Spe­cial re­port: How asana and med­i­ta­tion are tak­ing root in the mil­i­tary

Yoga Journal - - CONTENTS - By Lind­say Tucker

Spurred in part by the crush­ing opi­oid epi­demic, the Depart­ment of De­fense and other fed­eral agen­cies have been spear­head­ing ef­forts to man­age and mit­i­gate pain and men­tal health prob­lems among ac­tive ser­vice mem­bers. Yoga, as it turns out, is one of the ris­ing stars. While those in the trenches say there is a long way to go be­fore yoga can be broadly and sys­tem­i­cally de­ployed within the mil­i­tary, the foun­da­tion is be­ing laid for us­ing asana, med­i­ta­tion, and other holis­tic ther­a­pies to make mil­i­tary per­son­nel more re­silient.

iIN JULY 2010,

US Navy pi­lot Liz Cor­win was fly­ing her F-18 fighter jet on a com­bat mis­sion over Afghanistan at 350 knots. She had been in the air for seven hours and was strug­gling with the lit­tle hand-held uri­nal that fe­male pi­lots use to re­lieve them­selves mid-flight. Sud­denly, to her left, she caught a glimpse of her wing­man—just 50 feet away. The pair were on con­verg­ing paths. They were so close, in fact, that she could clearly see the con­trol panel in­side his cock­pit and the squadron’s mas­cot painted on his hel­met. Tak­ing a deep breath, she called on her eight years of avi­a­tion train­ing and yanked the jet’s con­trol stick to­ward her, flip­ping her plane up­side down in an ag­gres­sive at­tempt to avoid a col­li­sion. But the tur­bu­lence told her it was too late. As she glanced out of her cock­pit, there was no ques­tion: her wingtip was miss­ing.

Wrestling ego, un­cer­tainty, and self-crit­i­cism, Cor­win spent the next few mo­ments find­ing deep breaths to “wran­gle those demons back into their pens,” she says. In the back of her mind, she knew the real threat would emerge when she at­tempted to slow down, de­ploy her land­ing gear, and touch down on an air­craft car­rier float­ing some­where in the Ara­bian Sea—which at her cur­rent speed was ev­ery bit of an hour away.

That hour was bru­tal, says Cor­win, call­ing it the worst of her life. But she tapped into her yoga train­ing, em­ploy­ing the same breath­ing and mind­ful­ness tech­niques she had been prac­tic­ing through­out de­ploy­ment alone in her room on her yoga mat. Five thou­sand peo­ple awaited her re­turn on the car­rier, and she knew it would be a mo­ment of reck­on­ing for her rep­u­ta­tion as a pi­lot—a fe­male one at that. “The ca­coph­ony of voices in my head needed an or­ches­tra­tor, and I knew I couldn’t let self-doubt and shame be the loud­est,” Cor­win says. Yoga had been her sav­ior dur­ing flight school: “My en­tire re­la­tion­ship with my­self was at stake, but I knew if I could tap into pres­ence, calm, and self-care, I could pull my­self to­gether enough to land safely.”

As Cor­win re­calls, she paused for deep self-re­flec­tion and of­fered up some vi­tal self-love to the woman star­ing back at her in the rearview mir­ror of her cock­pit. “Yoga had taught me to loosen harsh self-judge­ments. It taught me that what­ever I did didn’t de­fine me, but was a tool for my own awak­en­ing. I knew in that mo­ment that what was hap­pen­ing wasn’t a fail­ure, but an op­por­tu­nity,” she says. “Yoga de­liv­ered a sense of peace to the mo­ment of hell I was liv­ing in.”

Ul­ti­mately, she de­liv­ered the best car­rier land­ing of her life—“a per­fect pass,” she calls it. Lit­tle did she know that at the same time, the US Depart­ment of De­fense (DoD) and the Depart­ment of Vet­er­ans Af­fairs (VA) were al­ready work­ing with the Na­tional Academy of Medicine (for­merly the In­sti­tute of Medicine) and the Na­tional In­sti­tutes of Health to ex­am­ine ex­actly how in­te­gra­tive ther­a­pies such as yoga and mind­ful­ness med­i­ta­tion might be used to ben­e­fit ser­vice mem­bers like her­self.

