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“Healing Yoga: Proven Postures to Treat 20 Common Ailments” – A Review of Dr. Loren Fishman’s New Book
Dr. Loren Fishman, MD, is renowned in the yoga therapy field as an innovative physician and yoga teacher. His medical practice, which is based at the Manhattan Physical Medicine and Rehabilitation center in New York (where he also serves as Medical Director), is famous for its skillful synthesis of clinical experience, yoga therapeutics, and medical research. Dr. Fishman is particularly known for his ability to develop novel, and in some cases astonishingly effective yoga-based interventions, many of which are described in his previous books, including Yoga for Osteoporosis and Yoga for Arthritis.
In his most recent book, “Healing Yoga: Proven Postures to Treat 20 Common Ailments – from Backache to Bone Loss, Shoulder Pain to Bunions, and More” (Norton 2014), Dr. Fishman provides an excellent introduction to his path-breaking work on using yoga to treat back pain, scoliosis, bone loss, and rotator cuff injuries. The book also provides cursory discussions of how yoga may be helpful in treating common conditions including colds, headaches, insomnia, and depression. While this content is of uneven quality, the strong parts are outstanding, and potentially life-transforming for those suffering from the conditions they address.
Diagnosing Back Pain
The discussion of the therapeutic applications of yoga in the treatment of back pain is by far the strongest section of the book. It is also the longest part of Healing Yoga, comprising 3 of 5 parts, or 88 of 226 pages. If the additional 13 pages devoted to scoliosis are included, then almost 45% of the text is devoted to back issues.
This material is excellent: accessible yet scientific, and comprehensive without being overwhelming. Crucially, it affirms the fantastic potential of yoga in the treatment of back pain without over-selling it. Plus, it’s vitally important: back pain is the leading cause of disability among people under 45 in the U.S. One study estimated that 26 million Americans between the ages of 20-64 experience it frequently.
As Dr. Fishman explains, however, “back pain is a symptom, not a diagnosis.” Although “many physicians and even clinical trials lump all back pain together as if it were only one problem,” there are, in fact, seven primary causes, which are quite different from one another. It is critical to properly diagnose the cause of back pain in order to determine proper treatment. Different causes require different interventions, and what may be helpful in one instance may prove harmful in another. Although Dr. Fishman offers a variety of self-diagnosis tools and expresses some reservations about the medical establishment, he also repeatedly recommends seeing a doctor if back pain persists for10-14 days.
The first step in diagnosis is determining whether the pain is neurological or musculoskeletal. Happily, “this is almost always easy.” If there is numbness, weakness, or pain going down the leg, the cause is almost always neurological: that is, stemming from the compression or irritation of nerve fibers that travel down and exit the spine in the low back. Issues involving the back muscles, alignment of spinal bones, or other “mechanical malfunctions,” in contrast, are musculoskeletal.
After providing an overview of yoga for back pain in Part 1, Parts 2 & 3 of Healing Yoga devote four chapters each to specific issues involving musculoskeletal and neurological back pain, respectively. Each chapter focuses on either a particular part of the body (e.g., tight hamstrings) or condition (e.g., herniated disc) and provides instructions on 2-5 asanas that should be helpful. For each pose suggested, the book lists 1) its specific benefits and why it works, 2) contraindications, and 3) how to do the pose. In most cases, “less challenging variations” and “helpful hints” are also provided.
Musculoskeletal vs. Neurological
Lifting, excessive sitting, and extreme bending or twisting cause the most common types of musculoskeletal back pain, which include strain of the tendons and/or muscles, sprain of an overstretched or torn ligament, and spasm of the quadratus lumborum muscles, which attach the pelvis to the spine via the ribs. Stiff, shortened hamstrings also frequently cause low back pain. Other common, but less widely understood musculoskeletal conditions include facet syndrome, in which the tiny sets of joints that connect the vertebrae to one another are out of alignment, and sacroiliac (SI) joint derangement, in which the vertical joints on either side of the sacrum become misaligned.
