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Yoga as therapy is the use of yoga as exercise, consisting mainly of postures called asanas, as a gentle form of exercise and relaxation applied specifically with the intention of improving health. This form of yoga is widely practised in classes, and may involve meditation, imagery, breath work (pranayama) and calming music as well as postural yoga.

At least three types of health claims have been made for yoga: magical claims for medieval haṭha yoga, including the power of healing; unsupported claims of benefits to organ systems from the practice of asanas; and more or less well supported claims of specific medical and psychological benefits from studies of differing sizes using a wide variety of methodologies.

Systematic reviews have found beneficial effects of yoga on low back pain and depression, but despite much investigation, little or no evidence of benefit for specific medical conditions. The study of trauma-sensitive yoga has been hampered by weak methodology.

Context

Yoga classes used as therapy usually consist of asanas (postures used for stretching), pranayama (breathing exercises), and relaxation in savasana (lying down). The physical asanas of modern yoga are related to medieval haṭha yoga tradition, but they were not widely practiced in India before the early 20th century.

The number of schools and styles of yoga in the Western world has grown rapidly from the late 20th century. By 2012, there were at least 19 widespread styles from Ashtanga Vinyasa Yoga to Viniyoga. These emphasise different aspects including aerobic exercise, precision in the asanas, and spirituality in the haṭha yoga tradition. These aspects can be illustrated by schools with distinctive styles. Bikram Yoga has an aerobic exercise style with rooms heated to 105 °F (41 °C) and a fixed sequence of 2 breathing exercises and 26 asanas performed in every session. Iyengar Yoga emphasises correct alignment in the postures, working slowly, if necessary with props, and ending with relaxation. Sivananda Yoga focuses more on spiritual practice, with 12 basic poses, chanting in Sanskrit, pranayama breathing exercises, meditation, and relaxation in each class, and importance is placed on a vegetarian diet.

Types of claims

At least three different types of claims of therapeutic benefit have been made for yoga from medieval times onwards, not counting the more general claims of good health made throughout this period: magical powers, biomedical claims for marketing purposes, and specific medical claims. Neither of the first two are supported by reliable evidence. The medical claims are supported by evidence of varying quality, from case studies to controlled trials and ultimately systematic review of multiple trials.

Magical powers

Medieval authors asserted that Haṭha yoga brought physical (as well as spiritual) benefits, and provided magical powers, including of healing. The Hatha Yoga Pradipika (HYP) states that asanas in general, described as the first auxiliary of haṭha yoga, give "steadiness, good health, and lightness of limb." (HYP 1.17) Specific asanas, it claims, bring additional benefits; for example, Matsyendrasana awakens Kundalini and helps to prevent semen from being shed involuntarily; (HYP 1.27) Paschimottanasana "stokes up the digestive fire, slims the belly and gives good health"; (HYP 1.29) Shavasana "takes away fatigue and relaxes the mind"; (HYP 1.32) while Padmasana "destroys all diseases" (HYP 1.47). These claims lie within a tradition across all forms of yoga that practitioners can gain supernatural powers. Hemachandra's Yogashastra (1.8–9) lists the magical powers, which include healing and the destruction of poisons.

Biomedical claims for marketing purposes

Twentieth century advocates of some schools of yoga, such as B. K. S. Iyengar, have for various reasons made claims for the effects of yoga on specific organs, without citing any evidence. The yoga scholar Suzanne Newcombe argues that this was one of several visions of yoga as in some sense therapeutic, ranging from medical to a more popular offer of health and well-being. The yoga scholar Andrea Jain describes these claims of Iyengar's in terms of "elaborating and fortifying his yoga brand" and "mass-marketing", calling Iyengar's 1966 book Light on Yoga "arguably the most significant event in the process of elaborating the brand." The yoga teacher Bernie Gourley notes that the book neither describes contraindications systematically, nor provides evidence for the claimed benefits. Jain suggests that "Its biomedical dialect was attractive to many." For example, in the book, Iyengar claims that the asanas of the Eka Pada Sirsasana cycle

...tone up the muscular, nervous and circulatory systems of the entire body. The spine receives a rich supply of blood, which increases the nervous energy in the chakras (the various nerve plexuses situated in the spine), the flywheels in the human body machine. These poses develop the chest and make the breathing fuller and the body firmer; they stop nervous trembling of the body and prevent the diseases which cause it; they also help to eliminate toxins by supplying pure blood to every part of the body and bringing the congested blood back to the heart and lungs for purification.

