Yoga for people with LE
We've always been discussing how downward dog can be a problem, and I read this article in the NY Times about Yoga injuries. I would love someone to create a series of poses for people with LE. I would imagine they'd be standing poses, spinal twists, back poses, child's pose. I'm no expert, but did enjoy my yoga class--I actually stopped because of a vertigo thing that happened while doing the "five Tibetans"--it's always something.
Here's the article
http://cityroom.blogs.nytimes.com/2010/07/24/24stretch/
City Room - Blogging From the Five Boroughs
July 24, 2010, 7:30 pm
Stretch | When Yoga Hurts
By LIZETTE ALVAREZ
Piotr Redlinski for The New York Times CAREFUL Upward-facing dog.
For Mind and Body
As Cathy Lilly folded into downward dog at a workshop in January, a novice instructor, eager to help, lifted Ms. Lilly's thumbs and angled them forward. Her thumbs are still recovering from the strain.
Ms. Lilly, 53, a yoga teacher with more than two decades on the mat, also once injured her rotator cuff jumping distractedly into plank pose. And after another instructor suggested she kiss her knee while in heron pose, her hamstring suffered the consequences.
Isn't yoga supposed to be good for you? After all, doctors prescribe it to injured athletes and cancer patients. And while tennis players can expect ripped-up elbows and runners know they may blow out their knees, yogis don't usually anticipate having to hobble off their mats.
It is this "do no harm" mind-set that can lead to strained backs, pulled knees, aching wrists and slipped discs. Ms. Lilly is part of a growing roster of yoga practitioners on injured reserve.
"Yoga is a good thing, so you tend to push further than you would in a sport where you are actually more attuned to injury and afraid of injuries," said Dr. Michelle Carlson, an orthopedic surgeon at the Hospital for Special Surgery in Manhattan who specializes in arms and hands. She said she recently "saw four women in a row in my office with hand injuries from yoga."
Nobody seems to keep careful track of the numbers. The most recent estimate comes from the United States Product Safety Commission, which tracks sports injuries: it listed 4,450 reported yoga injuries in 2006, up from 3,760 in 2004. But Dr. Carlson and several others said they had seen large increases lately, as yoga became more popular. "I have been doing this for 20 years, and I didn't see yoga injuries 20 years ago," Dr. Carlson said. "I can see a couple of injuries a week."
Training for yoga teachers can vary, and classes are so large in some studios that instructors do not pay enough attention to everybody. In New York, many people approach yoga with a no-pain, no-gain mind-set, with predictable results.
Then there is the age factor: you see a fair share of middle-aged people twisting and bending and lunging, and I know from experience that a 40-something body is temperamental.
Back injuries are quite common. Positions like upward dog and cobra, requiring backbends, can aggravate the spine. Others that call for elongating the back, like seated forward bend, can wreak havoc on discs. Rotator cuffs and wrists can get battered during plank poses and chaturangas, which are like push-ups, while knees are susceptible to the lotus position, hero's pose and the warrior positions.
The headstand - a more advanced move - is an equal opportunity offender. If done improperly, it can roil your back, neck, shoulders and wrists.
Then there are the freak injuries. A woman in crow pose fell over and broke her nose. Ouch.
"The most common form of injury is the overzealous student," said Dr. Loren Fishman, a spine specialist, yoga teacher and medical director of Manhattan Physical Medicine and Rehabilitation. "The second most common reason for injury is poor alignment, and that is usually crummy teaching."
The best way to avoid injury, particularly if your body is creaky, is to take it slow and make sure to nail the fundamentals, experts said. Injuries can happen with all forms of yoga, but one of the safer approaches is Iyengar, which moves at a slower pace, focuses meticulously on proper alignment and uses props. Iyengar teachers also undergo rigorous training.
At one recent class at the Iyengar Yoga Institute in Chelsea, we spent about 20 minutes on extended side angle pose; I learned quite a few things in those 20 minutes. (Anusara, based on Iyengar, is similar in its attention to alignment.) I love vinyasa - the breathing, the pace - but it can flow too quickly, and its many chaturangas have sometimes strained my wrists. Since classes are large, adjustments from instructors can be few and far between. Also, I find the lack of mirrors in most yoga studios cuts both ways: You're not obsessed with your own image, but you can't see your body in a pose.
