Liz Gillem Duncanson PT, MPT, ATC, CSCS, PYT is a practicing physical therapist in Oakland, California. She is a proud graduate of the Professional Yoga Therapy Institute. She enthusiastically shares how this education has shaped her current delivery of health care. 
Liz has been consistently blending dance, medicine, pilates, yoga, sports conditioning, and athletic training with physical therapy in a special approach to physical rehabilitation. She assesses biomechanics and treats the human body as a whole, versus one body part at a time, through integrated lenses. She brings this uncommon skill set to her holistic physical therapy practice, Body Temple Physical Therapy. At Body Temple PT she is able to meet her clients’ needs outside the traditional realm of healthcare delivery and serves in a wellness model.
Body Temple PT is an integrative physical therapy practice providing wellness through concierge, slow medicine. We are a cash pay, private practice model, working outside of the traditional insurance-based health care system in Oakland, California. Our vision is to help clients regain their trust in their body’s innate ability to self heal. We value whole body health, including the mental and spiritual, and understand that the layers are interconnected and cannot be separated from our physical health. Our mission is to combine traditional physical therapy modalities with complementary and alternative modalities (CAM) such as yoga as a tool to realize whole body health.
I love this question. The short answer is that I was hiking the Inca Trail in Peru and had a mystical experience and revelation. Perhaps it was the altitude, or maybe it was the local bacteria talking to me through a foreign gut-biome. After hiking for three days and once we reached Machu Picchu, I had a clear perspective on my life. I climbed up onto the sacred peak behind the citadel. I took off my pack, laid out a sarong, and sat down for some yoga. After some focused breathing and stretching, I crossed my tired legs and meditated. During this meditation, a huge hummingbird appeared on a rainbow, behind my third eye. He flew right over the sacred valley, and told me it was time to quit my job, start a holistic practice, and call it “Body Temple”.
At home, in California, I was working in a typical, outpatient orthopedic physical therapy clinic. Management needed to save costs and pushed me to see more clients. So they encouraged me to only perform 15 – 20 minutes of manual therapy during an hour session. Not long after the “hummingbird incident,” I was assisting a patient on the treatment table. The aide came in to tell me that the next client was ready for me and the current client could come with him for their exercises. The client burst into tears. With frustration she asked me, “why can’t you work on me for the entire hour?” I told her, sadly, that I couldn’t, because of our current relationship with the clinic. But, wasn’t she just telling me that her husband complained of low back pain and was looking for a personal trainer?
It was 2005 and California had recently updated their legal definition of PT practice to include interventions for wellness¹. It was clear that I could now see personal training clients for wellness without taking off my physical therapy hat. I could also, with professional discretion, use manual treatment (a physical therapy intervention) with wellness clients and without a doctor’s prescription.
The courage provided from my mystical experience in Peru combined with the changing laws in California opened up the opportunity to see private clients on my off days. I purchased a massage table for $310 and started making house calls for personal training right away. It was clear, with my additional certifications (athletic training and personal training) that I was working under the wellness statute. It was an easy jump to some additional income. The laws were such that I could file my business as my name and credentials. My business name was “Liz Gillem PT ATC CSCS”.
I transitioned to self-employment full time slowly, yet organically. It only took a few more months before I decided that I really loved this new delivery of wellness physical therapy. There was something intimate and creative about lugging a giant massage table into someone’s home.
I felt a permanent change after that trip to Peru. It sparked something in me and I began studying the sacred feminine. I was deep in my feminist studies and was accepted into and participated in a PhD program in Women’s Studies. This lead me to serious questioning of our country’s healthcare system and general inequality of income and women. From the top of the Andes, the correlation between our systematic raping of the earth for material goods looks no different than the rampant inequalities women face in the workplace and in healthcare. 
Ten years ago this month, I quit my full-time job in orthopedics to pursue a doctorate degree. I had a financial cushion (student loan) and I was happy as a clam. Ironically, school kept getting in the way of all the new clients asking for my help. After only two semesters in my pursuit of a doctoral life, I did the math. It was silly to take out more student loans. I could read and write on my own time and actually make money with my “side job”.
So that’s it, the Universe kept sending me private clients and I accepted them. When my schedule became too full for house calls, I rented space at a chiropractic clinic. Then when my husband and I were able to buy a house, we purchased a home that came already equipped with a room that had its own bathroom and a separate entrance for clients. When the taxes became too complicated for being self-employed, we incorporated, and the hummingbird already provided the name.
