The Use of Iyengar Yoga as a complementary therapy to

traditional medicine.
Introduction
Existing peer-reviewed scientific studies completed on the use of Yoga * as a Complementary
Therapy (or Medicine) show strong evidence that Yoga, if practiced correctly, can offer patients an
additional non-invasive source of treatment and pain management. Today, Yoga is mainstream, and
contemporary approaches to Yoga have become a trendy exercise and overshadow Classical Yoga's
potential benefits. The therapeutic benefits of Yoga are unfamiliar to physicians and
patients. Clinical trials presented in this article examine the role of Iyengar Yoga as a
Complementary Therapy (or Medicine) for the treatment of musculoskeletal injuries, osteoarthritis,
repetitive strain injuries, and stress management.
Defining Classical Yoga
Physicians and health care practitioners are unaware of what Yoga is and the benefit derived if
practiced correctly. Derived from the Sanskrit root 'yug,' "to join," Classical Yoga is the uniting of
body, mind, and spirit to achieve well being. (1) It is an ancient Indian practice consisting of
physical and mental disciplines. "By performing postures, known as asanas, and by controlling
breathing, known as pranayama, individuals would be able to cleanse their bodies' organs and
systems and achieve a higher state of consciousness." (2) "Yoga provides a holistic approach
to health that increases flexibility, strength, and stamina while it fosters self-awareness, emotional
stability, and peace of mind." (2) By following a sequence of selected postures performed
correctly, Yoga can be used as a "complementary health tool." (2)
Distinguishing Classical Yoga from Contemporary Yoga
Today, there are numerous approaches and definitions of Yoga. Contemporary Yoga has become a
lucrative business that advertises Yoga as a trendy exercise. It deviates from its origins and has
little or no similarity to what is defined as Classical Yoga.
In the tradition of Classical Yoga (as taught by Yoga Master B.K.S. Iyengar), teachers are trained
and certified through rigorous programs sponsored by the Iyengar Certification Committee or by
Yoga Master B.K.S. Iyengar. Classical Yoga refers to a technique of self development and self
actualization that is passed on to students by gurus over years and decades. Teachers in training
learn how to sequence poses, how to use proper poses for particular ailments, and how to observe
the development and progression of the students in practicing the poses correctly. A teacher must
demonstrate knowledge of the subject, proper sequencing of poses, and the ability to observe the
development and progression of the student in practicing the poses correctly.
In some contemporary approaches to Yoga, those who wish to become teachers attended classes
and become certified self-appointed teachers in a matter of hours and weeks. The correct
approaches to postures may not be taught; if postures are taught, they are presented as an end
in themselves to heal an illness, reduce stress, or cultivate a better body. (3) There is not a
systematic teaching of the subject of Yoga; Classical postures are distorted and new postures are
created, and there is an absence of the basic principles of alignment. Classical Yoga is not practiced
as a callisthenic, but as a preventive and curative system integrating body, mind, and spirit. (4)

