Book Reviews
Medical Therapeutic Yoga: Biopsychosocial
Rehabilitation and Wellness Care by Ginger Garner,
PT, DPT, ATC/LAT, PYT. Handspring Publishing
Limited, Edinburgh. 2016. Soft cover, 381 pages. $50
We were drawn to this text written by a fellow
physical therapist because we see the benefits of a
yoga practice and its integration in our physical ther-
apy practice. Physical therapists perform evaluations
to establish a diagnosis, and this leads to analyzing
yoga poses and movements throughout a series of
asanas to provide necessary information to reach a
diagnosis by revealing strength, range of motion, flex-
ibility, balance, breath, and coordination.
The well-credentialed Dr Garner founded the
Professional Yoga Therapy Institute and developed a
Medical Therapeutic Yoga (MYT) teacher certifica-
tion program for health care professionals. Dr Garner
invites the medical and yoga worlds, both worlds she
lives in, to partner together to form a “biopsychoso-
cial” model of care. Along with many yoga practicing
physical therapists, Dr Garner would like to see a more
scientific yoga used medically in the rehabilitation of the
“whole” person as the term “biopsychosocial” denotes.
Initially, Dr Garner espouses the philosophy of
yoga, discusses concepts of stability and mobility, and
examines breathing patterns. Algorithms are present-
ed both to evaluate functional stability/mobility and
to assist in progressing and sequencing yoga poses. Dr
Garner makes a case that yoga is much more than “a
form of physical movement.” Her 10 precepts/guide-
lines for Medical Yoga Therapy include the establish-
ment of yoga education programs in health care to
protect the consumer. The precepts also include an
Ayurvedic evaluation and voice analysis, which is
unclear to these readers whether this is regarded as
a required expertise. One of the precepts calls for the
protection of cervical joints by teaching non–weight-
bearing headstands and shoulder stands. Dr Garner
makes an excellent case for avoiding cervical weight
bearing unless one is extremely experienced. Although
even the experienced practitioner may consider being
prudent by avoiding this practice to prevent dispro-
portionate cervical shear forces, repeated cervical
flattening and potentially dangerous axial loading as
outlined in the Semi-Inversions chapter.
Dr Garner stresses the importance of stability
before mobility, along with the neurophysiological
components, to be assessed and treated including
respiratory and pelvic floor diaphragms, neutral
spine, shoulder, hip, and knee joints. The chapter
on respiratory assessment describes the importance
of recognizing abnormal breathing patterns and
then defines 2 functional breath types: transver-
sus abdominis–assisted thoracodiaphragmatic breath
Journal of Women’s Health Physical Therapy
Copyright © 2018 Section on Women’s Health, American Physical Therapy Association. Unauthorized reproduction of this article is prohibited.
(TATD) and abdominodiagphragmatic breath (A-D).
These 2 breath types are thoroughly discussed and
must be learned, as they are the starting point of all
the poses discussed in the text. The TATD and A-T
breath types are familiar to women’s health physical
therapists, but the author has uniquely named them.
Breath and pelvic floor are a major part of the assess-
ment and treatment guidelines, making sure breath
work enhances poses without adding unwarranted
strain on the pelvic floor.
Chapters 6 to 10 include the yoga poses with Dr
Garner’s notes on prerequisites, goals, modifications,
cueing and tactile ideas, and contraindications for
the various postures. The descriptions are sometimes
difficult to follow, but the addition of photographs
helps a great deal along with the available videos via a
QR reader. In discussing standing postures, the com-
mon and critical yoga injuries secondary to hip and
shoulder impingement are pointed out. These issues
are discussed for the appropriate poses along with
the significance of initially evaluating for acetabular
and femoral morphologies (hip anteversion and ret-
roversion). She makes it clear that clinicians and yoga
teachers must be aware of these orthopedic issues
and be able to modify poses as warranted for both
the prevention and treatment of hip labral tears or
rotator cuff injuries. Neutral spine and protection of
knee joints are addressed specifically within each of
the chapters on various poses.
The final chapter focuses on incorporating yoga in
rehabilitation, with guidelines for intervention, neural
tension screens, a teacher’s checklist, and helpful ideas
about sequencing. Recommendations are made for
myofascial release and neural mobilization as needed.
She reminds readers that yoga is appropriate for both
acute and chronic conditions and that using outcome
measures will help promote the “creation of clinical
guidelines for the use of yoga in rehabilitation.”
