Rotator Cuff Research -NIH Grant in conjunction with the University of Pittsburgh and Carnegie Mellon University
Manhattan Physical Medicine and Rehabilitation
133 E. 58th Street
New York, New York 10022
(212) 472-0077 * Please note: Phones in Midtown Manhattan are currently inconsistent. If problems, email Erika@sciatica.org.
We have received an NIH grant to study rotator cuff syndrome, a painful shoulder condition.
People with shoulder pain due to rotator cuff tears will be treated without cost. The protocol involves a yoga-like pose which has been shown in peer-review publications to relieve pain and restore normal movement in over 90% of patients.
This requires only a single visit. The pose takes a short time to learn, and usually less than a minute (60 seconds) to do. Those interested should call the office at (212) 472-0077. Bring any imaging studies or other relevant medical data with you. Be sure to tell Erika or Katie that you want to join the rotator cuff study.
The New Study
Our team just received a two-year NIH grant using yoga in a new method of assessing pain. Along with psychologists and computer specialists in facial recognition software at Carnegie Mellon University and the University of Pittsburgh, we will work with people having rotator cuff syndrome (RCS). The study works like this:
Study start date: May 1, 2017
Study end date: November 2018
Eligible participants: People with rotator cuff syndrome (RCS)
Cost: Free to participants
Procedure: Participants will fill out three simple behavior scales for depression and mental status, and then will be filmed doing simple tasks before and again after learning a maneuver that reduces shoulder pain 60% – 90% in most cases. The participant will estimate his or her pain in the usual 10-point scale after each set of tasks.
Benefits: Participants will learn the triangular forearm support maneuver which dramatically reduces the pain and improves the free range of motion in 90% of RCS cases.
Analysis: The researchers will study the facial expressions and bodily movements in the before- and after- situations, attempting to correlate different facial expression and movement patterns with the 10-point scale ratings of the patient, in light of the information from the behavior scales.
Nature of the study question: In spite of the fact that approximately 1/3 of Medicine is based in pain, we currently have nothing more than a puerile linear 1 – 10 scale to assess it. Further, these assessments are anything but objective. Computerized facial analyses already exist that reliably screen out non-genuine smiling and false expressions of pain. If successful, this study will open out a sensitive and multidimensional account of the unusually complex and misunderstood nature of pain. Such a measure would be invaluable for determining the efficacy of surgical and non-surgical attempts to reduce pain, assessment of analgesic pharmaceuticals, investigating psychological and emotional pain, with workers compensation and similar applications as well.
For preliminary signup, email Erika@sciatica.org
Previously Published Study:
New Yoga for Osteoporosis: a dose-response study
Manhattan Physical Medicine and Rehabilitation
133 East 58th Street (Between Park and Lexington)
In spite of positive comments about the study in the New York Times, the Harvard Women’s Health Letter and NPR, the almost free and effective treatment has not gained much application in the medical community. Dr. Ethel Siris, a prominent authority in the field of osteoporosis studied more than 100,000 osteoporotic women who had health insurance covering the cost of osteoporosis medications. She found that less than 30% actually took these medicines, at least partially because of their common and severe side-effects. But the side-effects of yoga are better posture, improved balance, greater strength, range of motion and coordination, and lower anxiety, all factors that mitigate against the fractures just about as strongly as the rise in bone mineral density. Therefore we are beginning a new study, seeking a dose-response relationship between yoga and bone mineral density and bone quality, a more compendious measure of a bone’s resistance to fracture.
For those interested in the new study, beginning summer-fall 2016 and ongoing until further notice, the following is relevant.
This study attempts to prove that properly chosen yoga poses can reverse osteoporosis without having negative effects on the joints. In addition, we hope to establish a dose-response relationship between the quantity and quality of yoga, and rise in bone mineral density, and possibly bone quality.
Conventional medical wisdom puts people in an impossible position: exercise with impact, jogging, for example, is needed to stimulate the cells that build bone, but unfortunately, such exercise fairly reliably brings about arthritic joint destruction. No-impact exercise is harmless to the joints, but unfortunately, leaves the bones to slowly weaken even to the breaking point.
Therefore when it comes to bones, it is literally both ends against the middle. At the same time, it is universally acknowledged that not exercising at all tightens joints and ligaments, weakens muscles and bones alike, and is the worst of both worlds.