Understanding the Benefits of Iyengar Yoga

Iyengar Yoga can be practiced by individuals regardless of disease, disability, or age if performed
under the guidance of a well-trained teacher unlike calisthenics, exercise, and various
Contemporary Yoga approaches that may limit participation to injury-free, healthy people. It can be
adapted for the person and the condition. "Health can also be improved in degrees," states B.K.S.
Iyengar. (6) The decision to practice Yoga is based on the individual's willingness to practice it. The
physical body, in any condition, can practice Iyengar Yoga and receive benefits.
Yoga's benefits are experienced through proper sequencing of postures called asanas. "The final
posture of an asana is achieved when all the parts of the body are positioned correctly, with
full awareness and intelligence," B.K.S. Iyengar explains further. (5) Asanas are not performed
mechanically. Consciousness must be involved in each movement of the asana. To perform the
posture correctly, the practitioner must know the fundamental points of the asana and adjust the
body accordingly. The body is taken to the structure of the asana.
The Iyengar approach to Yoga, used in the published clinical trialsin this article, is based on the
teachings of Yoga Master B.K.S.Iyengar. It emphasizes precise and careful structural
alignment,muscular balance, and development of strength, stamina, flexibility, andwell being. Yoga
can improve the functioning of the respiratory,circulatory, digestive, and hormonal systems, and
bring emotionalstability and clarity of mind. This is "... only the beginning ofthe journey to Samadhi,
or self-realization, which is the ultimate aimof Yoga," explains B.K.S. Iyengar. (5) A regular Yoga
practitionerhas control of his or her life situation, circumstances, andenvironment--regardless of
condition, age, prognosis. (5) The practiceof Yoga can have a profound impact on individuals.
Health is not just considered "freedom from disease." (5) B.K.S. Iyengar emphasizes, "For good
health, the joints, muscles, cells, nerves, glands, and each Yoga Flow system of the body must all be
in a state of perfect balance and harmony." (5) Health is defined holistically as "... the perfect
equilibrium of the body and mind, intellect, and soul." (5) Through the practice of Yoga,
many conditions the patient may be improved. Pain can be minimized, flexibility improved, anxiety
reduced, and attitude improved.
Distinguishing Yoga's Therapeutic Benefits from Exercise
"Therapeutic Yoga is the performance of postures for treating medical disorders." (2) "Iyengar Yoga
... prescribes orderly and progressive series of postures adjusted to meet a student's needs and
physical conditions." (2) "As a therapy, yoga works to refine human physiology." (2) Performed
properly the asanas are believed to benefit the whole body: toning the muscles, tissues, ligaments,
joints, and nerves, and maintaining the functioning and health of the body. (5) By relaxing the body
and mind, they enable the body to recover from daily stress. (5) "Asanas also boost metabolism,
lymphatic circulation, and hormonal secretions, and bring about a chemical balance in the body,"
B.K.S. Iyengar explains. (5)
Unlike many forms of exercise involving quick, forceful, and repetitive body movements that may
fatigue the body after 15 minutes, asanas require concentration and quality movements and
promote a sense of balance, calm, and well-being. (5) Exercise may temporarily boost energy levels
by increasing nerve function and circulation, but cellular reserves and endocrine glands quickly
become exhausted and pulse rate and blood pressure increase. (5) Exercises can overtax and injure
bones, joints, and ligaments. (5) In correct practice of Iyengar Yoga, "back bends are more
physically demanding than jogging, but the heart beats at a steady, rhythmic pace," explains B.K.S.
Iyengar. (5) Asanas are designed to achieve balance in the mind and all parts of the body. (5) Yoga

conditions the whole body--mentally and physically--and rejuvenates it rather than exhausts it.
B.K.S. Iyengar emphasizes further: "Only in Yoga can you keep both the body and the mind relaxed,
even as you stretch, extend, rotate, and flex your body." (5) By practicing Yoga, individuals can
improve their strength, coordination, flexibility, and well-being. 5 Yoga, unlike exercise, can be
practiced by anyone regardless of age or condition.
Prescribing Individualized Approaches to Yoga
A specific sequence of poses is prescribed for an individual taking into account his or her
conditions. Poses such as belts, ropes, bandages, blocks, chairs, or walls, an integral part of Iyengar
Yoga, allow an individual to adapt her or her body to the poses and practice them correctly. Props
enable an individual to enjoy the benefits of a pose. They contribute to gaining confidence and
increase the ability to remain in the pose and achieve benefits.
Relying on Documented Research on the Benefits of Yoga
The poses and sequence of poses prescribed for individuals must be based on documented research
and must be practiced correctly under the supervision of a knowledgeable instructor. Many
presentations on the use of Yoga exaggerate and make extravagant, misleading claims about
its benefits. It is necessary to distinguish these claims from peer-reviewed, documented research.
Documented research studies concerning the appropriateness and effectiveness of the use of Yoga
as a Complementary Medicine can provide physicians and health practitioners with necessary
information on how Yoga can be used as a complement to traditional medicine.
Evaluating Clinical Studies Using Iyengar Yoga

