Emily Large- Living Large Therapeutics -Viniyoga Therapist

Emily Large is the founder of Living Large Therapeutics, which combines the science of physical therapy with the time-honored practice of yoga. Emily has practiced physical therapy since 1994 in various settings, participated in physical therapy research, provided continuing education for health care professionals, and been featured in the New York Times, Yoga Journal, Palm Beach Post, PT Magazine, and NBC WPTV News Channel 5.

Emily received her Associate of Arts degree from the University of Florida, her Bachelor of Science degree in Physical Therapy from the University of Central Florida, and then attended Emory University for graduate studies in Neuroscience and Movement Science.

Emily has practiced yoga since 1997 and her teaching is inspired by her teachers, Gary Kraftsow and Mirka Scalco Kraftsow. Completing the four-year, 1000-hour yoga therapy program through the American Viniyoga Institute, Emily is registered with the Yoga Alliance as a Registered Yoga Instructor at the 500-hour level, and Certified Yoga Therapist. Currently, Emily is the only certified viniyoga therapist in the states of Florida and Georgia.

Yoga provides the means to bring out the best in each individual. This requires an understanding of a person’s present condition, personal potential, appropriate goals and the means available. As each person is different, these will vary with each individual.

Viniyoga is an ancient Sanskrit term that implies differentiation, adaptation, and appropriate application. As a style of practice, viniyoga refers to an approach to Yoga that adapts the various means and methods of practice to the unique condition, needs and interests of the individual—giving each practitioner the tools to individualize and actualize the process of self-discovery and personal transformation. This approach evolved out of the teachings transmitted by T. Krishnamacharya and T.K.V. Desikachar of Madras, India.

Emily Large is smart, compassionate and extremely personable.  She sat with us on a beautiful South Florida day at the Manatee Marina and answered some of Sleep Compass’s questions-

1.) You went from an Associate of Arts degree to a Bachelor of Science degree in Physical Therapy.  What attracted you to physical therapy?

I was practicing physical therapy before I even knew that it existed as a career.  As a child, I used to practice on my mom by applying pressure points to her head and neck when she got migraine headaches.  I also recall thinking that my elderly grandmother really could get up and down her steps, if she would only practice one step at a time, adding one step to her training every day.  As I learned about physical therapy, I became excited about the possibility of deepening my knowledge of the human system and sharing that knowledge with others in order to promote a healthy lifestyle and maximize a level of functioning.  I was also intrigued with the vast scope of practice and the diversity of settings in which PT’s are utilized.  My interests in movement, all of the sciences, psychology and wellness made physical therapy a perfect fit for me.

2.) Your graduate studies were in Neuroscience and Movement Science.  Could you explain about that science?

Neuroscience is the scientific study of the nervous system and how the nervous system corresponds with the rest of the body.  Movement science is the scientific study of human movement through bringing together biomechanics, biophysics, neurophysiology and psychology.

3.)  When did you begin your interest in yoga and where?

I became interested in yoga in 1997 while living in Atlanta, GA.

4.) Combining yoga and physical therapy makes so much sense.  How did this come about and when did you decide to become a Yoga Therapist?

I started looking into yoga in 1997 because I had a neck injury that I was interested in healing.  I had been through different courses of treatment such as physical therapy and massage, both of which did help, but didn’t seem to have lasting effects.  As I started practicing yoga (ashtanga style), I began to notice that sometimes my neck felt very good after practicing, and sometimes it felt much worse after practicing.  This inconsistent reaction to practice intrigued the physical therapist in me, and I began to inquire deeper into the healing aspects of yoga and yoga therapy.  A web search on “yoga therapy” in 2001 led me to the American Viniyoga Institute’s website which inspired me to travel and meet my teacher, Gary Kraftsow.  Concurrently, I was looking to move on from my graduate studies and discovered AVI’s yoga therapy training program, which I enrolled in 2002.

5.) What are the differences between a Yoga Instructor and a Yoga Therapist? (PLEASE SEE ATTACHMENT)

There is no regulation in the U.S. in the field of yoga therapy as a profession and these definitions are still being developed.  Currently, anyone can call herself a yoga teacher or a yoga therapist.  The Yoga Alliance is one independent organization that offers some standards over yoga teachers.  The International Association of Yoga Therapists ( IAYT, yoga therapists’ professional organization) offers definitions of yoga therapy:  Contemporary Definitions of Yoga Therapy

In my opinion, a yoga therapist works mostly one-on-one with people, has a therapeutic focus (for example, reducing pain or inflammation or anxiety), takes the tools of yoga (postures, breathing techniques, mental focus, ritual, sound, prayer) and applies these tools to the particular conditions of an individual, empowering that individual to move toward improved health and well being.  A yoga teacher has more of a developmental focus (for example, increasing strength or flexibility or focus), allowing the individual or group to continue to develop.  The need for a “therapist” implies that there is something present which is undesirable and can be reduced.  The need for a “teacher” implies that there is something present which is desirable and can be increased.

I would advise the public to have a “Buyer Beware” attitude when seeking out a yoga teacher or a yoga therapist in order to ensure that the teacher or therapist has proper training.

