Yoga therapy

Yoga therapy is the application of yoga practices to one person's specific health problem: an individual assessment, a small prescribed practice built for that person, a written home routine, and review as things change. The class you can walk into is designed for a room. This is designed for you, which is the whole of the difference.

The Sanskrit term is yoga chikitsa, meaning yoga as treatment, and it is old enough that the first sequence of ashtanga still carries the name. What is new is the professional apparatus around it, and in India that apparatus is unusually well defined, which is the most useful thing this page can tell you.

In practice a therapeutic session looks nothing like a class. Four postures instead of twenty. A great many props. Ten minutes on one breathing practice. Timings written down. Very often the instruction is to do less than you are currently doing, which is not what people expect to pay for and is frequently the correct prescription.

This is where India differs from most of the world, and it is worth knowing before you hand anybody money.

Yoga sits inside Ayush, the Government of India ministry whose name is drawn from Ayurveda, Yoga and Naturopathy, Unani, Siddha and Homeopathy. Under it, the Yoga Certification Board describes itself as the only board set up by any government for certification in the field of yoga, and it certifies yoga professionals at a ladder of distinct levels. The ones that matter for this page are the therapy levels, which sit above the teaching levels: the board lists Assistant Yoga Therapist and Yoga Therapist as separate certifications, alongside a Therapeutic Yoga Consultant level, and a yoga therapist is expected to work with a physician rather than instead of one.

Three practical consequences follow.

• The word therapist is not decorative here. If somebody in India offers you yoga therapy, you can ask which certification they hold and at which level, and there is a real answer.
• Teaching a class is not regulated. Anybody may teach yoga, and that includes this teacher, who holds no therapy certification and does not offer therapy. The certification exists precisely to mark out the narrower claim.
• Working alongside a doctor is part of the design, not a disclaimer. A therapist who will not communicate with the person treating you is not following the model their own certification describes.

The reason this section exists is that the phrase is used to sell a great deal that has nothing to do with it.

• It is not a diagnosis. Nobody working from a mat is in a position to tell you what is wrong with you. If a session begins with somebody naming your disease without any investigation, leave.
• It is not a cure, and it is not an alternative to treatment. Any instruction to reduce or stop a medication is a serious warning sign, and it is the one thing on this whole site that I would ask you to treat as disqualifying.
• It is not physiotherapy. There is genuine overlap in what the two do with a stiff shoulder, and the training, the scope and the accountability are different.
• It is not the same as a gentle class. A slow class is a class. Therapy is an assessment and a prescription for one person.
• It is not Ayurveda, although both sit under the same ministry. Ayurvedic diagnosis and herbal prescription are a separate discipline with separate training.
• It is not evidence free, and it is not strongly evidenced either. Which brings us to the next section.

The condition with the best evidence base is back pain, and it is a good illustration of how to read the rest.

A Cochrane review of 12 randomised trials with 1,080 participants found moderate certainty evidence that yoga produces small to moderate improvements in back related function compared with non exercise controls at six months. Improvements in pain did not reach a clinically meaningful threshold. Compared with other exercise, the evidence was very low certainty and the reviewers concluded it is uncertain whether there is any difference at all. On safety, there was moderate certainty evidence of a higher risk of adverse events than doing nothing, mainly increased back pain, at about a five per cent risk difference, with no serious adverse events and a risk comparable to other exercise.

Read that carefully, because it is what honest yoga therapy looks like. Yoga helps a bad back more than doing nothing. It has not been shown to help more than other kinds of exercise. And it is not risk free, in the ordinary way that exercise is not risk free. Anybody selling you more certainty than that is selling.

A second useful example is the props tradition. A systematic review of six randomised trials with 570 patients found Iyengar yoga effective for back and neck pain against control groups, with strong evidence for short term effectiveness and little evidence for long term effectiveness. That short term and long term distinction is the one that gets dropped in every summary, and it is the interesting part: the practice has to continue for the benefit to continue, which is an argument for an ordinary practice rather than a course of treatment. See Iyengar yoga, whose props are the reason it is the style closest to therapeutic work, and hatha vs Iyengar for what that precision costs you elsewhere.

