Yoga as Medicine

Dr. Timothy McCall has long been interested in the medical benefits of Yoga. Since 2000, he has been engaged in full time investigation of the therapeutic aspects of Yoga, as well as the scientific explanations of Yoga’s effects. Dr. McCall says, “There is no pose, practice or sequence that’s right for any condition (though there are some that are wrong). A good teacher or Yoga therapist will look at you and come with a practice plan based on your unique circumstances—and then it’s up to you.” In this interview, he shares what he has learned about Yoga as medicine—which is the title of his latest book—and what surprised him most about his Yoga research over the past decade.

Integral Yoga Magazine (IYM): What led you to write Yoga as Medicine?

Timothy McCall (TM): When I got interested in Yoga therapy ten years ago I did not find the kind of books that I was looking for. I recognized there was a need for a comprehensive guide about Yoga therapy. I felt that with my background in medicine and my training in science I could write a book that would explain Yoga to physicians and skeptical scientists in a language to which they could relate.

I wanted to represent Yoga therapy in a way that would not lose the medical audience, as I have come to believe that there is tremendous value in Yoga and that it has all kinds of therapeutic potential. This potential is partially captured in scientific studies, but there are aspects of Yoga—that yogis perceive—that cannot be captured in studies. It was my goal to see that both aspects of Yoga as medicine were represented in the book.

IYM: You state in the book, “The Yoga world is not sufficiently prepared for the likely boom in Yoga therapy.” You call for “an increased in qualified therapists.” What makes a qualified Yoga therapist?

TM:  The reason most people choose alternative medicine is because it is more consistent with their values. America has the generation of baby boomers who are philosophically open to natural, patient-controlled, cheap, effective approaches to healing—and Yoga is probably the best example of this. This generation is starting to come down with all the chronic diseases that come as you hit your 60s, 70s and 80s. Looking at these demographics and at how open people are to Yoga, it occurred to me that there are millions who can benefit from Yoga therapy and only hundreds of Yoga therapists. I thought, “Wow, the world is not ready.”

I believe that there is going to be a couple of tiers in Yoga therapy. There will be a few teachers who are at an extraordinarily high level; who have the ability to look at a body, see things that are going on, devise a program for that specific individual and carry it out expertly. For example, if you could have Mr. Iyengar or Mr. Desikachar come up with a program just for you, you are going to get something that you can’t get from an average Yoga teacher. The individuals who are featured in Yoga as Medicine have decades of training, but it seems to me that there is another level of Yoga therapy that does not require as much training. A good Yoga teacher can help people breathe better, help their posture, help relieve stress—these things can really facilitate healing. As long as you choose a reasonable approach, something that isn’t going to hurt you, and you practice, good things are going to happen.

IYM: Yoga as Medicine has an entire section on avoiding common injuries, which acknowledges that there can be potential harm in Yoga as well as benefit. Could you talk a little bit about contraindications?

TM: It takes some expertise to work with people who are older and sicker—these individuals may have several conditions happening simultaneously.  As I started getting interested in Yoga therapy, one of the first things I wondered was, “What can’t be done? Which practices are potentially harmful?” I was appalled that there is so little information on contraindications. I’ve been looking for ten years and the most complete information I found was a single two-page chart on contraindications—which to my mind was full of inaccuracies. That was the best I found.

I encourage readers in the afterword of the book to write me with their experiences because I feel like I took my best attempt at writing about contraindications, but I just extrapolated from what is known and my medical knowledge. Undoubtedly, I’ve forgotten things or not thought of things that match some people’s experiences. A close examination of contraindications is new territory for Yoga therapy.

Certainly physicians are seeing a lot of Yoga injuries. People who aren’t in great shape are doing very advanced practices and they are getting injured. The other problem is that physicians aren’t educated about Yoga; they don’t know there is any difference between Integral Yoga and Bikram.

For example, in 1998 a study was published with a specific series of Iyengar Yoga practices that was good for carpal tunnel syndrome. A doctor might open up this study and say, “Oh, Yoga is good for carpal tunnel syndrome” and tell her patient to take the Yoga class at a gym—where they are going to have you doing 37 chattaranga dandhasanas and you are guaranteed that your carpal tunnel syndrome is going to be worse.

People come to Yoga for healing. If we hurt them, we might not just lose a student, we will lose someone to Yoga entirely. There is such impatience. We could just slow it down, start students off gently and build their strength over time. Students just need a couple of tools and, if they find these tools helpful, they will come back. To me the breath is the great diagnostic test. If you are pushing yourself too hard, doing things that are going to result in injury, usually there is an abnormality in the breath before that happens.

We think of injuries from the lotus pose or advanced backbends but, by far, the practice that needs the most caution is pranayama. The breath is a direct link to the nervous system; if you do breathing practices in an ill advised way you can mess up your nervous system. There are stories of people having psychological breaks because of poorly designed breathing practices.

I find with pranayama that, if you are in any way straining, gasping, or have any loss of smoothness in the breath, it is a sign that you are pushing too hard. The other indication is that you finish your pranayama practice and you are spaced out or not able to function in the world. This is the mind showing you that what you are doing is not appropriate. You should be better able to engage in the world.

