by Timothy McCall, M.D.
Despite having gone through medical school where I studied human anatomy intensely, did a month-long rotation on the orthopedics service and another month on rheumatology, I had no idea my spine was anything other than normal until I started to attend yoga classes. None of my professors, classmates or primary care physicians noticed anything out of the ordinary either.
But when I started practicing asana a little over 20 years ago, my abnormal spine was obvious to seasoned yoga teachers, sometimes the very first time they laid eyes on me. Mary Lou Weprin, who was filling in for my teacher Donald Moyer at the Yoga Room in Berkeley, California several years ago, was one. “What’s going on with your spine?” she called out from the other side of the room, soon after class had begun. By that time, I knew the answer.
When I was 11 years old, I fell out of a second story window. I’d been diagnosed with a wrist fracture, which healed well. But when my yoga practice had loosened up my back muscles sufficiently — stiff from years of tennis and bike riding, and zero stretching — it became apparent that something else was going on in my spine that was limiting my range of motion. On my first trip to India in 2002, a yoga teacher and therapist who was also a family physician, Dr. S.V. Karandikar, suggested I get an X-ray of my spine.
Dr. Karandikar (left) at his yoga therapy center in Pune, India
“For how long you’ve been doing yoga,” Dr. Karandikar said as he watched me do a forward bend, “that’s not normal.” The X-ray and subsequent MRI and CAT scans revealed that many of my vertebrae were fused together (ankylosing is the term they used), there were compression fractures of T6 and T7 which were fused together, and the ribs in many places were also fused to the spine. In addition, I have scoliosis. All this was likely the result of multiple spinal fractures that had been missed after my fall from the window. My body appears to have fused the bones together to protect me.
That yoga teachers could see what even seasoned physicians could not shocked me. But over time, I came to realize that we physicians aren’t really that well-trained to look at bodies, despite all the focus on anatomy in our education. Part of the problem is that anatomy training is very reductionist. We learned many details about individual muscles, where they originate and attach, what bones they move, etc. but little about the way they actually work together in a living, breathing body. The other reason is that as diagnostic imaging has become increasingly sophisticated in the last few decades, doctors and medical educators have placed less and less value on the ability to perform a detailed clinical exam (with a few notable exceptions like Dr. Abraham Verghese, author of My Own Country: A Doctor’s Story).
I’ve been repeatedly amazed over the years watching master yoga teachers like BKS Iyengar, his daughter Geeta, and Donald Moyer, to name a few, work with students. They see so much. The same is true of the Ayurvedic physician, Chandukutty Vaidyar, who I study with in India. Without asking any questions (he was still pretending he spoke no English at that point!), Chandukutty detected my spinal condition within seconds the first time we met. “Two bones in one,” he once said about my fused compression fractures, without the benefit on having seen any of my films.
Chandukutty Vaidyar examining a patient in Kerala, India.
After years of working with such teachers, and pursuing my own practice intensely, I noticed that my abilities to read bodies was growing. My experience suggests that the more you practice and the more you teach (and the more you study), the better that ability becomes. I only wish I’d had been able to see as clearly in my years of practicing medicine, as it could have benefitted my patients enormously.
All of this, of course, is what medical scientists refer to disparagingly as “anecdotal evidence.” The direct experience that yogis value so highly is at the bottom of the totem pole in the world of “evidence-based medicine,” but in this case it’s been persuasive to me. As Henry David Thoreau once said, “Some circumstantial evidence is very strong, as when you find a trout in the milk.”
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How about you? Do you have a story related “reading” bodies in either a yoga or medical setting? Please leave a comment here or email me at YogaAsMedicine@gmail.com and in a future article, I’ll let you know what I’ve discovered.
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Dr. Timothy McCall is an internist, yogi and meditator, author of Yoga as Medicine, long-time medical editor of Yoga Journal, and co-editor of forthcoming medical textbook The Principles and Practice of Yoga in Health Care. Timothy, alongside his wife Eliana Moreira McCall, is the co-director of The Simply Yoga Institute, an ecumenical yoga therapy center in Summit, NJ, near Manhattan. Together, they teach Yoga As Medicine Seminars and Teacher Trainings, including a four-day course called “Seeing and Understanding Bodies.”
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Earlier…
It depends on the teacher and it depends on their training. And certainly not after a month or maybe not even a year…or two or three. My India-based yoga therapy teacher (an allopathic doctor and an ayurvedic doctor) has said most anatomy trainings in yoga teacher trainings are a complete waste of time and the best skill a yoga teacher can develop is observation of how the body moves…and that takes years of practice.
