PYI Yoga Therapy at Mt. Sinai St. Luke's Hospital

Think back: when was the last time you visited the doctor’s office and your primary care physician put on some groovy music and led you and the other patients in a spontaneous dance party?  Never?  Maybe it’s it hard to even imagine your doctor dancing? 

Not so for participants in Prema Yoga Institute’s Yoga Therapy Program at Morningside Clinic, which is run under the auspices of the Institute for Advanced Medicine (IAM) at Mount Sinai St. Luke’s Hospital.  Dr. Vani Gandhi, Infectious Diseases Specialist and Integrative Medicine Specialist and Director of Integrative Medicine at IAM / Mount Sinai St. Luke's and Mount Sinai West Hospitals–while she doesn’t actually dance in the waiting room—frequently attends the yoga therapy classes offered to the clinic’s patient population and starts things off with a energetic, free-flowing chi dance (traditionally employed in such disciplines as Tai Chi, Qi Gong and yoga to stimulate and awaken energy in the body).

Dr. Gandhi’s willingness to participate wholeheartedly in the application of the clinic’s integrative medicine programming is emblematic of IAM’s unique approach to holistic healthcare. In addition to yoga therapy, the Institute also offers massage, acupuncture, meditation and other stress reduction therapies to its patient population as complementary care to traditional medicine, all at no cost to the patient.  Besides primary care services and integrative medicine, IAM also offers HIV primary care, dental treatment, mental health treatment, care coordination to assist patients in obtaining access to care and services, as well as a host of additional programs ranging from transgender medicine and surgery, and support services for patients transitioning out of incarceration.  It is truly a unique public healthcare resource in New York City, and stunningly impressive in its scope.

I recently met with Dr. Gandhi, Susan Mandrew-Jones, the Administrative Manager for The Institute For Advanced Medicine, and Daniele Gates, PYI Yoga Therapist Candidate, E-RYT 500 and yoga therapist in practicum at Morningside Clinic, to find out more about the groundbreaking therapeutic work of IAM in general and the Prema Yoga Institute’s Program specifically.  What follows are excerpts from that conversation.

PYI: How long has the yoga therapy program been in existence?

Dr. Gandhi: There is a very long history of yoga here at the Institute; at least fifteen or sixteen years.   Originally the program provided for a paid position; when the funding for that fell through, I decided to look for volunteer organizations…shortly after that, I was introduced to Dana Slamp, Program Director of PYI, through a doctor who was working at Mount Sinai West, and Dana has continually sent us volunteer teachers.

PYI: Teachers doing their practicum requirement for Prema Yoga Institute’s Yoga Therapy Certification program?

Dr. G.: Yes, Dana sent us Marc Nelles, C-IAYT, who did yoga for the staff, and Angela Rendon, C-IAYT…and after that Susan (Mandrew-Jones) came into the picture and has been instrumental in bringing in consistent volunteers and enlarging the program.  We’ve had a variety of different offerings through our volunteers in the areas of yoga, meditation and mindfulness.

Susan Mandrew-Jones: Dr. Gandhi - in addition to being a primary care provider - also oversees our integrative medicine program. So within that practice we have acupuncture, yoga therapy, massage, frequent workshops: nutrition workshops, actual cooking demonstrations with registered dietitians, so it’s a really wide-ranging program.  We did an herbs and supplements program recently, and our mindfulness and stress reduction program is ongoing.

PYI: And all these offering are under the auspices of the Integrative Medicine Program?

Dr. G.: Yes, most of the offerings are here because this is where I’m based, but all the patients who use the IAM clinics at Mount Sinai Health System as their primary care are able to come here and avail themselves of our programming.

Daniele Gates: I’m curious: How are the programs funded?

Dr. G.:  The two acupuncturists, who work almost full-time—one works four days a week and one works three and a half days a week—they are paid, and the massage therapist who works three days a week is paid.  They are funded by the hospital.  Way back we had some grant funding for these positions, but not currently.  The nutrition program is grant-funded through a Ryan White Food and Nutrition Services grant.  A private donor funds the mindfulness-based stress reduction programming, and that’s been ongoing for four years now.

