Stress management

In general, stress is related to both external and internal factors. External factors include your physical environment, your job, relationships with others, your home, and all the situations, challenges, difficulties, and expectations you're confronted with on a daily basis. Internal factors determine your body's ability to respond to, and deal with, the external stress-inducing factors. Internal factors which influence your ability to handle stress include your nutritional status, overall health and fitness levels, emotional well-being, your ability to control stress through relaxation techniques or other strategies, and the amount of sleep and rest you get.

Managing stress, therefore, can involve learning tips to change the external factors which confront you or the internal factors which strengthen your ability to deal with what comes your way.

What are some effective techniques to cope with stress?

Exercise

Exercise can be a key, central method to compensate for stressors. Physical exercise not only promotes overall fitness, but it helps you to manage emotional stress and tension as well. Exercise can also aid in relaxation and improve sleep. For one thing, exercise can emotionally remove one temporarily from a stressful environment or situation. Being fit and healthy also increases your ability to deal with stress as it arises.

Relaxation techniques and meditation

There are many ways to use structured relaxation techniques to help control stress and improve your physical and mental well-being. While some types of meditation and relaxation therapies are best learned in a class, it's also possible to learn meditation techniques on your own. There are literally hundreds of different types of relaxation methods ranging from audio CDs to group martial arts and fitness classes. The following are only examples of the types of structured programs available that can increase our capacity for relaxation:

• Autogenic training: Developed in the early 20th century, this technique is based upon passive concentration and awareness of body sensations. Through repetition of so-called autogenic "formulas" one focuses upon different sensations, such as warmth or heaviness, in different regions of the body. Autogenic training has been used by physicians as a part of therapy for many conditions. Popular in Europe (where it is even covered by some insurance plans), this method is currently gaining acceptance in the United States. No particular physical skills or exercises are involved; however, people desiring to learn this technique must be prepared to invest time and patience. Since this technique is slightly more complex than some relaxation methods, a course is generally the best way to learn the method.
• Biofeedback: Biofeedback is one method of learning to achieve relaxation, control stress responses, or modify the body's reactions through the use of monitoring equipment that provides information from the body which would normally not be available. This method is based upon the principle first advanced in the early 1960s that the autonomic nervous system (the part we don't consciously use) is trainable. For example, instruments can be used to measure heart rate, blood pressure, brain activity, stomach acidity, muscle tension, or other parameters while people experiment with postural changes, breathing techniques, or thinking patterns. By receiving this feedback, one can learn to identify the processes that achieve the desired result, such as reduction in heart rate and blood pressure. Biofeedback is used by many practitioners for a variety of psychological and physical conditions. Because the technique involves the use of measuring devices, it can only be performed by a professional.
• Imagery: Imagery, sometimes referred to as guided imagery, is the use of pleasant or relaxing images to calm the mind and body. By controlling breathing and visualizing a soothing image, a state of deep relaxation can occur. This method can be learned by anyone and is relatively easy to try out.
• Meditation techniques: Ranging from practices associated with specific religions or beliefs to methods focusing purely on physical relaxation, meditation is one of the most popular techniques to achieve physical and mental relaxation. There are thousands of different types of meditation, and many can be learned on your own. The meditative state is one in which there is a deep centering and focusing upon the core of one's being; there is a quieting of the mind, emotions, and body. The meditative state can be achieved through structured (as in a daily practice of a routine) or unstructured (for example, while being alone outdoors) activities. While teachers of meditative arts are readily available, some techniques can be learned though books or online tutorials.
  
  A form of meditation popularized for several decades istranscendental meditation (TM). TM has the goal of achieving transcendental consciousness (the simplest form of awareness). It is practiced for 15-20 minutes in the mornings and evenings and is relatively easy to learn. Numerous classes and teaching materials are available for beginners.
  
  Another variant of a meditation technique has gained popularity in the U.S. since its description in the 1970s by Harvard physician Herbert Benson. This technique involves generation of the so-called relaxation response through the repetition of a word of phrase while quietly seated, 10-20 minutes per day. Designed to evoke the opposite bodily reaction to the stress response (or "fight or flight" reaction), this method carries no religious or spiritual overtones. Its value has been documented in the reduction of blood pressure and other bodily stress responses. Like other forms of meditation, it can be learned on one's own, but time and practice are required to elicit the desired relaxation state.
• Progressive muscle relaxation: Progressive muscle relaxation is a method developed in the 1930s in which muscle groups are tightened and then relaxed in succession. This method is based upon the idea that mental relaxation will be a natural outcome of physical relaxation. Although muscle activity is involved, this technique requires no special skills or conditioning, and it can be learned by almost anyone. Progressive muscle relaxation is generally practiced for 10-20 minutes a day. As with the relaxation response, practice and patience are required for maximum benefits.

