The Science of Yoga: The Risks and the Rewards

by William J Broad

  While eating, Fishman told of his therapeutic work. Often, he would jump up from his desk to show what he meant, either doing a pose or demonstrating his point on a human skeleton hanging nearby. He said he was sixty-six but looked to be in his fifties.

  Yes, he said, he learned much from Iyengar. But as Fishman spoke, it became clear that his guru was no guru in the sense of being a role model he followed slavishly. Instead, Fishman honored his mentor by exhibiting the same kind of pigheaded independence that Iyengar did, trying things on his own, experimenting on himself and his patients, arriving at cures and treatments in a roundabout way. It seemed that Iyengar provided the context, not the content. Fishman seemed to be a modern thinker who liked to tinker, a kind of Thomas Edison of yoga therapy.

  He told of his own painful experience with torn rotator cuffs, and how that led to what he called a miracle cure. He used the phrase with a wry smile.

  The shoulder is the most flexible joint of the hundred and fifty in the human body. It lets the arm achieve an astonishing range of motion—up, down, sideways, rotated—through a clever but risky stratagem that centers on a shallow ball-and-socket joint. The rounded head of the humerus, the main arm bone, rests in a very modest socket on the scapula, or shoulder blade, which children like to call angel wings. The shallowness of the socket gives the humerus wide freedom of movement but also raises the risk of the ball popping out. The job of holding it in place goes mainly to the rotator cuff. Its four or five muscles (the number depends on the authority) originate on the scapula and fasten to the head of the humerus through the tough cords known as tendons. Atop the humeral head, the tendons merge to form a taut cap of connective tissue that not only holds the shoulder tightly in place but also, in something of a contradiction, helps move the arm.

  Tears of the rotator cuff usually involve the tendons, limit arm motion, and can be quite painful. Athletes who raise their arms in repetitive patterns—swimmers, tennis players, baseball pitchers—know the problem well. The tears most often occur in the tendon of a muscle known as the supraspinatus, which lies above the rotator group. Its name derives from its origin just above a bony spine that runs across the scapula.

  Fishman said he tore his right rotator cuff while skiing. He had surgery on it and then, a few years later, tore his left rotator cuff as well. His surgeon judged the tear quite serious and suggested he get an appointment with the city’s best specialists. It was a total supraspinatus tear, and Fishman experienced the usual pain and arm limitations. Without assistance, he could raise his arm no higher than eighty degrees—a bit less than perpendicular to his body.

  One day at home, during the month-long wait for a surgical consultation (yes, even physicians get caught in that kind of delay), Fishman was doing yoga and decided to attempt a Headstand. He found he could do it. Getting his head down and arms into the right position was no problem.

  “My wife said, ‘What are you doing?’” he recalled. “I got up to tell her and found I could raise my arm. Before, I couldn’t. I went to the office and did it again. It kept working.”

  Astonished, Fishman threw himself into a program of research and confirmation, including visits with top surgeons. Both said he no longer needed surgery and expressed bewilderment at how little science understood the mechanics of the arm.

  At his own office, Fishman led an investigation into how the Headstand had achieved the cure. His main tool was the electromyograph—the heir to Jacobson’s methods for tracking muscle activity. It let Fishman and his aides zero in on rotator activation. The team took measurements as he stood upright and on his head. The readings showed that two other rotator muscles had joined the action—the subscapularis and the rhomboid major. They engaged most when Fishman inverted his posture and proceeded to raise his shoulders—a key feature of the Iyengar Headstand. Iyengar taught that, once students were upside down, they should widen and raise their shoulders as far from the floor as possible. That extra lift turned out to be the main factor that produced the healing benefits.

  Fishman concluded that the Headstand taught the other rotators to assume new roles. “It’s training yourself to use a different muscle,” he said, smiling, talking a mile a minute. By another name, it was muscle substitution—avoiding an existing problem by using other muscles.

