East West Rehab - Harmonizing east & west mind & body

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Restorative Yoga for Mind Body & Spirit

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Use the Mind, Body, Spirit in Restorative Yoga

  • “That was joyful; I haven’t felt this good in a long time.”
  • “This is the first time I’ve been pain free in a month.”
  • “My breath feels so full and easy.”
  • “I feel so relaxed, clearheaded and energized.”

This may not be the typical feedback you receive at the end of a session. Yet, when restorative yoga is used as a treatment modality to improve strength, coordination, flexibility, range of motion, posture and functional performance, these are common responses. In this age of complexity, restorative yoga offers a simple approach that addresses the multifaceted needs of our clients. These techniques can be adapted to all treatment settings and used with a diverse client population.

New and Traditional

In restorative yoga, props (e.g., bolsters, blankets, pillows, towels, belts) are used to support the body in comfortable postures that provide a gentle, safe, low-load stretch. This “supportive environment” facilitates focus on the breath and the body, thereby setting the stage for healing. Most patients come to us with a primary diagnosis; however, there are often other factors or co-morbidities that limit a patient’s functional progress. For example, a patient may have a rotator cuff injury, but the evaluation identifies other factors such as poor posture, soft tissue restrictions, inefficient breathing patterns and excessive anxiety. By incorporating restorative yoga as a treatment modality, each of these issues can be addressed simultaneously.1

Restorative yoga has its roots in traditional yoga. Classes begin with “active” postures and usually finish with deep relaxation in savassana (“corpse” pose). B.K.S. Iyengar is credited with the initial development of restorative yoga. He experimented with the use of props to modify traditional yoga poses and help people recover from illness and injury. “Yoga helps integrate the mental and physical plane, and it offers a sense of inner and outer balance, or alignment. True alignment means that the inner mind reaches every cell and fiber of the body.”2 Restorative yoga is used to achieve this balance. Central to this work is the mind-body-spirit connection. The relationship between health and a sense of well-being are directly related to a client’s ability not only to participate in therapy, but to re-engage in meaningful day-to-day activities.

Restorative Yoga for Rehab

Is yoga an effective rehabilitation tool? Although the current research is not definitive, there is a growing body of evidence indicating that yoga appears to be an effective intervention for clients with chronic obstructive pulmonary disease3, heart disease4, asthma5, rheumatoid arthritis, epilepsy, burns6, stroke7, multiple sclerosis8 and chronic pain syndromes9 including low back pain10 and repetitive strain injuries.11

So how can restorative yoga be helpful in a rehab environment? Restorative yoga provides a low load, prolonged stretch, elicits the relaxation response, improves breathing patterns and is compatible with gentle manual therapies like myofascial release. A low load prolonged stretch is an effective way to facilitate the restructuring of muscle tissue. A restorative posture allows the client to remain still for an extended period of time so muscles lengthen and broaden safely without eliciting a stretch reflex. As the client “lets go” and the body relaxes, the therapist can then provide manual therapy that can further address the needs of the client. The synergistic combination of a supported yoga posture with manual therapy is a powerful way to address soft tissue restrictions, improve flexibility and increase range of motion.

In this supported environment, as habitually tight muscles relax and the mind-chatter quiets down, motor learning is facilitated. For example, a posture called supported recline is ideal for stroke patients because it addresses the tendencies found in many clients with this diagnosis: posterior pelvic tilt, thoracic hyper-kyphosis and excessive upper cervical extension. When many of these patients reach for an object, compensatory patterns that perpetuate the postural dysfunction are present. In this posture (supported recline), the client is supine with the props positioned to promote thoracic extension, ease the pelvis into a neutral or slight anterior pelvic tilt and unwind sub-occipital tightness. Once the client settles into the posture and muscular tension releases, gentle movement patterns can be incorporated to help the client learn to isolate movement. Our clinical experience has shown that when a patient is later asked to reach, there is improvement. Often the client will report an increased awareness of the body and a greater sense of ease with movement.

Relieving Stress

Stress can both preclude participation in therapy and hamper functional gains. Sometimes, stress can be the major limiting factor to a client’s progress. Prolonged stress has many deleterious consequences.12 If the fight-or-flight mechanism of the autonomic nervous system (sympathetic) is frequently engaged, all the organ systems of the body are affected in a way that slows progress toward functional goals and can perpetuate impairments. Blood pressure, heart rate, respiration rate, blood coagulation, and muscle tension increase. The ability of the body to build muscle strength, digest food, heal wounds, respond to pathogens and learn new motor patterns is significantly hampered. Restorative yoga postures provide an effective means to help clients “switch off” the flight-or-flight mode, and “switch on” the rest and digest (parasympathetic) mode, thereby increasing the potential to improve function and comfort.

Breathing Patterns

Too often, as long as the client is not hypoxic, respiration is taken for granted. On the surface it seems like one of the simplest actions. Yet, when we look more closely, it becomes clear many people breathe inefficiently. On any given day in the clinic, it’s not uncommon to see a variety of breath holding patterns. Most common is chest breathing, where the abdomen is inappropriately contracted, forcing the breath into the upper chest. With this breathing pattern, the shoulders rise and fall with the breath as the secondary muscles of respiration (scalenes, sternocleidomastoid, trapezius and pectoralis minor) work to make up for the relatively static diaphragm. Hyperventilation, when chronic, can be quite subtle and therefore difficult to identify. Each of these breathing patterns has adverse effects and can contribute to the following symptoms: “Chronic tension in the upper body, lack of circulation in the abdominal area leading to indigestion, heart burn and bloating, a confused and disoriented state of mind, anxiety, increased stress response and greater difficulty learning movement because the movement of breath is uncoordinated.”13 Restorative yoga postures promote more efficient breathing patterns. Postures can be selected to gently stretch and release the holding of the abdominals and paraspinals to allow the diaphragm to move with greater ease. Once the tension is reduced, the client can be taught to coordinate the muscles to breathe diaphragmatically. Improved breathing patterns will have an almost immediate effect on pain and contribute to improved stamina and endurance.

Breath focused interventions can also have a particularly impressive impact on helping clients with back pain, as the coordination of muscles associated with breathing (transversus abdominus, pelvic floor and diaphragm) are key to lumbar stabilization.14 Excessive mental and muscular tension can perpetuate breathing pattern disorder and shallow, inefficient respiration can cause increased mental and muscular tension. In this way, breath is the bridge between the mind and the body. Breath awareness can also help anchor the mind into the present moment. Most of our mental stress (which in turn amplifies muscle tension, pain and illness) stems from our dissatisfaction with some aspect of the past (“If only I had not had this stroke”) and from worrying about the future (“I know I’ll never get back to where I was…”).

Focusing on the breath breaks that cycle by quieting the mind and bringing us into the present. Restorative postures provide the optimal circumstances to teach breath focused meditation. This is accomplished by giving the verbal cue to focus on the breath by sensing and feeling the movement of the air as it goes in and out. The meditative aspect of restorative yoga makes it an even more powerful, non-pharmaceutical approach to pain management.