• Qigong: The martial art qigong is an ancient Chinese health-care system that combines physical training (such as isometrics, isotonics, and aerobic conditioning) with Eastern philosophy and relaxation techniques. There are many different kinds of qigong, including medical qigong. Some forms are practiced while standing, sitting, or lying down; others involve structured movements or massage. Over 70 million Chinese practice some form of qigong daily. Qigong has been used for centuries in China for the treatment of a variety of medical conditions. Learning qigong involves time, commitment, patience, and determination, and learning from a master or group is advisable. Since this technique involves physical exertion, check with your doctor before beginning, particularly if you have a chronic medical condition or are over 40 years old.

• Tai chi: Like qigong, tai chi is a Chinese martial art. It has been termed a kind of "meditation in motion" and is characterized by soft, flowing movements that stress precision and force. Also known as tai chi chuan, this method is thousands of years old. As with qigong, training from a master is necessary to learn the art of tai chi. Again, since motion and force are required, check with your doctor before beginning training.

• Yoga: There are many forms of yoga, an ancient Indian form of exercise based upon the premise that the body and breathing are connected with the mind. The practice of yoga is thought to be over 5,000 years old. One goal of yoga is to restore balance and harmony to the body and emotions through numerous postural and breathing exercises. Yoga, which means "joining" or "union" in Sanskrit, has been called the "search for the soul" and the "union between the individual and the divine." Among the benefits of yoga are increased flexibility and capability for relaxation. No special level of conditioning is required; yoga can be learned by nearly anyone. Classes, books, and videos are widely available. Those with special or chronic physical conditions will want to get clearance from their doctor before beginning.

       Article taken from

       http://www.medicinenet.com/stress_management_techniques/

Health benefits of Yoga

Studies of the benefits of yoga are only beginning to accumulate and so the evidence is not overwhelming or conclusive at this point. One of the problems with the studies is that they are done with small numbers of subjects which can make firm conclusions sketchy, and many are conducted in India and published only in foreign medical journals, making it difficult to know what rigorous standards the journals place on the researchers. However, this is not to say that yoga isn't good for you, and the short list of studies may indicate a trend toward, or possibility of, benefits. Below is a brief review of some of the available yoga research.

High blood pressure (hypertension). 
Many people believe that practicing yoga can help lower blood pressure by teaching breathing techniques and reducing stress. It is true that lifestyle changes like regular physical activity and stress management can help lower and manage blood pressure, but it doesn't do so in all cases. As for yoga, there hasn't been enough research to make firm claims. The American Heart Association Report on Prevention, Evaluation, and Treatment of High Blood Pressure does not mention yoga even once. However, there is some indication that yoga can help. In one study, small but significant reductions in blood pressure were shown in just three weeks of daily yoga, and in another study, one hour of daily yoga for 11 weeks revealed that both medication and yoga were effective in controlling hypertension. In one of the best quantitative studies, systolic blood pressure (the top number) decreased from 142 to 126mmHg and diastolic blood pressure (the bottom number) decreased from 86 to 75mmHg after 40 days of a yoga regimen. These results do not mean that you should stop taking your blood pressure medication if you start practicing yoga (you should never go off medication without the approval of your doctor). More research needs to be done, but I think it's fair to say that if yoga helps you manage stress, calm yourself, and gets your muscles toned and strong, then there's at least a chance it can help with blood pressure, too.
 
Mood. After just one yoga class, men reported decreases in tension, fatigue, and anger after yoga, and women reported fairly similar mood benefits. It's well known that physical activity has a mood-elevating effect, and yoga ought to fit right in.

Cognition and quality of life. A group of 135 men and women 65-85 years of age participated in six months of Hatha yoga classes, and at the end of the study, they reported improvements in quality of life, well-being, energy, and fatigue. They also did better on balance (one-legged standing) and forward flexibility (bending).


Diabetes. There is some evidence to suggest that yoga may lower blood glucose. After just eight days of yoga in 98 men and women 20-74 years of age, fasting glucose was better than at the beginning of the study, but subjects in this study were also exposed to dietary counseling and other lifestyle interventions, and so it's difficult to know if the yoga on its own was responsible for the changes.


Carpal tunnel syndrome. Individuals with carpal tunnel syndrome who did yoga twice a week for eight weeks had less pain in their wrists than people with carpal tunnel who wore a splint. The effect may be due to improved grip strength in the yoga subjects.


Strength and flexibility. In one of the most persuasive yoga studies, men and women 18-27 years of age who participated in two yoga sessions per week for eight weeks increased the strength in their arms from 19% to 31%, and by 28% in their legs. Their ankle flexibility, shoulder elevation, trunk extension, and trunk flexion increased by 13%, 155%, 188%, and 14%, respectively!