Tra­di­tion­ally, mil­i­tary lead­ers of­ten met these prac­tices with skep­ti­cism. But over the past two decades, a se­ries of clin­i­cal tri­als backed by a grow­ing cat­a­log of sci­en­tific ev­i­dence has per­suaded high-level DoD health care ex­perts to ac­cept yoga and med­i­ta­tion as le­git­i­mate treat­ments for post-trau­matic stress dis­or­der (PTSD), pain man­age­ment, and much more. Part of the ap­peal: Ex­perts fa­mil­iar with the re­search sug­gest that yoga and mind­ful­ness may ac­tu­ally be more cost ef­fec­tive and faster at pro­mot­ing heal­ing and prevent­ing cer­tain in­juries than more-pop­u­lar modal­i­ties such as surgery and pre­scrip­tion drugs. On a more grass­roots level, ac­tive ser­vice mem­bers are tap­ping into the prac­tice’s per­for­mance-en­hanc­ing and pre­ven­tive ben­e­fits to make sol­diers and op­er­a­tional staff more calm and re­silient in the field—be­fore shock, in­jury, or PTSD set in. In fact, ef­forts to em­bed yoga into ev­ery branch of the mil­i­tary have never been more ag­gres­sive.

wWhile much of the early re­search on yoga and the mil­i­tary fo­cused on how med­i­ta­tion and mind­ful move­ment could help vet­er­ans mit­i­gate PTSD (which has had sig­nif­i­cant im­pact at VA hos­pi­tals and has been linked to record sui­cide rates among vets), by the mid-aughts, other re­lated ar­eas of con­cern were com­ing into sharp fo­cus.

Ac­cord­ing to the Na­tional Cen­ter for Com­ple­men­tary and In­te­gra­tive Health, stud­ies show that nearly 45 per­cent of sol­diers and 50 per­cent of vet­er­ans ex­pe­ri­ence pain reg­u­larly, and there’s a sig­nif­i­cant cor­re­la­tion among chronic pain, PTSD, and post-con­cus­sive symp­toms such as fa­tigue, poor bal­ance, sleep dis­tur­bances, and de­pres­sion (mean­ing, if you have one, you’re more likely to ex­pe­ri­ence one or more of the oth­ers). “Mus­cu­loskele­tal and men­tal health prob­lems have re­ally spiked, thanks to all the things that go along with ac­tive com­bat: car­ry­ing heavy loads, jump­ing in and out of air­craft—plus ex­po­sure to in­fec­tious dis­eases and vi­o­lence,” says 42nd US Army Sur­geon Gen­eral, Eric Schoomaker, MD, PhD, who re­tired in 2012 and now serves as vice chair for Lead­er­ship, Cen­ters, and Pro­grams in the Depart­ment of Mil­i­tary and Emer­gency Medicine at the Uni­formed Ser­vices Uni­ver­sity. Schoomaker is on a mis­sion to bring yoga and its ben­e­fits to the front­lines of mil­i­tary health care.

Dur­ing the mid-2000s, at the gov­ern­ment level, new pain treat­ments and preven­tion tech­niques were in high de­mand. Surgery and pre­scrip­tion drugs weren’t work­ing, and the mil­i­tary was hit es­pe­cially hard by the opi­oid epi­demic. In fact, in 2005—just two years into the Iraq War—nar­cotic painkillers were the most abused drugs in the mil­i­tary, ac­cord­ing to a DoD sur­vey of more than 16,000 ser­vice mem­bers. By 2011, it was es­ti­mated that up to 35 per­cent of wounded sol­diers were de­pen­dent on pre­scrip­tion pain re­liev­ers.