6.) Many doctors rely on two main methods to relieve chronic back pain: surgery and exercise. Yoga therapy has helped with crippling back pain when standard physical therapy hasn’t.  How open is the medical profession, including both the hospital and doctors, to prescribing it to their patients?

Back pain is a major problem in the adult population within the United States and has tremendous financial and personal impact.  Viniyoga has been proven to provide more effective relief than traditional physical therapy by a NIH-funded study that was published in the Annals of Internal Medicine in December of 2005.  With this type of peer-reviewed study supporting yoga therapy, I have found the medical community to be very open to offering this approach as an option in treating chronic low back pain.  In general, I have found the medical profession to be very open to yoga therapy.  On a client’s first visit, I usually hear something like “I don’t know what you do, but I hear it works.”  I have found that medical doctors tend to want the best for their patients and are mostly interested in what actually works, especially when they have tried several other unsuccessful approaches.  I think the fact that I have a physical therapy license also brings more credibility to the yoga therapy approach within my practice.

7.)  Not every child is competitive by nature and yoga seems to teach people  to work and improve at their own personal level. Why isn’t yoga taught in our school’s physical education programs?

I am not sure why yoga is not taught in schools and I strongly believe that it should be included.  From my physical therapy perspective, yoga offers a very efficient approach to fitness and wellness, including strengthening, muscular endurance, coordination, balance, flexibility and mental focus.  The only major weakness in yoga is cardiovascular conditioning, unless one is very diligent about including this aspect into the practice, which I believe can be done safely and effectively for a younger population.

Yoga therapy has many other applications that would be valued within a school system such as use of asana for motor delay, use of sound for verbal delay, use of mental focus for cognitive development, and combination of these tools for creating psychoemotional stability.  The scope of yoga therapy is vast, and the application of these techniques is applicable across many disciplines such as speech therapy, occupational therapy, physical therapy and mental health.

8.) Yoga has so many  varying images attached to it.  ‘New Age’, for ‘Movie Stars or even thought of more of an Asian movement.  I think there ought to be a ‘Yoga for the Stars’ like ‘Dancing With The Stars.’  Find an athlete or celebrity wanting to get in shape with killer abs. Develop grace and calm under the pressures of their careers.  Which stars would you like to teach and see in competition?  Did you notice I volunteered you?

Hmmm.  That’s a fun idea.  I’d like to see celebrities that have connected with the younger generation.  Perhaps a football star?  Personally, I’d love to teach & practice with Sting.

9.) If you could change one thing about people’s perception of yoga, what would it be?

My teacher, Gary Kraftsow, says “if you can breathe, you can do yoga.”

I’d like to see people begin to understand the broad application of yoga technology in relation to every level of the human condition, and how easily it can be accessed no matter what physical capabilities are present.  For example, I have a chronic neck condition, tend to have low morning energy, occasionally tend to have the blues, and am deeply connected to the Christian tradition and my family heritage.  I can build myself a simple and timely personal yoga practice that will help support the healing in my neck (asana or postures), boost my morning energy (pranayama or breathing techniques), break the blues cycle (meditation or mental focus), prepare my heart to commune with God (prayer, scripture) and connect with family ancestry (ritual).  All of these yoga tools can be custom tailored to each individual, providing a personal practice that will support that individual in their journey and in all levels of the human experience.  This person can be a professional athlete who needs a custom practice specific to healing an injury.  This person can be wheelchair bound and on a ventilator.  Yoga truly is available to anyone, as long as the person has interest or motivation (often times which is prompted by suffering).

10.) Yoga therapy is becoming better known in United States, although commonplace in India. One of its aspects you talked about was how it helps with the anxiety of living with varied illnesses.  Can you tell us which diseases it helps and how?

The most concrete answer I can use for this question is that of cancer.  Yoga therapy is not chemotherapy.  Yoga therapy will not actually treat the tumor.  Yoga therapy will give the individual who is dealing with the tumor the tools to address the symptoms of the tumor, or the side affects of the treatment for the tumor.  Yoga therapy will also give tools to the individual to address other conditions that occur with chronic illness, such as anxiety.

Common diseases/conditions helped by yoga therapy:  chronic painful conditions (low back, neck, other joints, fibromyalgia, etc), acute painful conditions (hamstring origin injuries, postoperative pain management), cancer, insomnia, IBS, chronic pelvic floor pain, peak performance such as professional athletes, pregnancy, anxiety/depression & a host of other psychoemotional conditions, sleep disorders, chronic obstructive pulmonary disease, asthma, neurological conditions such as stroke & spinal cord injury & Parkinson’s & ALS, multiple sclerosis, HIV/AIDS, balance deficits, special needs children such as Autism & Asperger’s, and the list goes on.

11.) Because yoga therapy helps with anxiety, have any psychologist or mental health workers referred patients to you?

Yes.  Actually, the majority of people in my yoga therapy training group were licensed mental health care professionals.  Yoga therapy can have a profound affect mental health conditions.  The majority of my clients come to me with physical issues because of my physical therapy training.  However, it is impossible to isolate a physical condition from an individual’s physiology, psycho-emotional construct, cognitive input and spirit.  Yoga therapy offers tools that will help support an individual on all of these different levels, resulting in a holistic and very efficient approach to overall wellness.