Asthma. There is some evidence to show that reducing symptoms of asthma and even reduction in asthma medication are the result of regular yoga. Again, this doesn't mean that you should stop taking your asthma medication if you start practicing yoga, but it does suggest that there could be some positive result, and you should ask your doctor if you have a question about it.


Independent of studies, I think it's fair to say that the majority of people who practice yoga regularly enjoy it and find it beneficial, otherwise they probably would not continue. I believe it's worth trying if you have even the slightest interest.

Physical Therapy and Back Pain

After an episode of low back pain has lasted between two and six weeks, or if there are frequent recurrences of low back pain, it is reasonable to consider back pain exercises and physical therapy for back treatment. (Some spine specialists consider back exercise and physical therapy sooner, particularly if the pain is severe.) In general, the goals of back pain exercises and physical therapy are to decrease back pain, increase function, and provide education on a maintenance program to prevent further recurrences.
 
There are many different forms of physical therapy. Acutely, the therapist may focus on decreasing pain with passive physical therapy (modalities). These are considered passive therapies because they are done to the patient. Examples of modalities include:

Heat/ice packs
TENS units
Iontophoresis
Ultrasound

In addition to passive therapies, active physical therapy (exercise) is also necessary to rehabilitate the spine. Generally, a patient’s back exercise program should encompass a combination of the following:
Stretching for back pain exercise
Strengthening for back pain exercise
Low-impact aerobic conditioning

Even patients with a very busy schedule should be able to maintain a moderate back pain exercise regimen that encompasses stretching, strengthening, and aerobic conditioning. These exercises suffice as physical therapy for back pain relief.

Stretching for back pain exercises. 
Almost every individual who has suffered from low back pain should stretch their hamstring muscles once or twice daily. Simple hamstring stretching does not take much time, although it can be difficult to remember, especially if there is little or no pain. Therefore, hamstring stretching exercises are best done at the same time every day so it becomes part of a persons daily routine.

Strengthening for back pain exercise. 
To strengthen the back muscles, 15-20 minutes of dynamic lumbar stabilization or other prescribed exercises should be done every other day.

Low-impact aerobic conditioning.
Low impact aerobics (such as walking, bicycling or swimming) should be done for 30-40 minutes three times weekly, on alternate days from the strengthening exercises.

Manual Physical Therapy

Manual Physical Therapy for Pain Relief

• Many patients arrive at their first physical therapy appointment expecting to receive hot packs, ultrasound and instructions on how to complete a series of exercises. These modalities are warranted in many instances and most therapists would agree that exercise is needed to help restore muscle imbalances. However, many therapists now approach the restoration of function from a different perspective. These therapists are interested in why a muscle isn’t functioning properly and view back exercise not as the driving mode of recovery but as a complement to manual therapy. They may, for instance, look to restore proper sacroiliac or lumbar joint function to treat piriformis syndrome rather then directly manipulate the piriformis muscle through exercise.
  

Manual physical therapy is a specialized form of physical therapy delivered with the hands as opposed to a device or machine. In manual therapy, practitioners use their hands to put pressure on muscle tissue and manipulate joints in an attempt to decrease back pain caused by muscle spasm, muscle tension and joint dysfunction.

Manual Physical Therapy is Less Established for Back Pain Management

While all physical therapists have the option to use manual therapy in their practices, many don’t spend the time or the resources to become efficient in this area of practice. Patients should be aware that it is a lesser known physical therapy technique among physicians and may not be as commonly prescribed. Also, many of the conditions that practitioners treat with manual therapy are not demonstrated with imaging or lab tests but rather during motion testing and treatment, and therefore insurance company reimbursement may be limited.

While patients may be referred for physical therapy treatment by their primary care doctor, an orthopedic surgeon, or other doctor involved in their back care, most states have direct access laws permitting patients to seek help for low back pain from a licensed physical therapist without having to seek a written referral.

Manual Physical Therapy can Offer Pain Relief for Acute and Chronic Back Pain

Manual therapy can be helpful for the treatment of joints that lack adequate mobility and range of motion in certain musculo-skeletal conditions. This limitation can cause discomfort, pain, and an alteration in function, posture, and movement. Manual physical therapy involves restoring mobility to stiff joints and reducing muscle tension in order to return the patient to more natural movement without pain. Thus, manual physical therapy may provide back pain relief both for patients with chronic back pain involving joint problems, such as sacroiliac joint dysfunction , and acute back pain from soft tissue injuries such as a back muscle strain or a pulled back ligament. Although extensive clinical studies have yet to be performed on all areas of manual therapy, limited clinical data and patient reports support the assertion that manual physical therapy can be effective in relieving back pain for certain patients.