In 2009, amidst the grow­ing opi­oid epi­demic, Schoomaker, then the Army Sur­geon Gen­eral, char­tered the Army Pain Man­age­ment Task Force. The goal? To come up with a new, com­pre­hen­sive pain-man­age­ment strat­egy utiliz­ing the most up-to-date re­search avail­able. The group in­cluded med­i­cal ex­perts from the Army, Navy, Air Force, the Vet­er­ans Health Ad­min­is­tra­tion, and Tri­care—the mil­i­tary’s health in­sur­ance pro­gram. Schoomaker tasked the group with ex­ten­sively re­search­ing any modal­i­ties that might be ef­fec­tive in com­bat­ing acute and chronic pain. Among the science-backed so­lu­tions pre­sented, he says, were yoga and mind­ful­ness med­i­ta­tion.

"WE REC­OG­NIZED TAHAT YOGA AND MIND­FUL­NESS WERE SORELY UN­DER­UTI­LIZED IN THIS COUN­TRY." CH­ESTER 'TRIP' BUCK­EN­MAIER III

Since the Pain Man­age­ment Task Force pub­lished its find­ings in 2010, in­ter­est in what’s now re­ferred to in the DoD as com­ple­men­tary in­te­gra­tive health and medicine (CIH/CIM) has height­ened within the gov­ern­ment and pri­vate health care or­ga­ni­za­tions look­ing to rev­o­lu­tion­ize men­tal and phys­i­cal pain man­age­ment in the armed forces. “By then, we rec­og­nized that yoga and mind­ful­ness were sorely un­der­uti­lized in this coun­try,” says re­tired US Army Colonel Ch­ester “Trip” Buck­en­maier III, MD, pro­gram di­rec­tor and prin­ci­pal in­ves­ti­ga­tor for the Uni­formed Ser­vices Uni­ver­sity’s De­fense and Vet­er­ans Cen­ter for In­te­gra­tive Pain Man­age­ment. But be­fore a case could be made for their im­ple­men­ta­tion among the armed forces, these prac­tices would have to be stud­ied in mil­i­tary-spe­cific en­vi­ron­ments. Cen­turies of anec­do­tal ev­i­dence and out­side re­search do not cut it when you’re talk­ing about a glob­ally de­ployed or­ga­ni­za­tion like the US mil­i­tary—es­pe­cially when some­one has to pick up the bill, Schoomaker says.

Sev­eral pain-re­search ef­forts en­sued. One of the most ground­break­ing was a study pub­lished in 2017 by the jour­nal Amer­i­can Congress of Re­ha­bil­i­ta­tion

Medicine that ex­am­ined the prac­ti­cal­ity and ef­fec­tive­ness of an in­di­vid­u­al­ized yoga pro­gram, dubbed RES­TORE (Restora­tive Ex­er­cise and Strength Train­ing for Op­er­a­tional Re­silience and Ex­cel­lence), de­signed to treat chronic lower-back pain in ser­vice mem­bers and their fam­i­lies. Re­searchers and yo­ga­treat­ment ex­perts cre­ated a 15-pose asana se­quence to pro­mote strength­en­ing, flex­i­bil­ity, and pos­tural align­ment—specif­i­cally to tar­get core, back, and gluteal mus­cles. (For the full se­quence, see page 74).

Yoga teach­ers who led the prac­tice went through a 200-hour Yoga Al­liance teacher train­ing and an ad­di­tional 50-hour pro­gram-spe­cific course “based on ther­a­peu­tic yoga,” says lead au­thor Krista High­land, PhD. A “cul­tural-com­pe­tence train­ing” en­sured that yoga in­struc­tors un­der­stood how to act within a mil­i­tary struc­ture and how to ad­dress “unique clin­i­cal char­ac­ter­is­tics that pa­tients in the mil­i­tary might present with,” such as post­trau­matic stress.

