Yoga and Vestibular Balance Disorders
Ackli Howell Timothy C. Hain, M.D. Page last modified:
April 25, 2016
Ackli Howell wrote the material concerning the practice of Yoga. Dr. Hain made comments within concerning the purpose of the exercises with respect to balance.
YOGA CAN HELP BALANCE
The goal of physical therapy for one who is suffering from a
vestibular disorder is to reduce or eliminate symptoms. Therapy to improve the patient's equilibrium,
mobility, and overall strength, flexibility and range of motion is included. Adding yoga to a patient’s therapy routine
can be very beneficial.
Some physical therapists believe that one of the best ways
for a patient to heal is performing the therapy exercises she gives them in
conjunction with yoga. For some patients,
the brain takes longer than anticipated to learn to compensate for impaired
balance. It can be months before
re-conditioning takes hold. In the
intervening time, yoga can be an additional component to a patient's overall
treatment. The positional movements of
the asanas` help reinforce the physical therapy balance and coordination
Patients with balance disorders also develop secondary
symptoms such as decreased strength, loss of range of motion, increased tension
– particularly in the cervical spine and shoulders, muscle fatigue and headaches. Yoga is well known for increasing the
strength and flexibility for those who practice. In addition, the added benefit of stress
relief that yoga offers helps anyone with a balance disorder as they are likely
to be anxious and more fearful. It is
well documented that yoga reduces stress, depression, and anxiety. Yoga also helps to retrain the brain because
it requires a person to move their body and head together and also in
opposition to each other. This positional
movement is crucial for a patient's retraining to take place.
Vestibular physical therapy has the following important components:
- strengthening, balance and postural exercises
- proprioception tasks (e.g. movements that challenge
your sensory input)
integration tasks (i.e. movements that improve the ability to interpret
sensory input – where your arm or leg is in space).
It sounds a lot like a yoga class. However, I wouldn’t call Virabhadrasana III (Warrior
3) a sensory integration task. And I
wouldn’t call Parivrtta Trikonasana (Revolved Triangle) a proprioception
task. But they both are.
TYPES of YOGA
After you have decided to add yoga to your therapy routine,
you should then familiarize yourself with the different types of yoga. It is important for you to select the one
that is right for you.
Yoga is a physical and spiritual practice from ancient
. Over the centuries, the practice has
developed and changed into the many forms of yoga we have today. The list below describes the most common
types of yoga. You may have heard of
several of them or know of someone who practices in one of the styles. This list is by no means a comprehensive list
of all the styles of yoga practiced in the
- Hatha Yoga: Hatha is a very general term that can
encompass many of the physical types of yoga. If a class is described as Hatha-style
it is a basic class with integration of breath work. This type of yoga introduces a variety
of poses. The class will most
likely include basic stretches, balancing poses, strengthening exercises
and relaxation techniques/meditation. Poses are usually held for a short period of time. The use of props is encouraged such as
blankets, blocks, straps, and chairs.
- Vinyasa yoga: Vinyasa is also a general term that is
used to describe many different types of classes. Vinyasa is more vigorous style of yoga matching
movement to breath. Movement is
from one pose to another quickly. This
style is sometimes called flow yoga.
- Astanga, Forrest and Power Yoga: This is a fast paced, intense style of
yoga. Core Power yoga falls into
this category. Expect a very
physical workout and in some instances (Bikram, Core Power and Hot Yoga)
the class will be conducted in a room with higher than average
temperatures (90 – 115 degrees).
- Viniyoga: This yoga is more adaptive and tailored to
the student. An experienced teacher
adapts poses personalizing each to the needs of the student. Viniyoga instructors are knowledgeable in
anatomy and yoga therapy.
- Anusara: This
yoga style teaches poses in a way that opens the heart, both physically
and mentally. "Heart-opening" poses such as backbends are taught and
the classes are more community-based. Props are used to help access the poses.
- Iyengar yoga: Based on the teaching of living master B.K.S. Iyengar of Pune,
India this type of practice is concerned with body alignment. In yoga, alignment is used to describe
the precise way in which the body should be positioned in each pose to
achieve the maximum benefit and avoid injury. This practice emphasizes the holding of
poses versus moving quickly from one pose to another. The use of props is encouraged such as
blankets, blocks, straps, chairs.
- Kundalini yoga: The emphasis is on the breath in conjunction with the movement. This style blends exercise, breath
control, and meditation. This is a
faster paced style of yoga.
- Kripalu Yoga: The emphasis is on meditation, physical
healing, and spiritual transformation. This is a hatha style of yoga and is associated with the Kripalu
Center, a yoga and wellness center in Massachusetts.
- Tantra Yoga: This style of yoga integrates the
physical poses, breathing exercises, contemplation, and visualization to
expand awareness and self-realization.
- Restorative/Gentle yoga: This style of yoga is
practiced with props with gentle, slow movement through the poses. This style is relaxing and
renewing. Restorative yoga involves
holding poses for extended periods of time to fully relax. You will connect your mind with your
body with this style of yoga.