As a group, manual physical therapy techniques are aimed at relaxing tense back muscles and restricted joints in order to decrease back pain and increase flexibility. In general, manual physical therapy techniques employ the following types of movement:

• Soft tissue work, including massage, which applies pressure to the soft tissues of the body such as the muscles. This pressure can help relax muscles, increase circulation, break up scar tissue, and ease pain in the soft tissues.
• Mobilization/manipulation, which uses measured movements of varying speed (slow to fast), force (gentle to forceful), and distances (called ‘amplitude’) to twist, pull, or push bones and joints into position. This can help loosen tight tissues around a joint, reduce pain in a joint and surrounding tissue, and help with flexibility and alignment.

The following page covers the specific manual physical therapy techniques that are designed to alleviate low back pain related to muscle spasm, muscle tension and joint problems.

Pain

Types Of Pain

Pain is your main guide with an injury. You will have to monitor your own pain during each exercise. In very simple terms, there are 2 types of pain:

• Pain due to stiffness.. this pain is bearable for the duration of your exercises. It will ease soon after you finish. This pain is basically telling you that your muscle is a bit out of practice and needs to be eased back in to working order. So it's OK to experience this pain. It will range from little or no pain to quite severe.
• Pain due to damage.. this pain is definitely NOT OK. It will range from unbearable to the point where you're screaming in agony (try to stop before you get to that stage!). It will carry on long after your exercises and may not ease for a few days. This pain is telling you that your muscle is still highly damaged and isn't ready to be exercised yet. If you experience this pain then stop your exercise immediately.

The amount of exercise you do depends on your monitoring of your pain. As with any other exercise, listen to your body.
If the pain is bearable and eases off soon after, then you've done the correct amount. So next time you could do the same amount and gradually increase it according to your pain.
If the pain is nearing severe and takes much longer to ease after, then you've probably pushed yourself too hard. Next time reduce the amount of repetitions you do and reassess your pain.
The best way to do these physiotherapy exercises is to set yourself a plan. For example, if your pain allows you to exercise 3 times a day, then write down the times and your pain response after each time. Stick to this plan everyday, and adjust it according to your pain and improvements in stiffness.
Your focus during each exercise should be on the quality of movement.Don't try and get through the repetitions as quickly as possible. You'll lose focus of the proper movement and it won't do you any good. Slow, smooth movements, with your focus strictly on the muscle/joint you're working, are best. 

History of Yoga

A Complete Overview of the Yoga History

The saying, "What's in the past, should stay in the past" - doesn't work here.

We might already have an idea of what Yoga is but to understand it better, we have to know what it has become as well as its roots and beginnings. A quick look at the history of Yoga will help us appreciate its rich tradition and who knows, it might help us incorporate Yoga into our lives. 

Although Yoga is said to be as old as civilization, there is no physical evidence to support this claim. Earliest archaeological evidence of Yoga's existence could be found in stone seals which depict figures of Yoga Poses. The stone seals place Yoga's existence around 3000 B.C. 


Scholars, however, have a reason to believe that Yoga existed long before that and traced its beginnings in Stone Age Shamanism. Both Shamanism and Yoga have similar characteristics particularly in their efforts to improve the human condition at that time. Also, they aim to heal community members and the practitioners act as religious mediators. Though we know Yoga as focusing more on the self, it started out as community-oriented before it turned inward. 

For a better discussion of the history of Yoga, we could divide it into four periods: the Vedic Period, Pre-Classical Period, Classical Period, and Post-Classical Period. 

Vedic Period

The existence of the Vedas marks this period. The Vedas is the sacred scripture of Brahmanism that is the basis of modern-day Hinduism. It is a collection of hymns which praise a divine power. The Vedas contains the oldest known Yogic teachings and as such, teachings found in the Vedas are called Vedic Yoga. This is characterized by rituals and ceremonies that strive to surpass the limitations of the mind. 

During this time, the Vedic people relied on rishis or dedicated Vedic Yogis to teach them how to live in divine harmony. Rishis were also gifted with the ability to see the ultimate reality through their intensive spiritual practice. It was also during this time that Yogis living in seclusion (in forests) were recorded.

Pre-Classical Yoga

The creation of the Upanishads marks the Pre-Classical Yoga. The 200 scriptures of the Upanishads (the conclusion of the revealed literature) describe the inner vision of reality resulting from devotion to Brahman. These explain three subjects: the ultimate reality (Brahman), the transcendental self (atman), and the relationship between the two. The Upanishads further explain the teachings of the Vedas. 

Yoga shares some characteristics not only with Hinduism but also with Buddhism that we can trace in its history. During the sixth century B.C., Buddha started teaching Buddhism, which stresses the importance of Meditation and the practice of physical postures. Siddharta Gautama, the first Buddhist to study Yoga, achieved enlightenment at the age of 35. 