IYM: What type of training do you think doctors and clinic directors are looking for when they hire a Yoga therapist?

TM: That is a tough question, as there are no standards for Yoga therapy certification. One thing I am starting to see is a search for a person with dual credentials—someone who is a nurse or physical therapist and a Yoga teacher. The real advantage of this approach is that this person has the clinical training and the familiarity with diagnosis, medical jargon and things that help the Yoga therapist know what is going on.  

IYM: Do you think HMOs will ever sponsor Yoga therapy?

TM: Among doctors there has been tremendous suspicion about HMOs—they couldn’t stand to see what they were doing in healthcare. Yet my friends in alternative medicine were saying, “What can we do to get in the HMOs? Wouldn’t the HMO be great?” How would you feel if a Yoga teacher was hired by an HMO, and they said you can see this person three times but that is all we will pay for? Or, you can have a 30-minute session, when what you feel you need is an hour.

HMOs put these kinds of restrictions on healthcare providers. The one disadvantage of Yoga being “a pay-as-you-go” system is that only people with money can afford it. The advantage is that there is a real spirit of selfless service in the Yoga world. I see some evidence that people are volunteering just because they want to help people.

IYM: You mention using sraddha (faith) as a tool in Yoga therapy. How does this work? 

TM: Yoga says that direct experience is your most valuable teacher. Direct experience trumps the testimony of experts or the words of the ancient texts. We are referring to highly cultivated direct experience. We build our awareness over decades of doing our practices and our perceptions become more subtle. Some things that I thought would happen as a result of my Yoga practice, like my body becoming more flexible, really haven’t happened that much. Yet other things, like being more peaceful, calm, secure and happy have definitely happened. So I have faith. I even have faith that my flexibility will improve—it just takes longer.

IYM: What advice do you have for Yoga therapists?

TM: Commit to your own practice. I don’t think you can be an effective Yoga therapist or teacher if you are not practicing yourself. The depth of Yoga teaching comes from those who are obtaining some depth in their practice. One of the great fruits of Yoga practice is heightening your internal awareness and using this internal awareness to progressively guide your life in terms of what Yoga you do, what food you eat, what people you hang out with, what pursuits you follow and what you do with your time. This awareness is cultivated with practice.  It is hard to teach tools that you don’t possess yourself.

For example, if you don’t have a pranayama or meditation practice it is going to be really hard to use breath and meditation in your therapy work because you don’t own those things. Therapists shouldn’t go to a weekend workshop, learn a technique and use it with their students on Monday. It would be better if they go home and practice that technique every day for a few weeks. I think you should pursue more training in the area you most need—which depends on the patients with whom you are likely to work and what you are likely to do.

The key to Yoga therapy is getting students to practice. The actual practice of Yoga is what is transformational. You can be the best Yoga therapist, with the best sequences and the best knowledge, but it is not going to help anyone if you cannot motivate your students to practice. Patanjali says the key to success in Yoga is regular practice done over a long period of time and with enthusiasm. Twenty minutes a day for months and years can change your life.

Let Yoga convince people. Get your students to say, “I am going to do these three poses for ten minutes every day for one week.” Set this kind of clear intention. And then, after one week, inquire, “Was it worthwhile?” Are they ready to set another intention? The techniques are simple—doing them every day is not simple.

IYM: Discipline is such a gift, and it is something we play down in our society. 

TM: We not only downplay it, we think discipline is a swear word. Yoga is really all about discipline. One definition of spirituality is doing stuff you don’t want to do—hearing the voices inside that say, “I don’t want to do this, I don’t have time, I don’t have to,” and doing it anyway.

When you commit to a Yoga path you are going to be asked to do things you don’t want to do, things you would rather skip. If you want to be a balanced person, you have to take on things that your mind, subconscious and behavior patterns would just prefer that you skip. Be willing to take on these things!

IYM: What was the most surprising thing you have encountered in your ten years of research on Yoga therapy?

TM: I started out a little skeptical of Ayurveda and originally was planning on writing a Yoga book that didn’t include much of Ayurveda. I ended up being really impressed with what a deep system Ayurveda is and how much it speaks to Yoga. Now I think it is so valuable to bring an Ayurvedic perspective to Yoga therapy that it would be a mistake not to. I went to India to check it out and I visited a number of Ayurvedic clinics. These clinics were really helping people—including people and conditions we don’t treat so well in Western medicine. Like Yoga, Ayurveda works slowly—its effects are accumulative, but it is very powerful. That was the biggest surprise.

About Dr. Timothy McCall:

Timothy McCall, M.D. is a board-certified internist who currently serves as the medical editor of Yoga Journal. He is the author of Examining Your Doctor: A Patient’s Guide to Avoiding Harmful Medical Care and the best selling Yoga as Medicine: The Yogic Prescription for Health and Healing which is now available in many different languages. Timothy has been a student of Patricia Walden since 1995 and has taught Yoga workshops with her, Eleanor Williams and Mary Dunn. Timothy has led Yoga workshops and delivered keynote addresses at national conferences. Over the years, he has given hundreds of media interviews on everything from National Public Radio programs to the “Today Show.” For more information, please visit his website; drmccall.com.

Reprinted from Integral Yoga Magazine, Fall 2008.

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