Yoga for Musculoskeletal

Conditions: Integrating the

Evidence into Rehabilitation
Medicine Practice






Mary Lou Galantino PT, PhD, MSCE
Richard Stockton College of NJ
University of Pennsylvania



Session Goals
Lengthen the spine into the extremities
What does the literature say about MS issues?
Impact on general populations and chronic pain
Present medically complex case
Address integration of yoga in pedagogy
Foster discussion regarding future research
Looking Through Our Yoga Lenses
Who are we as we view a
diagnosis?
As the patient?
As the partner?
As a parent?
As the healthcare professional?
As a researcher?
As a policy maker?
As a community based
organization?
Use of Yoga (Saper, 2004)
63% for maintenance of
wellness and disease
prevention
48% for specific health
conditions
Back or neck pain, anxiety,
arthritis, depression, and
fatigue
90% very or somewhat
helpful for their health

Yoga Therapy (Hart, 2008)
Yoga in medical therapy for specific ailments and
disease processes
Facilitated by a yoga teacher incorporating:
Physical postures (asanas), breathing techniques
(pranayama), chanting, meditation, relaxation
Protocol is adapted to the individuals capabilities
and needs
Clinical decision making to assess, plan treatments,
create and apply interventions
Yoga for Musculoskeletal Issues
General Population
Boyle et al.
Chen et al.
Cowen et al.
Telles et al.

Carpal Tunnel Syndrome
(CTS)
Garfinkel et al.


Sacketts Levels of
Evidence: 1, 2, 3, 4
Rheumatoid Arthritis (RA)
Bosch et al.
Dash et al.
Evans et al.
Osteoarthritis
Bukowski et al.
Galantino et al.
Garfinkel et al.
Kolasinski et al.

Boyle, C., Sayers, S., Jensen, B., Headley, S., & Manos, T. (2004). The
effects of yoga training and a single bout of yoga on delayed onset muscle
soreness in the lower extremity. J ournal of Strength & Conditioning
Research (Allen Press Publishing Services Inc.), 18(4), 723-729.
Level Of Evidence (LOE): 2c
Objective: Determine effects of yoga training and a
single bout of yoga on the intensity of delayed onset
muscle soreness (DOMS)
Participants: 24 yoga trained and non-trained female
volunteers
Intervention: DOMS inducing bench step exercise.
Results: Significant findings with VAS at 24 and 48
hours, appears to attenuate DOMS following eccentric
exercise
Chen, K., & Tseng, W. (2008). Pilot-testing the effects of a newly-developed
silver yoga exercise program for female seniors. J ournal of Nursing
Research (Taiwan Nurses Association), 16(1), 37-46.
LOE: 2c
Objective: Effects of a
silver yoga program for female
seniors
Participants: 16 community-dwelling seniors
Intervention: 70 minutes a week, 3 times a week for 4
weeks
Results: Percent body fat and systolic BP decreased, ROM for
shoulder flexion & extension increased, and sleep disturbance was
minimized (all p<.05)
Telles, S., Dash, M., & Naveen, K. (2009). Effect of yoga on musculoskeletal
discomfort and motor functions in professional computer
users. Work, 33(3), 297-306.
LOE: 1b
Objective: Effect of yoga on MS
discomfort in computer workers
Participants: 291 computer office
workers
Intervention: Randomized to 5
days of 1 hour yoga sessions (146)
or wait list control (145)
Results: Yoga group showed
significant decrease in frequency,
intensity, and degree of
interference due to MS
discomfort; increase in bilateral
hand grip, right hand tapping
speed, and sit and reach
Garfinkel, M., Singhal, A., Katz, W., Allan, D., Reshetar, R., & Schumacher,
H. (1998). Yoga-based intervention for carpal tunnel syndrome: a
randomized trial. J AMA: J ournal of the American Medical
Association, 280(18), 1601-1603.
Studied effectiveness of yoga
for CTS. LOE:2b
Participants: 42 individuals with CTS
Intervention: Randomized to yoga group with 11
postures biweekly for 8 weeks or a control group with a
wrist splint
Results: Yoga group had significant improvement in grip
strength (p=.009) and pain reduction), Phalen sign
(p=0.008). No significant differences seen in sleep
disturbance, Tinel sign, or median nerve conduction
time.
Garfinkel, M., Singhal, A., Katz, W., Allan, D., Reshetar, R., & Schumacher,
H. (1998). Yoga-based intervention for carpal tunnel syndrome: a
randomized trial. J AMA: J ournal of the American Medical
Association, 280(18), 1601-1603.