  Pleased with the results, Fishman decided to see if the benefits could extend to others. He asked the next patients with torn rotator cuffs if they would like to try the Headstand cure. Sure, ten answered. He and his assistants taught them an easy form of the inversion that they could do with the help of a folding chair.

  Fishman’s prescription? Do it once a day for thirty seconds. Nothing more. At the end of six weeks, he and his team checked the patients. To Fishman’s delight, nine of the ten found they could move their arms like a person with a healthy shoulder. All decided to forgo surgery.

  Sharon Williams, a development director at Dance Theater of Harlem, had come to Fishman with chronic pain in her right shoulder. It had ached for a month, and examination revealed a partly torn rotator cuff. After she started the Headstands, the pain went away and she found that her arm could once again move through its usual range of motion. It was a huge relief.

  The results were surprising. Fishman and his aides published them so other health professionals could learn the trick.

  I asked where else yoga could heal.

  Fishman said it excelled in such things as osteoporosis—the disease of the bone that removes minerals and leads to increased risk of fracture. It often strikes older women and, without pain or symptoms or diagnosis, lies behind millions of fractures of the hip, spine, and wrist. Yoga stretching, he said, worked beautifully to stimulate the rebuilding of the bone. It happened at a molecular level. Stress on a bone prompted it to grow denser and stronger in the way that best counteracted the stress. Fishman said that for three years he had been conducting a study to find out which poses worked best to stimulate the rejuvenation.

  “It’s a big thing,” he said of the disease. “Two hundred million women in the world have it and most can’t afford the drugs,” some of which produce serious side effects. By contrast, Fishman enthused, “Yoga is free” and completely natural.

  “There are bad things in yoga,” he volunteered. But not enough to outweigh the benefits.

  Fishman knew the dark side in detail, it turned out. He told me about an injury survey that he and his colleagues were doing—the one based at the Columbia College of Physicians and Surgeons that documented hundreds of yoga injuries, including strokes.

  On the plus side, Fishman said, yoga excelled at fighting the stiffness of arthritis. The inflammation and tight joints restrict movement, and yoga worked to increase the range of motion. As was his habit, Fishman had written a book about it, Yoga for Arthritis.

  How often do you prescribe yoga for your patients?

  Twice this morning, Fishman replied.

  A woman in her late thirties had severe osteoporosis. The loss of bone mineral had weakened her frame and she had broken her foot four times doing exercises. Fishman prescribed a series of yoga stretches to be done flat on her back, lessening the chance of spinal fracture and providing a stimulus to help bring back the minerals.

  Another woman, in her early forties, had severe neck pain. She also suffered from degeneration of the macula—the highly sensitive part of the retina responsible for central vision. Fishman suspected that her poor eyesight had caused her, a stock trader, to hold her head jutting forward and to the side all day long in an unnatural position that had resulted in her neck troubles. He prescribed yoga positions in which she would lie on her stomach and raise her head up and backward—the motion opposite of her daily grind. He said it would strengthen her neck and counteract the degeneration, letting the damaged tissues heal.

  “I prescribe a lot,” Fishman said. He had an unfair advantage over most yoga therapists, he added, because he could use all the diagnostic tools of modern medicine to pinpoint the problem, after which he co
uld come up with yogic remedies of unusual specificity.

  “A lot of yoga therapists don’t have that ability,” Fishman said. “They treat in a very generic fashion that can be dangerous.”

  The woman that morning with the neck pains illustrated the importance of good diagnostics, he said. An electromyogram revealed nerve damage in her neck and allowed him to prescribe the right physical treatment. By contrast, a diagnosis that was more informal might have blundered into a yoga treatment with false promise and possibly bad side effects.

  Fishman said he never distributed handouts showing yoga postures, though sometimes he handed out yoga books. Instead, he said he gave out prescriptions of the kind used for drugs and medicines. But instead of writing down names of pills, he drew pictures.

  He searched his desk, found a pad, and sketched away. After a minute, he showed the results. It was a three-step plan for battling spinal stenosis—the condition that had struck Glenn Black, where the spinal canal narrows, causing serious problems.