This book covers some essential issues for women’s
health practitioners and yoga practitioners, but one
may find it necessary to further investigate Dr Garner’s
approach, as it is a demanding text. It reads like a text-
book and is used in Dr Garner’s MYT teacher certi-
fication program. Supplementary instructional videos
are accessible via QR reader to more fully study an
exercise/pose or learn a patient assessment. Included
are many free instructional videos, and more are avail-
able with a monthly or yearly subscription fee. There
are a short glossary and a voluminous reference list. It
is a book for the advanced practitioners of yoga and
health care practitioners familiar with yoga philoso-
phy, yoga poses, and orthopedic principles. Dr Garner
has developed some new vocabulary for her MYT
practitioners, and the style of writing is sometimes
© 2018 Section on Women’s Health, American Physical Therapy Association 55
Book Reviews
challenging, but with continued effort the method
becomes more obvious. Overall, we recommend this
book for women’s health physical therapists, with a
background in yoga, looking to include more of a
yogic approach in their treatment.
Patricia J. Jenkyns, PT, DPT, WCS
Rachael Percoco, MSPT, DPT
The Leadership Gap: What Gets Between You and
Your Greatness by Lolly Daskal Portfolio/Penguin.
2017, 240 pages. ISBN 1101981350. Available in
Hardcover ($19.69), Kindle, Audiobook
This book is an essential guide for professionals
seeking to improve their own personal leadership
skills, whether it be for practice, educational, or cor-
porate administrative advancement or for their own
personal growth within their professional life. The
author serves as a guide to understand the definition
of the leadership gap and how the understanding of
the gap can change the way each person responds to
different situations that arise in the professional and
personal arena. She uses psychology, philosophy, and
her own experience to offer perspective on leadership.
How do you meet challenges? How do your respond
to adversity? Are you a risk taker? Are you a consensus
builder? Are you a courageous decision maker? Or, are
you a loyal member? These questions and more are
explained in a unique phenotype of leadership char-
acteristics that discuss both the positive and negative
qualities of each type. She expertly directs the readers
to objectively reflect upon their behaviors and habits
and how the different aspects of each phenotype can
paralyze or optimize their ability to lead. She explores
each of 7 leadership archetypes and its possible shadow
side. Real-world case studies are utilized to build the
understanding of the positive and negative aspects of
these categories from boardrooms and conversations
with industry leaders on what “leading from the gap’s”
impact is on behaviors, successes, and failures.
Lolly Daskal, author of the Leadership Gap, is
the founder of Leadership from Within, a global
leadership, executive coaching, and consulting firm
based in New York City. She has more than 30 years
of experience in coaching and consulting with the
world’s largest and most successful companies and
has written articles and columns for media includ-
ing INC, Harvard Business Review, Fast Company,
Huffington Post, and Psychology Today.
This leadership book is suggested for those read-
ers who want to build a stronger professional life
through relationship building, trust building, consen-
sus building, and leadership skill acquisition.
Susan C. Clinton, PT, DScPT, OCS, WCS,
FAAOMPT
56 © 2018 Section on Women’s Health, American Physical Therapy Association
Copyright © 2018 Section on Women’s Health, American Physical Therapy Association. Unauthorized reproduction of this article is prohibited.
Explain Pain Supercharged by G.L. Moseley and
D.S. Butler. 2017, NOI Publishers, available from
OPTP, 234 pages, soft cover, $170.
Lorimer Moseley and David Butler have done
it again by putting together an updated valuable
resource for physical therapists treating patients with
chronic pain. These 10 chapters are written for clini-
cians and rate high on the “scientific jargon meter.”
However, the book is written in their typical down-
to-earth writing style, with little comical inserts (page
9 has a table labeled “How are theories like farts?”).
Footnotes are included, which often lend a comical
clarification and keep the reading light.
Chapter one introduces the 6 target concepts of
pain and reviews the 4 current books that make up
the core of Neuro Orthopaedic Institute resourc-
es on pain neuroscience (Explain Pain, Explain
Pain Handbook: Protectometer, Painful Yarns, and
Explain Pain Supercharged). Chapters 2 and 3
expand on previous pain neuroscience biology.
Chapter 2 is about theories, and Chapter 3 has 49
pages and 115 references.