In general, if you are seeking a meditative experience,
Kundalini or Tantra yoga may appeal to you. If you are looking for an intense physical workout, Ashtanga, Bikram,
Forest or Power yoga classes are ideal. If you are interested in learning the proper
alignment of the poses and anatomy, Iyengar yoga may be a good choice for you. If you like to move, but not at an intense
rate, Vinyasa style yoga in which you flow from one pose to another may appeal. If you wish to learn a variety of poses along
with a mix of meditation and breath work, Hatha yoga may be your choice.
Once you have selected a yoga style that you are interested
in, create a list of what you would like to get out of your yoga class. Decide if you want a more meditative
experience or a physical one, a relaxing experience or a focus on
alignment. Then search websites for
classes in your area. Many local health
clubs and local YMCAs offer yoga classes. Ask for recommendations from those you know that practice yoga.
Find out about the teachers. Read their biographies, if posted online. Find out what style of yoga they teach, how
long they have been teaching, and how advanced their classes are. Check if the teacher certified and registered
with Yoga Alliance. The Yoga Alliance is
an association that offers a "stamp of approval" to yoga teachers who
meet certain training standards. Once,
you have narrowed down the style you would like to study and the instructor(s),
do the following:
- Try a class or two with different teachers at several
- If you are new to yoga, look for a yoga studio that
offers an introductory series of classes. This is a series of classes (usually 4-6 weeks in length) that are
designed for students new to yoga. The basic standing and other fundamental poses will be taught. This is a good way to start learning the
poses and will help you in maintaining a practice.
- Ask yourself how comfortable you feel with the
practice and the studio.
- Do you like the teacher? Does his/her personality resonate with
- Does the teacher keep in mind the health concerns of
their students while teaching.
- Does the teacher offer modified approaches for
students and warnings for each pose.
- In general, more experienced teachers usually have a
larger class making it harder for them to pay attention to each person in
class. More inexperienced teachers
often have smaller classes which means they can give more individual
attention. Decide what you want
from your teacher. More attention
or the experience of years of teaching.
- Does the class start with enough of a warmup and end
with at least 10 minutes of Savasana or post-class relaxation (minimum of
5 minutes if it's a 1 hour class).
- Does the teacher offer more than just the yoga poses. Are the elements of meditation and
breathing also incorporated into the practice.
- Approach the teacher after class. Ask about his/her experience with yoga,
where they studied, how long they studied, and with what teacher. If they lack formalized study, what
other training experience have they undergone that facilitated their
development as a teacher. And ask
for any clarifications you need for any of the poses.
- When in class, never perform any position that
generates "real" pain. You may feel an awareness of your muscles, particularly if you have
not been active, but you should not be gritting your teeth because you
feel pain. If you do, stop and ask your
teacher for a modification or sit on your mat. The teacher should always inform the
class that taking time out in child's pose is an option if any pose
becomes difficult or you become tired.
- Look for community. Do those who attend the class know each other. Are they welcoming to a new student, do
they interact and greet one another before or after class.
- Don't expect immediate results from the first few
classes. Practicing yoga is a
progression. Your body needs to
incorporate the poses and you need to feel fully at ease to reap the
benefits of practice.
- Once you have settled on a teacher, study or practice
with that person as much as possible, especially if you're working with a
particular problem such as an imbalance disorder. This gives the teacher time to get to
know you and tailor postures and instructions to suit your needs.
Selecting the right studio and the right teacher are
important factors in beginning a yoga practice and maintaining a practice. The more you feel a part of the
"community" the more you look forward to going to class and the more
yoga you practice.
Tai Chi is another complementary therapy that can improve
balance and relieve stress and anxiety. More about Tai Chi is found here:
Sequence for Positional Movement, Alignment and Strength
- Supine Tadasana
First part of sequence
are eye/limb positional movements to be performed supine on your back with
long, slow inhale/exhale.
- Lumbar Arch.
Inhale lift belly and slightly arch lower lumbar, exhale and
flatten belly towards floor, navel to spine. This is a small movement. 4x
- Same movements as Step 2 above, but raise arms
straight overhead when arching lumbar and lower arms as belly
- Same movement as Step 3 above, but chin moves up as
arms raise and back arches on inhale and on exhale chin moves to sternum
as arms are lowered. 4x
- Same movements as Step 4, but exaggerate the chin
movements so when chin is lifted the eyes look back and overhead in the
- Sit up.
This is a modified sit up. Bend knees and clasp hands behind head. Inhale. On exhale, lift shoulders off the ground as you move navel to
spine. Inhale to down position. 4x
- Same movements as Step 6 but on exhale exaggerate
chin movement to sternum as you lift shoulders off the ground and on
inhale lift chin up. 4x
- Spinal Twist.