  His sketch featured happy little stick men. The first stood, arms out, and the next frame showed it bent over sideways, hand to foot. The second sat upright on the floor with one leg stretched out and an arm reaching back in a spinal twist. The third lay flat and lifted the legs with a belt. The stick figures were informative but only rough outlines. Fishman said his usual method was to go over the details with patients.

  Every Tuesday in the late afternoon, he held a yoga session at his Upper West Side office. He called it a three-ring circus and invited me to visit.

  The office was slightly chaotic amid the transition from regular hours to yoga therapeutics. Patients came and went. A portly man hobbled around on crutches, his leg in a large cast. A young man sat on the floor, rubbing a bad ankle. “Undefeated in the Playoffs,” read the back of his bright red T-shirt. A big cardboard box overflowed with colorful yoga mats. The receptionist folded up a room divider and the area suddenly became large enough for a small class.

  Patients drifted in, put down mats, and began stretching. Maybe six or seven showed up, from their twenties to their sixties. There were also two yoga teachers, both women. One was a regular assistant. The other had recently met Fishman at a meeting in Los Angeles on yoga therapy and wanted to observe him in action.

  Fishman came in, bouncy and engaging, immediately the ringmaster. He chatted and led warm-ups, wearing bright yellow gym shorts and a gray muscle shirt. Nothing about him appeared to be sixty-six.

  When the visiting teacher volunteered that she had recently had surgery for a bunion—the painful curvature and swelling of the big toe—he showed us a simple treatment. It consisted of stretching both toes toward each other and then back to their normal straightforward positions; back and forth, back and forth, stretched and relaxed.

  Everyone tried it. He said the exercise worked to strengthen a specific muscle, the abductor hallucis. On the sole of his own foot, he showed us its location and confidently predicted that pumping it for twenty to thirty seconds each day would prevent bunions and might reduce or undo them. Fishman said he developed the method four years ago after discovering a bunion forming on his own foot. It went away. He predicted that the yoga teacher would never need surgery on her other foot if she did the exercise. Fishman added that, for a study, he was tracking about twenty patients with bunions who regularly did the stretch. “It seems to be working,” he remarked.

  Fishman divided the class into groups. In the smallest, his assistant worked with a petite woman who had multiple sclerosis. This degenerative disease of the central nervous system leaves its victims weak, numb, poorly coordinated, and prone to vision, speech, and bladder problems. Fishman wrote a book on the disease with Eric L. Small, a Los Angeles yogi who at the time of their collaboration had fought multiple sclerosis for more than a half century and had long found relief in yoga. Their recommended routine had nothing to do with fostering cures and everything to do with promoting a better quality of life—trying to reduce handicap and disability, increase safety, lessen fatigue, strengthen muscles, increase range of motion and coordination, improve balance, raise confidence, and promote inner calm.

  Teacher and patient began the session in a standing position. The workout was warm, informal, and quite different from the traditional rounds of yoga postures.

  The yogini, Rama Nina Patella, had the patient start by holding on to the top of a file cabinet and bending down, stretching her arms and back in a fashion similar to what would happen in Downward Facing Dog. It didn’t work. The left side of the patient’s body was beginning to atrophy, and her left hand had a hard time gripping the file cabinet. So Patella had her try again. Only this time the patient held onto Patella’s hips, and Patella clutched her arms. It worked. The patient was able to stretch down, long and slow. “Take your thighs back. Stretch this arm out as much as you can,” Patella said of the weakened side. “Keep breathing. Reach with this arm, the arm that’s kind of unwilling. Stretch that arm. That’s good.”

  After a minute or two in that pose, the patient stood back up, beaming.

  Mountain, Tadasana

  Patella had her do the Mountain pose, or Tadasana. From the outside, the pose seems simple and inconsequential. The student just stands there. But done right, it actually involves the subtle rearrangement and realignment of the whole body from head to heels, with muscles tensing and pulling and unbending the bones, the neck straight, the shoulders broad, the breath relaxed.

