The Science of Yoga: The Risks and the Rewards (26 page)

Today a growing number of physicians study yoga after medical school. Fishman was one of the first to do so beforehand. His medical immersion when he was already an advanced student of the discipline let him see yoga through a Western lens, understanding its routines in terms of the fine distinctions of anatomy and physiology, chemistry and physics. In some respects, he was able to fuse the West’s storehouse of scientific knowledge with the inspiration of Iyengar’s visceral creativity. It was a fresh approach that bristled with possibility and seemed to offer a new way to minister to the world.

Fishman graduated in 1979 and did a psychiatric internship at the Tufts Harvard Medical Center in Boston, eager to help troubled minds. But he found it unsatisfying and instead threw himself into rehabilitative medicine.

The field seeks to help individuals with broken bones, torn muscles, dead nerves, injured tissues, and other physical disabilities. Its rehabilitations draw on a wide variety of tools and treatments. Standard ones include slings, braces, crutches, drugs, prostheses, walkers, physical training, therapeutic exercise, and many adjustments to the lives of patients.

In Fishman’s case, the options include yoga.

Few locations in the world of medical real estate are classier than 1009 Park Avenue in New York City, between Eighty-Fourth and Eighty-Fifth. It has a large but discreet awning and the usual glint of polished brass. The old building is as elegant as any on the Upper East Side. The office sits amid a constellation of physician specialists up and down the wide boulevard and across the street from the tall spire and Tiffany glass of the Park Avenue Christian Church, a neighborhood icon. The Plaza Athénée lies twenty blocks south.

Inside, nothing suggests the office is special. It has the usual art and magazines. The main hint of individuality lies behind the receptionist—a large shelf of Fishman’s books on yoga therapy. They discuss how to treat everything from multiple sclerosis to sciatica, the condition in which irritation of the sciatic nerve causes pain to radiate through the buttocks and down the leg.

I learned of Fishman
while looking for ways to strengthen my back. His book
Relief Is in the Stretch: End Back Pain Through Yoga
prescribed what seemed to be a sensible regime of postures. I especially liked his explanation for what stretching did. He told of a hidden interplay between two kinds of sense organs woven into the body’s tendons and muscles. As a muscle stretched, he wrote, the two systems sent conflicting signals. Contraction was stronger than relaxation, so the muscle stayed tense. If the stretch continued, however, that signal began to diminish of its own accord and the relaxation impulse started to dominate. The transition took time, Fishman wrote. It started as the stretch continued from fifteen to thirty seconds, and the relaxation signal grew to dominate in less than two minutes.

That mechanism, Fishman wrote, is why students of yoga should hold poses patiently—at a minimum, fifteen seconds to two minutes. Only then can the muscle relax enough to stretch farther. He said the lengthening can dramatically help victims of back pain. It can increase the range of normal motion, relaxing the spinal regions and leaving them more supple, flexible, and resilient. And that in turn can help avoid conditions that lead to muscle spasm—the sudden, involuntary contraction of muscles, sometimes accompanied by great pain.

I enjoyed not only Fishman’s clear writing but also his earthiness. Many yoga books use fashion models to illustrate the poses. Fishman, lithe and limber, often modeled them himself.

He appeared in the reception area, saw a patient, and gave her a hug and a few encouraging words. He was short and wiry, a bundle of energy, his smile quick. He wore a pale-blue shirt in a checkered pattern and a discretely colorful bow tie.

We went into his office and he spread out trays of carryout sushi. The wall behind his desk was cluttered with the usual diplomas as well as a large photograph of Iyengar. The famous yogi sat in a Full Lotus, his head high and eyes open, a picture of pride and vitality. Nearby photos also showed two grown children in graduation caps and gowns. From my research, I knew Fishman had achieved quite a bit in his career. In addition to treating patients, he held a clinical professorship at the Columbia College of Physicians and Surgeons, the medical arm of Columbia University. He had published more than a hundred papers and articles. At one point, Fishman led the New York Society of Physical Medicine and Rehabilitation, serving as its
president. His thriving practice, Manhattan Physical Medicine and Rehabilitation, employed physicians at four offices around the city—on Park Avenue, on the Upper West Side, in Queens, and on City Island. He also served as treasurer of the Manhattan Institute for Cancer Research, a charity.

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 could 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.