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Ten years ago, Ginger Garner, MPT, ATC, ERYT, PYT, founded Professional Yoga Therapy Studies (PYTS)--the first and only program that offers post-graduate cross-cultural and cross-occupational CEs in therapeutic yoga for licensed health care professionals, including PTs, ATCs, OTs, physician assistants, nurses and others.
The continuing education program, located in Emerald Isle, NC, and offering course locations throughout North America, allows therapists and other health care professionals the opportunity to study therapeutic yoga application at a post-graduate level, side by side with like-minded peers who are also seeking out holistic means of physical therapy practice.
In addition, complex clinical evaluation and application, biomechanical analysis and case study take place at an advanced level--a level that cannot take place in a yoga therapy program where people without medical backgrounds study.
Incorporating Integrative Medicine
Therapists who graduate from PYTS are prepared to recognize, evaluate and design integrative rehabilitation programs at their place of practice, including hospitals, private practices and community centers.
"Our graduates have gone on to become the coordinators, founders and supervisors of the most progressive integrative rehabilitation and health programs in the country, such as Nick Cotiangco, one of our graduates," said Garner.
Cotiangco, PT, CLT, PYT-C, is an outpatient physical therapist at Riverside Medical Center in Kankakee, IL, who has helped develop programs that incorporate yoga physical therapy and cancer rehabilitation.
The rehabilitation services department at Riverside Medical Center is in the process of transitioning the cancer PT program to a more comprehensive program. An "Integrative Physical Therapy for Cancer" program will be comprised both of patients who are in active treatment for cancer and cancer patients in the survivorship phase. It will incorporate the principles of Ayurveda (a medical system that integrates and balances the body, mind and spirit), yoga and traditional physical therapy.
Look at the top 10 hospitals that make up the U.S. News and World Report's top cancer centers in the country, noted Cotiangco. "All of them embrace integrative medicine. They all have a separate department on integrative medicine for their cancer programs," he said.
The National Center for Complementary and Alternative Medicine, one of the 27 institutes and centers under the National Institutes of Health, acknowledged Ayurveda as a whole medical system.
Ayurveda and Yoga Defined
The Ayurvedic definition of health is a balanced dosha (humor or constitution), balanced agni (fire), properly formed dhatus (tissues), proper elimination of malas (waste products), and well functioning bodily processes.
Yoga, on the other hand, is a state of mind when the mind is still, which fosters awareness. This can be achieved by doing the eight limbs of yoga practices: the yamas (actions in relation toward others), niyamas (our attitudes toward ourselves), asana (posture), pranayama (mastery of the breath), pratyahara (withdrawal of the senses), dharana (concentration), dhyana (meditation) and samdhi (state of bliss).
"There are more than enough modalities in Ayurveda and yoga to use to help patients. Those will be the principles that I will be using to jump start our program," said Cotiangco.
Patients with a cancer diagnosis have much to gain from yoga therapy. It builds the patient physically, emotionally and spiritually. There are no rigid rules of exercise and protocols to follow. If the patient feels exhausted from chemotherapy, then the yoga therapist can teach restorative poses and calming breathing exercises. If the patient is in survivorship phase, then the patient and the therapist can collaborate to do more, taking into consideration the type of cancer the patient has, the kind of treatments he's had, and his dosha.
"By using these principles and teaching them to the patients, they will be empowered to bring about their own wellness and balance," said Cotiangco.
The Therapist's Role in Cancer Treatment
No longer is the eradication of cancer the only issue being discussed these days. Quality of life during survivorship is becoming increasingly important too as the number of cancer survivors grows.
Therapists treating patients with cancer play an important role during the active phase of treatment as well as during the survivorship phase. "We try to do interventions as soon as we can so that the patient will hopefully have fewer problems during the survivorship phase," said Cotiangco.
Patients diagnosed with cancer undergo two or more events during the course of their active treatment: surgery, chemotherapy, radiation, hormonal therapy and reconstruction. Each event poses different sets of problems. For example, mastectomy patients will have a swelling problem. Here, the swelling is not lymphedema, but a normal reaction of the body after undergoing surgery.
"As a lymphedema therapist, I can use skills that would reduce the swelling, like taping, but I would not treat the swelling as lymphedema, per se," said Cotiangco.
Another therapy intervention that can be performed is postural correction. Using the same example, chances are the patient will be in a protective posture of the operated site. A simple shoulder roll is one way to help correct the problem.
Patients undergoing chemotherapy will have their own sets of problems as well. When a physical therapist is trained in cancer rehabilitation, they will be able to tailor patient exercises depending on the chemo drug used to prevent possible long-term effect.
"For example, if the patient is getting Herceptin, a therapist specializing in cancer will know that Herceptin is cardio toxic and will reduce heart function. The PT's exercises of choice will consist of cardio exercises," Cotiangco said.
PYT and Therapists
Garner noted that PYTS offers students many methods for mastery of yoga and Ayurveda practice, including evaluation and management schematics. But the most important element a therapist can glean is learning to cultivate an elemental approach to healing, amid the noise of so many different methods and styles of practice in rehab today.
"[Therapists] learn to simplify their clinical practice through developing skills in evaluating human movement and behavior all through the context of yoga and Ayurveda," said Garner. "There is a small detail that has been lost in our medical world today: intuition. Intuitive healing is not learned; it is experienced and felt."
She feels that teaching the methods of professional yoga therapy--a combination of [therapy], yoga, Ayurveda and mind-body therapies--has improved not only her ability to be an effective therapist, but also her ability to teach students how to realize and manifest their own intuition.
Because therapists are experts in human movement, Garner feels that therapists are ideally suited to the task of practicing yoga therapy, since a large part of yoga uses movement. "Likewise, yoga is beautifully suited to use for those individuals who do need more than just 'physical' treatment-especially at the end of life. They need nurturing in all facets of their being and yoga offers that to patients with cancer and to their families as well," she noted.
No matter what combination of techniques is used, the most important factor for therapists who work with people who have cancer is their relationship. Therapists must cultivate a connection with each individual. "This truth is," said Garner, "what makes being a [therapist] exhausting and overwhelming at times is also what makes being a [therapist] incredibly rewarding."
Though she admits yoga cannot heal complex medical issues, Garner said that medical professionals are ideally suited to become master clinicians of yoga therapy because they are already trained in dealing with complex medical issues.
"Medical professionals can bridge the gap that health care so often leaves out today: that of a whole-body, holistic, patient-centered approach that addresses all facets of the being."
Beth Puliti is managing editor and Web editor at ADVANCE. She can be reached at epuliti@advanceweb.com.
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