As the population of the world grows older, these questions are critical for the continued activity and health of an increasing number of people. Present estimates are that 200,000,000 people suffer from osteoporosis or osteopenia.
Evidence in the animal literature confirms that unconventional tugs of the sinews and ligaments can arrest, and often reverse osteoporosis. The pilot study detailed below corroborates these findings. The transcriptional coactivator PGC-1alpha is liberated from muscles in exercises such as yoga, and suppresses a broad array of inflammatory responses, likely including arthritis.1 There are also physiological reasons to believe that yoga improves the circulation of synovial fluid, within joints, slowing the “wear and tear” that may stand at the origins of osteoarthritis.
The proposed study measures osteoporosis through the accepted means, radiographic bone density measurement, dual energy X-ray absorptiometry otherwise known as DEXA scans. We measure progression in osteoarthritis with standard hip and lumbar spine X-rays. Each subject has thyroid functions, standard electrolyte, mineral and liver/kidney function tests, two assays for vitamin D, and a urine test measuring the rate of bone resorption before learning the 12 yoga poses that comprise the program. Bone scans and X-rays, performed at study onset and at the end of year 2, are read by radiologists that have no idea which patients are receiving yoga, and which are not. The study participants will receive a newsletter about developments and research in osteoporosis. A DVD of the poses is for sale to all participants at the home page of this site, and it is streamed at without cost at:
There is an on-line message board for communication between the participants and also with the physicians and yoga teachers involved in the study. People may post messages in English and Spanish. Every two years a statistical analysis will be done, and a scientific paper will be written after results are judged significant.
In order to do a meaningful analysis of the “dose” of yoga, it will be necessary for participants to visit a yoga teacher certified in our method every two weeks. Your arrangement with the teachers is up to you and the teacher. It may be a group class or an individual session or a short review. There are currently only 18 certified teachers, mostly in New York and New Jersey, although there are also teachers in Pennsylvania, Texas, Illinois, and California. If you are not located near enough to one of these teachers, then unfortunately you will not be eligible for the study. We will be conducting more certification sessions in the winter in New York and Chicago, and in San Francisco in the summer of 2017. The current list of certified teachers is given on this website under the tab “Osteoporosis” and also under the tab “Certification for Teachers,” and the study itself, with induction forms can be found at:
Recently we have added a state-of-the-art measure of bone quality, that may also be offered to study participants without cost. After receiving the DVD, study participants and qualified others may be able to have every-two-years bone quality studies as well.
We have already completed a ten-year, with a paper published by the peer-reviewed journalTopics in Geriatric Rehabilitation. In it we analyze the outcome of 741 people who completed at least two years of yoga (the intervention group) these same people’s change in bone mineral density during the two year period before they began using the DVD. These people had an average age of over 68 years, and all had normal laboratory values. Over 80% had osteoporosis or osteopenia at the study’s onset.
As you can see, the patients that did yoga for two years now have stronger bones than they did when they started. Statistically, this result was significant.
Sometimes we have had to adapt the yoga poses for people that are unable to use the classical position. The DVD has three versions of each pose, and your teacher will very likely be able to help you with that.The idea is to progress from the simplest level to the more advanced levels in any pose for which it is safe to do so. Trying hard, putting some effort into the 12 minutes of yoga, is also important. The Iyengar yoga method that stands behind each of the poses pays great attention to alignment, enabling people to try hard without injury.
There were no injuries in the ten years of the study. With 741 people in the study, (227 fully documented) and well beyond 100,000 hours of people doing these poses, many of them having before-and-after X-rays of spine and hips, we had no reported fractures related to yoga. Interestingly, we have over 20 fractures reported from falls on the street, traffic accidents, and the like.
The results of the study are now in, and the statistician has found that yoga does significantly improve bone mineral density for the spine, (P <.05) the femur (P < .002) and, slightly less convincingly, for the hip (P < .05 on 2 of 3 measures; not significant for the third). This work appeared in the peer-review journal “Topics in Geriatric Rehabilitation,” and is available on line ahead of printing at the URL above.
If desired, the DVD may be purchased by anyone for $25 on the home page of this website.
To join the Dose-Response Study (Dose of yoga – Response in bone mineral density), candidates must:
Submit a current DEXA scan (less than 6 months from date of study entry).