PYI: Are you aware of another facility in the city that offers this level of integrative care for its primary care recipients?

Dr. G.: No. There are other integrative medicine centers/practices with a variety of offerings, but people have to pay out-of-pocket.  This kind of place doesn’t exist otherwise, as far as I know.

DG: And patients don’t pay, their insurance, if they have it, isn’t charged?

Dr. G: No.

PYI: Is it possible to talk a bit in general about recurring or chronic health issues you tend to see in the patient population who avail themselves of the yoga therapy program?

Dr. G: Our patient population is very diverse; they have a variety of medical conditions, but the ones I see participating are the ones with immune system problems, hypertension, depression, chronic pain: various pain conditions: back pain, nerve pain, headaches, IBS, conditions like that.  Either they ask about it or I refer them, because I have seen (yoga therapy) work well for these specific conditions.  But anyone who is interested is welcome—there are very rare contra-indications for participating in yoga therapy.

PYI: Do you hear any patterns regarding what’s helpful in their yoga therapy work - for example - from patients with HIV or patients recovering from injuries?

SMJ: I can tell there’s increased anxiety when it’s not available!  I think the practice offers the patients what the practice offers all of us.  The feedback… they way they articulate it to us…a sense of calm, and being able to address their life overall.  Someone told me last Thursday, “I feel more organized, I feel like I can set out to do things.”  We talked about being mindful and taking that off the mat.  He stopped in my office again and said, “It’s working.”  And I didn’t ask any more questions, because he looked happy.  The access—because yoga is now seen as this athletic practice—this setting has given them access in that they would never show up at, for example, YogaWorks.  So just being grateful that we’ve made it available and accessible in their bodies, and not addressing their conditions, per se, but supporting their wellness overall, has been what they say about Dr. Gandhi and what they say about the program. “She cares about us.” So it’s created a great sense of community.

PYI: I think that’s a great way of talking about yoga therapy, as not addressing specific conditions necessarily but as supporting wellness in general.

Dr. G.: In terms of specific things that people have said over the years, they say they are able to manage their stress better, they have less pain, they feel they can sleep better, people have said they feel stronger, improved confidence is something which I’ve also heard many times with repeated attendance.

PYI: Have you encountered pre-conceived ideas or trepidation about “yoga” or “meditation” from patients, and if so, how do you address it? 

SMJ: One thing I would credit our patients with is really knowing how take care of themselves and really being partners in their own care with their primary care provider.  So they come with a certain level of information, and based on what they know and what they want to achieve, they come with that curiosity.  They’re very informed: the student who is new and enthusiastic will more likely keep you on your toes than someone who is an experienced yogi.  I would credit our students with having expectations about what they expect to achieve through yoga therapy based on their research and their agency in their own healthcare.

DG: I would say that they’re really great with accepting modifications and not feeling like they’re not “doing it right”. I think that in the beginning students were more hesitant to say “I need to do this differently” and would really try to do it the way that I was teaching it, and I think that, over time, because of the community and because they’ve gotten to know me, they’ve become much more willing to say, “My knee isn’t doing this today, give me another option.”   And I think that’s really great—they’ve really developed a sense of voice and advocating for themselves and what their bodies need.

PYI: Can you speak to how being trauma-informed affects the way you teach the yoga therapy program?

SMJ: I think everything we do in our clinic is trauma-informed.  I think everyone on the staff approaches the patients from that perspective because we know them.

DG: I think the nature of the class, it being in a healthcare setting, necessitates that it’s trauma-informed, so you’re viewing your teaching through that lens from the beginning, more so than you might be in working with clients.  As a Yin teacher, I stick to a very specific number of postures in this class because we can’t use bolsters or blankets, we have to use blocks. So because I want them to feel confident, if I stick to the same postures, they feel like they’re making progress and they don’t feel like they’re thrown into something brand new every class, so in that way it’s trauma-informed.  I also think the language I use—I work really specifically with chakra work every time—I think about teaching the class not as a medical practice but more like teaching to people who have medical symptoms and need an outlet.  It’s not always about teaching yoga “medically,” it’s about dealing with all the ancillary stuff that happens when you have a medical condition of some kind.  That’s kind of the trauma-informed lens that I use: “How can I not be my illness?”  I try to create a room where you’re not your illness.

