Yoga.... Does it work?

Yoga is gaining popularity in the US, but can it truly help you?

Yoga is a growing trend in the US. Current estimates show that roughly 36 million Americans practice some form of yoga today. 1 in 3 Americans have at least tried yoga once. There are currently around 6,000 yoga studios in the United States alone. Yoga has become a big industry — some reports stating that we spend around 16 billion dollars on classes, clothing, accessories, and equipment per year.

Why all the buzz? Why is yoga becoming so popular world wide? [Around 300 million practitioners in the world]. Depending on the sources you look at you will hear different testimonials and theories. As a practicing physician I hope to provide my take on this practice that has taken the US by storm.

Flexibility, Posture, and Core

One of the biggest focuses of a yoga program is flexibility training. Most of us spend the majority of the day in a chair at a desk. Whether it be at school, work, or home the average American spends around 6 1/2 hours a day sitting. The human body is amazing in its ability to adapt and respond to the environment to which it is exposed. In many scenarios this can be advantageous. For example, a cyclist that pushes his or herself to ride hills every day, will eventually develop a resistance to fatigue and an improvement in performance. But the converse is true as well, if you are forced to sit for extended period of time your body gets used to it. Your hamstrings begin to get tighter. Your core gets weaker from the lack of engaging it. Your walking endurance decreases. Your neck and shoulders can start to tighten from having to maintain the same position for extended periods of time. The lower back can strain due to slouching forward, leading to a tensing of the paraspinal muscles or muscles along the spine. People have attempted to mitigate some of these problems with improved work place ergonomics. Raising the top of your screen to your eye level, the application of wrist and elbow paddings to avoid pressure points, using standing desks and allowing for frequent breaks also seem to be of some utility in helping avoid some of these problems. As an adjunct to good workplace ergonomics, yoga may prove to provide some benefit. Several studies have looked at using Yoga as an adjunct to occupational therapy interventions with overall good results. Some findings include overall improvements in occupational function, and increased engagement in activities by individuals doing yoga exercises. Some of the theories as to why there are benefits in theses settings are associated with yoga’s direct impact on flexibility training and posture. By directly impacting these specific areas, a lot of the work place harm is “undone” in a condensed period of time. This is through a variety of postures and forms that open up and stretch tense and strained areas of the body such as hamstrings and the lower back. Yoga also tends to have a good deal of focus on the core muscle groups. As an orthopedic surgeon when I think of the core, I not only think of the rectus abdominis (the abs), but also the external obliques (the obliques), and the paraspinal muscles. Think if the core as a belt of muscles that span front to back at the level above your waist. A strong core equals overall good health. A strong core reduces the occurrence of lower back pain and is integral in supporting good posture. Some of the static positions in Yoga sequences allow for engagement of these muscles groups helping to mitigate some of the workplace related issues.

Strengthening of Muscle Groups

One of the most common misconceptions is that Yoga is all about flexibility and core but has no effect on strength. The clinical scenario that comes readily to mind, is a typical 16 year old adolescent male coming to the office for lower back pain. When suggesting yoga as a therapuetic modality to help, I am commonly met with “But doc, I’m worried if I do too much yoga I’ll become scrawny and weak.” My rebuttal usually starts with listing all the professional athletes and teams that are or have utilized it as part of their training regimen. Usually when I mention LeBron James uses it as an integral part of his training regimen, I tend to garner thier interest. The majority of our traditional workouts rely on concentric muscle contraction. For example, when we perform bicep curls we engage our biceps and brachialis muscles to contract causing the fibers to shorten over the given movement. As we progressively load the muscle groups with more weight or more repetitions the muscle is “trained” and grows or hypertrophies over time as a response. When performing various yoga exercises various postures and positions can lead to a similar action but instead of using external weights, your body weight acts as the resistance or load. However there is another type of muscle directed training that is particular to yoga and similar activities called eccentric strengthening exercises. In yoga, depending on the posture or position performed the muscle groups can still see load being applied but instead of shortening over a given exercise they are actually lengthened. In the weight lifting world this is called a “negative.” Some studies have even supported the notion that negatives or eccentric muscle training can promote more mass gains than concentric exercises. Eccentric exercises are a mainstay of rehabilitation programs after injury (such as achilles tendinopathy) and have been shown to help recovery and prevent re-injury. As with any program a diverse training regimen is always the most effective, but yoga as a supplement to an already established program can help with strengthening and should not be overlooked.

Mental Benefits

Stress has become a constant part of our lives in the 21st century. Though so many studies have been conducted on trying to understand why we feel stress they way we do, I can say we are no closer to finding an answer. As a society we have more comforts than any time in our history. Food is readily available, majority of Americans have shelter, and overall we are living longer than ever before (average life expectancy in US is 78.6 years). However the US rates of reported stress, and stress related health issues are on the rise. Being able to pin point the exact cause of this is a tall task. There are some reports that increased levels of social isolation and loneliness may be a contributor. Increases in sedentary life style and accumulation of chronic health conditions may be to blame as well. Recently the focus has been to find ways to mitigate stress, even if the exact source is not easily identifiable. Some of the practices have been an increased focus on health and fitness as potential treatment. Yoga specifically has been noted to help reduce depression and decrease an individuals reported ”stress” score in some studies. There have also been positive effects on blood pressure and heart rate. My perception regarding this is twofold. Yoga just like any other exercise can help increase your heart rate and supply the individual with endorphin release. But another less thought of benefit is the focus on breathing. This is still an area we do not fully understand, but it seems that there is some connection between the central nervous system and respiration beyond our common conceptions . Yes of course your brain needs oxygen and when you breathe you supply it with the aforementioned .... but there is more to it. For some reason particular breathing patterns and techniques have been shown to help mitigate or reduce stress responses. A Harvard study showed that deep breathing techniques have an appreciable benefit in these areas. As part of yoga practice breathing is a central focus as the practitioner transitions from posture to posture. This deep and focused breathing pattern can be beneficial in many ways in helping offset to some degree the effects of stress in our lives.

In response to the question posed at the beginning of this article, “Yoga....... Does it work?” I would have to say I truly think it does. As with anything in life every person is different. Though our genetic code is almost completely identical to one another, there are nuances that allow one person to have a varied response to a given intervention compared to another individual. As a physician I am always reminded how similar and yet different humans can be. Whether it be a response to an injury, recovery after a particular surgery ...... every person has their own story and pathway. Yoga has a long tradition going thousands of years. Most of what we think of as modern yoga techniques came from years and years of observations, applications, and revisions through a wide and varied population. As a medical community I think it is important to gradually perform more evidence based research to truly objectively measure the effect. However, this takes time, money and effort. Those studies are coming, and prelim data looks very promising. However, what I can leave you with at this point is my personal experience — Yoga at the very least can’t hurt, if done properly with the appropriate guidance. Give it a try and you might surprise yourself.