YOGA FOR MEDICAL STUDENTS

YOGA FOR MEDICAL STUDENTS

Dr Manoj Naik
Consultant physician, Ramamani Iyengar Memorial Yoga Institute, Pune

Yoga is an art, science and philosophy. It is a science of health, happiness and longevity. All other health sciences give their views on health, happiness and longevity but not the way and means to achieve it. Yoga is a science which shows the way. In medical science we have many specialties and super specialties focusing on narrow or specific studies. Similarly, BKS Iyengar the legendary yogi has super specialized in two limbs of yoga: asana and pranayama. These limbs are important because they show the way to health. Comprehensive and holistic health can be developed by regular practice of asanas. If introduced in medical curriculum they will give good health to medicos. Other limbs of yoga seem abstract or remote. Asanas and pranayamas can be shown, demonstrated, experienced and studied by medical students.
Asanas are postures. Their innumerable health benefits accrue from precise placement of various anatomic parts. Knowledge of anatomy, especially surface anatomy is extremely helpful for asana practice. Iyengar Yoga gives emphasis to correct placement of various parts and alignment of external body. This alignment results in balance, transformation and evolution of inner subtle body (mind, intelligence, ego, awareness).External body is used as a tool to access and shape the mind. In this sense, asanas are a somatopsychic science. Asanas give many benefits. They give physical health, organic health, as well as mental, emotional, intellectual and spiritual health. However, the higher aspects cannot be felt by a beginner. Hence, introduction has to be with the basics.
Standing postures help develop a strong healthy musculoskeletal body. All muscles, bones and ligaments are made strong, stable and flexible. These postures are difficult for beginner. Hence, supports are used for ease, timing and correct action.
Further, higher grades of asanas do not come by negating the body but from evolving from the base given by standing postures. After exercising the muscles and skeletal body, asanas exercise the organic body. This is a unique term coined by Guruji. Various exercise forms exercise only the limbs and muscles. Asanas also exercise abdominal organs like liver, spleen, intestines and kidneys. They also exercise heart and lungs. All asanas have this action but this action is especially prominent with twisting asanas. Negative intra abdominal pressure coupled with rotation of the spine causes extension, twisting and massage of these organs and keeps them healthy. Various props and supports are used to achieve this action. For these higher effects correct alignment is of paramount importance. These can be understood when anatomy of abdomen and thorax is introduced.
After exercising various systems and organic body, neurological exercise is done. After a few months when students are well versed with standing, sitting, twisting and supine postures, inversions can gradually be introduced. Here again for neurological, intellectual and mental exercise, the body is used as a tool. These include inversions, shirshasana, sarvangasana, and back bends. These can be introduced when neurology is taught. Inversions are actually advanced use of various neurological facilities.
Anatomy teaches us parts of human being on a dead body. Asanas teach us the function of anatomy in a live body. Thus physiology of the anatomy is learned and experienced. So many of the known physiological facts are used in asanas brilliantly. It is surprising how the yogis could use these even before physiology was known.

Interview with Dr Manoj Naik

Dr. Manoj Naik is a qualified medical doctor who practices in Pune and also studies yoga at the Institute. The interview, which is reproduced here, was taken by the French Television.

How did you start doing yoga?

A senior colleague practicing at the Institute introduced me to this subject. She said you must do yoga as you will benefit in all aspects. I was skeptical initially and told her that I swim regularly, jog etc., and I did not need any other form of exercise. Frankly, six years ago I did not know about the Institute at all. I started yoga at my colleague`s insistence.

Do you feel any benefit?

The results were surprising. I was exercising earlier but no exercise produced such a sense of exhilaration, such a deep sense of relaxation as felt after asanas. Initially the benefits were more physical, apparently in the form of flexibility etc. But now I am feeling the mental aspects (nature) of asanas. Regular practice is helping me very much especially considering my irregular schedule as a doctor and stresses of emergencies in medicine. I make it a point not to miss practice and if I do then it makes me uneasy.