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I also had the opportunity to speak to two students after observing Daniele’s Yin class at the Morningside Clinic, Douglas and Marquis, who were gracious enough to answer questions about the patient experience of yoga therapy.

PYI: Did you have any preconceived ideas or concerns about practicing asana or meditation before you began the class?  How, if at all, did these ideas or concerns change?

Marquis: The beautiful thing about taking different practices of yoga is that each teacher brings in something that is individualistic or subjective, and so that allows the experience of the practice to be different.  So for me, I get something from Daniele that I don’t get from other teachers, even though I practice yoga regularly.

PYI: You have a regular practice outside of your yoga therapy practice here at the clinic?

M: I do. I do, it’s necessary because I’m overcoming both emotional and physical trauma, and so with that I really have to work very hard to release pent-up energy that is just not circulating in my body, so my body just holds on to tension and stress.

PYI: Is this the only Yin class you take?

M: Yes. Iyengar, which I also take, is definitely a “yang” class! (laughter)

Douglas: I mean, you come to this class trying to figure out, “What is going to make me come back?” and for me, it was the challenge.  I came here and it was like, if I got here, if I just got here, I wasn’t going to leave, I was going to stay and I was going to practice.  You work on things that are helpful, and as you keep working on them…I never did a Yin class, so this was my first time, and also, if I go into yoga classes and they’re too hard—

M: Right.

D: —this had challenges, but it wasn’t so physically challenging that it felt like you didn’t want to come back, you’re going to harm yourself, or it wasn’t accessible to you after, you know: you’re lucky if you got me here.

M: Certainly it’s a nurturing environment.

D: Oh, and the dance part!  Today we had a little intro and that helps gets the body flowing and allows you to open up and accept.  Staying still for a certain periods of time, which is Yin, is very helpful but it’s not as easy as people think.

PYI: Not at all!  Many people consider it one of the most challenging forms of yoga.

D: There is ease in it, but there’s also challenge.  It’s not necessarily strenuous, but for balance for me—I have neuropathy—so for balance positions for me, anything where I have to move around and balance, well, I’m already wobbly. And I’m getting better because of these classes, but that’s an issue for me: too much movement.  It helps to slow it down.

PYI: It’s been said by Dr. Chris Walling that yoga doesn’t heal anything, but that yoga can support the body in healing itself.  Does this resonate with your experience of yoga therapy?

M: I would challenge you on that.  I would say that yoga therapy actually does heal—

D: Me, too.

M: —because it opens up the blockages and allows the healing to take place.  It’s as if you said, “Soap doesn’t clean, but it does allow water to clean, so therefore soap is a cleaning agent.” 

PYI: I see: yoga is so linked to your experience of healing…?

M: Yes. Yoga is a healing agent.

D: Well, actually, for me, for example when we did the exercise today with the abdominals (note: here Douglas is referencing a face-down, supine pose with the low belly supported by a block), I immediately felt it, there was a lot going on that was being released immediately.  It targeted specific issues I was having abdominally.  I think it’s extremely healing.  I’m always the one who wants to feel the effect right away; I don’t want to wait a long time.

PYI: And that pose had that effect for you today.

M: It did.

D: You know, it is one of those things where you will feel the effects right away, but, I think as a guy you might feel that, you know, you’re not working out, you’re not lifting weights, so you’re not doing a whole lot, you’re just doing movement.  But when I leave, the whole realm of my energy is much more controlled, and my ability to just observe and take in information is much more focused.  And so in that, it is a passive reception, and you don’t think that you’re doing a lot, and then two or three days later, you’re body’s like, “Oh!”

M: Also, it’s the simplicity of taking it home with you.  You can do it at home, at your own pace, it’s so simple, and four exercises—I mean, I’ve learned more than four, but there’s four that I do at home in twenty minutes and really feel like I’ve worked on my body: very lightly, very gently, not too much fuss.

