Category: practice

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Child's pose modifications for Yoga Therapy for Breast Cancer

We usually think of child’s pose, sometimes known as bheki, as a relaxation pose.  It figures in yin yoga and restorative sequences and is generally used as a counter-pose after more strenuous work.  However, what seems an easy pose actually represents certain challenges to the breast cancer patient.  
Firstly, the classic arm positions in child’s pose – arms alongside the legs or extended and next to the ears – can be challenging for these students.  To lay the arms alongside the legs suggests that the person is low enough into the pose (ie:  backside is sitting on the heels) so that the upper arm is on the floor.  My ladies aren’t all able to do this.  Also, anyone with serratus-flap reconstruction is going to find the required rounding of the shoulders hard on the affected side.  The extend the arms taxes both serratus anterior and trapezius.  There are some people who just can’t lift the extended arm that high.  This calls for a modification!  Read on…
The ankles can present a problem in ladies of a certain age.   If there is undue strain on the front of the ankles, the pose becomes unstable.  A simple solution is the prop the ankles on a tubular prop, or simply roll up the end of your mat and use that.
If there is a bit of belly – and let’s face it, with all the cortisone administered in chemo, most students arrive a bit on the heavy side – we need to make room for it.  Simply separating the legs helps the body settle comfortably into the deep forward bend.
In people who carry neck tension – and most mastectomized and reconstructed ladies do – you will see that the cervical curve persists in this pose.  Do your best to bring attention to the dorsal zone, instructing students to separate the shoulder blades on the inhale. Tell students to pull the chin down towards the sternum.  (For those who are comfortable on the pose, you can suggest a little breath retention after each exhale.)

Arm Modifications

Take the arms out to the side, just above shoulder height, with the elbows bent.  Keep a slight pressure between the forearms and  the floor.  Splay the fingers and keep a slight pressure on the fingertips.  Keep awareness at the fingertips.

Child's pose for breast cancer rehab
Child’s Pose- modified for breast cancer yogis

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Muscles most affected by breast cancer and its treatment.

The skeletal muscles most affected by breast cancer and its treatment are:

  • pectoralis major:
  • serratus anterior
  • coraco-brachialis
  • trapezius.

(Don’t forget that chemo and radio-therapy affect the heart (cardiac) muscle. )

Why? and What to look for?

Pectoralis major:  The pec major suffers a lot.  Even conservative surgery leaves scars.  During wound healing, a protective arm position is logically adopted.  This may last for some weeks, leading to loss of muscle tone in the pectoral of the affected side. This muscle is frequently burnt by radiation.  Burn scars are deep and inelastic – the muscle loses stretchiness.   If an implant reconstruction has been performed, the expander and/or implant will likely be below the pectoral muscle.  This puts the muscle fibers under tension, leading the shoulder drop and poor arm abduction, extension and external rotation (difficulty taking arm back, outwards and palm up).
Serratus anterior: Watch for radiation burns (radio placement tattoos are often seen just around S.anterior digitations, on the side of the chest, below the armpit).  Often this muscle also suffers from the protective arm position post-surgery.  Poor shoulder position weakens S.anterior because the insertion fibers are under tension (sunken chest/rounded back posture). In re-constructed women, this muscle may be used for Serratus-flap reconstruction.  If this is the case, full arm rotation can probably never be re-established.  Watch for pain under the armpit and at the mid shoulder blade area.
Coraco-brachialis:  Usually loses elasticity due to inward rotation and adduction of the arm  (arm is pulled in towards the body, and rotated so that the back of the hand faces the front).  Majorly affected by axilliary web syndrome, or cording. Watch for pain in the inner arm, in the soft fleshy part, about two finger-widths down from the armpit).
Trapezius:  The trap is majorly affected by shoulder drop and poor posture post-therapy. Also, weakened S.anterior and P.major muscles mean the trap is unsupported.  Muscles work in pairs, that is, when one pulls the other gives.  If the pec is pulling down and forward, the upper fibers of the trap are being stretched.  After a while, they will get annoyed and pull back.  Then, watch for neck and shoulder pain, including headaches.
The shoulder capsule is frequently scarred as a result of radiation burns.
This list is not exhaustive. Each case is unique.  I have chosen to high-light these four major muscles because they are the ones that most often need rehabilitation.
Here are some oft-used postures, modified for yoga therapy for breast cancer.
Dvipâda-pitam or half-bridge pose:  Lying on the back, with legs bent and feet hip-width apart, heels towards buttocks without using the hands to adjust position.  Arms by the sides, palms down. Inhale, raise hips and lower back, at the same time, rotating the arms so that the palms face the ceiling (watch limitations).  Watch out for rotation from the elbow, protecting the shoulder joint.  If this is the case, advise that the student lift the forearm off the floor, bending the elbow, and while rotating the arm, see if she can place the back of the hand on the floor.

Dvipada-pitam or Half-bridge pose.
Dvipada-pitam or Half-bridge pose.