12.) Dr. Michael Sinel, is an assistant professor of physical medicine and rehabilitation at the University of California, Los Angeles, who has a private practice in Santa Monica. In an interview with Pranapeutics, he states, “I deeply believe in yoga and know the therapeutic value of yoga for health care,”  So much so, that he has plans to  start YogaMed, a company that will offer medical care and therapeutic yoga within the Yoga Works chain of studios.   Do you see this type of practice as being the way  of therapeutic yoga’s future?

Yoga therapy is an emerging profession and is being offered in several different venues.  For example, I offer yoga therapy services within a physical therapy clinic and within a yoga studio.  I know other yoga therapists who have their own private practice, and still others that offer the services in an integrative health care system such as Duke University (Duke University Interative Medicine).  Yoga therapy has a diverse scope of application with potentially profound effects and will continue to evolve into mainstream health and wellness.

13.) Do you think the fact that there is no national credentialing system for yoga hurts the profession?  Do you see licensure in the field’s future?  Or even made as part of the physical therapy program in colleges? (PLEASE SEE ATTACHMENT)

The International Association of Yoga Therapists has recently formed the IAYT Educational Standards Committee, which is charged with developing recommendations to the IAYT Board about entry-level standards for the training of yoga therapists and related issues. These recommendations are due in July, 2011.  More importantly that hurting the profession, I believe that lack of standards can hurt the consumer.  Any person in the U.S. can call herself a yoga teacher or a yoga therapist and project this image to the public.  Because no regulation exists, individuals who lack the proper training can (and have) hurt other individuals and groups, even with the best of intentions.  One of the primary tenants in yoga is the idea of “ahimsa” which is a Sanskrit word that translates as “do no harm.”  I strongly encourage the public to do their research when picking either a yoga teacher or especially a yoga therapist.  I also strongly encourage “yoga teachers” and “yoga therapists” to practice with integrity, never misleading the public and providing an honest biography.  Lastly, I believe that the term “therapy” or “therapeutic” should be used by a certified yoga therapist or by a licensed health care professional such as a physical therapist or mental health practitioner.

14.) Are your services covered by insurance?  Do patients need a referral by their doctor or can they contact you directly?

Because I am a licensed physical therapist, my services are covered by insurance, depending on each individual’s plan and the physical therapy benefits included in that specific plan. Most insurance companies do require a doctor’s referral in order for these services to be covered.

Potential patients or clients can contact me directly and Florida state law requires that we obtain a doctor’s referral within 21 days of starting treatment.

15.) When I think of yoga, I think of different physical poses along with balance and grace.  It came as a surprised then when you talked about how important breathing is in yoga.  Could you elaborate?

Yoga in the U.S. has been mostly diluted into the physical poses.  Traditionally, yoga is a way to train the mind and is a means for transformation.  Breathing is the path for transformation, and this can be explained through the physiology of breathing and the nervous system.

Breathing happens automatically and is controlled through the autonomic nervous system.  However, one can access and alter the breath instantly just by “taking a deep breath.”  Therefore, the breath is a vehicle in which a person can focus on changing a deep pattern.  This pattern can be structural, neurological, emotional, spiritual, and cognitive.

16.) What poses of yoga help sleep and how do they work?

Yoga postures can help with sleep, are mainly performed before bedtime, and should include forward bends and twists.  Moving in these directions helps to deactivate the sympathetic nervous system (fight or flight or freeze), which is responsible for the stress response.  These poses also help to activate the parasympathetic nervous system (relax or repose), which is responsible for the relaxation response.  Often times, a stronger physical practice may be necessary earlier in the evening in order to use up energy so that the person can actually begin the relaxation process.

http://www.yogajournal.com/practice/1467

In addition to the postures, pranayama (breathing techniques) is an effective tool used to calm the nervous system.  Done toward the end of the asana practice, pranayama can simply involve progressively lengthening the exhale.  And then adding a slight pause after each exhale.  This technique has a calming effect on the nervous system.  There are several other breathing techniques (just like there are several postures) that can be used to assist a person into a more relaxed state.

17.) Could you explain about yoga nidra, which is the yoga of sleep?

I have not had extensive training in this arena, so I will refer to a few trusted resources:

http://www.irest.us/projects/sleep-insomnia

http://en.wikipedia.org/wiki/Yoga_Nidra

http://www.swamij.com/yoga-nidra.htm

18.) What about your sleep Emily?  How was it before doing yoga? And now?

For the most part, I have always been blessed with easy and deep sleep.  However, there have been a few nights in which I have had difficulty going to sleep for various reasons.  I now know how to assist myself to sleep.

–

Emily Large, PT, CYT, RYT

Living Large Therapeutics

Atlanta & West Palm Beach

561.762.3105

www.livinglargetherapy.com

“Combining the science of physical therapy with the time honored practice of yoga”

Thank you Emily, for your energy and dedication to your passions and sharing that knowledge with us!

Sweet Dreams- Sleep Compass