dr. loren fishman: the humble elegance of yoga

Still from my video conversation with Loren Fishman.

Loren Fishman, MD is the co-chair of the upcoming MISTY (Montreal International Symposium on Therapeutic Yoga) convergence, October 29 & 30. We recently had a Skype conversation about his work in the field of therapeutic yoga, but the quality of the video recording was low. I captured his gems of wisdom in this Q&A interview.

In addition to being Medical Director of Manhattan Physical Medicine and Rehabilitation in New York City, Dr. Fishman is also author of seven books, author or editor of more than 70 academic articles, and a world-recognized pioneer in the treatment of piriformis syndrome and rotator cuff tear.

He has earned wide acclaim for his ability to diagnose and cure all types of back pain. Dr. Fishman has applied yoga to the treatment of sciatica, scoliosis, rotator cuff syndrome, multiple sclerosis, osteoarthritis, osteoporosis, and shoulder pain. He is also known for his great taste in bowties, and he graciously agreed to wear one for our video interview.

Therapeutic yoga is still considered a new and growing field, but you’ve been straddling the yoga and medical worlds for a few decades now. How do you do this? Is it difficult to bridge these two seemingly different worlds?

I went to India to study with B.K.S. Iyengar years before I went to medical school. When I met Mr. Iyengar, he said, “Why do you want to learn my yoga?” and I said, “Because I want to heal.” A big motivation for going to medical school was to figure out how yoga works.

The medical community did not and still has not really accepted yoga fully, and I’m not sure they ever will. In a way, they’re in competition with each other because they both aim to heal. Yet many doctors have loved yoga and practiced yoga from its inception. All the way back to the times of Patanjali – who was himself a physician – yoga and medicine have been closely unified.

It’s impossible to generalize. There are some doctors who embrace yoga and are happy to bring yoga to their patients. And there are others who think it’s utterly worthless. So it’s a broad spectrum. But I’d say more are accepting it.

So you went to medical school to try to understand how yoga works. Have you figured that out yet?

In some cases I have. In the most important cases – meditation, liberation – no. I have experienced some of what it’s worth. But the understanding is well beyond the conferences I’ve been to and my own research.

I’d like to hear about your practice in New York City and how you apply the therapeutic aspect of yoga in a clinical setting.

It’s very straightforward. I see the patient, I figure out what’s wrong as best as I can, then I figure out treatment as best as I can. We have yoga therapists in the office. Often the insurance doesn’t cover the treatment, so they pay cash and they’re almost always willing to do it.

We also have physical therapy, acupuncture, a lot of so-called “alternative” medicines in our clinic. We like to think of those treatments as “complementary” rather than alternative, as we are much more on the complementary side. For example, I might give a patient an injection, and them send them to the yoga therapist. I may prescribe medicine, or in some cases (hopefully not too often), I may even suggest surgery. In other words, we combine the treatments when we need to. We put things together that we think will work.

Lately, I’ve noticed that more people are interested in doing yoga over physical therapy. But we try to persuade them to do what we think is right.

It’s interesting that more people are asking for yoga over physical therapy. What do people think is the difference?

I think some people see physical therapy as a humdrum kind of thing, and they see yoga as something interesting, a little bit beyond the beyond. This is not to malign the wonderful practice of physical therapy. Really, I think yoga has incorporated a lot of physical therapy and physical therapy has taken in some yoga.

It’s more about the efficacy and charm of yoga, I think. People are coming to yoga because they think it’s more interesting. In fact, because the yoga poses are so memorable, it is something that they’re likely to be able to do at home.

But I don’t want to give the idea that everyone in the US wants yoga rather than physical therapy. I just realized that my practice and the people I attract are open to yoga. It’s by no means a random sampling. I just want to clarify that.

I understand that a lot of your research and work is about how yoga can be used to heal. But I read one of your studies about yoga and injuries, and I was surprised to see that one of the conclusions is that “ego” is a main cause of yoga-related injuries.

Well, that’s a little bit of a short answer, but it conveys the truth. More accurately, I would say it’s over-enthusiastic yogis. It could be related to ego or perfectionism, or a genuine zeal to do well in yoga, compete or show off. It happens to people that basically try too hard. I’m not implying that you shouldn’t try in yoga, and try very diligently, but you can overdo it in various ways.

Do you think there’s a cultural thing that not so much encourages people to get over enthusiastic, but creates an environment where that can happen? Can you think of any factors that contribute to that? For example, crowded classes in big studios…

I think many North Americans tend to treat yoga partially like a sport. And in some ways, it is like a sport, but I don’t know many sports where you get ahead by taking it easy. The cross-cultural aspect of it is there, too. We’ve actually tried to explain yoga in ways that in the East they explained it long ago, with a totally different physiology. Indian science is quite elaborate and refined, but it’s not what we believe in the west.

There are those other factors that you mentioned too. They’re really there. Those large classes, to me, are an effect of urban economics. The average teacher can’t afford to live unless she has big classes, because how else can she pay the rent? So she does that, and it’s generally much less successful than one-on-one.

Yoga therapy, as opposed to yoga teaching, is definitely a one-on-one thing. Just like the difference between teaching medicine and being a doctor. When you’re a professor in a medical school, you teach 20 – 30 people at once. But a doctor using medicine in therapy almost always works one-on-one.

Another factor is that people don’t always tell their yoga teachers about their injuries. That’s something you would do if you were seeing a therapist. So people have a bit of a misconception: they go to yoga to get healed, but they don’t tell the person they expect to be a healer, what’s wrong with them!

A final factor may be the transcendental aspect of yoga. People expect yoga to do miraculous things, and therefore they may go beyond what is common sense.

Do you believe that yoga has the capacity to do miraculous things?

I’ve seen it. Yes, yoga does miraculous things. But the wonderful thing about yoga is its humble elegance.

One of the objectives of the MISTY symposium is to explore how yoga and medical treatments can be combined to help heal many conditions. Do you have any ideas for that?

We’ve done some research and one of them is how certain poses work for certain conditions. For example, with something like spinal stenosis, we’d look at how yoga poses might affect herniated discs. There are various ways in which yoga works to do that. There are also ways yoga works to counter osteoporosis. It’s present, they say, in 200 million people on the planet right now, and most of these people have neither the money nor the access to care.

Interesting. So yoga can be a way for patients to take their health and healing into their own hands. I’d like to know, what is your hope for the future of therapeutic yoga?

My dreams for the future of therapeutic yoga are that we learn more of these serendipitous insights into how yoga works and where it works. My goal is not particularly that it gets paid for by insurance or that it gets accepted by the editors of popular periodicals, but that it proves its worth to more people because it’s so good.

What kind of changes have you seen in your own practice and your own health as you’ve been doing this work?

I think I’m nicer to my children and my wife, I’m able to control many more aspects of my life than I ever thought possible. I think I’m wiser than I was when I first started. And I’m a happier guy.