I was thinking the same thing as Linda Sama. This is totally different from people who practice off and on for a few years, take a few anatomy courses and than think they are anatomy experts. The type of teachers mentioned in this article are rare birds.
I am definitely talking about seasoned teachers in this article, and totally agree you and Linda that you cannot expect this from recent or not-so-well trained teachers. This is only going to happen with people who are serious practitioners for a bunch of years and who make a real effort to study anatomy beyond what comes in most teacher trainings.
I have caught problems on students like vitamin deficiencies, fibroid tumors, digestive disorders…as well as saved students from uneccessary procedures. One woman was told she had ovarian problems when it was actually a muscle spasm. Another student was about to get a hip replacement without even having the doctor touch her hip( massive spasms).
An Iyengar yoga teacher is the first person who ever noticed my scoliosis. He casually asked me if I had ever seen a doctor about the scoliosis. I was astonished–Who, me? Scoiosis? Then it all made sense about why clothing often fit oddly, why I could twist to one side much more easily than to the other side, etc. I was grateful to him for pointing it out.
This can also be true for seasoned dance instructors. When the body is asked to perform more active and passive extreme ranges of motion the deficits become more apparent. I feel if your are going to be working with the bodies of other people (orthopedist, physical therapists, etc…) you should have experience working in your own as all dance, yoga, Pilates, gymnastic, athletic instructors are required to do. It gives you a level of awareness that goes beyond what a mere textbook can achieve and draws together the bigger picture. I can attest to this as I am a dance instructor, yoga and Pilates practitioner, and doctor of physical therapy student.
I agree with the above comments. I am a certified Yoga Therapist and Instructor~ it took me many years of teaching and practice to feel at ease with my skills. I am also a Holistic Practitioner of Iridology and Energy Healing~ I weave my skills together to help Yoga students and clients. Many instructors have on-line certificates which are accepted on the same level as students who have schooled like myself for years.
Namaste
Unfortunately for our medical profession, the skills of physical diagnosis are continually fading giving way to overwhelming dependency on medical technology which focuses on static anatomic findings and has very little relationship to the intricate web of movement and function of the human body. Such skills do not seem to be valued in our “evidence based”, one size fits all medical system. Very sad.
Same with well trained, seasoned and dedicated Pilates teachers. Unfortunately there are only few. And few training programs that demand never-ending ininterrupted studies from the teachers in the network.
I was trained by Romana Kryzanowska, Joseph Pilates’ protege. She was one of these very special – and rare – people. Fortunately, there a a bunch in our school.
Once she looked at me and asked “are you expecting, dear?” I was only two months pregnant, very fit, and nobody really knew of my pregnancy. This is just one example. I saw too many, lost count.
Some teachers see things some doctors don’t on some days with some students. That’s why evidence bases will always be the winner. I’ve seen very good teachers solve something for a student which had baffled their doctor, only for the student to slip a disk in class a week later. Where was the magic “eye” when it came time to warn the student about their back before it went wrong?
People tell me their Astanga practice, as taught by “guruji” fixed their knees and wrists. I believe them. People tell me their Astanga practice destroyed their wrists and “guruji” adjusted them so clumsily their knee has never recovered. I believe them too. That’s why, when I get injured I make evidence based medicine a priority. My doctor isn’t trained to diagnose or treat movement issues but he’s part of a system that will put me in front of some one who studied anatomy, practiced medicine, specialised in specific injuries, did a phd on causes, and has spent 20 years helping professional athletes recover from similar problems and avoid them going forward. That’s the evidence based medicine system. We chose it over word of mouth for a reason.
Ironically, the yoga teachers I know with by far the best success rate for “miracle cures” are no longer teaching “yoga”. Too many students said “it’s not spiritual” “it’s too hard” “it’s too fast” “the poses are different”. Those teachers have left yoga and are working in the evidence based field as rehab/injury prevention specialists.
Your article made me reflect on a few occasions where I had noticed things about some of the students attending the classes I give in France. The first one was when I address a student telling her : “Your column looked as if you were pregnant !”. I was very surprised to hear say somewhat angrily :”But… I am pregnant”. Then a person who had quite a problem with Ardha Matsyendrasana and another one whose abnormally red complexion, made me very uneasy. But not being a doctor I could not bring myself to say anything to either one after I had asked them if they were seeing a doctor. The first was diagnosed with terminal intestinal cancer within 2 months and died soon after that, and the man had an heart attack within a few months. He is all right now if you ask the doctors. Personally, I feel he is not out of trouble yet. Your article made me ponder about this awareness in a class. I feel it is probably because we listen to our students presence without their words distracting us from what we feel, relying a more precise form of communication. We are with them. We hear what their bodies are telling us. Many forms, One Spirit.