Table 3. - Comparison Between Grip Strength, Pain, and Sensory and Motor Nerve Conduction Times
Variable n Pre-test Post-test Improvement
Grip Strength
Yoga 33 161.6 (70.4) 187.4 (68.8) 25.8 (41.4) 0.01
Control 29 183.9 (69.5) 190.5 (68.2) 6.6 (41.1) 0.37
Pain, visual analog scale (1-10)
Yoga 22 5.0 (2.8) 2.9 (2.2) 2.1 (3.1) 0.02
Control 20 5.2 (2.1) 4.3 (2.2) 0.9 (2.8) 0.16
Median nerve sensory conduction, ms
Yoga 35 4.4 (1.5) 3.97 (1.5) .42 (1.8) 0.18
Control 32 4.66 (1.4) 4.36 (1.6) .29 (1.5) 0.28
Median nerve motor conduction, ms
Yoga 33 4.79 (1.3) 4.27 (1.4) .52 (1.7) 0.08
Control 29 4.78 (1.1) 4.52 (1.1) .26 (0.8) 0.09
P Value
Bosch, P., Traustadttir, T., Howard, P., & Matt, K. (2009). Functional and
physiological effects of yoga in women with rheumatoid arthritis: a pilot
study. Alternative Therapies in Health & Medicine, 15(4), 24-31.

LOE: 2c

Objective: The effect of Yoga on
neuroendocrine & physical function in
women with rheumatoid arthritis

Participants: 16 postmenopausal women
with RA I, II, or III

Intervention: 75 minute yoga classes 3 times
a week for 10 weeks

Results: Significant decreases in HAQ
disability index, decreased perception of
pain and depression, improved balance, no
changes in awakening or diurnal cortisol
patterns
Dash, M., & Telles, S. (2001). Improvement in hand grip strength in normal
volunteers and rheumatoid arthritis patients following yoga training. Indian
J ournal of Physiology and Pharmacology, 45(3): 355-360.
LOE: 2b
Objective: Study effects of yoga on normal adults
and children and patients with RA
Participants: 37 normal adults, 86 normal children,
and 20 RA patients
Intervention: Regular yoga exercises and control
group
Results: Hand grip strength improved for all
participants, with adult females improving more
than adult males
Evans, S., Moieni, M., Taub, R., Subramanian, S., Tsao, J., Sternlieb, B., et
al. (2010). Iyengar yoga for young adults with rheumatoid arthritis: results
from a mixed-methods pilot study. J ournal of Pain & Symptom
Management, 39(5), 904-913
LOE: 2c
Objective: Investigated the feasibility of using Iyengar
Yoga to treat RA in young adults
Participants: 8 young adults with RA
Intervention: 6 week biweekly Iyengar yoga program
Results: Significant improvement in pain, pain
disability, depression, mental health, vitality and self-
efficacy were found. Interviews showed improvements
with RA symptoms and functioning but uncertainty on
its effect on pain
Garfinkel, M., Schumacher, H., Husain, A., Levy, M., & Reshetar, R. (1994).
Evaluation of a yoga based regimen for treatment of osteoarthritis of the
hands. J ournal of Rheumatology, 21(12), 2341-2343.
LOE: 2b
Objective: Study effect of yoga on
hand osteoarthritis
Participants: Adult patients
Intervention: 8 week yoga program
(control group or no therapy)
Results: Yoga group improved
significantly more in pain during
activity, tenderness, and finger ROM
than the control
Kolasinski, S., Garfinkel, M., Tsai, A., Matz, W., Van Dyke, A., &
Schumacher, H. (2005). Iyengar yoga for treating symptoms of
osteoarthritis of the knees: a pilot study. J ournal of Alternative &
Complementary Medicine, 11(4), 689-693.
LOE: 2c
Objective: Study feasibility and
effectiveness of yoga on knee OA
Participants: 11 obese subjects
Intervention: 8 weeks of 90 minute Iyengar yoga classes
once weekly
Results: Significant reductions in WOMAC pain, and
physical function, AIMS2 affect were observed.
Trends of improvement were seen in WOMAC
stiffness, AIMS2 stiffness, social and role, Physician GA
and Patient GA
Kolasinski, S., Garfinkel, M., Tsai, A., Matz, W., Van Dyke, A., &
Schumacher, H. (2005). Iyengar yoga for treating symptoms of
osteoarthritis of the knees: a pilot study. J ournal of Alternative &
Complementary Medicine, 11(4), 689-693.