The condition pages on this site are written on the same principle. Yoga for back pain, thyroid, PCOS and diabetes each carry their own sources and their own avoid lists, and none of them claims to treat anything.

The question is usually whether you need therapy at all, and most of the time the answer is no.

• You have a specific condition and a doctor who is managing it. Then a therapist who will write to that doctor is a reasonable addition. Ask for the certification level.
• You have a bad back and no diagnosis. Get the diagnosis first. Then yoga for back pain and an ordinary slow class will do most of what therapy would.
• You are recovering from surgery or a significant injury. Physiotherapy first, and yoga afterwards, in that order, and let the physiotherapist tell you when.
• You are stiff, tired, anxious or unfit. None of those needs therapy. They need a class you can get to twice a week. Hatha, chair yoga or restorative depending on which of the four is loudest.
• You are pregnant. A prenatal teacher rather than a therapist, and your midwife before either. See prenatal yoga.
• Somebody has offered to cure something. Then the answer is no, whatever certificate is on the wall.

My verdict. I am not a yoga therapist, I hold no therapy certification, and I am not going to describe what I do as therapy because the word now means something specific and I have not earned it. What I will say is that in forty years the great majority of people who arrived asking for something therapeutic needed a small, slow, unremarkable practice done four times a week for a year, and there is no certificate required for that. The people I have genuinely wanted to send to a therapist are a much smaller group: a specific limitation, a specific condition, and a doctor already involved. If you are in that group, find somebody certified, ask them to write to your doctor, and judge them by whether they take things away from your practice rather than adding to it. If you are not in that group, take a class, and put the money towards attending it for longer.

Yoga therapy is not offered here and nothing on this site should be read as therapy. The classes are one teacher, about forty years of teaching, one hall at the residents' association in MSR Nagar in north Bangalore, in person there or live online, all ages and all levels. The hour is asana, pranayama and relaxation, taught slowly. It is a general class, it is not labelled by style, and it is not a treatment for anything.

What that means practically. Nobody here will assess you, name a condition, design a practice around a diagnosis or write you a prescription, and nobody here will ever suggest changing anything a doctor has told you. What does happen is ordinary and useful: if you say your knee will not kneel, a chair appears; if your neck will not turn, the postures that load it are left out for you and something else is given instead. That is teaching with attention, and calling it therapy would be dishonest even though it is the part people find most valuable.

The condition pages on this site are written to the same standard: every claim about a body is either sourced to something you can read or attributed to what this teacher has seen, and each carries a list of what to avoid as well as what to do. If you want a place to start that asks nothing of anybody's certification, the seven day beginner plan is a fixed and unglamorous week, how to start yoga at home explains the order, and the first class is free if you would rather ask your questions in person. The classes page has the timings and the costs.

Therapeutic practices are short and repetitive, and the postures in them are mostly the plainest ones on this site, which is worth noticing.

Almost every prescription starts from standing and sitting well: Tadasana and Dandasana, or their chair versions, because most complaints are made worse by how somebody holds themselves for the other twenty three hours. Marjariasana and Setu Bandhasana are the two most commonly given for a back, both with a shortened range and often with support. Balasana and Savasana are given as the rests they are, with props, and Vajrasana or a chair for the breathing.

The breathing is usually a larger part of a therapeutic practice than the postures. Anulom Vilom and Nadi Shodhana for the slow work, Bhramari where there is anxiety, and Yoga Nidra where there is pain and poor sleep together. The forceful practices are the ones a therapist is most likely to take away rather than give. What is almost never prescribed, and this is the useful pattern to hold on to, is anything that appears in the avoid list of yoga for high blood pressure or yoga for neck and shoulder pain. If you want the vocabulary, the glossary defines chikitsa, kriya and the rest without the mysticism.