Later, around 500" class="related_products_container" B.C., the Bhagavad-Gita or Lord's Song was created and this is currently the oldest known Yoga scripture. It is devoted entirely to Yoga and has confirmed that it has been an old practice for some time. However, it doesn't point to a specific time wherein Yoga could have started. The central point to the Gita is that - to be alive means to be active and in order to avoid difficulties in our lives and in others, our actions have to benign and have to exceed our egos. 

Just as the Upanishads further the Vedas, the Gita builds on and incorporates the doctrines found in the Upanishads. In the Gita, three facets must be brought together in our lifestyle: Bhakti or loving devotion, Jnana which is knowledge or contemplation, and Karma which is about selfless actions. The Gita then tried to unify Bhakti Yoga, Jnana Yoga, and Karma Yoga and it is because of this that it has gained importance. The Gita was a conversation between Prince Arjuna and God-man Krishna and it basically stresses the importance of opposing evil. 

Classical Period

The Classical Period is marked by another creation - the Yoga Sutra. Written by Patanjali around the second century, it was an attempt to define and standardize Classical Yoga. It is composed of 195 aphorisms or sutras (from the Sanskrit word which means thread) that expound upon the Raja Yoga and its underlying principle, Patanjali's Eightfold path of Yoga (also called Eight Limbs of Classical Yoga). These are: 

1. Yama, which means social restraints or ethical values;
2. Niyama, which is personal observance of purity, tolerance, and study;
3. Asanas or physical exercises;
4. Pranayama, which means breath control or regulation;
5. Pratyahara or sense withdrawal in preparation for Meditation;
6. Dharana, which is about concentration;
7. Dhyana, which means Meditation; and
8. Samadhi, which means ecstasy.

Patanjali believed that each individual is a composite of matter (prakriti) and spirit (purusha). He further believed that the two must be separated in order to cleanse the spirit - a stark contrast to Vedic and Pre-Classical Yoga that signify the union of body and spirit. 

Patanjali's concept was dominant for some centuries that some Yogis focused exclusively on Meditation and neglected their Asanas. It was only later that the belief of the body as a temple was rekindled and attention to the importance of the Asana was revived. This time, Yogis attempted to use Yoga techniques to change the body and make it immortal. 

Post-Classical Yoga

At this point, we see a proliferation of literature as well as the practice of Yoga. Post-classical Yoga differs from the first three since its focus is more on thepresent. It no longer strives to liberate a person from reality but rather teaches one to accept it and live at the moment. 

Yoga was introduced in the West during the early 19th century. It was first studied as part of Eastern Philosophy and began as a movement for health and vegetarianism around the 1930's. By the 1960's, there was an influx of Indian teachers who expounded on Yoga. One of them was Maharishi Mahesh, the Yogi who popularized Transcendental Meditation. Another one is a prominent Yoga Guru Swami Sivananda. Sivananda was a doctor in Malaysia and he later opened schools in America and Europe. The most prominent of his works is his modified Five Principles of Yoga which are:

1. Savasana or proper relaxation;
2. Asanas or proper exercise;
3. Pranayama or proper breathing;
4. Proper diet; and
5. Dhyana or positive thinking and Meditation

Sivananda wrote more than 200 books on Yoga and Philosophy and had many disciples who furthered Yoga. Some of them were Swami Satchitananda who introduced chanting and Yoga to Woodstock; Swami Sivananada Radha who explored the connection between psychology and Yoga, and Yogi Bhajan who started teachingKundalini Yoga in the 70's. 


Up to this day, Yoga continues to proliferate and spread its teachings, crossing the boundaries of culture and language. 

Yoga Sutras of Patanjali

Yoga Sutras of Patanjali
Pada (Chapter)	English meaning	Sutras
Samadhi Pada	On being absorbed in spirit	51
Sadhana Pada	On being immersed in spirit	55
Vibhuti Pada	On supernatural abilities and gifts	56
Kaivalya Pada	On absolute freedom	34

In Hindu philosophy, Yoga is the name of one of the six orthodox philosophical schools. The Yoga philosophical system is closely allied with the Samkhya school.The Yoga school as expounded by the sage Patanjali accepts the Samkhya psychology and metaphysics, but is more theistic than the Samkhya, as evidenced by the addition of a divine entity to the Samkhya's twenty-five elements of reality. The parallels between Yoga and Samkhya were so close that Max Müller says that "the two philosophies were in popular parlance distinguished from each other as Samkhya with and Samkhya without a Lord...." The intimate relationship between Samkhya and Yoga is explained by Heinrich Zimmer:

These two are regarded in India as twins, the two aspects of a single discipline. Sāṅkhya provides a basic theoretical exposition of human nature, enumerating and defining its elements, analyzing their manner of co-operation in a state of bondage ("bandha"), and describing their state of disentanglement or separation in release ("mokṣa"), while Yoga treats specifically of the dynamics of the process for the disentanglement, and outlines practical techniques for the gaining of release, or "isolation-integration" ("kaivalya").

