by Dr. Anni Sanner, PT, DPT
Welcome to the “This is What I Do” Series. In this posts, clinicians discuss how they use yoga in healthcare, specifically how their training in medical therapeutic yoga is helping them achieve superior outcomes and beat burnout. Join us as we learn about moving toward a sustainable model for healthcare practice! ~ PYTI® Founder, Dr. Ginger Garner, PT, DPT
As a licensed physical therapist practicing in the area of orthopedics, I am faced with a number of challenges that the modern healthcare professional is undergoing. We are expected to get quicker results, have a greater depth of knowledge, and impart that knowledge in shorter appointment times. All the while, we have massive student loan debt, incommensurate pay, and third-party payers are reimbursing less and less, yet continue to expect the same level of care. This is a recipe for burnout, and is not sustainable at the current rate.
In addition to these pressures, it is painful to hear studies report that other modalities are just as effective as physical therapy, yoga being one of them. A study performed by Saper, et al. in 2017 revealed that physical therapy and yoga have similar outcomes for chronic moderate low back pain when it comes to pain, activity limitation and quality of life.1 The conclusion here is PT and yoga are equally effective at treating chronic low back pain, which is the leading cause of disability worldwide.2 Yes, that’s right, WORLDWIDE. The real kicker in this study was the limitation they reported, “the PT group had a disproportionate loss to follow-up.”1 People don’t want to come back to physical therapy! This low back pain candle is burning from both ends, the patient and the healthcare provider.
What is the solution?
Now, I certainly know that my job security is not at risk. What concerns me is that so much hype is placed on yoga as an intervention for back pain, but yoga instructors often are not supplied with the education required to screen for red flags, understand pathophysiology, or even basic anatomy. Hence, the birth of yoga therapy. The International Association of Yoga Therapy (IAYT) was born to “establish yoga as a recognized and respected form of therapy.”3 The scope of practice of yoga therapists remains nebulously broad, as detailed from the IAYT webpage stating:
“Scopes of practice in some healthcare fields are highly prescriptive and indicate in detail what practitioners can and cannot do. This can work in fields where there is consistency in education and what is actually practiced. However, in the field of yoga therapy, there is considerable diversity in the approach taken to providing ‘therapy,’ based on the diversity of traditions and styles. Accordingly, the IAYT SoP generally provides broad statements in relation to what a practitioner can do in order to maintain an inclusivity that is the hallmark of the Educational Standards and the accreditation and certification processes that stem from the Standards.”3
It is encouraging to see that there are growing standards and a process to educate lay yoga teachers to provide yoga on a therapeutic basis, however, the scope of practice by yoga therapists detailed above makes me question the consistency in education and what is actually practiced by the IAYT community. My main concern is for the public, who does not do the research to understand the background and limitations their yoga teacher or yoga therapist has in “treating” their symptoms.
Cue Medical Therapeutic Yoga.
The Professional Yoga Therapy Institute® (PYTI) recognizes the issues of clinician burnout, the value of yoga and several other functional and integrative disciplines, and the expertise of licensed healthcare providers. I propose that the missing link between outcomes from PT and yoga in the Saper study is a biopsychosocial (BPS) approach and application of the right yogic practices.
As a PYT candidate, I am grateful that the BPS approach is a pillar in the program for several reasons.
First, it encourages a patient-provider relationship that fosters healthy communication that doesn’t place blame, incite fear, or recreate traumatic experiences through the use of poetic language and active listening. This method of communication flips the traditional biomedical model on its head, where typically the provider places blame on the person, and promises to “fix” the problem the client created. With the BPS model, mutual responsibility is placed on both parties to tackle the health concern; the patient is required to do their part, with our guidance and expertise. What a novel way to reduce burnout!
Second, the PYTI® program does not succumb to the traditional lineages of yoga; there is careful selection and scientific rationale behind the utilization of the poses (asana), breathing practices (pranayama), etc. taught in the curriculum, that can be fully appreciated, understood, and applied by those with licenses in healthcare.
Now that you’ve seen the trajectory that the modern day orthopedic physical therapist faces, you can appreciate the need for a different approach. Perhaps more research could be done that compares the BPS model of medical therapeutic yoga delivered by a physical therapist to determine if this provides superior outcomes to our current model today. If the positive changes can be seen in my clinical practice, think of the benefits worldwide.
Anni Sanner, PT, DPT, is originally from southern California. She received her degree in Physical Therapy from Northwestern University in Chicago IL. Anni specializes in total joint replacements, vestibular, TMJ, chronic pain, as well as treatment of spine issues.
1 Saper RB, Lemaster C, Delitto A, Sherman KJ, Herman PM, Sadikova E, et al. Yoga, Physical Therapy, or Education for Chronic Low Back Pain: A Randomized Noninferiority Trial. Ann Intern Med. 2017;167:85–94. doi: 10.7326/M16-2579
2 Licciardone JC, Gatchel RJ, Phillips N, Aryal S. The Pain Registry for Epidemiological, Clinical, and Interventional Studies and Innovation (PRECISION): registry overview and protocol for a propensity score-matched study of opioid prescribing in patients with low back pain. J Pain Res. 2018;11:1751–1760. Published 2018 Sep 6. doi:10.2147/JPR.S169275
3 Blashki L. Introduction to the IAYT Scope of Practice. https://www.iayt.org/page/IntroScope. Accessed June 2, 2019.