Universities Index Score Before and after Yoga Intervention
Change % Change % SD p
Pain 46.7 53.2 0.04a
Physical Function 39.1 44 0.04a
Stiffness 39 55.4 0.06b
SD, standard deviation
Table 1 Change in Western Ontario and McMaster (WOMAC)
WOMAC subscale
aSigned rank test
bStudent's t Test
Table 2 Change in Arthritis Impact Measurement Scales 2 (AIMS2)
Scores Before and After Yoga Intervention
AIMS2 component Change % Change % SD p
Affect 23.2 13.5 0.002a
Symptoms 36.5 65.9 0.1b
Social 2.2 38.9 0.6b
Role 37.3 100.6 0.8b
SD, standard deviation
aSigned rank test
bt Test
Table 3 Change in Global Assessments (GA) Before and After
Yoga Intervention
GA Change % Change % SD p
Patient 24.1 62.3 0.2a
Physician 29.5 79.3 0.2a
SD, standard deviation
aSigned rank test
Bukowski, E., Conway, A., Glentz, L., Kurland, K., & Galantino, ML. (2006). The
effect of Iyengar yoga and strengthening exercises for people living with
osteoarthritis of the knee: a case series. International Quarterly of Community
Health Education, 26(3), 287-305.
LOE: 4 Case series
Objective: Effectiveness of Iyengar yoga and exercise on
knee osteoarthritis
Participants: 15 men and women with knee osteoarthritis
Intervention: Randomization to either an Iyengar yoga
group, stretching/exercise group, or a control group with no
structured program for 6 weeks
Outcome Measures: Participants were rated before and after
by right and left quadriceps strength, WOMAC scores, a
globalized questionnaire, and sit and reach test
Bukowski, E., Conway, A., Glentz, L., Kurland, K., & Galantino, M. (2006). The
effect of Iyengar yoga and strengthening exercises for people living with
osteoarthritis of the knee: a case series. International Quarterly of Community
Health Education, 26(3), 287-305.
Participants 4, 5, 6, 11, 12, and 15 experienced decreases
or no change in flexibility while the others all improved.
9 participants experienced improvement in pain and
functional abilities according to their WOMAC scores.
Sit and Reach Test
-8
-6
-4
-2
0
2
4
6
8
10
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15
Participants
S
c
o
r
e
s
Pre
Post
WOMAC Scores
0
10
20
30
40
50
60
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15
Participants
S
c
o
r
e
s
Pre
Post
Bukowski, E., Conway, A., Glentz, L., Kurland, K., & Galantino, ML. (2006). The
effect of Iyengar yoga and strengthening exercises for people living with
osteoarthritis of the knee: a case series. International Quarterly of Community
Health Education, 26(3), 287-305.
Almost all participants improved in quadriceps
strength. Those who did also rated better or the
same on the sit and reach and WOMAC scores.
Right Quadriceps Strength
0
2
4
6
8
10
12
14
16
18
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15
Participants
S
c
o
r
e
s

