The concept of holistic health care was first introduced to me in the form of Yoga Nidra (Sleep Yoga) while I was on my 4th overseas assignment. I was a US Diplomat at the time and despite working out several times a week; chronic low back pain continued to plague me. My military doctor referred me to physical therapy as well as recommended Yoga Nidra, which is offered through the VA health care system.

Yoga Nidra involves guided meditation, journaling, goal setting in the present tense and can be done anywhere by anyone and also helps improve one’s quality of sleep. But, what did this have to do with curing my low back pain?


Low back pain is extremely common, ranking as the second most symptomatic reason for office visits in the United States. 8 out of 10 of us will experience low back pain at some time in our lives. Risk factors are multifactorial; however, studies show that psychosocial factors appear to play a larger prognostic role than physical factors in low back pain lasting more than six months.

The concept of holistic health care whether in the military or not isn’t new. In 2013, Vice Admiral Matthew Nathan, surgeon general of the US Navy, wrote, “the implications of poor health on military readiness are profound,” but praised a collaborative approach that “allows us to embed within a primary care environment the psychologists, nutritionists, tobacco-cessation specialists, mind-body medicine therapists, and health educators our patients need in order to develop and maintain mindful, healthy behaviors along with the ‘mental armor’ our active duty military personnel need to increase their operational effectiveness and their resiliency in bouncing back from stressful situations.”


Being mentally and physically fit is something I’d prided myself on having over the years while serving in the Navy as well as the US State Department. But my idea of mental fitness was to not show emotion to my colleagues and/or subordinates when events like 9/11 occurred or when another Teammate of ours was killed in action. However, it wasn’t until I started practicing Yoga Nidra as well as other forms of yoga that I realized that I, like most of us, stored my “issues in my tissues” by stuffing my feelings down and that my chronic low back pain was due to the way I was handling (or in my case not handling) my stress. I needed to re-vamp my Mental Fitness game and do it fast if I wanted to be pain free and decrease my stressful life.

I started journaling, listening to the guided meditations and setting goals as if they’d already happened. Before I knew it, I became a certified yoga instructor; two years later a Pilates apparatus instructor, then I ran my first marathon, then the Boston Marathon, and followed that up with my first 50 miler.

My path to obtaining a Doctorate of Physical Therapy (DPT) at the age of 43 after serving 21 years in both the military and Foreign Service was unconventional and holistic health care in collaboration with physical therapy provided the catalyst for my amazing second career act as well as my ability to continue as an endurance athlete at age 47, pain free! At APRS, we recognize that treating the whole patient extends far beyond the patient’s health and that achieving optimal health requires one to be both mentally and physically fit.

Ali Ramirez is a military veteran and Bozeman native. Dr. Ramirez utilizes a holistic approach focusing on improving the body-mind-spirit connection incorporating apparatus Pilates, strength training and manual techniques to facilitate normalized movement patterns as well as various yoga styles to promote mental fitness.