Evidence for pain neuroscience is covered in chapter
4, with 34 references. There are now 20 randomized
control trials and 4 systematic reviews on this modal-
ity, after only 15 years since neuroscience was first dis-
cussed. The authors point out that they purposefully
have tested the treatment extensively before releasing it
to be taught to others (as opposed to many treatments
that are taught in the university before they are fully
tested in the clinic). The systematic reviews, published
from 2011 to 2016, are summarized in a “serious data
table,” including possible bias from authors. A brief
review of interpreting research includes the definition
of the number needed to treat (NNT) a 50% decrease
in pain at 6 months. For pain neuroscience education
that number is 4; under 4 is “considered clinically
fabulous,” and gabapentin has an NNT of 6.3.
Chapter 5 looks at “conceptual change” and
“deep learning,” with much of the information taken
from solid education techniques. Factors related to
the message are covered, including educational level
of the content; delivery methods (spoiler alert: hand-
outs are not enough); multimedia learning, including
pictures and videos; and the type of learner (visual,
auditory, kinesthetic) that can synthesize the learning.
It points out that deep learning changes the thought
process and is ultimately related to action. When the
patient has achieved deep learning, these concepts can
also be transferred to other pains in the body and to
the pain of others. Types of misconceptions include
gaps in knowledge or many pieces of knowledge that
do not connect into one framework, or having beliefs
so set in stone that they are hard to modify.
Qualities of the deliverer are reviewed in
chapter 6. It is important that the therapist teaching the
Volume 42 • Number 1 • January/April 2018

information can “live explain pain” as a cognitive
lifestyle and has a deep understanding of pain neu-
roscience. It reviews cultivating education skills by
practicing explaining concepts to yourself and your
family and colleges. How to identify misconceptions
and learning style and how to create objectives are
included.
Metaphors and other linguistic structures are
described in much detail in chapter 7. Four types of
linguistic structure discussed are metaphor, simile,
metonym, and euphemism. Table 7.3 is quite inter-
esting, outlining the shift from “pain as the enemy”
(hence the need for painkillers) to “pain as the
protector”—a very important conceptual shift for
patients with chronic pain. Seven types of metaphors
are described in detail over the next 13 pages, with
alternative metaphors useful in physical therapy prac-
tice. Many examples of helpful and unhelpful meta-
phors are given.
Chapters 8 and 9 are “The Pain Library,”
which includes 71 “nuggets” (short stories, 2 to
3 paragraphs long) and 15 new “novellas” (lon-
ger stories of 1 to 2 pages, sometimes with pic-
tures). Novellas have historically been the bulk of
Explain Pain and Painful Yarns. Each novella has
linked concepts from the nuggets and additional
resources listing page numbers of other core texts,
all part of the start of a complex teaching style.
All stories are written in patient-friendly language
that could be read to the patient but would be
much better individualized and explained consid-
ering their own condition. Many can be modified
to fit pelvic pain.
The last chapter of the book is curriculum devel-
opment, with the 10 target concepts. It includes 4
fold-out sections: multisession training, 60-minute
Journal of Women’s Health Physical Therapy
Copyright © 2018 Section on Women’s Health, American Physical Therapy Association. Unauthorized reproduction of this article is prohibited.
Book Reviews
training, training specific to chronic low back pain,
and training specific to chronic regional pain syn-
drome. The table lists ways to express the concept,
content, delivery suggestions, novellas, nuggets,
and pages from other core texts, experiential learn-
ing suggestions, assessment techniques, and con-
siderations for learner, both in context and deliv-
ery. I did feel that my head was spinning looking at
the charts. The diagnosis-specific charts start with
a case study and give specifics on how the concepts
can be explained. This section took me quite some
time to digest, and I am not sure I have it all.
I found myself frequently flipping to the list of
abbreviations (about 60, many unique to this text) at
the beginning of the text. For those fully schooled in
NOI courses, it may not be so time-consuming. This
text is heavy with educational concepts and is ideal for
those in education and who have a strong understand-
ing of creating curriculum. I believe this is purposeful,
as not all PTs are educators and when pain neurosci-
ence education “doesn’t work” it is often because
it was not provided in a way that the patient could
achieve deep learning—the key to success. However,
I found some of the educational concepts and curricu-
lum development overwhelming. Every chapter has
up-to-date references, and there is an index in the back.
In summary, pain neuroscience education works
and is a valuable skill to have. This book is a valuable
tool for those seeking to be more effective teachers of
this modality.
Beth Shelly, PT, DPT, WCS, BCB PMD
Beth Shelly is a consultant for Analytica.
The other authors declare no conflicts of interest.
DOI: 10.1097/JWH.0000000000000097
© 2018 Section on Women’s Health, American Physical Therapy Association 57