Hey people, sorry it’s been a while. The summer term has gone swimmingly and I’ve been kept busyingly busy!. Classes were sometimes full to overflowing, sometimes empty to the point of silence. But, the 90-days of consecutive classes is drawing to an end. And, of course, I have got my fingers in the pot, planning for next term.
Firstly, I am going to take a few days off teaching. Last class is this Friday, 1-Sept-2017. Then, until Tuesday 12-Sept-2017, rien de rien.
From 12-Sept-2017, I will offer a five-days-per-week teaching schedule. No class Sunday or Monday, but every other day, yes. Start time is 9:30, pricing model remains the same: 7€ first class, 6€ the second one in the same week, 5€ for the third and so on. Weekly cost for all five classes is 25€, and there is no monthly fee.
So, I hope to see you there. Not for me, but for you. Yoga has special, magic powers and my most sincere wish is that everyone reading this could feel that blissfulness at least once. No, yoga won’t change the world: only activism and engagement can do that. But yoga can change your inner world and that might be a good starting point. Om.
Some wise words about "how" to do yoga.
PMPS: Post Mastectomy Pain Syndrome
Introduction
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.
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?
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.
References
Yoga vs Pilates: What's the difference?
“Should I do yoga or Pilates?”
I hear this question a lot. As a yoga teacher, I am naturally inclined to say yoga. However, I recognise the usefulness and appropriateness of both systems, depending on the person and their circumstances.
Let’s explore the similarities and differences between Yoga and Pilates.
Fundamentals
Yoga is an ancient system of healthcare and spiritual inquiry. What most of us consider yoga is really only a fraction of the entire body of Ayurvedic medicine. Hatha yoga consists of specifically applied breathing and postures. There are many branches of hatha yoga, including Astanga and flow styles (vigourous, stimulating), Kundalini and tantric lineages (spiritual), and everything in between. The objective of yoga is to heal the physical body and prepare body and mind to sit in contemplation and, eventually, meditate profoundly. The stilling of the mind is paramount in yoga.
Pilates, is a system of exercise developed in Germany by Josef Pilates. Setting out to align and strengthen the body, Mr. Pilates believed that the mind, when properly oriented towards the physical endeavour, could completely dominate the body, bringing it into harmony through force of will, as it were. Thus, as in yoga, there is mental focus required, but the objectives are quite different. In our modern world, we tend to believe the the intellect reigns supreme and human ingenuity can solve any problem. For this reason, the Pilates philosophy may be more comprehensible for the beginner. It is hard to imagine what “stilling the mind” might entail until we have experienced it. When choosing between Yoga and Pilates, review your belief system: are you more materially or spiritually oriented? While yoga doesn’t have to be spiritual, I could not deny the spiritual underpinnings of the practice.
Movements
Yoga can be both dynamic or static, depending on the style. Dynamic yoga places poses in a sequence and one moves smoothly from one to the other. This can be used for warming up – the famous Sun Salutation, for example – or the whole series can be built around flowing vinyasa-s. More static styles work on holding poses. The time can be measured in number of breaths or in seconds/minutes. Yin yoga, for example, holds poses for five minutes or more, allowing deep work into the connective tissue. Some styles combine the two: Viniyoga usually takes each pose through a dynamic phase before holding the pose for a certain number of breaths. The idea behind yoga is that the subtle energy needs to flow in all parts of the body, so a practice could focus on one area (hips, chest) or indeed a whole season could be dedicated to working slowly towards a certain key pose. Again, depending on the style, because the flow styles are more “full body” and some systems work with a set series of poses that work the entire body.
PIlates is always a full body workout, but you may use certain props such as balls, stretchy bands and magic rings to focus a class. There is also simply mat Pilates which perhaps looks more like yoga. Notwithstanding, some yoga styles, such as Iyengar, use props. Pilates is focused on aligning the joints, toning the muscles and strengthening the core abdominal musculature.