 
 
 
 
 
 
 
Virabhadrâsana or Warrior pose:  Stand, feet together at the back of your mat.  Turn your right foot out about 45º.  Step forward with the left.  Arms down by the side, back of the hand facing towards the front.  Exhale.  Inhale as the knee bends, and at the same time, rotate the palms forward and out, opening the chest and separating the arms from the trunk.  Exhaling, return to starting position.  Repeat six times.  Optionally, include 1-6 breaths in the warrior pose, holding static, deep breath, awareness chest and shoulderblades.
Warrior pose
Warrior pose – modified

Let us yog. Om.

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Yoga teaches to listen to my body

Yoga teaches me that the body has needs, wants and desires.  These are communicated to the mind through pain, pleasure and longing.
Yoga teaches me that male and female – and everything in between – practitioners can come to respect the needs and signals of their bodies, overcoming the dominance of the mind.
Yoga teaches me that until we come to yog, we are necessarily involved in a submissive or dominant mind-body relationship.  When the mind commands the body to move-make-do-act constantly, incessantly, the body is obliged to do so, until it collapses in a foetal heap in need of sleep.  Sometimes, the abuse is so severe that the body rebels completely and starts to run the show.  But, the body does so through a passive-aggressive kind of submission.  “Oh, how I ache, it cries, I cannot wake I cannot sleep.  Help me!”
Does the mind listen?  Maybe, maybe not.  I suspect that quantities of pain killers are usually consumed before any listening begins.
Yoga teaches me that the dominant mind will first chastise the body, bending it to its will.  The body will oblige, but again, only for so long.
Yoga teaches me that true yoga begins to happen when the mind and body listen to one another, establish a mutually co-operative, symbiotic relationship.  Like a settled old couple, the mind asks for booze, the liver says perhaps not, the mind concurs, then perhaps has a small nip before bed, and the body happily settles into a comfortable sleep.  Or the body asks for magnesium, the mind is listening attentively and selects appropriate foods, the body is satisfied and the cravings cease.
Yoga teaches me that this is possible.  Yoga relies on an ancient body of knowledge in which a reproducible formula for self-realisation is laid out.  I have trod this path for 16 years.  I have lived these changes. I would not bother to blog about things I did not experience myself.
Yoga teaches me that we can heal the mind-body relationship.  Abhyasa-vairagya, discipline and detachment.  Yoga teaches me to keep at it.

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We need love, not splits

Yoga teaches me that what this world needs is more love, not more flexible bodies.
Yoga teaches me that postures linked to breath are part of a path, but the path leads to compassion and comprehension, not contortion or competition.
Yoga teaches me that when we undo the knots and become soft, we can learn to love without asking to be loved in kind. Yoga teaches me that we don’t lose anything by doing this – it is a safe practice, once we truly arrive at the place where this is possible, rather than forcing the practice by spiritual bypass.
Yoga teaches me to know myself deeply, profoundly, intimately.  Yoga teaches me to let go of the shame I feel about showing who I really am.  Yoga teaches me that when I do so, the anger also evaporates because it no longer serves.  It was just the tool I used to protect myself from the shame of showing my true self.  On guard!
Yoga teaches me that there are many people who are on the path who may be bendy but are still angry and/or ashamed.  Yoga teaches me that this is okay, that I may be one of these people and not know it, but if I am lucky enough not to be, then I can shine that good fortune out and be patient and encouraging, not critical.

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Yoga teaches me that arm balances improve shoulder alignment

Thoracic outlet syndrome.  TMJ.  Frozen shoulder.  Tingling fingers.  All these conditions, and many more, have to do with the shoulder joint.  Yoga teaches me that using arm balances helps bring the shoulder joint into alignment. There is a group of muscles known as the rotator cuff.  Put simply, these muscles stabilise the shoulder.  They are usually pretty weak.  Modern life doesn’t encourage us to develop them.  Most people can’t even detect the rotator cuff muscles, when prompted. Arm balances can be symmetric or asymmetric postures.  Symmetric postures, like plank or downward dog, or handstand are more easily maintained because it’s easier to balance.  Beware bad habits, like rotating the shoulders upwards and inwards, hyperextending the shoulder and/or elbow joints.  The feeling I seek is like rolling the arms down and inwards from beneath the armpits.  If you aren’t feeling that, you are not engaging the rotator cuff.  Yoga teaches me to ignore the rotator cuff at my peril.  I will only get neck ache and head ache. Asymmetric arm balances are harder, but as with all asymmetric postures, they teach me about imbalances between the two hemispheres of my body.  Yoga teaches me to ask why I balance better on my right arm than my left?  Why do I rotate more on the left than the right?  Why does one shoulder click and the other lock or hurt.  I watch my imbalances, keep practising, and over time they correct.  Or they are less pronounced. Yoga teaches me to love my body anyway, just cuz. My osteopath adjusts my diaphragm, pericardium and hyoid and reminds me that seeking help is good.  When the yoga gets deep, things shift around.  Professionals are there to help keep us aligned and to reflect back at us what we are projecting.  I tend to overwork spinal extensions.  My osteopath reminds me that this tends to put my T10-T12 out of alignment.  So, I hold back.  Yoga teaches me to listen to the opinions of others, to let go of my egotistical all-knowing and to surrender. Yoga suggests to me that when I finally align my shoulders, my heart will feel freer.  All I want to do in this world is learn to love.  My armour comes off piece by piece.  Yoga teaches me not to fear my nakedness.