The following peer-reviewed, randomized, controlled studies present credible preliminary medical
evidence documenting the therapeutic benefits of Iyengar Yoga. In each of the following studies, a
sequence of poses was selected and adapted with the addition of props, which allow each student to
experience the benefits of the poses without strain or injury.
Use of Iyengar Yoga for the Treatment of Osteoarthritis of the Hands and Finger Joints
In the Treating Osteoarthritis (OA) in the Hands and Finger Joints study, 2 (6) possible subjects
were tested for osteoarthritis of the hands and finger joints. (7) Of the 26 possible subjects, 17
subjects were suitable for inclusion in the study. These subjects had OA of the distal
interphalangeal and/or proximal interphalangeal joints of the fingers. All patients suffered from
pain, aching, and/or stiffness in the hands. The 17 subjects were randomly assigned to either

the treatment or the control group so that eight subjects were in the control group and nine were in
the treatment group. One of the control group subjects dropped out of the study before post-testing
leaving seven subjects in the control group.
The subject were tested for the following primary outcomes: (a) range of motion of the finger joints
measured with a goniometer, (b) hand grip strength evaluated with a JAMR hydraulic hand
dynamometer, (c) tenderness of the finger joints measured with a Chatillion
instrument dolorimeter, (d) circumference of the finger joints recorded with a jeweler's ring sizer,
(e) hand pain on a visual analog scale, and (f) hand function measured by the Stanford Hand
Assessment Questionnaire. The nine subjects in the treatment group took a weekly 60-minute Yoga
class for eight weeks conducted by the author. The Yoga sequence of postures focused on the upper
body, particularly hands, fingers, arms and shoulders. The postures were designed to align
the participants' bones, muscles, and joints, and to bring awareness to the joints during flexion and
extension. Two of the poses used in this intervention were Parvatasana (Hero Pose with Arms
Lifted) and Utkatasana (Olympic Diver's Pose). The control group received no treatment.
In post-tests, the treated group's levels of tenderness of the finger joints for both hands, range of
motion of the finger joints for the right hand, and pain during activity for both hands realized
a statistically significant improvement (p<.05). Thus, pain during activity, tenderness, and finger
range of motion significantly improved compared with controls. The results of the Yoga intervention
demonstrate that a sequence of Yoga postures be used to increase range of motion of the finger
joints, decrease tenderness of the finger joints, and decrease hand pain during activity.
Use of Iyengar Yoga for http://www.thesecretsofyoga.com/ Treatment of Carpal Tunnel Syndrome
In the Carpal Tunnel Syndrome study, approximately 400 potential subjects were recruited through
newspaper advertisements and public notices. (8) Of those 400 individuals, 72 suitable study
participants were selected. Those 72 individuals were interviewed in person and examined. Of
those 72 individuals, 51 subjects met the criteria for inclusion in the study. Entry criteria required
each study participant to have two of the following five clinical findings present: positive results on
the Phalen sign, (9) positive results on Tinel sign, (10) pain the median nerve distribution, sleep
disturbances results from hand symptoms, and numbness of paresthesias in the median nerve
distribution. All participants were required to have abnormal median nerve conduction latencies on
neuroelectrical testing. Forty-two individuals with carpal tunnel syndrome completed the Yoga
intervention.
The participants took biweekly 90-minute Iyengar Yoga classes for eight weeks. Subjects were
randomly placed into two groups. Twenty subjects (32 wrists) in the control group were given a
standard wrist splint with a metal insert to supplement their current treatment. Twenty-two
subjects (35 wrists) in the Yoga-based intervention group received a program focused on upper
body postures: improving flexibility, correcting alignment of hands, wrists, arms, and
shoulders; stretching; and increasing awareness of optimal joint position during use. Yoga poses
used in the intervention included the following: Dandasana, Namaste, Urdhva Hastasana,
Garudasana, Bharadvajasana, Tadasana, Half Uttanasana, Virabhadrasana, Urdhva Mukha
Svanasana, and Namaste. (1)
Each week the study participants indicated the intensity of pain for the previous week on a visual
analog scale. The Phalen sign and Tinnel sign for each participant were assessed each week. Grip
strength was measured with a sphygmomanometer cuff that was rolled, taped, and inflated to 20
mm Hg. The subject squeezed the cuff with maximum strength. The three best efforts of each hand
were recorded. (8) An electroneurometer (NERVEPACE, NeuMed Neurotron Medical,