Patanjali is widely regarded as the founder of the formal Yoga philosophy. Patanjali's yoga is known as Raja yoga, which is a system for control of the mind. Patanjali defines the word "yoga" in his second sutra, which is the definitional sutra for his entire work:

This terse definition hinges on the meaning of three Sanskrit terms. I. K. Taimni translates it as "Yoga is the inhibition (nirodhaḥ) of the modifications (vṛtti) of the mind (citta)". The use of the word nirodhaḥ in the opening definition of yoga is an example of the important role that Buddhist technical terminology and concepts play in the Yoga Sutra; this role suggests that Patanjali was aware of Buddhist ideas and wove them into his system.Swami Vivekananda translates the sutra as "Yoga is restraining the mind-stuff (Citta) from taking various forms (Vrittis)."

Yama (The five "abstentions"): non-violence, non-lying, non-covetousness, non-sensuality, and non-possessiveness.Patanjali's writing also became the basis for a system referred to as "Ashtanga Yoga" ("Eight-Limbed Yoga"). This eight-limbed concept derived from the 29^th Sutra of the 2^nd book, and is a core characteristic of practically every Raja yoga variation taught today. The Eight Limbs are:

1. Niyama (The five "observances"): purity, contentment, austerity, study, and surrender to god.
2. Asana: Literally means "seat", and in Patanjali's Sutras refers to the seated position used for meditation.
3. Pranayama ("Suspending Breath"): Prāna, breath, "āyāma", to restrain or stop. Also interpreted as control of the life force.
4. Pratyahara ("Abstraction"): Withdrawal of the sense organs from external objects.
5. Dharana ("Concentration"): Fixing the attention on a single object.
6. Dhyana ("Meditation"): Intense contemplation of the nature of the object of meditation.
7. Samādhi ("Liberation"): merging consciousness with the object of meditation.

In the view of this school, the highest attainment does not reveal the experienced diversity of the world to be illusion. The everyday world is real. Furthermore, the highest attainment is the event of one of many individual selves discovering itself; there is no single universal self shared by all persons.

History of and Branches in Physical therapy

History

Physicians like Hippocrates and later Galenus are believed to have been the first practitioners of physical therapy, advocating massage, manual therapy techniques and hydrotherapy to treat people in 460 B.C. After the development of orthopedics in the eighteenth century, machines like the Gymnasticon were developed to treat gout and similar diseases by systematic exercise of the joints, similar to later developments in physical therapy.

The earliest documented origins of actual physical therapy as a professional group date back to Per Henrik Ling, “Father of Swedish Gymnastics,” who founded the Royal Central Institute of Gymnastics (RCIG) in 1813 for massage, manipulation, and exercise. The Swedish word for physical therapist is “sjukgymnast” = “sick-gymnast.” In 1887, PTs were given official registration by Sweden’s National Board of Health and Welfare.

Other countries soon followed. In 1894 four nurses in Great Britain formed the Chartered Society of Physiotherapy.The School of Physiotherapy at the University of Otago in New Zealand in 1913, and the United States' 1914 Reed College in Portland, Oregon, which graduated "reconstruction aides."

Modern physical therapy was established in Britain towards the end of the 19th century. Soon following American orthopedic surgeons began treating children with disabilities and began employing women trained in physical education, massage, and remedial exercise. These treatments were applied and promoted further during the Polio outbreak of 1916. During the First World War women were recruited to work with and restore physical function to injured soldiers, and the field of physical therapy was institutionalized. In 1918 the term "Reconstruction Aide" was used to refer to individuals practicing physical therapy. The first school of physical therapy was established at Walter Reed Army Hospital in Washtington D.C. following the outbreak of World War I.

Research catalyzed the physical therapy movement. The first physical therapy research was published in the United States in March 1921 in "The PT Review." In the same year, Mary McMillan organized the Physical Therapy Association (now called the American Physical Therapy Association (APTA). In 1924, the Georgia Warm Springs Foundation promoted the field by touting physical therapy as a treatment for polio

Treatment through the 1940s primarily consisted of exercise, massage, and traction. Manipulative procedures to the spine and extremity joints began to be practiced, especially in the British Commonwealth countries, in the early 1950s. Later that decade, physical therapists started to move beyond hospital-based practice to outpatient orthopedic clinics, public schools, colleges/universities, geriatric settings (skilled nursing facilities), rehabilitation centers and medical centers.

In 1921 in the United States physical therapists formed the first professional association called the American Women's Physical Therapeutic Association. This gave birth to what is known today as the APTA (American Physical Therapy Association), and currently represents approximately 76,000 members throughout the United States. The APTA defines physical therapy as: "clinical applications in the restoration, maintenance, and promotion of optimal physical function."