i
n

K
i
l
o
g
r
a
m
s
Pre
Post
Left Quadriceps Strength
0
2
4
6
8
10
12
14
16
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15
Participants
S
c
o
r
e
s

i
n

K
i
l
o
g
r
a
m
s
Pre
Post
Bukowski, E., Conway, A., Glentz, L., Kurland, K., & Galantino, M. (2006). The
effect of Iyengar yoga and strengthening exercises for people living with
osteoarthritis of the knee: a case series. International Quarterly of Community
Health Education, 26(3), 287-305.
2 participants reported
decreased function (non-
exercise group); 3 reported
no change (2 in non-
exercise, 1 in exercise); 5
reported slight increase (2
yoga, 3 exercise); and 4
reported significant
improvement (1 yoga, 3
exercise).
Global Assessments
-1.5
-1
-0.5
0
0.5
1
1.5
2
2.5
1 3 5 7 9 11 13 15
Participants
S
c
o
r
e
s
Self
Health Care
Provider
Galantino et al. (2010). Impact of Yoga on Functional Outcomes in Breast
Cancer Survivors with Aromatase Inhibitor-Associated Arthralgias.
LOE: 2b
Objective: Establish the feasibility of studying the impact of yoga on
objective functional outcomes for AI-associated arthralgia (AIAA).
Participants: Postmenopausal women with stage I-III breast cancer
who reported AIAA were enrolled in a single arm feasibility trial.
Intervention: Iyengar yoga for twice a week (1.5 hours) for 8 weeks
and participants were instructed to do a home-based yoga program.
Results: Significant improvement in flexibility measured by SR and in
balance measured by FR, both p<.01. Improvements were also seen in
PSFS, QOL by FACT-B, both p<0.05. 80% adherence to HEP (15 mins,
3x/week), and no adverse effects.


Galantino et al. (2010). Impact of Yoga on Functional Outcomes in Breast
Cancer Survivors with Aromatase Inhibitor-Associated Arthralgias.
Measure Baseline
Mean (SD)
Week 5
Mean (SD)
p value*
Sit and Reach 22.90 (12.98) 30.10 (12.3) .009
Functional Reach 24.36 (16.37) 39.19 (14.62) .048
PSFS 4.40 (1.86) 7.21 (2.00) .004
BPI: Pain Severity 3.90 (1.63) 2.79 (1.84) .016
BPI: Pain
Interference
2.75 (2.77) 1.45 (1.84) .070
FACT-B 89.33 (20.18) 106.05 (17.02) .015
Qualitative Analysis
Increased Energy
Feel sluggish before yoga, feel ready to go after! (JA)
The yoga session left me feeling invigorated(EP)
My body felt really good after class, not tense, with more energy (NB)
My muscles are sore, but I feel more energized (L)
Relieved Stress/Anxiety
As usual I feel so relaxed and ready to face my day with a more
mellow approachafter yoga classyoga helps me breathe and be
more patient (EP)
I left class relaxed and thrilled to see the sunlight as I walked out the
door (EP)
it calms my mind and gives me positive energy, especially on a day
like today which could turn bad at any moment (NG)
I went out side to meditate. The sun was warm, so I focused on it. Lots
of chatter in my head, but it went away and I tried to relax. I also did
alternate nostril breathing. It was nice. (L)

Frequency of Responses
Empowering
I am feeling good about myself (JA)
I do not have the words to express how much I have gained
from this experience. I know that yoga will continue to be part
of my life (LF)
It makes me feel like I can do something about the aches
instead of groaning and complaining (NB)
Relief from Aches & Pains
my body was aching, so I finally did a good 20 minute yoga
practice I love yoga! It cures all that ails ya! I feel much
better already. (EP)
The wrist exercises were great for all the problems in my
hands and wrists (EP)
The lunges against the wall are helping to relieve my knee
painmy knees feel betterlower back pain is definitely
better! (LF)

