether the intervention affected pain.
These preliminary findings indicate that IY is a feasible complementary approach for young people with RA, although larger clinical trials are needed to demonstrate safety and efficacy.
Yoga and relaxation techniques have traditionally been used by nonmedical practitioners to help alleviate musculoskeletal symptoms. The objective of this study was to collect controlled observations of the effect of yoga on the hands of patients with osteoarthritis (OA).
Patients with OA of the hands were randomly assigned to receive either the yoga program or no therapy. Yoga techniques were supervised by one instructor once/week for 8 weeks. Variables assessed were pain, strength, motion, joint circumference, tenderness, and hand function using the Stanford Hand Assessment questionnaire.
The yoga treated group improved significantly more than the control group in pain during activity, tenderness and finger range of motion. Other trends also favored the yoga program.
This yoga derived program was effective in providing relief in hand OA. Further studies are needed to compare this with other treatments and to examine longterm effects.
Carpal tunnel syndrome is a common complication of repetitive activities and causes significant morbidity.
To determine the effectiveness of a yoga-based regimen for relieving symptoms of carpal tunnel syndrome.
Randomized, single-blind, controlled trial.
A geriatric center and an industrial site in 1994-1995.
Forty-two employed or retired individuals with carpal tunnel syndrome (median age, 52 years; range, 24-77 years).
Subjects assigned to the yoga group received a yoga-based intervention consisting of 11 yoga postures designed for strengthening, stretching, and balancing each joint in the upper body along with relaxation given twice weekly for 8 weeks. Patients in the control group were offered a wrist splint to supplement their current treatment.
Changes from baseline to 8 weeks in grip strength, pain intensity, sleep disturbance, Phalen sign, and Tinel sign, and in median nerve motor and sensory conduction time.
Subjects in the yoga groups had significant improvement in grip strength (increased from 162 to 187 mm Hg; P = .009) and pain reduction (decreased from 5.0 to 2.9 mm; P = .02), but changes in grip strength and pain were not significant for control subjects. The yoga group had significantly more improvement in Phalen sign (12 improved vs 2 in control group; P = .008), but no significant differences were found in sleep disturbance, Tinel sign, and median nerve motor and sensory conduction time.
In this preliminary study, a yoga-based regimen was more effective than wrist splinting or no treatment in relieving some symptoms and signs of carpal tunnel syndrome.
Yoga is an ancient tradition that has been westernized and often practiced for its proposed health benefits. Traditional texts describe its benefits for many types of arthritis. Two limited studies of yoga in osteoarthritis of the hands and carpal tunnel syndrome show greater improvement in pain than in control groups. Yoga uses stretching and improves strength so that it theoretically should be beneficial for some musculoskeletal problems. Yoga merits further study into its cellular and physiologic effects.
Pain-associated disability syndrome (PADS) is a recently defined term that describes patients with chronic pain whose restriction in daily activities appears disproportionately severe for the observable pathology. The aim of this study is to describe the features of a group of pediatric patients with abdominal symptoms fitting this diagnosis.
To identify factors associated with visceral PADS, we reviewed the records of 40 patients (18 males; age range, 7-21 years) with gastrointestinal symptoms severe enough to prevent school attendance or eating for 2 months or more. These patients, in whom pain was neither feigned nor self-induced, met the diagnostic criteria for visceral PADS, including failure of usual treatments and lack of a satisfactory organic explanation for the severity of the pain.
The dominant symptom was abdominal pain in 30 patients, regurgitation in 5 patients, nausea in 3 patients, and chest pain in 2 patients. All patients complained of pain or discomfort, and all met symptom-based criteria for one or more functional gastrointestinal disorder. Disordered sleep was a problem for 39 patients. Factors associated with PADS included learning disabilities, unrealistic goals in a perfectionist, high-achieving child, early pain experiences, passive or dependent coping style, marital problems in the home, and chronic illness in a parent. All patients had at least two associated factors, and a majority had four or more associated factors. Possible triggering events included an acute febrile illness in 20 patients, school change in 11 patients, trauma in 2 patients, death of a loved one in 2 patients, and sexual abuse in 2 patients. Before diagnosis, all patients underwent extensive negative evaluations. Nearly all patients had mental health evaluations that ruled out eating disorder and psychosis. Medical management had failed, and surgeries worsened symptoms. In a majority of patients, we identified a comorbid psychiatric disorder.
Evaluation of preteens and teens unable to go to school or eat because of unexplained incapacitating symptoms should include queries about factors associated with PADS. To treat PADS, medical and mental health clinicians must recognize pain as having both nociceptive and affective components and address treatment collaboratively. Invasive procedures and surgery reinforce the cycle of arousal and pain and are to be avoided. Age for the onset of PADS in the preteen and early teen years suggests that developmental issues play a role.
Yoga teachers and students often report that yoga has an uplifting effect on their moods, but scientific research on yoga and depression is limited.
To examine the effects of a short-term Iyengar yoga course on mood in mildly depressed young adults.
Young adults pre-screened for mild levels of depression were randomly assigned to a yoga course or wait-list control group.
College campus recreation center.