The other day I took a class in Union Square with Ellen Saltonstall, an acclaimed Anusara teacher who recently wrote a book with Dr. Fishman on yoga for osteoporosis. Her class is slow enough that you can settle into the right alignment. Afterward, she critiqued my push-up pose. My elbows were not at right angles, and she cautioned me about dropping too far down. She also gave me stretches for my wrists.
"Precision," she said, "is important."
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Comments
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Kira, I will ask my yoga instructor about this...she did some research last week after class after she saw me skipping down dog, tabletop, and these other horrific, torturous poses that kill my arm. She was sooooo upset that she had suggested them. I told her she can't organize the whole class around my stupid arm, so she's working on modifications to these poses.
I am skipping yoga tomorrow due to infected, watermelon arm, but I'll email her and see if she's come up with anything that I can post.
She's a stitch and a half...she's the one that sent me the 'namaste this' card. Love her.
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Thanks, I love that card. Cracks me up.
I hope you feel better soon. Everyone was so worried--I know it's "just" the internet, but the connections are real.
I used to have this great yoga teacher who retired, and she was a PT also and she was great. We did the class at the middle school, and one day we were locked out, and she was banging on the door hollering "We need to get in, so we can relax!" Nameste that.
Feel better, and I'd love a series of poses that would work for us with challenged arms.
Kira
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Oh wow. Perfect timing.
Last summer I took a twice a week course. Ends up that the 63 year old instuctor is herself a 5 year survivor of BC. I found that out at the end of the summer season, when she mentioned it in passing.
Anyhow. As we returned this summer, I knew that I wouldn't be 'up' to the calibar of the group class, even though there wre usually only 10 to 12. I also knew that she was willing to work one on one.
SOoooooooooooooooooooooo, she has come to the privacy of my little living room for 3 Tuesdays, with the last two off, since I was on the road.
Anyhow. Today is Tuesday!!! We had our 90 minute tutorial. We spoke at length about downward dog specifically. Yes. She is brilliant. She is one part counselor. One part mentor. Twelve parts amazing speciman of human strength. Oh yeah, and about another ten parts of yoga master.
She has started me on alllllllll sorts of breathing. She's really big on tailoring each pose to my capability. She's really big on 'inversions' and so for me, laying on my back, my feet go up the wall. Inversion.
Downward dog. She showed me the actual aspiration pose, and then half dog and quarter dog, and a bitty baby whimpy LE dog. She feels that the length of time holding the pose is key to how I will tolerate it over time...... but that everything comes in baby steps.
She has been teaching yoga for over 30 years. She is built like a solid muscle. She is the most upbeat, encouraging, knowledgable person that I have met.
I know that what she is teaching me is what is actually helping me.
Turning off computer. Alarm for 4:00 a.m.
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Any way she'd be interested in creating a series of poses that are safe/good for us?
Have a great trip.
Kira
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It would be really nice to see pics of the different half dog, quarter dog and bitty baby whimpy LE dog. I really need to get back to doing yoga but I don't want to do anything to aggravate my LE arm.
When I was doing yoga before bc the basic rules is not to do more that your body is able to. Well one night I thought I could stretch just a little farther, bad move, tore ligement in my knee. Won't do that again, I'll be more careful.
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Hi all, I've been doing yoga for a bunch of years (26) and have a very senior teacher I've discussed both prevention and treatment of LE with. There's a set of asanas that focuses on arms that are good for both preventing lymphedema and for helping resolve LE when it's active, according to senior teachers in the Iyengar tradition. These are the first thing my yoga teacher gave me when I returned to class after my MX and he's emphasized they're the basis for me going forward. I found a set of pictures at this page that includes these asanas: http://www.yogaartandscience.com/pblog/files/fda443fdee8e7f54d32571b57f6ea7b9-22.php, Specifically the first 7 poses, except the third. That one should be fine too but I didn't learn it as part of my sequence so I'm not going to comment on it.
When you see the pictures it will look obvious how to do them, but it's really important how you move into and out of them, and how you work when you're in them, so I'm going to describe all of that. In addition, you can refer to the discussion by Jaki Nett at http://www.yogajournal.com/practice/955 about yoga for breast cancer survivors. She includes these poses and discusses others as well.