The history of such claims was reviewed by William J. Broad in his 2012 book The Science of Yoga. Broad argues that while the health claims for yoga began as Hindu nationalist posturing, it turns out that there is ironically "a wealth of real benefits".

Types of activity

Remedial yoga

The International Association of Yoga Therapists offers a definition of yoga therapy that can encompass a wide range of activities and practices, calling it "the process of empowering individuals to progress toward improved health and well-being through the application of the teachings and practices of Yoga".

The history of remedial yoga goes back to the pioneers of modern yoga, Krishnamacharya and Iyengar. Iyengar was sickly as a child, and yoga with his brother-in-law Krishnamacharya improved his health; it had also helped his daughter Geeta, so his response to his students' health issues, in Newcombe's view, "was an intense and personal one." In effect Iyengar was treating "remedial yoga" as analogous to Henrik Ling's medical gymnastics. As early as 1940, Iyengar was using yoga as a therapy for common conditions such as sinus problems, backache, and fatigue. Iyengar was willing to push people through pain "to them new possibilities." In the 1960s, he trained a few people such as Diana Clifton and Silva Mehta to deliver this remedial yoga; particular asanas were used for different conditions, and non-remedial Iyengar Yoga teachers were taught to inform students that ordinary classes were not suitable for "serious health issues". Mehta taught a remedial yoga class in the Iyengar Yoga Institute in Maida Vale from its opening in 1984. She contributed "Remedial Programs" for conditions such as arthritis, backache, knee cartilage problems, pregnancy, sciatica, scoliosis and varicose veins in the Mehtas' 1990 book Yoga the Iyengar Way. However, Iyengar was deferential to Western medicine and its assessments, so in Newcombe's view Iyengar Yoga is "positioned as complementary to standard medical treatment rather than as an alternative".

Newcombe argues that in Britain, yoga "largely avoided overt conflict with the medical profession by simultaneously professionalising with educational qualifications and deferring to medical expertise." After Richard Hittleman's Yoga for Health series on ITV from 1971 to 1974, the series producer Howard Kent founded a charity, the Yoga for Health Foundation, for "Research into the therapeutic benefits to be obtained by the practice of yoga"; residential courses began in 1978 at Ickwell Bury in Bedfordshire. The Foundation stated that yoga was not a therapy or cure but had "therapeutic benefits", whether physical, mental, or emotional, and it worked especially with "the physically handicapped". Newcombe notes that a third organisation, the Yoga Biomedical Trust, was founded in Cambridge in 1983 by a biologist, Robin Monro, to research complementary therapies. He found it difficult to obtain research funding, and in the 1990s moved to London, focusing on training yoga teachers in yoga as therapy and providing yoga as individualised therapy, using pranayama, relaxation and asanas.

Sports medicine

From the point of view of sports medicine, asanas function as active stretches, helping to protect muscles from injury; these need to be performed equally on both sides, the stronger side first if used for physical rehabilitation.

Research

Methodology

Much of the research on the therapeutic use of yoga has been in the form of preliminary studies or clinical trials of low methodological quality, including small sample sizes, inadequate control and blinding, lack of randomization, and high risk of bias. Further research is needed to quantify the benefits and to clarify the mechanisms involved.

For example, a 2010 literature review on the use of yoga for depression stated, "although the results from these trials are encouraging, they should be viewed as very preliminary because the trials, as a group, suffered from substantial methodological limitations." A 2015 systematic review on the effect of yoga on mood and the brain recommended that future clinical trials should apply more methodological rigour.