PYI: Gentlemen, thank you for sharing your thoughts, it’s been very enlightening.

D: You’re welcome.

M: You’re very welcome.  You’re welcome back any time!

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The time I spent with the Mt. Sinai team and students illuminated and expanded my understanding of the practical role of yoga therapy in healthcare and its efficacy in the support of primary care.  I am indebted to Dr. Gandhi, Susan Mandrew-Jones, Daniele Gates and the patients at the Institute for Advanced Medicine for allowing me to observe and investigate their process.  Further information about Prema Yoga Institute’s Yoga Therapy Certification Program—which includes a practicum such as the one Daniele is completing at Morningside Clinic, can be found here.

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Molly Goforth is a yoga and meditation teacher and a student at Prema Yoga Institute. She specializes in accessibility and trauma-informed yoga teaching and practice.

Medical Journal Publishes PYI-Led Pilot Study on Yoga for Cardiac Health

Really good tidings! Motivated by her mother’s own cardiac event, Prema Yoga Institute alumna and faculty member Sonja Rzepski created a yoga therapy program alongside doctors at New York’s Lenox Hill Hospital to help manage stress in female patients recovering from similar experiences. The cardiac care program was part of PYI's Clinical Yoga Therapy Practicum, and was staffed by PYI grads completing their yoga therapy certification.

The results are in and not only are they are encouraging but they are now published in the Annals of Clinical Cardiology (Jesus SD, Schultz E, Bond RM. The yoga–meditation heart connection: A pilot study looking to improve women's heart health. Ann Clin Cardiol 2019;1:24-9). 

While on the decline overall, the CDC still declares heart disease the leading cause of death for women in the United States. For women older than 55, the data shows a stagnation in the decrease of fatal incidents. Stress, anxiety, and depression are nontraditional risk factors for cardiovascular disease (CVD) that are more common in women. Sonja’s hypothesis appears to be supported by evidence that regular, supervised sessions of chair yoga and meditation can be a complementary measure to decrease these factors in female patients with or at risk for CVD, as well as increase their likelihood to pursue lifestyle modifications. 
 
Sonja’s program addressed this specific group by providing 16 female participants with or at risk for CVD and with a mean age of 64, 45-minute supervised sessions of complimentary chair yoga and meditation over 24 weeks. Through the practice of Yoga Nidra, psychic sleep or deep relaxation with inner awareness, the patients reported a lower level of depression overall as well as a 3-9 pound weight loss in 1/3 of the students which reflects the program’s encouragement to mindfully eat heart-healthy foods.
 
Kudos to Sonja and her team that included PYI Practicum students Yuliana Kim Grant, Irina Chernova, Judy Glassman, and Michelle Lauren. Want to dig in and read the complete study?  Click here! 

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An Interview with Erin Moon, PYI Graduate and Director/Co-Creator of the World Spine Care Yoga Project

As a student in Prema Yoga Institute’s Yoga Therapy Certification program, I had the privilege of undergoing a 50 hour training in Functional Anatomy under the tutelage of Erin Moon, a certified yoga therapist and Prema graduate, and director and co-creator of the World Spine Care Yoga Project.

World Spine Care created the Global Spine Care Initiative (GSCI) in 2018 as a community project, to “reduce the global burden of disease and disability by bringing together leading healthcare providers, scientists, specialists, government agencies, and other stakeholders to transform the delivery of spine care.”

I recently had the opportunity to sit down with Erin and ask her some questions about her work as a yoga therapist in general and the Project in particular in advance of World Spine Day, which will mark its eighth year of official celebration on October 16th.  What follows are excerpts from that conversation.

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PYI: What originally drew you to yoga therapy?

EM: It was a natural progression as the term came into greater recognition and regulation within the modern yoga community. I was grandfathered into IAYT partially because, like so many collogues, I had been and continue to work with every client with deep care and the approach of the holistic health paradigm that the ancient practices and philosophies of yoga provide. I felt it was important, as I furthered my education, to dive deeper into the intersection of the allopathic and holistic approaches to health and healing. As it does for so many others, the desire to deepen my training arose from personal trauma and the old adage “teacher heal thyself.”