First, for all the poses:
--Look straight ahead keeping face, jaw, &neck relaxed!
--Hold each to your capacity, for as little as a few seconds or as long as a minute. Repeat each 2-3 times.
--Move slowly and deliberately into and out of the poses, no jerking, no fast movements.
--these look like simple stretches but your arms and shoulders are working in them to extend and rotate as described, and the muscular actions should be such that the skin moves to the flesh and the flesh to the bone. (Sounds weird I know, but give it a try.)
--As you stand and move into/out of the poses, keep the body alignment described for tadasana (#1) at all times, not allowing the ribs or hips to fall forward or the lower back to arch.
The poses:
1. Tadasana: (this is the starting point for all the others): stand upright; legs straight, feet together, wt spread evenly over feet; tighten kneecaps and lift the knees up; make sure head is above shoulders (not pushed forward) and shoulders, hips and ankles are all in one line; front of thighs pressed back; spine erect and chest lifted; arms straight down in line with the hips; roll the shoulders back and tuck the shoulder blades in; look straight ahead.
2a. Urdhva hastasana with palms facing each other. Start from tadasana (#1), but with feet hips width apart. Extend arms forward, horizontal to floor palms facing each other. Roll shoulders back and down and upper arms outward while keeping palms facing each other. Keeping those arm and shoulder actions, raise the arms straight overhead (or as much as you can). Exhale and release arms to horizontal in front of you, then down to your sides.
Excellent video that demonstrates this perfectly!! http://www.youtube.com/watch?v=YjDgvJYpyDw
2b. Urdhva hastasana with palms facing forward. Do 2a, and when your arms are vertical, rotate the upper arms so that the palms face forward. Keep elbows, wrists and fingers extended. Keep the shoulder-blades and trapezium moving down the back. Release as described for 2a.
3. Urdhva Baddhanguliyasana. Like #2a, with interlocked fingers. Stand in tadasana (#1) with feet hip width apart. Extend arms forward, horizontal to floor, palms facing eachother. Roll shoulders back and down and upper arms outward. Interlock fingers of the two hands fully. Rotate the palms of the hands and wrists away from you, thumbs pointing to floor. Straighten elbows. Extend the arms up towards the ceiling until vertical (if possible). Open the palms fully towards ceiling. Keep shoulders rolling back and down. Exhale and bring the hands forward, release the interlock, and lower the arms. Repeat, switching the interlock of the fingers (other little finger on the outside).
3. Gomukhasana. Stand with feet hip width apart. First do just the upper arm, then the lower arm, then put the two together. (a) Upper arm: Inhale, raise the right arm to vertical. Rotate the upper arm inward, even using your other hand to do so. Bend the elbow so the hand comes between the shoulderblades, fingers pointing down. Exhale and release arm down. Repeat with other arm. (b) Lower arm: Bend the right arm and take it behind you so the back of the palm is against the buttocks. The slide the hand up between the shoulderblades (or to as high as you can). Exhale and release. Repeat on the left. (c) Full pose: Fix the right arm from above as in part (a), then bring your left arm behind and up as in (b) and clasp the fingers together between the shoulder blades. If your fingers can't reach each other, put a cloth belt in the top hand before entering the pose, and grab it with the lower hand. Walk the fingers together as possible. Exhale to release, and repeat, switching the arm on top and bottom.
4. Paschima Namaskarasana. This is learned only after #3. Start with feet hip width apart. Take the arms behind the back and press the fingertipss together, fingers pointing down. Rotate the arms and wrists so the fingers point towards the back and then point upwards. Slike the hands upwards to bring them in line with the shoulderblades (if possible). Make even pressure across the entire palm, all fingers extended. Rotate the shoulder bones back and move the shoulderblades into the back. Move the elbows towards the floor and the hands further up the back. To release, slide the hands down and return to tadasana.
5. Garudasana arms. Stand with feet hip width apart. Raise the arms in front of you and bend both elbows. Move the arms so they are crossed close to the body, right elbow above the left (or as close as possible), then continue wrapping the lower arm and hands around each other so that the left fingers are on the right palm. Exhale and release. Repeat, switching the arms.