Notably, SI joint derangement, which is very common among yoga practitioners, is “perhaps the most under-recognized and untreated cause of low back pain,” Dr. Fishman notes. Not only is it hard to diagnose – it can’t be seen via x-rays, MRIs, and EMGs unless it becomes super-serious – but, some doctors refuse to believe SI joint derangement even exists. Healing Yoga provides a simple self-test that you can do at home to check for this condition, and Dr. Fishman recommends three poses (Gomukhasana, Garudasana, and Mayurasana) that can be used to treat it and prevent recurrence.
Common neurological problems covered in Healing Yoga include:
1. Herniated or “slipped” disc. Thisvery common condition occurs when the surface of an intervertebral disc cracks and its contents partially or completely leaks out, causing compression of the spinal nerve. This can be caused by bending over, playing sports, being in an accident, etc. Risk increases with age.
2. Stenosis. This condition occurs when the spinal nerves are compressed due to the narrowing of the bony canal that goes from the brain to the bottom of the spine. It is primarily caused by arthritis, a bulging or herniated disc, or spondylolisthesis (slippage of vertebrae).
3. Piriformis syndrome. This condition occurs when the piriformis muscle gets compressed or irritated and impinges on the sciatic nerve, causing pain in buttock. Often caused by sitting for long periods, it is generally highly responsive to yoga therapy.
Notably, piriformis syndrome is one of several causes of sciatica, which manifests as mild to intense pain that shoots down the back or side or one or both legs. Again, Dr. Fishman emphasizes that sciatica is a symptom, not a disease, and that the underlying cause must be diagnosed in order to treat it effectively. Sciatic pain indicates that there is something happening in the back or buttock that is compressing or inflaming the sciatic nerve. Other common causes of sciatica include herniated disc, spondylolisthesis, and stenosis, as well as musculoskeletal imbalances caused by poor posture, excessive sitting, etc.
The final chapter in Healing Yoga’s examination of back pain discusses how these key neurological conditions often occur in tandem. When this is the case, it is once again imperative to diagnose the causes of pain correctly, and determine which is primary and should be treated first. Co-existing conditions may require different interventions, and what helps in one case may hurt in the other if improperly sequenced. Although such combination problems can be difficult to diagnose, even for a specialist, Dr. Fishman provides guidelines on how yoga can help identify and treat them.
Rotator Cuff Injuries, Bone Health, & Scoliosis
Part 4 of Healing Yoga includes eight chapters, each of which is devoted to a specific injury or systemic problem. Specifically, these include rotator cuff injuries, headaches, weight control, the common cold, bone health, insomnia, scoliosis, premenstrual syndrome, and depression.
Unfortunately, the quality of the chapters in this section is quite choppy, and compares unfavorably to the consistently high quality of the preceding discussion of back pain. While the chapters on rotator cuff injuries, bone health, and scoliosis are impressive, the others are weak – in some cases, at least from this author’s point of view, dismayingly so.
That being said, Dr. Fishman’s work using yoga to treat rotator cuff injuries, bone health, and scoliosis is nothing short of revolutionary. In the course of dealing with two of his own rotator cuff injuries, he discovered that practicing Sirasana (Headstand) using the Iyengar method of strongly raising the shoulders away from the floor eliminated pain and restored range of motion in the injured shoulder. The reason for this, he notes, is that the posture engages the subscapularis muscle in a way that enables it to take over the role of the injured supraspinatus muscle when raising the arm.
Subsequently, Dr. Fishman has generalized the mechanism he discovered in Headstand into a method that he calls Triangular Forearm Support (TFS). Amazingly, 90% of the 1,200 patients suffering from rotator cuff injuries he has treated with TFS have experienced pain relief and restored range of motion. And, in most cases this dramatic turnaround took only a few minutes and one office visit!
Dr. Fishman’s success in using yoga to treat osteoporosis and scoliosis is similarly astonishing. Tracking the progress of 45 people suffering from bone density loss who stuck with their prescribed yoga routine for two years, he found that 82% (or 36 total) had completely reversed course and were actually gaining bone density.