Qualitative Findings from
Journals
Weight loss/increased physical fitness
It makes me feel stronger when I can find the time to do
30 minutes a day (EP)
My whole body feels less bulky (NB)
Increased flexibility/functioning
my body will function better throughout the dayand I
feel so good all overnice and loose with mental
calmness too. (EP)
I am glad we are practicing balancing, I am awful at it and
have found that [Andees] instructions really help (NB)
When Naida used the wall it was challenging, and I am
sure I will be sore, but I really got a great stretch. I feel
my inner thighs (NG)
my still achy body feels almost like new again (EP)

Sustainability
Importance of Breathing
The breathing through the poses really helps, especially when she
[Andee] suggested I visualized my breath passing right along and
through the problem areasit worked! (EP)
Deep breathing helps to alleviates stress, calm my nerves (EP)
Importance of Camaraderie, Community & Sharing
I wish more people would come and see the benefits of participating
in this trial (EP)
We spent some time going over how we felt that day and then
addressed our aches and pains in class. It felt good to share with
other who have the same experience (JA)
Can be done anywhere/transferability
had to get a mammogram and while waiting there did pranayama.
Just the thing to tune your mind off (NB)
I did some breathing and wrist stretches at the eye doctor. It took the
stress out of the possibility of surgery (JA)

Research Summary
While some of these studies were randomized
controlled trials (RCT), most were:
small sample size
pilot studies
cohort studies
requiring future investigation on
Various Patient populations
Medically Complex Populations



Case Study
A Simple Orthopedic Case Leading to Other
Medically Complex Issues

Referral to PT for TKR Rehab
Initial Referral and Treatment
54 yr old female with R
TKR 1/24/09
Edema and pain
Antalgic Gait
Amb w/ walker
progressed to cane
Pt motivated to return to full
function
MLD to RLE
MFR to scar
Corrected ant ileum
Instructed in ADL and
optimal body mechanics
HEP (including self MLD,
exercises and breathing
techniques)
6 weeks post IE
Good results in amb skills
use of cane only
Patient eager to return to
ice skating
c/o systemic MS pain
Hx of IBS
Primary relationship
concerns
Referral for psychosocial
support

12 weeks after PT initiation
Noted 12/18 points + for FMS,
BP increased
Pt c/o TMJ dysfunction and c-
spine pain
Continued psychosocial support
Rx: MLD, MFR, intraoral
techniques, CST, METs,
breathing and mind-body
techniques
HEP emphasis on stress
management
Complexity of Evolving Diagnoses
Warrants Addition of Comprehensive and
Holistic Care
WB on RLE with Cat/Cow
Attention to the spine
Patient c/o LBP secondary
to pelvic obliquity
MET
MFR
Core stability exercises
BP concerns
Breathing Focus in Cat/Cow
Developmental Process in Yoga
Warrior Pose to Increase WB RLE
Continued Manual Therapy Before
Movement Dynamics
Provided safe environment for
expression of emotions
Focused on the connection
between stress and physical
manifestations
Nutritional consult to address
IBS and weight loss (BP)
Emphasis on self-corrections &
mind-body in HEP
Triangle
Pain Management and Yoga
Effects of chemical dependence on affective disorders
in pain management is well documented
Yoga has been shown to decrease somatic complaints
in normal women
Shavasana or corpse pose (supine) is an effective
technique for alleviating depression and increase
positive change significantly

Wahbeh H, Elsas M, Oken BS. (2008). Mindbody
interventions: Applications in neurology. Neurology, 70:
23212328.

Although the evidence is still
limited, the American
College of Physicians and
American Pain Society
recently recommended the
addition of yoga or
progressive relaxation for
patients with acute low back
pain who do not improve
with self-care options.

