How to choose a yoga teacher

As a yoga teacher, this is a healthy and humble article to post.  I have had a long journey with yoga, and have been gifted with humility as a result.  Believe me, I did not arrive at adulthood knowing how to love, nor how to transmit compassion, nor how to respect other people’s limitations, beliefs or lifestyles.  In yoga, this is fundamental, because every single student is singular, unique and on their own journey.  You can only teach yoga from the heart, respecting physical limitations of the human body, and believing wholeheartedly that there is a Spirit guiding us from within if only we learn to tune into it.  Om.
https://www.theguardian.com/commentisfree/2016/oct/27/yoga-injury-class-regulation-bad-practitioners

Yoga in prisons

https://www.theguardian.com/world/2016/oct/10/doing-a-stretch-how-yoga-is-cutting-stress-in-south-african-prisons
 
 

How to be a good yoga student

There is a lot of talk out there these days about how to  be a good yoga teacher.  I think that the best way to be a good yoga teacher is to be a good yoga student.  Here are my tips for how I try to be a good student of yoga.

  1.  I use my own yoga mat.  This is a pretty basic aspect of yoga.  You will spend quite a lot of time on your mat.  Your bare feet and your sweet face will most likely touch the same parts of the mat on many occasions.  I don’t know about you, but I don’t tend to nuzzle strangers’ feet.  I also happen to think that, over time, your mat becomes impregnated with your psychic energy.  I really encourage all good students of yoga to invest in a non-slip mat, and to keep it clean (they launder on a cool cycle really well – tip of the day!)
  2. I don’t eat for two hours before practice, and don’t drink for one hour.  I don’t drink during class.  The energy of digestion is a downward-moving energy.   In yoga, we are channelling energy and moving it upwards, usually.  If you are digesting, you create confusion within.  Better to practice while fasting.
  3. I don’t practice when I have my period.  Guys, you beat us on this one.  The ladies are required to miss a few days per month, for the same reason as above.  The menses are downward-moving.  Yoga moves things upwards.
  4. To be a good student of yoga, I maintain silence before and during practice.  Enough said.
  5. I practice six days per week, usually the same practice for a period of months, if not years.  I know that this sounds craaazy to a beginner, but it really is the essence of the yogic mind.  I figured this one out right at the beginning:  I took a beginner’s class at the Sivananda Centre in London.  There, they told me that the objective of the course was to encourage home practice.  I thought “ok”, bought their book and started practising their simple sequence of Sun Salutations and 12 postures.  I encourage you to do the same.  The only way to be a good yoga practitioner is to practise!

 
 

A Summer Sequence for Strong Shoulders- *FREE* Printable Download

Here is a nice shoulder sequence. Not all the arm balances are advisable for breast cancer survivors, but by paying attention to the modifications that are possible in each pose (eg: not raising the arms as high, not extending the shoulders as much, doing more dynamic work and less static), you will benefit for the stabilising effects of these postures.

PMPS: Post Mastectomy Pain Syndrome

Introduction  

om
om

Among breast cancer patients, a common complaint is numbness or tingling in the upper-inner arm.  This is called neuropathy and is often down to damage to one particular nerve:  the intercostobrachial nerve.

ICBN

The intercostobrachial nerve (ICBN) is connected to the brachial plexus and innervates the axilla, medial arm and anterior chest wall.  The brachial plexus is a group of nerves that originate in the neck and whose basic function is to move the arms.  (plexus definition:  a network of nerves or vessels in the body. an intricate network or web-like formation.)
It is well known that many breast cancer survivors have problems with mobility, strength and sensation in the arm of the affected side.  Today, we are going to talk about the specific complaint of tingling, numbness, pain and loss of sensation in the armpit and the inner arm.  Here is an image, lifted from the pdf whose link is in the references section, that illustrates perfectly the areas of skin that are innervated by the ICBN.

icbn skin innervation
Area of skin innervation by the ICBN

PMPS

Intercostobrachial neuralgia, also known as Post-mastectomy Pain Syndrome (PMPS) is estimated to occur in about 33% of breast cancer survivors. I can’t find reference to whether these are 5-year remissions,  or longer or shorter intervals, but 33% seems to be the agreed upon figure, and this is for PMPS that persists for longer than three months after the breast surgery.  There are other nerves involved in PMPS, but it appears that the the ICBN is the main nerve affected in most cases.  Thus, some people say it is more correct to refer to Intercostobrachial neuralgia.  However, as that doesn’t exactly roll off the tongue, let’s stick to PMPS and try not to think about PMS (ouch!).