Specialization for physical therapy in the U.S. occurred in 1974, with the Orthopaedic Section of the APTA being formed for those physical therapists specializing in orthopaedics. In the same year, the International Federation of Orthopaedic Manipulative Physical Therapists was formed, which has ever since played an important role in advancing manual therapy worldwide.

Education

World Confederation of Physical Therapy (WCPT) recognises there is considerable diversity in the social, economic, cultural, and political environments in which physical therapist education is conducted throughout the world. WCPT recommends physical therapist entry-level educational programs be based on university or university-level studies, of a minimum of four years, independently validated and accredited as being at a standard that accords graduates full statutory and professional recognition. WCPT acknowledges there is innovation and variation in program delivery and in entry-level qualifications, including first university degrees (Bachelors/Baccalaureate/Licensed or equivalent), Masters and Doctorate entry qualifications. What is expected is that any program should deliver a curriculum that will enable physical therapists to attain the knowledge, skills, and attributes described in these guidelines. Professional education prepares physical therapists to be autonomous practitioners, that may work in collaboration with other members of the health care team.

Physical therapist entry-level educational programs integrate theory, evidence and practice along a continuum of learning. This begins with admission to an accredited physical therapy program and ending with retirement from active practice.

206 of 213 accredited physical therapy programs in the US are accredited at the doctoral level offering the Doctor of Physical Therapy degree (DPT)

The physical therapist professional curriculum includes content and learning experiences in the clinical sciences (e.g., content about the cardiovascular, pulmonary, endocrine, metabolic, gastrointestinal, genitourinary, integumentary, musculoskeletal, and neuromuscular systems and the medical and surgical conditions frequently seen by physical therapists)

Curriculum related to Patient/Client Management includes:

• Screening to determine when patients/clients need further examination or consultation by a physicaltherapist or referral to another health care professional.
• Examination: Examine patients/clients by obtaining a history from them and from other sources. Examine patients/clients by performing systems reviews. Examine patients/clients by selecting and administering culturally appropriate and age related tests and measures. Tests and measures include, but are not limited to, those that assess: a. Aerobic Capacity/Endurance, b. Anthropometric Characteristics, c. Arousal, Attention, and Cognition, d. Assistive and Adaptive Devices, e. Circulation (Arterial, Venous, Lymphatic), f. Cranial and Peripheral Nerve Integrity, g. Environmental, Home, and Work (Job/School/Play) Barriers, h. Ergonomics and Body Mechanics, i. Gait, Locomotion, and Balance, j. Integumentary Integrity, k. Joint Integrity and Mobility, l. Motor Function (Motor Control and Motor Learning), m. Muscle Performance (including Strength, Power, and Endurance), n. Neuromotor Development and Sensory Integration, o. Orthotic, Protective, and Supportive Devices, p. Pain, q. Posture, r. Prosthetic Requirements, s. Range of Motion (including Muscle Length), t. Reflex Integrity, u. Self-Care and Home Management (including activities of daily living [ADL] and instrumental activities of daily living [IADL]), v. Sensory Integrity, w. Ventilation and Respiration/Gas Exchange, x. Work (Job/School/Play), Community, and Leisure Integration or Reintegration (including IADL)
• Evaluation: Evaluate data from the examination (history, systems review, and tests and measures) to make clinical judgments regarding patients/clients.
• Diagnosis: Determine a diagnosis that guides future patient/client management.
• Prognosis: Determine patient/client prognoses.
• Plan of Care: Collaborate with patients/clients, family members, payers, other professionals, and other individuals to determine a plan of care that is acceptable, realistic, culturally competent, and patient-centered.
• Intervention:Provide physical therapy interventions to achieve patient/client goals and outcomes. Interventions include: a. Therapeutic Exercise, b. Functional Training in Self-Care and Home Management, c. Functional Training in Work (Job/School/Play), Community, and Leisure Integration or Reintegration, d. Manual Therapy Techniques (including Mobilization/Manipulation Thrust and Nonthrust Techniques), e. Prescription, Application, and, as Appropriate, Fabrication of Devices and Equipment, f. Airway Clearance Techniques, g. Integumentary Repair and Protection Techniques, h. Electrotherapeutic Modalities,
• Provide effective culturally competent instruction to patients/clients and others to achieve goals and outcomes.
• Prevention, Health Promotion, Fitness, and Wellness: Provide culturally competent physical therapy services for prevention, health promotion, fitness, and wellness to individuals, groups, and communities. Apply principles of prevention to defined population groups.
• Students completing a Doctor of Physical Therapy program are also required to successfully complete clinical internships prior to graduation.