Fifty-nine ser­vice mem­bers par­tic­i­pated in the eight-week trial, the ma­jor­ity of whom were ac­tive duty. Dur­ing this time, the RES­TORE and con­trol groups con­tin­ued in­di­vid­ual treat­ment as usual (think med­i­ca­tion, phys­i­cal ther­apy, chi­ro­prac­tic, in­jec­tions, mas­sage, or acupunc­ture). The RES­TORE group, how­ever, also in­cor­po­rated one to two yoga ses­sions per week, ac­com­pa­nied by breath­work and a guided med­i­ta­tion. Pain lev­els and symp­toms such as phys­i­cal im­pair­ments and sleep dis­tur­bance were mon­i­tored for six months af­ter the trial be­gan. The yoga and med­i­ta­tion group ex­pe­ri­enced symp­tom re­lief more quickly than those in the con­trol group, re­port­ing lower pain in­ten­sity at mid-treat­ment (four weeks) and post treat­ment (eight weeks).

“That’s ex­tra months to get back to work, to func­tion so­cially—to get out with friends and fam­ily mem­bers,” says Buck­en­maier, who was one of the 11 re­searchers. “That’s so ben­e­fi­cial for these pa­tients.” Schoomaker agrees: “In those weeks in which yoga has re­stored func­tion and im­proved pain, other peo­ple turn to surgery and drugs—things that get them into trou­ble.” In­stead, Schoomaker says, we ought to be front­load­ing prac­tices such as yoga that fo­cus on func­tion and whole-body well­ness—us­ing them of­fen­sively and de­fen­sively as the first step in pre­ven­tive care and med­i­cal treat­ment be­fore chronic pain, ill­ness, and drug use be­come is­sues.

wWhile the gov­ern­ment amasses the em­pir­i­cal ev­i­dence it needs, dozens of yoga non-prof­its are tak­ing mat­ters into their own hands. Lieu­tenant Colonel Jan­nell MacAu­lay, who re­tired from the mil­i­tary in June, was just 17 when she snapped her fe­mur in half af­ter a stress frac­ture went un­di­ag­nosed in ba­sic train­ing. Dev­as­tated and de­bil­i­tated, MacAu­lay went through two surg­eries and three months of rig­or­ous re­hab. In her de­ter­mi­na­tion to be­come a US Air Force pi­lot, she tried a va­ri­ety of ther­a­pies—yoga, acupunc­ture, and trig­ger-point mas­sage among them— in or­der to im­prove mo­bil­ity. Once she found a reg­u­lar yoga rou­tine, scar tis­sue, stiff­ness, and pain started im­prov­ing lit­tle by lit­tle. “Yoga be­came a space of non­judg­ment and grat­i­tude that I wasn’t get­ting any­where else in my life,” MacAu­lay says. “I was com­pletely stressed all the time—just go­ing, go­ing, go­ing. But when I prac­ticed yoga, I could be my­self and in­vest in slow­ing down, which ac­tu­ally helped me speed up my ca­reer path as a pro­fes­sional in the mil­i­tary.”

Back in 2012, while gov­ern­ment re­search was ramp­ing up, MacAu­lay founded Healthy Body Healthy Life— a free, first-of-its-kind health-andwell­ness ini­tia­tive for mil­i­tary fam­i­lies that in­cor­po­rates yoga, med­i­ta­tion, nu­tri­tion, and high-in­ten­sity in­ter­val train­ing. She also pi­o­neered a sim­i­lar pro­gram at Kirt­land Air Force Base, in New Mex­ico, when she was sta­tioned there last year. To­day, the Air Force pays her to travel the globe ed­u­cat­ing se­nior lead­ers about the im­por­tance of in­cor­po­rat­ing yoga into ba­sic train­ing—so sol­diers can get ahead of men­tal and phys­i­cal in­juries be­fore they hap­pen. “We need to bet­ter pre­pare our mil­i­tary, not just to do the job, but to do the job un­der ex­treme stress,” she says. “Be­cause that’s the real­ity in a com­bat zone. If we’re not us­ing yoga and mind­ful­ness, we’re miss­ing out on cre­at­ing the best hu­man-weapon sys­tems to op­er­ate in those en­vi­ron­ments.”

She’s not wrong. A re­silience-train­ing pro­gram that ap­peared in the Amer­i­can

Jour­nal of Psy­chi­a­try in 2014 stud­ied 147 Marines who had un­der­gone

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