  “Press your feet into the floor and lift your chest,” Patella said. “You want a feeling in your feet like the roots of a tree growing into the earth and, from that rooted action, uplifting. Chest is open. Your shoulders are back. Let your breath flow as freely as possible. Good.”

  The patient had her eyes closed, concentrating, lifting and stretching. Her usual list to the left was somewhat diminished. She smiled.

  Elsewhere, the room pulsed. A man in the class had, like me, herniated the disk that lies between the fourth and fifth lumbar vertebrae. Fishman had him doing a series of spinal extensions and elongations, and had the visiting yoga teacher shower him with attention.

  As for himself, Fishman worked with a group of three women who, he said, had various kinds of abdominal problems. One suffered from prolapse—a condition where the uterus falls out of place, descending from the pelvis into the vagina. Normally, the muscles and ligaments of the pelvic floor hold the uterus in place. Uterine prolapse occurs when the muscles and ligaments weaken and stretch, undoing the usual support. Treatments include surgery, exercise, lifestyle changes, and a device worn inside the vagina that props up the uterus. Fishman took a direct approach that addressed the roots of the problem by seeking to strengthen core muscles and abdominal support.

  He showed the women how to do a variation of the Warrior pose, or Virabhadrasana. From a standing position, he moved one foot forward and the other back, raised his arms straight up, and bent his forward knee. The result was the slow lowering of his pelvis as well as the stretching of his legs and abdomen. “Then you come down,” Fishman said, dropping the thigh so low that it formed a right angle with the back. “Like this.” He stretched his arms high up and his pelvis down low. Then the women tried.

  Warrior, Virabhadrasana

  Fishman moved among them, offering words of advice, encouragement, and—sparingly—praise. He exuded confidence and encouraged them to try hard. “Stretch up as high as you can,” he urged, “stretching way up, way up. Good.”

  After a pause, Fishman led the women into another Warrior variant. It required not only stretching but balance. From the first pose, he had them stand on one leg while raising the rear leg to a horizontal position and lowering the arms and torso. It was like Superman flying with one leg extended straight down. Fishman moved among the women, offering alignment tips. “Bring this hip down,” he told one woman, lightly touching the hip. She quickly rotated her hips into a horizontal plane.

  “Good. With the hip down, raise the leg up.” He put his hand unde
r her leg, signaling how he wanted her to raise it, and she gave a little moan at the effort. “See what you’re doing?” he asked. “You’re stretching everything in here”—he motioned to her lower torso—“front and back.”

  And so it went. For the better part of an hour, Fishman led the women through numerous sitting and standing poses, all aimed at stretching and strengthening their midregions. “Try to engage those muscles,” he said at one point, encouraging the women to push themselves even while paying attention to the sensations.

  Fishman closed with a meditation. It began with a few minutes of relaxed breathing with eyes shut to foster inner awareness of body position and sensation, especially in the lungs.

  “Feel on the right side and the left side,” he said. “Is it the same? Feel your shirt against your skin. Is it pushing equally? How about the tenor of your breathing? Are you a soprano or an alto or a baritone? Listen to your breathing. Don’t try to do anything. Just pay attention. How does the air go in? Both nostrils? One? Feel the bottom of your lungs, the sides, the back and front. Feel what’s going on in there—these capricious things that we need so desperately and never see.”

  Then there was quiet.

  Weeks later, I returned to Fishman’s Upper East Side office to ask some follow-up questions. He said his staff was dismantling his West Side office for a bigger space around Columbus Circle. It would have a larger room for classes, Fishman said. The yoga aspect of his practice was clearly expanding.

  He said none of the other doctors in his practice did yoga or prescribed it to patients. It was his specialty alone, though, he added, one of his aides and a physical therapist also studied the discipline.

  I asked how, overall, yoga had aided his practice. He said it acted as a kind of laboratory for the nurturing of physical creativity, letting him experiment on his own body and that of willing patients to discover new kinds of natural cures and therapies. Without yoga, he said, “I’d lack the most interesting, least expensive, and most helpful and versatile form of treatment that I have.”