So I learnt to become less shy about sharing my doubts when something in a student’s body attracts my attention… All that we have lived is written in this cage…
Thanks everyone. Great comments. It’s too bad that at this point, we mostly need to choose between embodied awareness and evidence-based medicine. A truly embodied physician, like one who dances, studies bodywork, does yoga, etc. who also keeps up on science can do things that most of their colleagues, who are generally not very embodied, can do.
Dear Dr. McCall: I admire your work very much. Your book Yoga as Medicine was one of my required textbooks when a I first trained to become a teacher. It gave me a lot of insight and specialized knowledge. I hope one day you come to Florida to give your YAM trainings. I would be honored to host you at the Curtiss Mansion where I teach.
Regarding your article on body reading, I’ll give you my version. I have taught yoga to seniors with disabilities for the last five years (about 100 students). I still do. It’s a laboratory to read bodies. I have learned so much about anatomical imbalances and how early injuries can deteriorate your balance, limit your flexibility and ROM, and in general affect your daily living functions. Some of them have real bad cases of scholiosis and they dont even know they have it. You are 100% correct. Doctors these days rely too much on imaging. A good and experienced yoga teacher can spot body imbalances with finess….
Warmy, Natasha
Interesting perspective. Obviously each person’s experience will vary. As a yoga teacher (albeit a newer one) and a student – if a teacher told me she thought I looked pregnant – s/eh would be WAY overstepping his or her bounds! As someone with a history of food issues, anxiety, and depression, I would find it way out of line for a yoga teacher to try to diagnose me. If some people happen to have a special ability with bodies and wind up helping someone, great. In the US at least, people are not coming to yoga classes for medical diagnoses and I just think there is so much risk of teachers getting carried away with that. Safety is one thing but trying to diagnose people (or ask about their spine out of .. .curiousity? None of your business, what’s up with my spine!) goes too far.
From the article:
“For how long you’ve been doing yoga,” Dr. Karandikar said as he watched me do a forward bend, “that’s not normal.” The X-ray and subsequent MRI and CAT scans revealed that many of my vertebrae were fused together (ankylosing is the term they used), there were compression fractures of T6 and T7 which were fused together, and the ribs in many places were also fused to the spine. In addition, I have scoliosis. All this was likely the result of multiple spinal fractures that had been missed after my fall from the window. My body appears to have fused the bones together to protect me.”
I guess the operating term here is, “All this was likely the result of multiple spinal fractures that had been missed after my fall from the window.”
When you were 11 years old…like 50 years ago…
I guess the larger, more pertinent question would be, since you seemed to have been doing fine for the last 50 or so years, (barring some stiffness over the past 20 years), did you really need to get x-rays, MRI and CAT scans? In the West, those exams would run about $3-4k. Because Dr. Karandikar thought something didn’t look normal?
Many yoga teachers can read bodies well. Fortunately, they can’t get a slew of exams every time they see a quirky body. Have you considered that Dr. Karandikar might have sent you, the rich westerner, to his own (or buddy’s) imaging center? Don’t mean to be cynical, but it sounds like that might be the case.
While it’s fun to learn about the various oddities of our bodies, fortunately in the West we also have to be cost conscious, not to mention avoiding the radiation exposure. Never mind that the majority of people would have some type of abnormality on the exam–especially the aging yogis. These are called “incidental findings” and we don’t do anything about them (not to diminish your plight, but most of the findings you describe in this article from your imaging are “incidental”).
In your case, if your scoliosis was that severe, Karandikar should have been able to diagnose it by physical exam (gibbosity) and saved you all of that unnecessary imaging. Anyway, as a doctor yourself, you should know we don’t go on expensive fishing expeditions by running a shotgun approach to testing someone. I actually saw an article quoting Karandikar’s approach saying that he got imaging studies on everyone prior to beginning classes. While you can get away with that in India (cash on the barrel head, no doubt), fortunately you couldn’t do such a wasteful and potentially dangerous expedition in America.
The reality is, if you hadn’t gotten this barrage of testing you probably would have spent the rest of your life blissfully unaware of the “problems” you describe. And maybe that wouldn’t have been such a bad thing.