Specialty areas

Because the body of knowledge of physical therapy is quite large, some PTs specialize in a specific clinical area. While there are many different types of physical therapy, theAmerican Board of Physical Therapy Specialties list eight specialist certifications.

Cardiovascular & Pulmonary

Cardiovascular and pulmonary rehabilitation physical therapists treat a wide variety of individuals with cardiopulmonary disorders or those who have had cardiac or pulmonary surgery. Primary goals of this specialty include increasing endurance and functional independence. Manual therapy is used in this field to assist in clearing lung secretions experienced withcystic fibrosis. Disorders, including heart attacks, post coronary bypass surgery, chronic obstructive pulmonary disease, and pulmonary fibrosis, treatments can benefit from cardiovascular and pulmonary specialized physical therapists.

Clinical Electrophysiology

This specialty area encompasses electrotherapy/physical agents, electrophysiological evaluation (EMG/NCV), physical agents, and wound management.

Geriatric

Geriatric physical therapy covers a wide area of issues concerning people as they go through normal adult aging but is usually focused on the older adult. There are many conditions that affect many people as they grow older and include but are not limited to the following: arthritis, osteoporosis, cancer, Alzheimer's disease, hip and joint replacement, balance disorders,incontinence, etc. Geriatric physical therapists specialize in treating older adults.

Integumentary

Integumentary (treatment of conditions involving the skin and related organs). Common conditions managed include wounds and burns. Physical therapists utilize surgical instruments, mechanical lavage, dressings and topical agents to debride necrotic tissue and promote tissue healing. Other commonly used interventions include exercise, edema control, splinting, and compression garments.

Neurological

Neurological physical therapy is a field focused on working with individuals who have a neurological disorder or disease. These include Alzheimer's disease, Charcot-Marie-Tooth disease (CMT), ALS, brain injury, cerebral palsy, multiple sclerosis, Parkinson's disease, spinal cord injury, and stroke. Common impairments associated with neurologic conditions include impairments of vision, balance, ambulation, activities of daily living, movement, muscle strength and loss of functional independence. Physiotherapy can address many of these impairments and aid in restoring and maintaining function, slowing disease progression, and improving quality of life.

Orthopedic

Orthopedic physical therapists diagnose, manage, and treat disorders and injuries of the musculoskeletal system including rehabilitation after orthopaedic surgery. This specialty of physical therapy is most often found in the out-patient clinical setting. Orthopedic therapists are trained in the treatment of post-operative orthopedic procedures, fractures, acute sports injuries, arthritis, sprains, strains, back and neck pain, spinal conditions and amputations.

Joint and spine mobilization/manipulation, therapeutic exercise, neuromuscular reeducation, hot/cold packs, and electrical muscle stimulation (e.g., cryotherapy, iontophoresis,electrotherapy) are modalities often used to expedite recovery in the orthopedic setting. Additionally, an emerging adjunct to diagnosis and treatment is the use of sonography for diagnosis and to guide treatments such as muscle retraining. Those who have suffered injury or disease affecting the muscles, bones, ligaments, or tendons will benefit from assessment by a physical therapist specialized in orthopedics.

Vestibular

Vestibular physiotherapy often coexists with neurological or orthopedic programs. Physiotherapists with knowledge in vestibular rehabilitation can effectively reduce the symptoms associated with vestibular conditions (vertigo, disequilibrium, mobility and balance disturbances) through the use of individualized intervention programs.Vestibular rehabilitation usually includes one or more of the following: education, physical repositioning maneuvers, balance and gait exercises, and head and body positioning techniques. Vestibular rehabilitation is shown to be highly effective in the reduction of symptoms due to unilateral peripheral vestibular dysfunctions (vestibular neuritis, Ménière's disease, following vestibular surgery, benign paroxysmal positional vertigo).

Vestibular physiotherapists are also essential in identifying vestibular symptoms that may be related to a more severe condition and making referrals onto the appropriate medical professional for further investigation.

Pediatric

Pediatric physical therapy assists in early detection of health problems and uses a wide variety of modalities to treat disorders in the pediatric population. These therapists are specialized in the diagnosis, treatment, and management of infants, children, and adolescents with a variety of congenital, developmental, neuromuscular, skeletal, or acquired disorders/diseases. Treatments focus on improving gross and fine motor skills, balance and coordination, strength and endurance as well as cognitive and sensory processing/integration. Children with developmental delays, cerebral palsy, spina bifida, or torticollis may be treated by pediatric physical therapists.

Sports

Physical therapists can be involved in the care of athletes from recreational to professional and Olympians. This area of practice (Athletic Training) includes athletic injury management, including acute care, treatment and rehabilitation, prevention, and education.

Women's health

Women's health physical therapy addresses women's issues related to child birth, and post partum. These conditions include lymphedema, osteoporosis, pelvic pain, prenatal and post partum periods, and urinary incontinence.