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Thank you, this is wonderful and so are your descriptions!
Kira
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Sure, You're welcome. Not sure if people will find it buried in these responses but that's ok.
I realize I didn't address the broader yoga practice. I think anything non-weight bearing on the arms would be fine with LE. So your suggestions of standing poses, twists, and childs pose with arms extended forward or back along legs should all be good. The arms in the standings should be done such that skin moves to flesh and flesh to bone to stimulate lymph movement. I'm not sure what you mean by "back poses". Do you mean backbends?
As for dog pose, in its normal form with weight on the arms I'd say no, but if you have access to wall ropes in a studio then there's a way to use those so the arms are essentially weightless. There's a picture here - the woman on the LEFT with her arms on the chair and legs in rope is the correct one: http://www.eldr.com/article/fitness/healthy-aging-master-pose-downward-facing-dog. Most Iyengar yoga studios would have these ropes. There's a way to do it at home by looping belts on doorknobs of an open door but I haven't found a picture...I'll see what I can find.
I'm less psyched about recommending inversions like sirsasana (headstand). There are ways to do them supported so no weight is on arms which are great for rehabbing after MX and for preventing LE, but if you already have LE I'm hesitant to suggest anything that lowers the arm for a few minutes. Anyone wanting to do those I'd recommend check with your LE specialists first and then work with your own yoga teacher on appropriate variations.
As for that NYTimes article you pasted at the top, well....it seems like much ado about something obvious. In other words, of course people get injured doing hatha yoga practices, just like they get injured running or doing aerobics or any physical activity. As for being injured by a bad adjustment by the teacher, that's not good obivously, but again not different than having a weight trainer or aerobics teacher do a bad adjustment or instruction. Well that's my reaction to it anyway. If you walk, you might trip. I'm going to walk anyway.
And do yoga. -
cs777,
I agree that the article is stating the obvious, but I posted it because yoga, if not done thoughtfully, can pose problems for women with LE.
I used to have a yoga teacher who was a middle aged PT, and she was amazing. Then I took a class from a young woman who was oblivious to the fact that we could hurt ourselves.
We used to have a horse, and the magazine Equus wrote that more people are injured during a lesson than riding on their own: you follow the instructor, despite your common sense. I had that happen when one told me to "sit the trot' for an extended period. My back took a beating.
There are DVD's out there for Pilates for women rehabbing from breast cancer, and I'd love to see a series of poses for women with LE.
The instructor who was a PT also, was great about helping people modify poses.
Thanks for all this good information.
Kira
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Ah, that's a good point Kira. I was reading the article literally and so thinking "well duh" whereas you were trying to get people to recognize it does have similar risks as other physical activities. Having done yoga for so long now and having one teacher for a long time I'm pretty attuned to where to draw the line in various poses for myself, but it can be easy not to realize until it's too late. And I have had injuries like pulled muscles, but always from pushing too far myself, not from a teacher's bad instruction or adjustment. Interestingly, a class assistant was trying to get me to do something in class last week that I just kept replying about, "I understand what you're asking me to do, but I can't move that far." Finally the teacher came over and said "do X" and I said "I can't move that far" and he asked where my limitation was and then worked with me appropriately based on that limitation. Luckily he "got" what I was saying. But it's not always so.
Re poses for LE, no I don't know of any DVDs of such, unfortunately, but the set I described above is a good place to start as we already discussed. The youtube video of John Schumacher, a very senior Iyengar teacher, that I linked to gives a nice demo of the 2nd pose and all of that can be translated into the later poses.
Best to all who give yoga a try!
CS
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Tomorrow is TUESDAY!!
That means my personal yoga instruction.
CS you have given such great insight, suggestions & links.
I'm going to speak specifically to my instructor & see if she might be willing to let me film her. Maybe we could post something on YouTube.
At the very least I think that she'd be willing to let me take some pictures. I think that the photos would not be best here in my little living room....... maybe we could go to the town hall where she gives the group classes & take them there.
In any case, I've got some specifics to ask her tomorrow.
xx00xx00xx00xx
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We spoke at length today about how to best convey her experience & make it specific to the LE community. She is putting her brains to work.
We have dubbed this our "project."
