Many of us in the field of yoga and other complementary therapies are guided by our hearts. That’s one of the great strengths of natural therapies – being able to connect with clients on an intuitive level and offering more than a formulaic treatment plan. We are also our own favourite guinea pigs – talk to any yoga teacher or complementary therapist and you’re likely to find a personal story of overcoming health problems by using the techniques that they now offer to others. Again, that’s a great strength, giving practitioners deep insight and empathy for clients who are tackling their own health challenges.
However it’s important to recognise that just because something works for you (or your kids or somebody else you know), it doesn’t necessarily make it effective for everybody else. Whether it’s a yoga pose or a natural remedy, we cannot assume that something works just because it feels good. If it works for you, AWESOME! Keep going. But if you’re selling your treatment to a client, it’s important to understand the evidence base for what you’re giving them.
As the director of an accredited Yoga Therapy training program, I place a strong emphasis on encouraging yoga teachers to develop their understanding and appreciation of the evidence base for what they're learning. There are a lot of claims made in the name of yoga, but some of those claims need a fact-check.
Evidence based practice
I train yoga therapists in a huge variety of techniques to help students to manage their health. Some of those techniques are evidence based, some are not. When I teach something that does not have a strong evidence base (hasta mudra, for example), I explain that the practice is part of the yoga tradition and some people have found it very helpful. However, I’m careful not to make any definitive claims for its curative properties. On the other hand, when I teach a breathing technique to help students manage performance anxiety, I am able to say with confidence that there is good evidence for believing that this technique will help to reduce symptoms (Nemati, 2013). But what exactly does that mean?
Not all research is equal
Finding a book or a research paper on a particular technique or substance doesn’t mean that thing has been ‘proven’ to work. For example, not everything that happens in a petri dish or a white mouse works for humans.
Plenty of lab studies show promise, but we can’t take data from early stage research and conclude that a particular yoga posture, pranayama or potion will work on our clients. Then there’s the problem of low-quality studies. If a study only has a small number of participants, or the methodology is unsound, the results can be unreliable.
It’s also helpful to know who conducted and funded a piece of research – if a cat tries to prove that cats are smarter than dogs by citing qualitative research performed by cats at a university funded by wealthy cats and peer reviewed by cats, you might call into question the impartiality of the work.
Why quality research matters
Whether you’re a cardiologist or a yoga teacher, it’s important to understand whether the advice you give your clients is accurate and ethical. Developing protocols that are underpinned by a firm evidence base helps us to support our clients safely and effectively.
Acupuncture (or dry needling) is routinely practiced by GP’s, physios and other mainstream practitioners. Why? Because there is a strong evidence base for using acupuncture to help reduce the symptoms of several health conditions (AACMA, 2017). Creating and promoting high quality research validates our modalities, builds confidence in the community, increases acceptance of complementary medicine in the medical community and raises standards in an industry that is largely self regulated.
What is ‘quality’ research?
There are many different types of research, ranging from case studies conducted with a single participant through to meta-analyses that review the results of several previously conducted studies. Some research takes a qualitative approach (an exploratory approach that takes environmental factors and the subjective opinions of the participants into account) while others are quantitative (focusing on statistical outcomes). All types of research are helpful for putting together a fuller picture of how a particular technique or modality works. However, not every piece of research can be taken in isolation and used to prove that something does or doesn't work.
The gold standard of research is the Randomised Control Trial (or RCT). In an RCT, participants are randomly split in to two or more groups. For example, if I want to find out if meditation helps people manage chronic pain, I might offer a program of meditation to one group of participants, while a second group would receive the standard treatment for chronic pain (such as medication). I can then measure if the people who participated in the meditation program experienced a reduction in pain compared to a similar group of people who did not receive the meditation training.
However, results are still open to interpretation, which is why many of the highest quality studies use ‘blinding’ to reduce bias. ‘Blinding’ occurs when either the researchers or the study participants (or both) do not know who has or hasn’t been given the intervention that is being tested. Only when the trial is over can researchers look to see if the people who received the intervention experienced any improvement in their symptoms. Without ‘blinding’, researchers are more likely to believe that interventions are effective (Nosworthy et al. 1994), demonstrating that even randomised control trials are subject to bias.
How to find quality research.
If you haven’t conducted or learned how to interpret academic research, it can all seem a bit daunting at first. However, you can cut through the jargon with a bit of practice. Start by searching for research on your particular modality or area of interest (such as 'yoga for pain management') using Google Scholar. Scholar makes literally millions of research papers available to anyone with a smart phone. If you want to read more than the ‘abstract’ (or basic description) of a piece of research, you may be asked to pay by the publisher. However, state libraries have subscriptions to a number of research databases which you can access for free with your library membership.
Non-profit professional organisations are another good source of research material. For example, the International Association of Yoga Therapists publishes the International Journal of Yoga Therapy each year, packed with research, insights and articles to help yoga teachers and therapists stay up to date with yoga research. For-profit organisations that have a financial interest in promoting a particular service or product may be less reliable sources of quality research – ‘independent research’ can be a fairly elastic term.
Yoga is more than a set of studies
Yoga is a multi faceted discipline that offers practitioners much more than things you can measure in a research project. There’s no scientific evidence for the panca kosha. We can't measure nadis or chakras. As yoga teachers and therapists, we should not be limited to offering only the techniques we can back up with research. Yoga is a rich and often mysterious tradition that invites us to cultivate Shraddha (faith) and practice Ishwarapranidana (surrender to the supreme teacher). It cannot and should not be reduced to only those things that can be measured in a lab.
However, we need to be careful with our claims when offering clients practices that have no evidence base. I have a student who, while recovering from cancer, was told by a yoga teacher that cancer was her karma, that chemo was poison and she should use a combination of crystal therapy and yoga to help her heal instead. While that teacher may truly believe those things, it is neither appropriate nor ethical to share those beliefs with her student. When we are guided by high quality research and strong professional principles, we can minimise the potential harm to students and develop practices that effectively support their physical, emotional and mental healing.
Learn more about evidence based yoga with the Adore Yoga Therapy Training Prospectus:
Australian Acupuncture and Chinese Medicine Association Ltd. The Acupuncture Evidence Project: A Comparative Literature Review (2017)
Nemati, Azadeh (2013). The effect of pranayama on test anxiety and test performance. Int J Yoga. 6(1): 55–60. doi: 10.4103/0973-6131.105947
Noseworthy JH, Ebers GC, Vandervoort MK, Farquhar RE, Yetisir E, Roberts R (1994). "The impact of blinding on the results of a randomized, placebo-controlled multiple sclerosis clinical trial". Neurology. 44 (1): 16–20. PMID 8290055. doi:10.1212/wnl.44.1.16.