PYI: While studying at PYI, what was your favorite module?

EM: I loved Yoga in Healthcare. In my 300hr training, before Prema, I focused on yoga and healing and then narrowed my focus to yoga and stress, specifically the neurobiology of stress. Yogic practices, I believe, work with stress in a very special way and provide our greatest opportunity for intervention through many, many tools. So getting a chance to learn from soma-psychotherapists, physicians and physical therapists who are also yoga therapists about what they have learned clinically was astoundingly enlightening.

PYI: When did you first begin to focus on spinal care?

EM: In 2015 I met the Clinical Director of World Spine Care (WSC), Geoff Outerbridge, at an adult sleep-away camp called Camp Good Life Project and we realized that we had a lot to talk about. He was developing an idea for a community Project for WSC that needed a teacher of yoga teachers with a strong anatomy and therapeutics background who happened to also have international volunteer experience (the flagship clinic is in Botswana, so being culturally aware and sensitive was very important).  That is when I became the co-director/creator (along with my co-creator Barrie Risman and, since 2017, Jesal Parikh and Letizzia Wastavino) and particularly interested in Spine Care. However, the Yoga Project (YP) is not solely focused on Spine Care but also more generally on all musculoskeletal care, pain management, and active and preventative self-care.

PYI: Please tell us about the World Spine Care YOGA Project.

EM: I think the best way to start is with our mission and vision:

Mission

We are focused on building community capacity for low mobility populations by sharing the practices of Yoga as tools for management and prevention of musculoskeletal pain.

Vision

To globally inspire self-directed, self-led and self-sustaining communities, who experience low mobility, to use the practices of Yoga for active and preventative self-care and pain management.

 We began in 2016 when Barrie Risman and I first rolled out the program in the flagship clinic in Shoshong (a village) and Mahalapye (a town) in Botswana. That first time, we worked with two different groups: one with higher mobility and one with lower mobility. We’ve since learned that the more mature group with lower mobility, who themselves benefited from the protocol, are the group that has kept the program going. They are also living in an area with a tighter community spirit. Because the Yoga Project is a community-oriented program, we learned, over time, how fundamental that tightly knit community is to the success of the program. They have taught us a lot and we have since gone back and offered level two of our protocol with more standing postures and breath and mindfulness.

Overall, this is how we function:

1. We work only with populations who have asked for a preventative/active self-care and pain management modal.

2. We work in our respective home countries and in global communities where World Spine Care has an existing presence with potential for expansion beyond WSC clinical modal into interested and supportive communities.

3. We train people who are interested in using the benefits of the Yoga Project protocol to contribute to their community and themselves.

4. We adapt to the individual needs of the communities we are working with; cultural norms and practices are incorporated into the program, i.e. dance, song, physical appropriateness of postures, posture names, etc.

5. We are a secular program, meaning that we are open to the beliefs of all the communities we serve and happily encourage worship where appropriate, but we do not come in with any religious overlay or agenda. We also teach that the history of the practice’s roots come from India and that there are many more practices, not included in the Yoga Project protocol, that can be explored individually.

6. We adapt the Yoga Project protocol as new information about mobility, physiology and psychology is made available to us through research.

7. We offer practices of mindfulness based upon research concerning mindfulness-based stress reduction and the 3000 years of Yogic practices for pain and stress management.

8. We offer practices of breath based upon vagal nerve research, etc., and the 3000 years of Yogic practices for pain and stress management.

9. We offer poses that explore stable, long-term, functional range of motion for lower mobility populations. We encourage adapting to offer low too no pain- movements to those experiencing pain.

10. We offer multiple levels of trainings as is appropriate for different levels of mobility and pain. Currently our offerings include: a level one training with a larger percentage of chair supported postures and a level two training with more standing postures and greater physical challenge.

11. We also offer our programs to MD, PT, OT and chiropractors as well as trained yoga instructors as continuing education to better serve their communities and patients.