Dr. Fishman also discovered that Vasisthasana (Side Plank) is an astonishingly effective treatment for scoliosis. Simply having patients hold the posture as long as possible on a daily basis with the weaker side of their body down (that is, with the convex side of their spinal curve closest to the floor), he found that the size of the primary scoliotic curve reduced an average of 36% in just 4.4 months.
Weaknesses and Omissions
Healing Yoga does, however, have a number of weaknesses, which this reviewer hopes will be addressed in future editions. For example, the first pose featured in the chapter on “Headache” depicts a woman in a supported version of Setu Bandhasana on a chair. Although the text notes that the “stretch has to be gradual and adapted to your neck to be used safely,” the suggested modification requires a “trustworthy partner” to hold and “gradually lower” the head – which seems like a disaster waiting to happen unless the partner happens to be a very experienced yoga therapist.
Similarly, the chapter on “Weight Control” suggests that the reason that most yoga practitioners are thin is that “many yoga poses stretch the stomach lining.” No solid evidence is provided to support this assertion, however. Nor is the obvious counter-explanation that existing yoga culture disproportionately caters to and attracts thinner-bodied people to begin with addressed.
The final part of the book, which briefly discusses research projects in which Dr. Fishman is exploring yoga treatments for restless leg syndrome, bunion, and plantar fasciitis, also does not live up to the high standards set in the first part of the book. Basically, the research is so preliminary that publication seems premature.
Including more information on sequencing and depicting more basic postures would, in this reviewer’s opinion, make Healing Yoga a better resource for readers without prior knowledge of yoga therapy or a similar modality. Even when a series of poses for a specific condition is given, it’s unclear whether it’s important to do them in the order depicted.
It would also be helpful to provide more photographs of less challenging asana options. Generally, the asanas depicted feature an advanced version of the pose. Picture of less challenging modifications are often omitted, although they may be described in the text. In some cases, the “less challenging variation” itself seems very advanced: for example, the photo depicting the supposedly easier version of Supta Virasana (Supine Hero Pose) shows a woman lying with her back flat on the floor and arms outstretched overhead, holding onto a partner’s ankles.
Healing Yoga offers critically important information on how yoga may be used to treat back pain, rotator cuff injury, osteoporosis, and scoliosis. For readers without prior knowledge of the anatomical causes of these conditions, it provides an incredibly useful introduction, which manages to combine scientific rigor with engaging, accessible prose. Even for experienced yoga therapists and others who have prior knowledge of these conditions, learning about Dr. Fishman’s innovative work using yoga to treat them should prove invaluable. Other parts of the book, however, are considerably weaker. In this reviewer’s opinion, it would have been better to restrict its focus to the strongest and most tested aspects of Dr. Fishman’s work.
How useful readers find Healing Yoga will depend on what information they’re interested in, as well as how much prior knowledge they possess. The stated intention of the book is to be accessible to both beginning and advanced yoga practitioners. However, from this author’s point of view, the fact that it requires readers to distinguish stronger from weaker material, as well as its tendency to feature relatively advanced postures, makes it most suitable for advanced students, yoga teachers and therapists, and others with relevant experience (e.g., bodyworkers or physical therapists). Hopefully, a revised version of Healing Yoga will address its current omissions and inconsistencies, while further enhancing its exceptional strengths.
Carol Horton, Ph.D., is the author of Yoga PhD: Integrating the Life of the Mind and the Wisdom of the Body (Kleio Books, 2012); and Race and the Making of American Liberalism (Oxford University Press, 2005). She is also the co-editor (with Roseanne Harvey) of 21st Century Yoga: Culture, Politics and Practice (Kleio Books, 2012). Carol holds a doctorate in Political Science from the University of Chicago, served on the faculty at Macalester College, and has extensive experience as a research consultant specializing in issues affecting low-income children and families. A Certified Forrest Yoga teacher, Carol teaches yoga to women in the Cook County Jail with Yoga for Recovery, and at Chaturanga Holistic Fitness in Chicago. To learn more, visit her website at carolhortonphd.com