Mechanisms

The practice of asanas has been claimed to improve flexibility, strength, and balance; to alleviate stress and anxiety, and to reduce the symptoms of lower back pain, without necessarily demonstrating the precise mechanisms involved. A review of five studies noted that three psychological mechanisms (positive affect, mindfulness, self-compassion) and four biological mechanisms (posterior hypothalamus, interleukin-6, C-reactive protein and cortisol) that might act on stress had been examined empirically, whereas many other potential mechanisms remain to be studied; four of the mechanisms (positive affect, self-compassion, inhibition of the posterior hypothalamus and salivary cortisol) were found to mediate yoga's effect on stress.

Low back pain

Back pain is one reason people take up yoga, and since at least the 1960s some practitioners have claimed that it relieved their symptoms.

A 2013 systematic review on the use of yoga for low back pain found strong evidence for short- and long-term effects on pain, and moderate evidence for long-term benefit in back-specific disability, with no serious adverse events. Ten randomised controlled trials were analysed, of which eight had a low risk of bias. The outcomes measured included improvements in "pain, back-specific disability, generic disability, health-related quality of life, and global improvement". The review stated that yoga can be recommended as an additional therapy to chronic low back pain patients. A 2022 Cochrane systematic review of yoga for chronic non-specific low back pain included 21 randomised controlled trials and found that yoga produced clinically unimportant improvements in pain and back-specific function. Improvements in back-specific function were similar to those obtained from other forms of therapeutic exercise, such as physical therapy.

Mental disorders

Trauma-sensitive yoga has been developed by David Emerson and others of the Trauma Center at the Justice Resource Institute in Brookline, Massachusetts. The center uses yoga alongside other treatments to support recovery from traumatic episodes and to enable healing from post-traumatic stress disorder (PTSD). Workers including Bessel van der Kolk and Richard Miller have studied how clients can "regain comfort in their bodies, counteract rumination, and improve self-regulation through yoga."

Systematic reviews indicate that yoga offers moderate benefit in the treatment of PTSD. A 2017 systematic review of PTSD in post-9/11 veterans showed that participants in studies who had received mindfulness training, mind-body therapy, and yoga "reported significant improvements in PTSD symptoms". Another systematic review on veterans the same year also found improvement in PTSD symptoms. Other systematic reviews postulate that designing the style and instructions to the needs of the veterans leads to better results and a larger impact on PTSD symptoms.

A 2013 systematic review on the use of yoga for depression found moderate evidence of short-term benefit over "usual care" and limited evidence compared to relaxation and aerobic exercise. Only 3 of 12 randomised controlled trials had a low risk of bias. The diversity of the studies precluded analysis of long-term effects. A 2015 systematic review on the effect of yoga on mood and the brain concluded that "yoga is associated with better regulation of the sympathetic nervous system and hypothalamic-pituitary-adrenal system, as well as a decrease in depressive and anxious symptoms in a range of populations." A systematic review in 2017 found some evidence of benefit in major depressive disorders, examining outcomes primarily of improvements in remission rates and severity of depression (and secondarily of anxiety and adverse events), but considered that better randomised controlled trials were required.

Cardiovascular health

A 2012 survey of yoga in Australia notes that there is "good evidence" that yoga and its associated healthy lifestyle—often vegetarian, usually non-smoking, preferring organic food, drinking less or no alcohol–are beneficial for cardiovascular health, but that there was "little apparent uptake of yoga to address cardiovascular conditions and risk factors". Yoga was cited by respondents as a cause of these lifestyle changes. The survey notes that the relative importance of the various factors had not been assessed.

Other conditions

There is little reliable evidence that yoga is beneficial for specific medical conditions, and an increasing amount of evidence that it is not.

Safety

Although relatively safe, yoga is not a risk-free form of exercise. Sensible precautions can usefully be taken, such as avoiding advanced moves by beginners, not combining practice with psychoactive drug use, and avoiding competitiveness.

A small percentage of yoga practitioners each year suffer physical injuries analogous to sports injuries. The practice of yoga has been cited as a cause of hyperextension or rotation of the neck, which may be a precipitating factor in cervical artery dissection.

See also

• Exercise is Medicine
• Neurobiological effects of physical exercise
• Yoga foot drop

References

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Sources

Broad, William J. (2012). The Science of Yoga: The Risks and the Rewards. Simon and Schuster. ISBN 978-1-4516-4142-4.