12. We are an online resource for low mobility and pain populations world wide for at-home practice and capacity-building, using the practices of Mindfulness, Breath and Posture.

PYI: We understand that you train teachers in Botswana.  Have the Botswana teachers found specific spinal needs in their communities?

EM: They themselves are dealing with a host of different spinal and musculoskeletal issues, pain and bio-psycho-social factors. We do not encourage or have time to specifically train our teachers to work with each different type of malady. Every issue they see and we have seen is multifactorial. The program is focused on keeping people mindfully active and offering stress management tools to help with pain management. Also, because we include such things as good biomechanics for getting in and out of a chair, seated posture work, etc., we are offering day-to-day applications of mindful movement. Basically, instead of working with individual conditions, we focus on mindfulness and svadyaya (self-reflection) as tools for choosing and working with movement that “feels good”. 

Statistically, the most affected populations with chronic (long-lasting) pain due to musculoskeletal and specific spinal issues are women over 50 in developing nations, due to a host of reasons ranging from access to good health care options and self-care education to highly labor-oriented lifestyles (though that is never to say that someone who sits all day at work will suffer less pain). It is always a complicated mix of elements that includes: which musculoskeletal issues and pain issues arise as well as the bio-psycho-social factors in any given population, so I want to be careful about being too reductive. 

That being said, here is a little bit from WSC website to help: 

The Global Burden of Disease report was published in Lancet in December 2012 (Murray et al, Vos et al, 2012). In this report, the following information regarding spinal conditions was reported:

• Low back pain is the leading cause of disability.

• Neck pain is the fourth leading cause of disability.

• Low back pain and neck pain affect 1 billion people worldwide.

• Spinal pain contributes more to the global burden of disease (including death and disability) than: HIV, diabetes, malaria, stroke, Alzheimer’s disease, breast and lung cancer combined, traffic injuries, and lower respiratory infections. 

PYI: In the recent past in America, yoga has been mostly available and marketed to a more privileged group of students.  How do you suggest we work to diversify to provide yoga for all?

EM: Well, this really is the question! It certainly is on my mind all the time. I cannot propose to have the answer, though, because for me, I feel it is time to really listen, to ask questions and get curious, to listen again and then listen again and then to stand beside rather than in front of the voices that are rising in our community about intersectionality and inclusion. Perhaps through this process things will change: through good, true allyship. 

The question I pose to any yoga business is this: what face, body, ability and/or sexual identity are you representing in your teaching staff and in your advertisements? How are you creating a sangha that feels safe and accessible to all the bodies you hope to serve in your community? Who is in your community? Have you asked what they want? If it is not a visible shift, I don’t think a shift can actually happen. If it is not a fundamental values shift, I don’t think a shift can happen.

PYI: Do you have any advice for therapeutic yoga teachers wishing to start their own not-for-profit initiative? 

EM: Ask questions, listen and go slowly. Do not think you know what a community needs because something has served you or “the research says” or “the tradition says”. Listen to what people are actually asking for: what their bodies and hearts and minds are asking for. Be open to learning and adapting. Ask, observe, adapt and then ask again! 

PYI: How can we donate to your initiative?

EM: On this page you can specifically donate to the Yoga Project. You can find us on Facebook and Instagram  @worldspinecareyogaproject, where we offer pain management tools and active self care from our protocol.

If you are an MD, PT or YT and want to do a Work-A-Day for WSCYP on the 16th in honor or World Spine day, follow this link.

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It was truly an honor to spend time with Erin and learn about her important and groundbreaking work incorporating yoga therapy into the work of the World Spine Care—the PYI community extends its thanks and appreciation to her and the healthcare professionals and dedicated communities with whom she works.  We look forward to offering you more interviews and insight on the exciting work being done by our students and graduates in the coming months.

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Erin Moon, C-IAYT, is the lead teacher of Functional Anatomy 1 and a Mentor at PYI.

Molly Goforth is a yoga and meditation teacher and a student at Prema Yoga Institute. She specializes in accessibility and trauma-informed yoga teaching and practice.