Yoga as Therapeutic Exercise: A Practical Guide for Manual Therapists

4

Chapter

Motivation and cognitive-behavioral intervention strategies

Practical measures Practical measures

Practical measures Practical measures

When placing a stumbling block, it is advisable

first to connect it to a conscious visual and verbal

instruction. Later on this link will then call up the

desired memory.

Consolidating new habits and

transferring them to daily life

As soon as exercises are practiced regularly, the skills

that have been developed should be transferred to

everyday life. Once patients have established their

exercise routines, encourage them to practice in dif-

ferent situations and in new sequences, varying the

place, time, length, and procedure. It is a good idea

to vary just one thing first, e.g., practicing in another

room, outside, or while traveling. After that all the

other variables can be changed one at a time or all

together.

To transfer basic exercises into everyday move-

ments, patients should choose any frequently per-

formed movement from their daily routine. The patient

then carries out this movement in slow motion, at sig-

nificantly lower speed than normal. If the exercise is

not performed optimally, this will be difficult. If that

is the case, patients can start to refine the movement

in accordance with the principles and aims they have

been taught (for example, precision, mindfulness,

finetuning, coordination, and synchronization).

In addition, patients are asked to integrate parts of

their basic exercises into their everyday movements,

i.e., to modify that familiar movement slightly. The

movement is at its optimum level when it can be

stopped and varied at any point. Only then does it

become possible to execute the movement easily in

slow motion. Patients should explore their problem-

atic everyday movements – and their improvement –

on their own.

Positive attitude

Behavior that generates less aversion and fear tends to

occur increasingly often, and it is easy for such avoid-

ance behavior to take root. If, however, unpleasant

feelings are stopped by solution-oriented measures

(like setting appropriate positive goals, planning a

realistic exercise schedule, and taking small steps if

pain arises), a constructive momentum develops in

the course of time (Ludwig 2000).

In a spirit of mindfulness patients are told about

the importance of their inner dialogue and positive

imagery. By observing themselves mindfully, they

will become aware of this internal conversation.

Then they can create positive statements in the form

of an inner dialogue or visualize a realistic image of

future success.

A positive inner attitude and positive images

lead to a readiness to change our behavior in a

goal- oriented way. While an inner dialogue can

express itself as bitter self-criticism (“I can’t do that;

it’s impossible!”), it can also be phrased positively

(“I’m curious how many days I’ll need to learn this”

or “At present this doesn’t work yet but if I persist

it will get better”).

Usually a feeling manifests itself as a facial expres-

sion, which can also be used the other way round

(Ekman et al 1983). In other words, a relaxed,

friendly face can change our emotional state and

ease tensions within the body. Patients should be

encouraged to use this method because exercising

should be joy.

Here, the therapist acts as a role model by pre-

senting a positive attitude that is transferred to

patients. For that reason explanations as well as

demonstrations of exercises should always be given

very carefully. It is vital to use positive phrases like

“Breathe naturally!” instead of negative ones like

“Don’t stop breathing!”

Correcting mistakes

If you correct mistakes, some patients may feel

offended, which will reduce their motivation to

exercise. To avoid this, it is advisable not to insist

on what is “right” and “wrong.” Instead, give extra

advice. Encourage patients to try out variations and

compare them by asking questions like “Which

movement feels good?” or “Which movement is

easier, more pleasant, or more effective?”

If the patient makes a mistake during a sequence

of movements, don’t always stop the sequence but

wait until the patient finishes, unless there is a dan-

ger of injury. Then explain the correct movement as

a variation so that the patient can make a compari-

son before repeating that movement. Explain that

it is good to enlarged the exercise routine (Hotz

1988 ).