Lawrenceville, NJ) was used to measure the distal latency of the median nerve across the wrist.
(11) All of the tests were taken initially to establish a baseline, and then were repeated at the end of
the eight-week Yoga intervention.
To measure improvement, pre-intervention and post-intervention changes in grip strength, nerve
conduction times, and pain intensity were examined using repeated-measures analysis of variance
for within-group differences. Of the 51 subjects who began the Yoga intervention, nine dropped out
or were excluded. Final data were analyzed for 42 participants, who accounted for 67 unique wrists
with carpal tunnel syndrome. The Yoga group consisted of 22 participants and 35 wrists, and the
control group consisted of 20 subjects and 32 wrists. The pre-intervention and post-intervention
results for grip strength and pain reduction revealed that the Yoga group significantly improved
grip strength (p=0.009) and pain reduction (p=0.02 improved). Changes in control subjects' grip
strength and pain were not significant. A Yoga-based program of simple stretching and postural
alignment can reduce pain and improve grip strength of carpal tunnel syndrome patients.
Use of Iyengar Yoga for the Treatment of Osteoarthritis of the Knee
In the Yoga for Osteoarthritis (OA) of the Knee Pilot Study (12,13) the study subjects fulfilled the
Criteria for Idiopathic Osteoarthritis (OA) of the Knee of the American College of Rheumatology
(ACR). Eleven subjects with osteoarthritis of the knee enrolled; nine participated in at least one
Yoga intervention session. Seven had data pre- and post-course available for analysis; 1 subject
dropped the class due to an unrelated illness and another subject could not accommodate the
class in her work schedule. Participants had not previously practiced Yoga. The seven participants
who completed the trial were all women, had a mean age of 58.6 (range: 50-68), and had a mean
body mass index of 35.6 (28.7-39.1).
The seven participants, who were women, completed a medical history and physical examination,
Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Arthritis Impact
Measurement Scales 2 (AIMS2) social, psychological and physical subsets, Patient
Global Assessment (PGA) by Visual Analog Scale (VAS), Physical Global Assessment by VAS and 50'
Walk Time prior to and following an eight week program of Yoga instruction. The study subjects
participated in a weekly 90-minute Yoga class for eight weeks. Subjects practiced the following
poses as part of their Yoga intervention: Utthita Trikonasana (Extended Triangle Pose),
Virabhadrasana II (Warrior Pose II), Baddha Konasana (Bound Angle Pose), and Baddha Konasana
(Cobbler Pose).
Subject participants experienced the following statistically significant results after the Yoga
intervention: WOMAC pain was reduced by 46.7% (p=0.039), WOMAC disability was reduced by
39.1% (p=0.039), and AIMS2 Affect improved by 23.2% (p=0.002). To arrive at these
results, participants' pre-course and post-course statistics were compared. Trends in improvement
of symptoms were measured in WOMAC Stiffness (39.0%; p=0.06), PGA (29.5%; p=0.18), and AIM2
Symptoms (36.5%; p=0.1), but did not reach statistical significance. The 50' Walk Time
was unchanged. The intervention demonstrated that a Yoga sequence of postures designed to treat
and manage osteoarthritis of the knee has the potential to reduce pain and disability for participants
with OA of the knee. (12)
Identifying What to Look for in Yoga Therapy
"... Physicians should become more knowledgeable about alternative medicine and increase their
understanding of the possible benefits and limitations of alternative therapies," states
(JAMA editors) Dr. Fontanarosa and Dr. Lundberg. (14) With regard to Yoga as an alternative

therapy, physicians need to know: What is Yoga? How can Yoga be used as a Complementary
Medicine? If doctors are conversant with the use of Complementary Therapy as an adjunct to
traditional medicine, they may find Yoga useful in managing symptoms or diseases for
their patients. "The benefits of yoga's application as complementary therapy for rheumatic diseases
and musculoskeletal disorders are worthy of physicians' inquiries." (2)