Goldberg, Elliott (2016). The Path of Modern Yoga : the history of an embodied spiritual practice. Inner Traditions. ISBN 978-1-62055-567-5. OCLC 926062252.

Iyengar, B. K. S. (1979) . Light on Yoga: Yoga Dipika. Unwin Paperbacks. ISBN 978-1855381667.

Jain, Andrea (2015). Selling Yoga : from Counterculture to Pop culture. Oxford University Press. ISBN 978-0-19-939024-3. OCLC 878953765.

Mallinson, James; Singleton, Mark (2017). Roots of Yoga. Penguin Books. ISBN 978-0-241-25304-5. OCLC 928480104.

Mehta, Silva; Mehta, Mira; Mehta, Shyam (1990). Yoga the Iyengar Way: The new definitive guide to the most practised form of yoga. Dorling Kindersley. ISBN 978-0863184208.

Newcombe, Suzanne (2019). Yoga in Britain: Stretching Spirituality and Educating Yogis. Bristol, England: Equinox Publishing. ISBN 978-1-78179-661-0.

Singleton, Mark (2010). Yoga Body : the origins of modern posture practice. Oxford University Press. ISBN 978-0-19-539534-1. OCLC 318191988.

External links

• International Association of Yoga Therapists
• Vox: I read more than 50 scientific studies about yoga. Here's what I learned by Julia Belluz

v t e Asanas
Asana • Kriya • Mudra • Drishti • Pranayama • Sun Salutation • Vinyasa • Yoga as exercise • Yoga as therapy • Hatha yoga • Yoga
Backbends	Anjaneyasana (crescent moon) Bidalasana (cat)/Bitilasana (cow) Bhujangasana (cobra) Chakrasana (wheel) or Urdhva Dhanurasana (upward bow) Viparita Dandasana (inverted staff) Kapotasana (pigeon) Eka Pada Rajakapotasana (king pigeon) Ushtrasana (camel)
Arm balances	Ashtavakrasana (8-angled) Bakasana (crane) or Kakasana (crow) Koundinyasana (the sage Kaundinya) Kukkutasana (cockerel) Mayurasana (peacock) Tittibhasana (firefly)
Inverted	Adho Mukha Svanasana (downward dog) Adho Mukha Vrkshasana (handstand) Halasana (plough) Sarvangasana (shoulderstand) Setu Bandha Sarvangasana (bridge) Shirshasana (headstand) Viparita Karani (legs up the wall) Vrischikasana (scorpion)
Reclining	Anantasana (Vishnu's couch) Ashtanga Namaskara (eight-limbed) Bhekasana (frog) Chaturanga Dandasana (low plank) Dhanurasana (bow) Jathara Parivartanasana (belly twist) Makarasana (crocodile) Matsyasana (fish) Shalabhasana (locust) Shavasana (corpse) Vasishtasana (side plank) Yoganidrasana (yogic sleep)
Sitting	Meditation Baddha Konasana (cobbler) Gomukhasana (cow face) Gorakshasana (cowherd) Padmasana (lotus) Siddhasana (accomplished) Simhasana (lion) Vajrasana (thunderbolt) Twists Bharadvajasana (the sage Bharadvaja) Marichyasana (the sage Marichi) Matsyendrasana (the sage Matsyendra, lord of the fishes) Pashasana (noose) Other Akarna Dhanurasana (shooting bow) Balasana (child) Garbha Pindasana (embryo in womb) Hanumanasana (monkey) Kraunchasana (heron) Kurmasana (tortoise) Malasana (garland) Mandukasana (frog) Mulabandhasana (root lock) Navasana (boat) Paschimottanasana (seated forward bend) Samakonasana (split) Virasana (hero)
Standing	Both legs Parighasana (gate) Parshvottanasana (intense side stretch) Prasarita Padottanasana (wide stance forward bend) Tadasana (mountain) Trikonasana (triangle) Utkatasana (powerful) Uttanasana (standing forward bend) Utthita Parshvakonasana (sideways) Virabhadrasana (warrior) One leg Ardha Chandrasana (half moon) Durvasasana (the sage Durvasa) Garudasana (eagle) Natarajasana (lord of the dance) Utthita Padangusthasana (standing big toe hold) Vrikshasana (tree)