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Yoga teaches me.

I don’t teach yoga.  Yoga teaches me.
For the past few months, I have maintained mostly silence.  All the amazing and transformative experiences brought to me by constant practice, I have kept to myself.   I lost the impulse to share, to blog or post about my feelings or openings or closings or understandings.  It…just went.
I stopped caring about capturing yoga students.  I stopped caring about adding a fresh voice to the yoga blogosphere.  I stopped trying to be clever, new or insightful.  I guess that I went inside.  It felt good.  It feels good.  My inner voice is loudly private.  What bearing has my experience of yoga on yours?  Very little.
For this reason, out of the silence came this phrase:  I don’t teach yoga.  Yoga teaches me.
Say it to yourself.  Repeat it a few times.  Change the intonation.  You will see what I mean.
Yoga teaches me to be patient.
Yoga teaches me to listen.
Yoga teaches me the value of constancy and dedication.
Yoga teaches me that pain is a signal to stop.
Yoga teaches me to listen to my intuition, to stop when it says stop and to pay little heed to what others are doing.
Yoga teaches me that when people are ready, they will arrive.
Yoga teaches me that some people are never going to be ready for yoga, in this lifetime, or perhaps in the bit of a lifetime that you may know them.
Yoga teaches me to love those who don’t practice with equal intensity and without judgement.
Yoga teaches me that people’s bad behaviour is a sign of their inner suffering and they need compassion, not criticism.  But you don’t need to be their best friend, either.
Yoga teaches me that being alone and maintaining silence is often the only remedy.
Yoga teaches me to delay gratification.
Yoga teaches me to communicate clearly and non-violently, verbally and non-verbally.
Yoga teaches me to look within, assess clinically what I find, undo the knots and find out that I too have a lovely, gentle, kind, open, accepting soul.
Yoga teaches me that what I thought to be “me”, what I mistook for “who I am”, those things people call character, is all an illusion, an armour that I made while trying to protect myself.
Yoga teaches me to remember this armour for when I need it, but to shed it most of the time.
Yoga teaches me to relax.
Yoga teaches me to be, and in being, to do good, while remaining detached from the fruits of the actions.
I don’t teach yoga.  Yoga teaches me.

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Into joint – healing the shoulders

The shoulder joint is the joint in the human body with the greatest range of motion. To keep the shoulder joint stable, we have the wonderful rotator cuff, a group of small muscles below the armpit and shoulderblade.  Sadly, these little muscles are ofter under-developed, leaving the shoulder unsupported and prone to pain and dislocation.  This little sequence is very healing for shoulders.  I learned it from Claude Maréchal, the head of the Viniyoga lineage in Europe. But, the shoulder-drop to the floor with the arms at vertical is pure Rachel…my little contribution to the sequence to make it more healing…Try to do this six times, twice a day.

Into Joint - healing the shoulders
Into Joint – healing the shoulders

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Worrier to warrior

Most of us spend a lot of time worrying.  Worry is perhaps the most futile mental activity imaginable.  Worrying, sometimes called excessive rumination, is when we sit there turning the same thoughts over in our heads, envisioning all possible outcomes, all possible reasons, abstracting and having imaginary conversations and doing absolutely nothing – NOTHING – about the problem at hand.
No, worrying achieves nothing.  Action achieves results.  Planning your action is healthy.  Worrying is not planning, though.  It is worrying.  My mother was a champion worrier.  I learned from the best and spent many years perfecting my craft.  The only thing I can say all this worrying gave me was the concrete and iron-clad desire to change the way my mind worked.  To stop worrying.  Don’t worry, be happy, y’know?
I had the good fortune to find yoga at the age of 27 and the good sense to keep practising.  I was good at the postures from the start.  Most ex-gymnasts can do most yoga postures, it’s true.  But, despite appearing to practise yoga, I wasn’t really.  I was doing “yogâsana” – yoga postures – but my mind was everywhere but on the mat.  Shopping lists…things to do…arguments unresolved…oh wait…time to breathe.
Only once I got in touch with my diaphragm and my breath did I develop the ability to be present in my practice.  With presence comes concentration and with concentration, meditation.  And with meditation, peace.  Yes, dear readers.  I no longer worry.  Would you believe it possible?  I would not have, if someone had told me just like that.  But, yoga is an experiential science.  The sutras say “here is the road, go walk it, see what you find.”  No spoon feeding here.
Here’s the magic part.  When we stop worrying, we become brave.  You see, with inner stillness one finds one’s purpose.  And with purpose, one finds one’s personal power.  From frailty we grow resilient and we will take on all adversaries.  This is not combat mode like in capitalist echelons and hierarchies.  This is about your mission.  I have this unshakable faith in humanity and my experience is that when people find their purpose, it is very often much more altruistic than anything they had done before.  We become a kind of spiritual warrior.
So, worrier (->yoga)->warrior.  Wanna join in?