Utilizing yoga as a tool in healthcare delivery has eliminated the burden on myself to heal everyone passively. I find myself telling clients “this is physical therapy and I am going to teach you how to heal yourself, actively.” At first, there was some pushback; some clients just came to me for bodywork and wanted me to fix and heal them. But this was not sustainable for me, nor was it helping the client’s long-term progress. I now see myself as a teacher, versus a healer. 
Using yoga as a tool in physical therapy practice has eased my role as a caregiver responsible for healing someone else. I am a guide to help clients self heal and treat. It is a transformation in health care that I am ecstatic to be on the front lines of. It has shifted the way I practice physical therapy. Yoga has given me the tools to treat the whole person, not just a body part. Professional Yoga Therapy Studies and Medical Therapeutic Yoga have introduced me to the other 4 layers of health (besides the physical layer). These are also called Koshas, as taught in Ayurveda. I can now refer more appropriately to nutritionists, mental health providers, other physical therapists, and other health care providers, when I see the disease in all the sheaths of the person in front of me.
Yoga has provided me with a bigger toolbox for language, intervention, and exquisite nuance for individual exercise prescription. Yoga has helped me walk my talk in my own healing journey. This surely makes for a powerful case of its effectiveness. I can verbally relay my failures through anecdotes, which allows my humanness to come through. The clients who have stuck with Body Temple through my personal transformations have all seen changes in their own healing journey. We are now partners in healing, we are all on this journey of life together. Yoga has helped me soften my rigidity that I used to believe people in white coats were entitled to possess.
We all have wounds. Yoga helps me put aside my own past traumas. It helps me be more present with clients. Yoga provides the context for the utmost empathy and compassion required in a healing journey. I say no a lot more than I used to. It is getting easier to say no; my new yoga practice extends beyond the mat because I can better calibrate my own self-care barometer.
My body speaks and I am able to hear it clearly now. I know I need more rest or that I won’t get away with that sugary treat and I respond differently now. I choose healthier actions such as unrolling and stepping on the yoga mat, actually getting a nap, going to bed earlier, choosing a healthier snack, or a drink of water. When clients see me feeling better and making healthy choices, they gain inspiration to take action to help themselves feel better.
The education I received at PYTI supported the path I was already on and gave me the confidence that I was not alone in making healthcare more caring. Before studying with Ginger, I knew there was a better way of sharing my skills with people in pain and with physical injury. I had developed the practice organically, updating practices and policies as necessary. PYTI gave me the finishing touches to name and organize what I was offering.
The most practical tool I received from PYTI has been the Functional Movement Assessment (FMA) Algorithms. This way of organizing the asanas (therapeutic movements) has really helped me screen movement patterns and quickly narrow down and choose the correct assessment for the client directly in front of me. I would like to believe that time is art. However clients usually come in with the attitude that time is money. The latter statement more accurately reflects the society that we live in. So getting quickly to the root of a client’s movement dysfunction is key. It matters how people feel when they leave the studio. I find that they leave feeling healthier and happier if I give them my full attention and use assessment tools that quickly get to the root of their biomechanical imbalance.
I often use the same yogic movement to evaluate the client’s motor abilities. I then turn it into a self-treatment and home exercise program. This allows me to merge multiple treatment and assessment modalities simultaneously. This saves time and allows the client to self treat while we assess their movement dysfunctions.
For instance, I have always used movement as an assessment and a tool. However, I used to compartmentalize the different body parts of the person in front of me. Now, instead of using a shoulder flexion, open-chained, range of motion measurement in the chair, I simply ask the client to lie on the yoga mat on their back and stretch their arms overhead. I will know more about her function immediately by just watching her transition to the mat (or decline to move) than I would if I approached her sitting in the chair with a goniometer and asked her to raise her arm above her head.
Some clients don’t check the “interested in yoga” box in their initial paperwork. So I simply shift my language (and still use yoga) as a movement assessment. This simple shift in perspective makes the sessions more efficient. Before the client even gets on the manual treatment table, treatment and healing and have already begun. This allows the client to feel better sooner. It also makes the manual tissue and joint work easier because the client is warm. I can also observe any misarticulations or joint dysfunctions from the mat.
The FMA way of organizing asana has also helped me finely tune and choose the most appropriate physical exercise to assess and treat multiple physical conditions and whole body mechanics simultaneously. Often, the client who ends up in the Body Temple has already been to several health care providers. The client has probably had a surgery or two, and they still have chronic musculoskeletal conditions and pain. Yoga has been the answer to helping these clients. And, as an added bonus, it often helps their digestion, sleep, and other systems in their body benefit. What a positive side effect! I like to tell clients that the only uncomfortable side effect their home exercises might produce is temporary muscle fatigue or soreness. Contrast this with the myriad of appalling side effects listed on their pharmaceutical bottles!