v t e Yoga as exercise
Topics	Asanas List of asanas Standing asanas Downward dog Lotus position Meditation seats Sun Salutation Tree pose Warrior Accompaniments Drishti Pranayama Vinyāsa Hasta Vinyasas Teacher training Standards British Wheel of Yoga European Union of Yoga André Van Lysebeth Yoga Alliance Therapy Yoga using props 1979 Accessible yoga 2002 Trauma-sensitive yoga 2007 Restorative Yoga 2008 Yoga nidra International Association of Yoga Therapists • Richard Miller Janice Gates Events Competitive yoga International Day of Yoga Journals Asana Journal Yoga Journal Props Yoga brick Yoga mat Angela Farmer Hugger Mugger Yoga pants Lululemon
History	Early Early modern yoga Vivekananda 1896 Raja Yoga Pierre Bernard Harmonial gymnastics/yoga Marguerite Agniel Mary Bagot Stack Genevieve Stebbins Physical culture B. C. Ghosh K. V. Iyer Seetharaman Sundaram Paramahansa Yogananda Autobiography of a Yogi Aspects Hot yoga Science of yoga Sexual abuse by yoga gurus Matthew Remski Yoga and cultural appropriation In advertising For children For women Geeta Iyengar Yoga tourism Hybrids 1938 Naked yoga 1990 Mindful Yoga Frank Jude Boccio Anne Cushman Janice Gates Jon Kabat-Zinn Cyndi Lee Phillip Moffitt 2003 Acroyoga Doga 2013 Paddleboard Yoga 2014 Aerial yoga Beer yoga By country America 1961 Yoga for Health 1970 Lilias, Yoga and You Britain 1976 Lyn Marshall France Germany India Italy Russia Sweden 2015 Rachel Brathen Switzerland 1941 Selvarajan Yesudian Books 1996 Yoga Tradition of the Mysore Palace 2004 Yoga in Modern India A History of Modern Yoga 2005 Positioning Yoga 2010 Yoga Body The Subtle Body 2015 Selling Yoga 2016 The Path of Modern Yoga 2017 Roots of Yoga 2019 Yoga in Britain 2020 The Story of Yoga Films 2006 Guru 2009 Enlighten Up! 2012 Breath of the Gods
Schools (Gurus)	1918 The Yoga Institute Shri Yogendra Hansa Yogendra 1924 Kaivalyadhama Swami Kuvalayananda 1934 Viniyoga Tirumalai Krishnamacharya Yoga Makaranda T. K. V. Desikachar A. G. Mohan Indra Devi Srivatsa Ramaswami Vanda Scaravelli c. 1948 Ashtanga Vinyasa Yoga K. Pattabhi Jois Mysore style Tim Miller Kino MacGregor Larry Schultz 1959 Sivananda Yoga Vishnudevananda Saraswati Complete Illustrated Book of Yoga 1963 Bihar School of Yoga Satyananda Saraswati 1965 Ananda Yoga Kriyananda 1966 Integral Yoga Satchidananda Saraswati 1966 Kripalu Yoga Amrit Desai Stephen Cope 1971 Himalayan Institute Swami Rama 1973 Bikram Yoga Bikram Choudhury 1975 Iyengar Yoga B. K. S. Iyengar Light on Yoga Yoga the Iyengar Way 1975 Dharma Mittra c. 1975 Yin Yoga Paulie Zink Paul Grilley Sarah Powers 1982 Forrest Yoga 1984 Jivamukti Yoga Sharon Gannon 1995 Power Yoga Beryl Bender Birch Bryan Kest 1997 Anusara Yoga John Friend 2006 Core Strength Vinyasa Yoga (Sadie Nardini)
Related	Yoga Hatha yoga Modern yoga Post-lineage yoga Asanas (template) List of yoga schools Yoga scholars (template) Yoga teachers (category) Modern Yoginis (template)

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