Why does it hurt?

 

axilla dissection
Axilliary lymph node dissection.

The origin of the pain is either:

  • nerve damage during surgery, or
  • scar tissue around the nerve.

Surgery in the axilla is usually to remove lymph nodes, and these are deep to the ICBN. Here is an image of the technique that is used to remove lymph nodes.  I lifted it from the medscape article that is cited in the references section.  Radiation therapy (RT) tends to damage nerve tissue and promote the formation of fibrosis, is also a cause of the PMPS.
Here is a wonderfully concise description of the surgical reasons for PMPS:  

“The most commonly cited theory of chronic postoperative pain in breast cancer patients is the intentional sacrificing of the intercostobrachial nerves. These sensory nerves exit through the muscles of the chest wall, and provide sensation predominantly to the shoulder and upper arm. Because these nerves usually run through the packet of lymph nodes in the armpit, they are commonly cut by the surgeon in the process of removing the lymph nodes.” (http://www.cancersupportivecare.com/surgerypain.html)

I tried to understand what a “lymph node packet” might be, as this isn’t a term that we use in MLD speak.  I think that it is a surgical term for the bundle of lymph nodes that is excised.  [An article unrelated to PMPS and ICBN contained this phrase “We prospectively assessed 61 pelvic lymph node dissection specimens (packets) in 14 consecutive patients undergoing radical cystectomy.” ]

What to do?

As usual, when we use yoga therapy for breast cancer rehabilitation, we must respect limitations.  Firstly, PMPS won’t be cured by practising yoga.  But, it can be helped.  Secondly, there is variability in the extent and severity of pain and impairment to range of motion.  So, adopt a personalised approach and be patient.  Use simple, slow movements with breath synchronisation to achieve optimum results.  If you are a yoga teacher, you probably believe in prana.  I certainly do, and no matter how scientific the tone of my posts, I will absolutely vouch for the healing effects of good prana circulation.  So, when teaching, keep your students focused on the practice, not on the results.  Also, use your own healing energy and direct it towards them.  Wish them well.  Ask for guidance and the blessing of whatever guiding energy you believe in.  
Here are a few suggestions for sequences that you can integrate into your own practice and bring some flexibility and mobility to the chest and inner arm region.  Note that all sequences mobilise the brachial plexus in general.   

ICBN PMPS sequences
ICBN PMPS sequences

 References

Practical stuff for the pericardium

In my last post, I described the pericardium and offered some information about how it may be affected in breast cancer survivors.  Here are a few suggestions for sequences that could go into your own yoga sequence and help focus it on the diaphragm/pericardium

practical pericardium
practical pericardium

Yoga therapy for the pericardium

a grey and purple mandala
Harlequin Mandala

Radiation therapy (RT) has improved life expectancy for many cancer patients.   However, it is well known that RT has long-lasting side effects that can range from mild to severe. Breast cancer patients treated with RT are at risk of damage to any of the structures near to the breast.  This includes the heart, lungs, pericardium, skin, lymphatic vessels and nodes, and skeletal muscles.  Today we are going to talk about the pericardium, what it is, how it may be affected/damaged in yoga therapy students, and how we can present a hatha yoga class to benefit and rehabilitate the pericardium.

What is the pericardium?