Most clients come to me for physical therapy versus yoga therapy. I think that the biggest barrier to using yoga as treatment is the misconception that yoga is simply stretching with chanting and religious overtones thrown in. Some clients, even in a neighborhood bordering Berkeley, CA (one of the most progressive areas in the United States) dislike the “new age” mentality. Clients can find cheap yoga classes for a dime a dozen around here.
Yoga was originally taught one on one with a student and guru. The guru didn’t even teach the physical asanas until the student had a clear and focused mind. This often occurred after several years of focused meditation. While this is not exactly practical in today’s modern healthcare system, the biggest barrier to helping clients use yoga as therapy, is still the client’s mental block.
To help clients with this barrier, I simply shift my language. I still use yoga as a tool, but I use physical therapy words. For example, after the initial history intake with a client, I test the client’s range of motion and strength. If a client has low back pain and I suspect a disc lesion, one of the most benign ways of checking their spinal flexion and extension range is in a gravity neutral position, such as supine or prone. Depending on the severity of the symptoms in the moment, I will disguise the observation as an exercise.
I have the client get on the mat on their hands and knees and take a deep breath. By observing their reaction, I will have an idea of their quality of movement and state of their nervous system. If the client is breathing smoothly and has no pain, then I will instruct them to gently flex into the “cat stretch” position. I remind them to listen to their body’s signals and to stop the movement before the pain reoccurs. Immediately, I can observe their vertebral movement (is it segmental? articulated? limited?) and I have an immediate impression of their entire spinal awareness, motor control, and range of flexion.
I just used yoga as an effective assessment, treatment, and a home exercise program. However, I didn’t name it as such. As healthcare providers, we can draw on the wisdom of yoga itself to help clients overcome whatever preconceived notions they may have about using yoga as therapy.
Every time I get on the yoga mat, I learn more about my own body and its abilities and limits. As healthcare providers, our burnout rate is very high. We need to put on your oxygen mask before helping others. Just like an obese doctor won’t be heard doling out nutrition and exercise advice, we won’t be heard if we are fidgeting or expressing body language that confesses we would rather be somewhere else. 
Yoga helps us learn about our own body-mind health. With consistent practice, we find our center, our still-point, which is magical and healing. Somewhere along the way, I heard someone say that when we find our still-point, the doctor within arises. We just have to learn how to listen to our bodies. Yoga helps us find that. Then we can begin to see that in our clients. Yoga helps us widen our perspective and gives us a new lens to help ourselves and others.
There are plenty of clients to go around. As healthcare providers, we all come with special skills, talents, and personalities. It is OK if a client doesn’t seem to “jive” with your style of care delivery. Yes, at first, when we are starting a business our financial bottom line tends to drive our decisions. We often will see anyone who fits in our schedule. As our schedules fill, natural pruning takes place and the people who will benefit from your care will find you. You have value and probably are ahead of our time. There is a growing need for healthcare providers like us. Keep listening to your heart (ahem, get on the mat) and your vision will gain clarity. With clarity, the clients and healing will come.
Body Temple Physical Therapy’s founder and operator, Liz Duncanson, has been involved with physical rehabilitation and sports medicine since high school. She participated in her school’s athletic training program and volunteered at a sports medicine clinic, where she gained exposure to Pilates and worked with injured ballet dancers and athletes. Liz graduated from Fresno State with a Bachelor’s degree in Kinesiology, with an emphasis in Sports Medicine/Athletic Training, and a minor in Music Performance (Percussion). She worked as an athletic trainer at St. Joseph’s College in Indiana, served as a freshman advisor, and traveled with the sports teams.
She then received her Master’s Degree in Physical Therapy from Western University of Health Sciences in Pomona, California (formerly known as COMP) an Osteopathic Medical School. The school’s mission, Humanism In Medicine, greatly influenced and shapes her current delivery of healthcare. Liz graduated physical therapy school, became a certified strength and conditioning coach and a licensed physical therapist in the State of California in 2002.
She returned to the San Francisco Bay Area after graduation and worked at Stanford Hospital and a few out-patient orthopedic sports clinics. In 2006, one year after the California PT Board changed its Direct Access Laws to allow individuals to receive wellness without a doctor’s referral, Liz ventured out on her own to fill the new niche. She now sees clients solely in private practice in her home studio.
Through Body Temple PT http://www.bodytemplept.com
On Facebook https://www.facebook.com/BodyTemplePTandYoga
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