Iyengar Yoga vs. Enhanced Usual Care on Blood Pressure in Patients with
Prehypertension to Stage I Hypertension: A Randomized Controlled Trial
Cohen D, Bloedon LT, Rothman R, Farrar JT, Galantino ML, Volger S, MayorC, Szapary P, Townsend RR
PURPOSE: Iyengar Yoga (IY) has been purported to
reduce blood pressure though evidence from
randomized trials is lacking.
METHODS: RCT to assess the effects of 12 weeks of IY
vs. Enhanced Usual Care (EUC) on 24 hour
ambulatory BP in yoga-nave adults with untreated pre-
hypertension or stage I HTN.
RESULTS: 26 and 31 subjects in the IY and EUC arms,
respectively, completed the study. There were no
differences in BP between the groups at 6 or 12
weeks.
Results
In the EUC group, 24 hr systolic blood pressure (SBP), diastolic
blood pressure (DBP) and mean arterial pressure (MAP)
significantly decreased by 5, 3, and 3 mm Hg, respectively from
baseline at 6 weeks (p<0.05), but were no longer significant at
12 weeks.
In the IY group, 24 hr SBP was reduced by 6 mm Hg at 12 weeks
compared to baseline (p=0.05). 24 h DBP (p<0.01) and MAP
(p<0.05) decreased significantly each by 5 mm Hg. No
differences were observed in catecholamine or cortisol
metabolism to explain the decrease in blood pressure in the IY
group at 12 weeks.

IY for HTN Funded by NCCAM
12 weeks of IY produces
clinically meaningful
improvements in 24 hr
SBP and DBP. Larger
studies are needed to
establish the long term
efficacy, acceptability,
utility, and potential
mechanisms of IY to
control blood pressure.

One year later with Holistic
Rehabilitation
Spiritual aspects addressed
Living with chronic disease
Focus on self-care
Hone positive attributes
HEP with emphasis on
mind-body-spirit techniques

What does this case teach us?
Be aware of underlying systemic
issues
Attend to psychospiritual
concerns
Intervene with what resonates
with the client
Be fully present to emerging
concerns throughout various
episodes of care
Keep current on the latest
evidence to add to our repertoire
of interventions


How do we increase health care
professionals knowledge of yoga?
Need for continuing education on yoga and
other CAM
Issues limiting integration into PT school
curriculum:
Time, evidence, speakers available
Other disciplines offering CAM content in
curriculum
Nursing, occupational therapy (OT), medicine,
physician assistant, pharmacy, public health
Geigle P, Galantino ML. (2009) Complementary and Alternative
Medicine in Physical Therapist Curriculum in the U.S.
Physiother Inter Res.
Purpose: Determine the current prevalence, and at what level,
CAM content is included in PT education
All 196 US-accredited programs were surveyed.
Results: 47% PT programs responded. Most commonly
included CAM areas were: manipulative and body-based
methods, alternative medical systems and biologically
based therapies. Most frequent responses to limitations to
including CAM in PT curriculum were: limited curriculum
time, lack of evidence supporting CAM practices and
trouble locating qualified CAM presenters.
Integrating Wellness Coaching
and Yoga
Implemented an 8 week group WC program for
first year DPT students (2 cohorts)
Weekly practice of yoga as part of the WC
Measures: Perceived Stress Scale, Student
Stress Scale, Qualitative data
Outcome: PSS significant trends noted over the
course of 2 years
Integrate CAM into Health
Professional Programs (Gaylord & Mann, 2007)
1. Prevalence and growth of CAM in the United States
2. Response to governmental, legislative, and other mandates
3. Need for enhanced communication between conventional providers and patients using
CAM
4. Need to enhance safety of CAM use and interactions with conventional care
5. CAM education's positive impact on broadening core competencies for conventional
health care professionals
6. Positive impact on enhancing cultural competency
7. Need for better communication between conventional and CAM providers
8. Potential for improving health care coordination
9. Potential impact on increasing CAM research quality and capacity
10. Potential for enhancing quality of care through informed CAM use