Will keep you posted when we make progress-on-our-project. She is really excited to be a resource to a wider audience, particularly the BC community & even more specifically to our swell sorority.
She feels that I have made so much progress already this summer. I am going to attend the group class on Fri & see if I can adapt the exercises with the suggestions that she has already lead me to grasp. It's time to leave the sanctity of my livingroom and be amidst people.
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Very exciting--and I'd love to see the results of your project. You're an inspiration!
Kira
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We have begun our project in earnest.
I attended the group class today, for the first time since my Jan. surgery.
We took pictures afterward of some basic stretches to help open up the chest and arms.
It is all on my blog already & I will transfer it here later tonight.
Just in case you can't wait:
Twill be adding more as the weeks unfold. Couldn't figure out the movie filming portion of my own camera, so that will unfold in time, as well!!
xx00xx00xx00xx
Marcia is wearing the white t-shirt, I'm in all black.
She is 63 years old, has taught yoga for over 30 years and is a 5 year BC survivor.
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That's great faithandfifty! It will be so helpful to have actual pics and video for people to see.
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Wow, Faith, that's really lovely -- so inviting and easy to follow. I'm looking forward to the next installments. Thank you!
As I looked over the page it occurred to me that your avatar, the "Door County Butterfly" from 2007, was especially poignant -- the butterfly is the international symbol of lymphedema. Hope! Beauty! Freedom! New life!
Onward!
Binney -
Debbie, thank you, thank you, thank you!
Kira
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I suppose it would have been better to put a disclaimer BEFORE the pictures. LOL
Obviously only engage in this gentle stretching upon consulting with your med team/LE specialist and all Martians who comment on your LE management.
As you can see my arms do not yet reach the official pose, due to my slowly thawing frozen shoulder.... so we are working on approximation. Her main goal for me is to get my shoulders "back" and begin to feel & build strength and confidence -- by extending my arms.
If we could have figured out how to film this, you would have heard Marcia, talking continuously about breathing. Matching your inhale to your exhale, making it as long & controlled in each direction as possible..... working to lengthen the depth of the breathing is a MAJOR goal in and of itself.
Never, ever push beyond where your body is capable of stretching. "Think" beyond where you are now, but don't push beyond your limitations today.
The whole idea is to slow down, to relax, to get in tune with your body.
I'm going to have Marcia join BCO and you can ask her questions directly. She's very excited to be a resource to our super sorority.
xx00xx00xx00xx
Edited to add pose name: This is known as the 'eagle' pose, Garudasana.
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Wow, Faith, thank you!!!!!! This is awesome.
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Faith this is WONDERFUL! Thanks so much for doing this. The photos are excellent and so helpful for seeing correct body positions. Thank Marcia for us and we look forward to having her join our LE community here!
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Here's another one.
Think breathing. Always with the breathings:
Marcia has some "issues" with her rotator cuff, so she must assist the stretch with her extra hand. I am still getting my arm to the floor as well.
This is to help strengthen my shoulders & arms -- particularly with the internal rotations issues I still face. The extra hand lays on your middle, to remind your ribs to stay 'down' near to the floor, as they have a tendency to move away from the floor, into an arch, which is not the best posture for the best result.
REMINDER: Match breathing in to breathing out. Slow. Methodical. Deep.
xx00xx00xx00xx
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This is wonderful! Thank you again.
Kira
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I finally had a minute to add another pose.
Back to the yoga mat. I forgot to label the pictures before posting them, but I think you can follow the photos to get the idea. The first thing is to have a yoga strap with a buckle. Two 'yoga-blankets' make for a gorgously supported pose. It is officially known as: Reclining Bound Angle Pose, or for the absolutely accurate: Supta Baddha Konasana. This is SERIOUSLY restorative...... as in truly & fully & completely restorative, to the very bottom of the soles of my happy feet, I feel restored after even just a few minutes. Remember: deep breathing, matching the inhale to the exhale. Go ahead, restore yourself!!
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Finished treatment end of April 2009 and am still finding that I am pretty wobbly during balance poses - even relatively easy ones. No problems with balance otherwise and I was able to do most balance poses without to much issue prior to BC.
Anyone else have this issue?
Thanks
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bump
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bumping for carol57
Namaste!
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