Would you call yoga a form of exercise?

It may seem like exercise to a beginner but it is a philosophy, it is a way of life. With the modern craze for fitness, it is often projected as an exercise only. In fact this is one of the reasons why several persons say asanas are physical.

What is the difference between yoga and other forms of exercise ?

Let us first compare the physical aspects. In other exercises there is a limited movement of a few joints e.g. running involves predominantly legs/arms, so also in swimming. In asanas, all the joints of body are used to a full extent and kept mobile.

In other forms of exercise, the effects on the organic body (abdominal organs and thoracic organs) are marginal. Asanas have a tremendous effect on these organs. You don`t exercise your organs while running, weight lifting, cycling etc. But consider twistings e.g. in Bharadvajasana (when correctly done), the upper abdominal organs (liver/spleen/stomach) are exercised. In Marichyasana/Ardha Matsyendrasana, the middle abdominal organs (intestines, kidneys) are exercised. In Pasasana/Paripurna Matsyendrasana, the lower abdominal organs (pelvic organs/colon) etc. are involved. In fact in each and every asana there is some form of organic exercise.

The best effect of the asana is on the mind. To achieve a correct posture you have to use the mind and other mental faculties intensively. In fact asana/pranayama is more of a mental exercise. The effect on the mind includes stability, lesser anxiety, no depression, no nervousness, and development of patience and perseverance. Also with proper modifications anybody from the young to the elderly can perform asanas.

What is the basis of therapeutic yoga?

The answer is found in yoga sutras, which states: "Sthira sukham asanam".

In any asana you should be stable and experience joy or a pleasing sensation, in each and every part of the body and mind. So if a diseased region is placed correctly in an asana then there is relief. Certain asanas have pronounced effects on certain regions e.g. twistings on back, standing poses, Urdhva Prasarita Padasana on the knees. So they are used for relieving back pain or knee problems. But it is impossible for a patient to perform the classical postures. Hence, the classical pose is modified in such a way that only the diseased part is placed in "asana-sthiti" – only then does the patient get relief.

Have you learnt this at the medical school? Are doctors aware of the therapeutic yoga?

No we don`t have yoga in our curriculum in our education. Nowadays some doctors are turning to yoga but majority of doctors are unaware. The feedback they get is only from patients who take both medicine and do yoga.

Do doctors accept the role of yoga in treatment?

These days, yoga is accepted as an alternative medicine but the response to it is mixed. Some laugh it off, some ask patients to continue, some even give bizarre suggestions such as don`t do Sirsasana etc., do only Savasana or, do Surya Namaskara etc.

Why is this so?

Medicine has its base on objective demonstration of facts, hence I think we put blinkers and tend to believe only in objective medical scientific studies or objective research. All other branches are viewed skeptically. Yoga is an entirely subjective science. The practitioner only on practice can experience the subjective experience in asana and pranayama. Hence until doctors practice they wouldn`t be able experience or understand the benefits of yoga.

Objective documentation is difficult. A MRI scan can be done only when the patient is lying down; it cannot be done when the patient is in a sitting posture. Even if we manage to do a scan, the radiologist will find it difficult to interpret it. Functional anatomy has to be experienced, it cannot be documented.

Most doctors have little knowledge about asana/pranayama so when some patient questions a doctor about them, he should humbly say that he doesn`t have any knowledge about the subject and cannot give any opinion or recommendation.

How did you accept yoga as a therapeutic science?

I will narrate one incident, which brought this change in me. Two to three years ago, when I was talking with Guruji he looked at my right hand and said: "Hey your right hand has problems!" I said "No". Then he pointed out that my forearm muscles were thicker on the right as compared to the left. He moved my hand and said "your right shoulder blade has spondylosis." I remained silent but thought "how can I have spondylosis? I can do all activities and move my neck without pain etc." I also took the opinion of my colleague who is an orthopaedic surgeon. He told me that my hand was normal and that my right side being dominant was better built.