Submit one or more past DEXA scans, at least one year previous to study entry.
Complete the Induction Form available at the website “sciatica.org” under the tab “Osteoporosis.”
If the candidate’s most recent DEXA scan shows osteopenia or osteoporosis, then he or she must complete six blood tests and one urine test:
TSH (thyroid stimulating hormone
PTH (parathyroid hormone)
Vitamin D,25 – hydroxyl
Vitamin D, 1,25 dihydroxyl
CMP (Complete Metabolic Profile
ESR Erythrocyte Sedimentation rate) or CRP (C-reactive protein
NTX (a measure of collagen bonds to determine bone resorption rate)
Continue all the same medications, diet and exercise for the 2 years of the study.
If the candidate’s most recent DEXA scan does not show osteoporosis or osteopenia, he or she does not need to have these blood tests and urine tests.
If you are under 75 years of age, take 1500 mg Calcium, 1500 IU of Vitamin D3, and 250 mg of Magnesium, preferably as a chelate with amino acids. This is available in health food stores and online at “Ancient Minerals.” Those over 75 should take 500 mg of Calcium.
Have a session with a Certified Teacher every 2 weeks for the 2-year study period.**
Complete another DEXA scan two years after entering the study, preferably at the same facility.
Optional: hip and spine X-rays at study onset and after 2 years.
*Candidates whose DEXA scans do not reveal osteopenia or osteoporosis do not need to take these tests.
**Certified teachers’ names and emails are listed by state on “sciatica.org” under “Certification.”
We request that all study participants inform us of any medical, dietary and/or major activity changes that occur during the course of the study.
Questions may be addressed to the Study Administrator, Tina Paul at Tina@sciatica.org or to Dr. Fishman at Loren@sciatica.org. To save time and trouble, see the FAQ section below first.
- When does the study start and end?
The study has begun and we are taking rolling admission until further notice.
- What is required of me to be in the study?
Two DEXA scans one from at least one year – 5 years ago, the other within 6 months of entering the study.
If the current DEXA scan shows you have osteopenia or osteoporosis, then you must complete the blood tests and urine test described above. If you do not have osteopenia or osteoporosis the you do not need the blood and urine tests.
Complete Form: http://sciatica.org/?page_id=940
Receive a Study Number from Tina Paul (Tina@sciatica.org).
Set up to meet with certified teacher bi-monthly: http://sciatica.org/?page_id=838
Track progress on scorecard (which will be provided both to you and your teacher). See the outline above these FAQ.
3. Do I need to work with a certified teacher 30 min bi-weekly or 60 min? What is the cost?
You can work with a teacher for 30 min or 60 min. Yes, please find a list of certified teachers here. You are required to meet with them bi-monthly in person or via Skype. Costs vary per teacher. Please contact the teacher directly to learn about rates. Some teachers are developing Yoga for Osteoporosis classes, which are likely to be lower cost.
- When does the study officially begin for me? Does it start after my first session with the certified teacher?
Yes. By then you will also have a Study Number, which will uniquely identify your Google Sheets record where you can add the values for your weekly scoresheet, and the Certified Teacher can add his or her estimate of your effort.
- What is the new study?
The new study measures the participants’ involvement closely, and compares the versions of the poses they use, their frequency, and the intensity with which they are performed.
- Why do another study about yoga and osteoporosis?
The first 741 patient study had 243 patients who submitted all the data we requested. The study showed that yoga significantly improved bone mineral density in the spine and the hip bone and caused no known fractures or serious injuries of any kind in over 100,000 hours of people, 83% of whom had osteoporosis or osteopenia. But it did not change most physicians’ minds; the vast majority still prescribe the medicines, and regard yoga as just recreation and “dangerous” for people with weakened bones. This second study matches the amount, quality and intensity of -the yoga with the resultant changes in bone mineral density. This is one of the ways pharmaceutical firms establish and illustrate the beneficial effects of medications. The second study attempts to match the model that is quite familiar to physicians and health-care executives in an effort to persuade them at least to try yoga to reverse osteoporosis.
- If I have osteoporosis, is it dangerous for me to do the Osteopenia or Preventive versions of the postures?