Knees bent with legs together, arms
straight out at sides, shoulder width apart. On inhale lower legs to right and externally rotate left arm while
internally rotating right. Exhale legs
back to center and arms to starting position. The arm movement is like a flipper movement back and forth. Repeat on left side. 4x
- Repeat Step 8 and move head in same direction as
- Repeat Step 8 with head moving in opposite direction
from legs. 4x times on each side
- Stretch legs out and lift arms overhead and rest
hands on elbows. Move arms slowly
to left and then to right. 4x
- Repeat Step 11. Move head in same direction as arms. 4x
- Repeat Step 11. Move head in opposite direction as arms. 4x
- With arms still lifted overhead, elbows clasped, move
arms in a complete circle over head keeping eyes on the wrist or forearm
during the whole of the movement.
- Bring knees to chest, roll to right side up to table.
- Cat/cow 6x
Standing Poses for
Stability and Strength
|Uttanasana (Foreward Fold). Note that this exercise is best avoided in persons who have positional vertigo.
- Uttanasana vinyasa: urdhva hastasana to uttanasana to ardha uttansana to uttanasana to
urdhva hastasana 3x
- To Uttanasana. Step left leg back, bend right knee and come into
anjaneyasana. Stay in position getting
balance and then raise left arm, stretch arm overhead to the right for
lateral stretch as you move head and look to left. Move arm and body back to center and
stretch to right once more.
- Still in anjaneyasana, with left arm lifted, move
into revolved prayer twist to the right.
- To adho mukka svanasana and lift left leg and place
it between hands, bend left knee into anjaneyasana. Stay in position getting balance and
then raise right arm, stretch arm overhead to left for lateral stretch as
you move head and look right. Move
arm and body back to center and stretch to left once more.
- Still in anjaneyasana, with right arm lifted, move
into revolved prayer twist to the left.
- Bring right foot up to meet left and step into
- Slowly uncurl spine to Tadasana.
- Trikonasana on right side and then repeat on left.
- Vira II on right - hold the position, eyes gazing out
over out stretched hand.
- While still in Vira II straighten bent knee and move
head back to center. Move back into
the pose once again with eyes gazing over hand. Repeat 2x.
- Repeat Vira II on left side – hold the position, eyes
gazing out over out stretched hand.
- While still in Vira II on left straighten bent knee
and move head back to center. Move
back into the pose once again with eyes gazing over hand. Repeat 2x
- Parsvakonasana on both sides
- Vrksasana on both sides using wall for support.
- To table to Dandasana
- Setu Bandha Sarvangasana, supported with block
- Maricyansana 3 twist to both sides
- Sukhasana with alternate nostril breathing (exhale
longer than inhale) 8 rounds
- Viparita Karani (as savasana)
Sequence for Stress and Relaxation
1. Supine on bolster with belly breathing. Roll out to right side up to Sukhasana.
2. Sukhasana - countinuing belly breathing for several
3. Raise right arm. Lateral stretch to the left as you look to the right. Repeat other side.
4. Parsvasukhasana (cross-legged twist on both sides).
5. Adho Mukka Virasana resting head on blanket.
7. Uttanasana vinyasa: urdhva hastasana to uttanasana to ardha uttansana to uttanasana to
urdhva hastasana 3x
9. Standing Balance
With arms out at shoulder height, shift weight to right foot
as you lift the left foot off the floor. Hold position for 3 breaths. Repeat with the left foot. Complete both sides 6x
with yoga mudra behind back
Feet hip distance apart. Bring fingertips together over front of hips/look to right/inhale and
move right arm up at a diagonal to the body as you extend and point the left
foot out. The left arm moves downward so
the arms are in a diagonal line. Hold
position for 3 breaths. Repeat other
side. Complete both sides 6x.
I on the right. Hold the position for 5
breaths. Then straighten knee as the
head moves to look to the right, arms remain in position. Bend knee to move into full position
again. Straighten knee and move head to
look left. Bend knee to move into full position
Vira I on the left following the instructions in Step 13.
on right with blocks for support. Repeat on other side.
Mukka Svanasana to table.
Salabasana. 3 variations. Lift only legs for first variation/lift only
arms for second variation/full pose lifting both arms and legs for third
Mukka Svanasana to seated
Paschimottanasana using bolster for body and head support
child’s pose with bolster
setu bandha sarvangasana
3 twist to both sides
with So Ham pranayama
Shown below are common yoga
poses that you will encounter in any yoga class you may attend. Both the Sanskrit name of the pose and the
more commonly used term has been given for each pose.
|Adho Mukka Svanasana (Downward
Facing Dog). Note that this exercise is best avoided in persons who have positional vertigo.
Virahabdrasana I (Warrior I)
Virahabdrasana II (Warrior 2)
This posture can trigger dizziness from BPPV.
|Setu Bandha Sarvangasana
(Bridge). Like the downward dog, this exercise is best avoided in persons who have positional vertigo.
I owe a huge thank-you to the
following two people. This paper would
not have happened without them.
- Mary B. Ziegler for her
suggestions and advice.
- Michele Kehrer for promptly replying to an email from an
unknown person (me) asking for information and for being so generous with her
knowledge and her time.
April 25, 2016
, Timothy C. Hain, M.D.
All rights reserved.
Last saved on
April 25, 2016