The pericardium is “a fibrous sac that attaches to the central tendon of the diaphragm and fuses with the adventitia of the great vessels superiorly.”  The great vessels are the large blood vessels that carry blood to a from the heart.  The adventitia is the outermost layer of the wall of a blood vessel.  So, the pericardium is:

  • A fibrous sac (two-walled, in fact, with fluid in the space between).
  • Attached to the central tendon of the diaphragm (the main muscle of breathing).
  • Fused with the outermost walls of the big blood vessels of the heart.

What does the pericardium do?

The pericardium has four functions.

  • It protects the heart from infections,
  • It protects the heart from knocks and jolts (this due to the fluid in the space between the two sacs),
  • It lubricates the heart and
  • It prevents excessive swelling of the heart in the case of a sudden increase in blood volume, which is usually associated with other illnesses or problems with sodium levels in the blood.

Unsurprisingly, given its roles, in Traditional Chinese Medicine, the pericardium is also referred to as the heart protector.  The pericardium meridian runs down the inner arms, between the two tendons of the inner forearm, crosses the palm and then runs along the middle finger, terminating at its tip.  Anyone who has treated secondary lymphoedema of breast cancer will observe that the affected areas coincide spectacularly with the pericardium meridian…

What happens to the pericardium during cancer treatment?

Fibrosis is the thickening and scarring of connective tissue usually as a result of injury.  The injury in this case is a radiation burn. Bear in mind that there are diseases that cause a primary fibrosis (cystic fibrosis, for example).  We are not talking about yoga therapy for such diseases here, although some of the underlying theory may be applicable.  We are discussing yoga therapy for breast cancer patients who may have pericardium fibrosis caused by RT.  This would be a secondary fibrosis, just at the lymphoedema seen in breast cancer patients is secondary to lymph node excision or what have you.
RT has a tendency to burn the surrounding tissue as well as the tumour.  The pericardium is already defined as a “fibrous sac” and the fibrosity that can develop as a result of radiation burns is our main concern here.  Bear in mind that different RT techniques will have greater or lesser probability of damaging the pericardium.  I observe that women with deep tumours often have RT tattoos on the other side of the chest, meaning that at least one ray had to cross the chest the get to the tumour.  Shudder.  Indeed, this article (from 2010) says that 20% of oncology patients who have had RT in the chest develop constrictive pericarditis.  This is called “radiation-induced constrictive pericarditis.” Constrictive pericarditis is a medical condition characterized by a thickened, fibrotic pericardium, limiting the hearts ability to function normally.
Let’s also take a moment to recall that chemotherapy often damages the heart.

Yoga poses for the pericardium.

Spinal extensions, backbends, outwards arm rotations, held inhales, arm raises with inhales and basically anything that stretches the chest and moves the diaphragm will be therapeutic for the pericardium.  However, as usual, there are limitations and contraindications that must be considered.  A glance at this page is useful in that it demonstrates a number of poses that quite frankly could not be used in the classes that I give.
Firstly, recall that fibrosis is not reversible.  It can be improved and loosened, but under normal circumstances, it is chronic.  I mention this to help you pace your program and not expect miracles.  I also warn strongly that overwork and tears are not desirable.  So, work within your students’ limits.
Referring back to the last page I mentioned, the “puppy dog pose” could be modified to a cat-cow sequence, breathing out with rounding the back and in when arching.  Another typical viniyoga sequence is moving slowly between cat pose and child’s pose.

cat-child's pose sequence
cat-child’s pose sequence

Another typical sequence is alternating between standing on the tiptoes with the arms reaching up (keep to shoulder height in some cases, elbows may also need to bend, ideal is palms facing at the top) and a half-squat with a spinal twist.  If you alternate sides and breathe in when you go up and out when you go down, you get a really nice loosening effect in the mid-trunk without really running risk of injury.
twist utkatasana - tiptoes sequence
twist utkatasana – tiptoes sequence

What can be interesting is using breath retentions to increase the lung volume and mobilise the intercostal and the serratus anterior muscles.  Next week I will post a sequence that I use and love.  Right now, I have to go.  It’s been a long post and I think that I have communicated what I set out to.
To yog is to live.  Keep at it!!!