It is important to find a qualified, credentialed Iyengar Yoga instructor who understands

physiological and biomechanical effects of the poses, applies the Classical poses based on the
subject's needs, and observes the subject performing the poses correctly. The goals of Yoga therapy
are to decrease the pain, reduce the symptoms, improve the patient's attitude, and build
confidence.
Identifying the Need for Future Studies
There must be more peer-reviewed, randomized studies that demonstrate the benefits of Yoga for
the treatment and management of various conditions and diseases. "As with conventional
therapies, advice should be based on data and scientific information rather than anecdotal
information, misperceptions, or preconceived or unfounded notions about the effectiveness or lack
thereof," observed Fontanarosa and Lundberg. (14)
Conclusion
Promising medical studies are being conducted (by this author) to examine the effect of Iyengar
Yoga on musculoskeletal problems and postural stability. Iyengar Yoga has the potential to
improve patients' lives by enabling them to use this alternative therapy as a non-invasive source of
treatment and pain management. Physicians' increased knowledge of the therapeutic benefits of
Yoga as a Complementary Therapy, based on peer-reviewed scientific studies, will enable Iyengar
Yoga to be used for more patients as a treatment for musculoskeletal injuries, osteoarthritis,
repetitive strain injuries, and stress management.
References
(1.) Iyengar, B. K. S. (1979). Light on yoga. New York: Shocken Books.
(2.) Garfinkel, M. (2006). "Yoga as a complementary medicine." Geriatrics and
https://app.box.com/s/ot16z7ws6t506utl17j6o4mzogn7g5ow Aging, 9, 190-194.
(3.) Garfinkel, M., Schumacher H. R. "Yoga." In: Panush, R.S., editor. (2000) Complementary and
alternative therapies for rheumatic diseases II, rheumatic disease clinics of north
america. Philadelphia (PA): W.B. Saunders Co., 125-132.
(4.) Iyengar, B. K. S. (1988). The tree of yoga. Oxford: Fine Line Books.
(5.) Iyengar, B. K. S. (2001). Yoga: the path to holistic health. Great Britain: Dorling Kindersley Ltd,
14-24.
(6.) Iyengar, B. K. S. (2003) "Yogacharya B.K.S. Iyengar answers questions on aging." Yoga
Smachar. Minneapolis: Iyengar National Association of the United States, 5.

(7.) Garfinkel, M., et al. (1994) "Evaluation of a yoga-based regimen for treatment of osteoarthritis
of the hands." Journal of Rheumatology, 21, 2341-2343.
(8.) Garfinkel, M., et al. (1998). "Yoga-based intervention for carpal tunnel syndrome." Journal of the
American Medical Association, 280, 1601-1603.
(9.) Phalen, G. S. (1966) "The carpal tunnel syndrome: seventeen years' experience in diagnosis and
treatment of six hundred fifty-four hands." The Journal of Bone and Joint Surgery, 48, 211-228.
(10.) Mossman, S. S., Blau, J. N. (1987). "Tinel's sign and the carpal tunnel syndrome." British
Medical Journal, 294, 680.
(11.) Atroshi, I., Johnsson, R. (1996). "Evaluation of portable nerve conduction testing in the
diagnosis of carpal tunnel syndrome." Journal of Hand Surgery, 21, 651-654.
(12.) Matz, W., et al. (2002). "The feasibility of using yoga for treating symptoms of osteoarthritis of
the knees." Osteoarthritis and Cartilage Supplement, 10, 62.
(13.) Kolasinski, S., et al. (2005). "Iyengar yoga for treating symptoms of osteoarthritis of the knees:
a pilot study." Journal of Alternative and Complementary Medicine, 11, 689-693.
(14.) Fontanarosa, P. B., Lundberg, G. D. (1998) "Alternative medicine meets science." Journal of
the American Medical Association, 280, 1618-1619.
(15.) Evangelisto, et al. (2002) "Change in gait parameters after participation in a yoga program for
treatment of symptoms of osteoarthritis of the knee: a pilot study." Osteoarthritis and Cartilage
Supplement, 11, 4.
* Yoga refers to the method of B.K.S. Iyengar, which emphasizes strength, correct alignment, and
development of strength and stability.
MARIAN GARFINKEL, ED.D.
Adjunct Professor, Temple University School of Medicine, Philadelphia, Pennsylvania; Clinical
Investigator and Researcher, Temple University School of Podiatric Medicine; Adjunct Professor,
Temple University, College of Health Professions, Department of Kinesiology, Philadelphia,
Pennsylvania; Director, B.K.S. Iyengar Yoga Studio of Philadelphia, Philadelphia, Pennsylvania.
2301 Cherry Street, Suite 8D, Philadelphia, PA 19103.
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