Absolutely not. We ask everybody to start with the Osteoporosis (beginning) poses for a week, but then encourage each person to advance as quickly as he or she safely can. That means in some poses an individual with osteoporosis may be doing the Osteopenia (intermediate) version, and before long be doing the Preventive (classical) version of some of the poses. The key to doing safe, vigorous poses is good alignment. That is what the visits to the Certified Teacher are for.
- Do I have to advance from all Osteoporosis poses to all Osteopenia poses and then to all Preventive poses?
Definitely not. Pretty soon after starting you will be doing some poses in each category. There is space on the scoresheet to record that quite painlessly,
- Are the Preventive poses more powerful bone builders than the Osteopenia poses, and are the Osteopenia poses better bone builders than the Osteoporosis poses?
We’re not sure, but we think so. But each pose at each level will benefit those people more who practice it more vigorously. Still, in every case, safety first.
- What if I am sick for a week and cannot do the poses. Am I out of the study?
By no means. This is a dose-response study. A lower “dose” of yoga may affect your second DEXA scan a little. There are 104 weeks in your participation. One week is less than 1%.
- How does the study record participants’ yoga?
You will record your own consistency, and which versions of the poses you are performing. For example, you might indicate that you did the transitional version of the twisted triangle 5 times last week. When you are admitted to the study, you will receive a unique identifying number, and an invitation to join Google Sheets. In order to comply with HIPAA rules, you must use the number when you input your yoga involvement for the last week. If unfeasible, you can report your yoga activity on a two-week basis, but if you let it go longer than that, the data becomes unreliable.
The other parameter, the intensity with which you do the yoga, will be reported by the certified teacher you see every other week. Therefore you will have to share your unique number with the certified teacher(s) whom you see every two weeks.
- What stops people from “cheating,” by working harder when they see the teacher than when they are at home, or saying they did the poses more often (or less often) than they really did?
We expect people to tell the truth. If they do not, to please us or their teachers, or for whatever reason, it will impair or ruin the entire effort.
16. Do I need both DEXA scans and labs to join the study?
Yes, you need a DEXA scan from at least a year ago, and another within 6 months of your entry to the study. This may be within the 6 months after study entry too. It is best to have it close to study entry, so the results can determine whether or not you need the blood and urine tests. If your DEXA does not reveal either osteopenia or osteoporosis, you do not need the blood or urine tests.If you have either osteopenia or osteoporosis, you need the blood and urine tests. If any of the tests are abnormal, then you must see the appropriate specialist and correct the value(s) before entering the study. In any event, you need to have a DEXA scan again after 24 months.
Reference (Click on name to go to reference)
1. Handschin C, Spiegelman BM. “The role of exercise and PGC1alpha in inflammation and chronic disease.”Nature. 2008 Jul 24;454(7203):463-9.
What are the major causes of yoga injuries, in which poses, and what are the major injuries?
A 33,000 yoga teacher and student study.
We have recently completed a double blinded randomized controlled study comparing botulinum injection to placebo in people for whom the electromyographic evidence favored piriformis syndrome.
The entire study is being reviewed now for publication (August 27, 2016), but the graphic representations of the results are so good that I cannot resist putting them here.
Rotator Cuff Syndrome
We stumbled upon a series of maneuvers which activates muscles that perform the actions of the torn supraspinatus muscle. Then a process akin to operant conditioning prompts the same muscles to be active whenever the torn muscle would be brought into play, perpetuating the substitution so that people may painlessly and powerfully lift the arm in ways that previously were prevented by the torn muscle.
Yoga Poses to Reverse Scoliosis
We have found a simple yoga pose which, done one time daily, reverses nearly every case of scoliosis we have encountered. We published a small series of adolescent idiopathic scoliosis patients’ and degenerative scoliosis patients’ successes with this simple method, and are currently studying more advanced methods with more complex curves.
Emboldened by this early success, we did a larger study, published in November 2017:
Surprising to some, the method works almost as well for adults with degenerative scoliosis as it does for adolescent idiopathic scoliosis. Once again, although mentioned and appreciated in main-stream news media such as the Wall Street Journal, the pediatricians, family practitioners and orthopedic surgeons of this world have taken little note of what we have shown can be done.
Therefore we are continuing to study the patients we are honored to treat with this non-invasive do-it-yourself-at-home method that takes minutes a day and works for almost everyone. Those interested should just make an appointment at our office: (212)-472-0077. For people too far away, we have actually taught the method with equal success through Skype.