Themes of CAM Education
(Sierpina, Schneeweiss, Frenkel, et al, 2007)
1. Integration into the existing required curriculum
2. Visibility/Identifiable
3. Faculty development
4. Leadership
5. Accessible and reliable reference resources
6. Long-term sustainability

Creative Strategies
Group setting with rehabilitation specialists also
trained in yoga therapy
Welcome trained yoga teachers into clinical
settings for collaborative work
Offer special classes for specific conditions
Integrate individual poses into standard
therapeutic exercise to familiarize patients

Acknowledgements
Patients participating in
our yoga research
Graduate DPT students
FUNDING SOURCES:
RSC
NJ Cancer Consortium for
Research
NIH-NCCAM
Translational Research
Wellness Community
With Gratitude
Family
Friends
Dedicated mentors
Each one of YOU!

Works Cited
Bosch, P., Traustadttir, T., Howard, P., & Matt, K. (2009). Functional and physiological effects of yoga in women with rheumatoid arthritis: a pilot
study. Alternative Therapies in Health & Medicine, 15(4), 24-31.
Boyle, C., Sayers, S., Jensen, B., Headley, S., & Manos, T. (2004). The effects of yoga training and a single bout of yoga on delayed onset
muscle soreness in the lower extremity. Journal of Strength & Conditioning Research (Allen Press Publishing Services Inc.), 18(4), 723-729.
Bukowski, E., Conway, A., Glentz, L., Kurland, K., & Galantino, M. (2006). The effect of Iyengar yoga and strengthening exercises for people
living with osteoarthritis of the knee: a case series. International Quarterly of Community Health Education, 26(3), 287-305.
Chen, K., & Tseng, W. (2008). Pilot-testing the effects of a newly-developed silver yoga exercise program for female seniors. Journal of Nursing
Research (Taiwan Nurses Association), 16(1), 37-46.
Cowen, V., & Adams, T. (2005). Physical and perceptual benefits of yoga asana practice: results of a pilot study. Journal of Bodywork &
Movement Therapies, 9(3), 211-219.
Dash, M., & Telles, S. (2001). Improvement in hand grip strength in normal volunteers and rheumatoid arthritis patients following yoga training.
Indian Journal of Physiology and Pharmacology, 45(3): 355-360.
DiStasio, S. A. (2008). Integrating yoga into cancer care. Clinical Journal of Oncology Nursing, 12(1): 125-130.
Evans, S., Moieni, M., Taub, R., Subramanian, S., Tsao, J., Sternlieb, B., et al. (2010). Iyengar yoga for young adults with rheumatoid arthritis:
results from a mixed-methods pilot study. Journal of Pain & Symptom Management, 39(5), 904-913.
Galantino et al. (2010). Impact of Yoga on Functional Outcomes in Breast Cancer Survivors with Aromatase Inhibitor-Associated Arthralgias.
Garfinkel, M., Schumacher, H., Husain, A., Levy, M., & Reshetar, R. (1994). Evaluation of a yoga based regimen for treatment of osteoarthritis of
the hands. Journal of Rheumatology, 21(12), 2341-2343.
Garfinkel, M., Singhal, A., Katz, W., Allan, D., Reshetar, R., & Schumacher, H. (1998). Yoga-based intervention for carpal tunnel syndrome: a
randomized trial. JAMA: Journal of the American Medical Association, 280(18), 1601-1603.



Works Cited
Gaylord, S. A., & Mann, J. D. (2007). Rationales for CAM Education in Health Professions Training Programs. Academic Medicine, 82(10), 927
- 933.
Hart, J. (2008). An overview of clinical applications of therapeutic yoga. Alternative and Complementary Therapies, 14(1): 29-32.
Kolasinski, S., Garfinkel, M., Tsai, A., Matz, W., Van Dyke, A., & Schumacher, H. (2005). Iyengar yoga for treating symptoms of osteoarthritis of
the knees: a pilot study. Journal of Alternative & Complementary Medicine, 11(4), 689-693.
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