Twenty-eight volunteers ages 18 to 29. At intake, all participants were experiencing mild levels of depression, but had received no current psychiatric diagnoses or treatments. None had significant yoga experience.
Subjects in the yoga group attended two 1-hour Iyengar yoga classes each week for 5 consecutive weeks. The classes emphasized yoga postures thought to alleviate depression, particularly back bends, standing poses, and inversions.
Beck Depression Inventory, State-Trait Anxiety Inventory, Profile of Mood States, morning cortisol levels.
Subjects who participated in the yoga course demonstrated significant decreases in self-reported symptoms of depression and trait anxiety. These effects emerged by the middle of the yoga course and were maintained by the end. Changes also were observed in acute mood, with subjects reporting decreased levels of negative mood and fatigue following yoga classes. Finally, there was a trend for higher morning cortisol levels in the yoga group by the end of the yoga course, compared to controls. These findings provide suggestive evidence of the utility of yoga asanas in improving mood and support the need for future studies with larger samples and more complex study designs to more fully evaluate the effects of yoga on mood disturbances.
Low back pain is a significant public health problem and one of the most commonly reported reasons for the use of Complementary Alternative Medicine. A randomized control trial was conducted in subjects with non-specific chronic low back pain comparing Iyengar yoga therapy to an educational control group. Both programs were 16 weeks long. Subjects were primarily self-referred and screened by primary care physicians for study of inclusion/exclusion criteria. The primary outcome for the study was functional disability. Secondary outcomes including present pain intensity, pain medication usage, pain-related attitudes and behaviors, and spinal range of motion were measured before and after the interventions. Subjects had low back pain for 11.2+/-1.54 years and 48% used pain medication. Overall, subjects presented with less pain and lower functional disability than subjects in other published intervention studies for chronic low back pain. Of the 60 subjects enrolled, 42 (70%) completed the study. Multivariate analyses of outcomes in the categories of medical, functional, psychological and behavioral factors indicated that significant differences between groups existed in functional and medical outcomes but not for the psychological or behavioral outcomes. Univariate analyses of medical and functional outcomes revealed significant reductions in pain intensity (64%), functional disability (77%) and pain medication usage (88%) in the yoga group at the post and 3-month follow-up assessments. These preliminary data indicate that the majority of self-referred persons with mild chronic low back pain will comply to and report improvement on medical and functional pain-related outcomes from Iyengar yoga therapy.
The American College of Rheumatology (ACR) Guidelines for the medical management of osteoarthritis (OA) emphasize the use of nonpharmacologic interventions including exercise. Implementation of an exercise program can be difficult for patients, and little is known about the benefits of alternative therapies such as yoga. The aim of this pilot study was to assess the feasibility of using yoga in the tradition of B.K.S. Iyengar to treat the symptoms of osteoarthritis of the knee.
Participants were instructed in modified Iyengar yoga postures during 90-minute classes once weekly for 8 weeks.
Participants met ACR criteria for osteoarthritis of the knee and completed a medical history and physical examination, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Arthritis Impact Measurement Scale 2 (AIMS2), Patient Global Assessment (GA) by Visual Analog Scale (VAS), Physician GA by VAS, and 50-foot Walk Time before and following an 8-week course of yoga instruction. Eleven (11) subjects enrolled, nine completed at least one session and seven (six of whom were obese) had data from pre- and post-course time points available for analysis.
Statistically significant reductions in WOMAC Pain, WOMAC Physical Function, and AIMS2 Affect were observed when participants' status were compared to their pre-course status. WOMAC Stiffness, AIMS2 Symptoms, Social and Role, Physician GA, and Patient GA measured trends in improvement of symptoms. No adverse events from treatment were reported.
This pilot study suggests that yoga may provide a feasible treatment option for previously yoga-naive, obese patients >50 years of age and offers potential reductions in pain and disability caused by knee OA. Future studies should compare yoga to other nonpharmacologic interventions for knee OA, such as patient education or quadriceps-strengthening exercises.
To determine the effectiveness of yoga on improving the quality of life in patients of chronic pancreatitis.
The patients were randomized to two groups. The control group continued their usual care as directed by their physicians. Patients in the yoga group, in addition, received biweekly yoga sessions for 12 wk. The patients' demographic and health behaviour variables were assessed before and after the yoga programme using Medical Outcomes Short Form (SF-36) for quality of life, Profile of Mood States for assessing mood and Symptoms of Stress Inventory for measuring stress.
A total of 60 patients were enrolled, with 8 drop-outs. Thirty patients were randomized to the yoga group and 30 to the control group. Significant improvements were seen in overall quality of life, symptoms of stress, mood changes, alcohol dependence and appetite after the 12 wk period apart from the general feeling of well-being and desire to continue with the programme in future in the yoga group, while there was no difference in the control group.
Yoga is effective on improving the quality of life in patients of chronic pancreatitis.
Iyengar's Guide to a Woman's Yoga Practice
- L Steinberg
- S Geeta
Steinberg, L., editor. Geeta S. Iyengar's Guide to a Woman's Yoga Practice. Vol. Vol 1. Urbana, IL:
Parvati Productions; 2006.