But now I realize that what Guruji said was true. I see the faulty movements of right vs. left shoulder in Parsvottanasana and Gomukhasana. Occasionally, I get pain on the right deltoid, arm and forearm.

Now, all x-rays will be normal, but if I don`t work on it, then it will progress to spondylosis after another 10-20 years. Now I understand something. Yoga is diagnostic as well as therapeutic. Asymmetry of two portions in asana, e.g. shoulder, gives us an idea of a forthcoming disease. One should learn to scan the full body with the mind once one is in the pose to notice any irregularities (diagnostic yoga). In therapeutic yoga, you use the region of the healthy side of the body as a guide for repositioning the side of the body that is diseased till the pain and discomfort disappears and a healthy sensation appears. Parsvottanasana etc. can be used for diagnoses as well as cure for shoulder and neck problems.

Can you tell us about what medical aspects you have learnt in Iyengar Yoga?

The above incident surprised me that I did not know my own body despite being a doctor. How could Guruji diagnose this defect in one glance? How is it that an orthopaedic could not diagnose it? That was when I would say that my medical ego was humbled.

Subsequently I started attending and observing the medical classes. I started observing patients with various diseases: Heart problems, Spondylosis, Slip disc, Diabetes, Knee problems, Hip problems, Hypertension being treated in these classes and getting relief. But I had no clue on the mechanism of action. The realization then dawned that a lot of practice and subjective evaluation of effects of asana in various regions were a prerequisite for understanding medical effects.

I must admit that even after six years of practice, my subjective knowledge is poor. Learning is a very slow process. I wonder how much effort Guruji must have taken for such subjective knowledge about therapy. It is amazing. He doesn`t even ask many patients what they are suffering from. A simple look at the person while standing/walking or in a posture is sufficient for him to diagnose the patient`s disease.

What is the similarity between yoga and medicine?

Both are for helping or alleviating the suffering of mankind. But yoga is a preventive medicine par excellence. WHO defines health as not only absence of disease but social, physical and mental well being. Medicine has no answer for physical, mental and social well being of the individual.

But these concepts are imbibed in Astanga Yoga very well. Personal mental well being is niyamas – sauc, santosa, tapas, svadhyaya, Isvarapranidhana. Social well being is yamas – ahimsa, satya, asteya, brahmaccarya, and aparigrahah. Medicine is like sighting a fire once it starts. Yogic principles are safety measures to prevent a fire. Thus if properly used then their roles could be complementary.

Has attending the medical classes helped you ?

Yes, Though medicine is an objective science, it has many myths that were entirely shattered. For example, in cases of slip-discs, we doctors recommend that the patient should avoid bending forward. But, here you see that forward asanas when done correctly give great relief to the back. My wife has three prolapsed discs on a MRI scan and she gets a lot of relief.

Another myth is that one should not do Sirsasana after the age of 60 or if you have stroke etc. But Guruji at 82 does all the inverted asanas. There is a patient who is over 65 and has had a stroke. Guruji teaches him Sirsasana after making him perform the proper preparatory postures.

Medical principle is "do no harm." Even if you may not help the patient improve but do no harm. So, you advice the patient not to climb stairs for a knee problem, or ask him not to bend for back problems or advice bed rest for substantial periods.

Guruji recommends another principle. Can you help the patient do more without doing any harm? In fact this is the principle of therapeutic Iyengar yoga.

How did yoga help your wife ?

She had episodes of acute disc prolapse requiring bed rest for eight days or more each time. Even ordinary household activities gave her chronic pain. Now after six months of attending medical class, the range of her back movements has increased and she has practically no pain. She is a general surgeon and has probably understood the importance of yoga in preventive surgery.

In what type of illness is yoga helpful?

The medical class has patients with a range of disorders. In yogic research our own body is the laboratory while the mind is the researcher and analyst; the new movements and actions which give relief are the pills or injections. So if you have a patient with a particular problem then research on your own body for the appropriate pill (asana) and then gently apply it to any patient.