Breathing
Correct breathing is important in both systems. In Yoga, breath and movement are co-ordinated and interdependent. Inhaling for opening movements (extensions, lifts), we exhale to close (flexions, lowering). The breath brackets the movement. That is, the breath is longer than the movement, beginning before and finishing after. Most Yoga classes involve a component of “pranayama” or breathwork. This can be done during the practice, or in special gentle sequences. More often, we close the class by sitting with a straight back and breathing through one or both nostrils following a pattern and rhythm designed by the teacher.
Pilates also has specific breathing patterns, but they are distinct. Inhaling to open and exhaling the close is usually observed, but this pattern is reversed in some exercises. In strength work, we are taught to exhale when applying force (think of a weightlifter’s grunt when squatting). Pilates uses this technique for its strength component. In Pilates, the navel is usually held in. However, with tensed abs, we can produce “paradoxical breathing” as we draw breath, . Paradoxical breathing is a breathing pattern in which the pressure in the lungs increases due to intake of air, but the lung volume does not increase (the lungs can’t expand because the tensed abs limit diaphragm movement). Paradoxical breathing is the hallmark of anxiety and even trying it for a few seconds brings on quite a nervous feeling. Try it yourself: pull your abs in then breathe deeply a few times. That heady feeling? The brain’s response the the increased lung pressure. So, while Pilates will produce more toning and strengthening than yoga might, it can have undesired secondary effects due to the breathing. When deciding between Yoga and Pilates, review your personality and challenges: are you nervous, anxious and looking for mental peace? Or are you more interested in toning and firming?
Adaptations for Breast Cancer Survivors
A yoga teacher with a good training will know how to adapt yoga poses (and flows) to minimise their potential harmfulness to irradiated and/or post-operative areas. Bear in mind that this somewhat eliminates styles in which a set of poses “has to” be practised as a sequence. If these sequence is what the teacher CAN teach – and many 200-hour trainings teach their teachers only set sequences, not how to sequence postures – then a practitioner who “cannot” do the equence will put pressure on herself, the teacher and the class. We need a therapeutic style for breast cancer work, so make sure your teacher knows how to adapt both postures and sequences. Bear in mind that yoga teaching is economically unrewarding and some teachers will be under pressure to fill their classes at any cost. Bear in mind, also, that some teachers might be unaware of their limitations. By reading this post, you are gaining the knowledge necessary to assess your potential teacher and decide.
Astanga-style flows are awesome for the fit body, but tend to include quite a few arm balances. Bear in mind that even the ever-famous Downward Dog (Adho-mukha-svanâsana) is an arm balance. This seemingly simple pose puts pressure on wrists and arms, requires full range of motion in the shoulder joint and requires that Serratus anterior be stretched. All of these factors make Downward dog a tough pose for breast cancer patients. I am not saying “Don’t do it”. I am saying – assess carefully just how important this pose is to the final objective of yoga – stilling the mind through body and breath work – and decide if a class that involves a lot of Downward dog is the BEST option.
Kundalini classes also tend to work set kriyas – sequences – but are probably easier on the breast cancer survivor as the âsana element is less important. There tend to be poses that work pretty intensly the abdominal region, so those with shoulder drop might find this imbalance makes some kundalini poses more challenging.
Bikram is out because of the heat. Too dangerous for lymphedema.
I practice and teach Viniyoga. It covers all the bases when it comes to adaptation of postures and sequences. The therapeutic aspect of Viniyoga also makes it more useful when working with the very personal journey each breast cancer survivor is coursing.
Pilates is subject to the same general contra-indications I mentioned about Astanga and flow styles. It may be difficult for a teacher to adapt a class to one single student. Arm balances for core work may be unavoidable. It may be left to the student to adapt the poses, rather than receive specific instructions about how to do so. Pilates will be great for bringing the shoulders back into alignment and keeping the shoulders joint stable, but again, interview your teacher and decide if they are the person best able to help you.
Conclusion
Gentle physical exercise is a must for breast cancer patients. How tough you want to go is up to you, but it also depends on where you were when you were diagnosed. Did you have a good level of physical fitness, or had you been making excuses for too long? How old are you? Have you any extenuating circumstances like injuries or co-pathologies? Answering these questions helps you to decide what your goal is. But, really, I urge you to go slow at first, and keep a steady pace over time. This will bring greater rewards, over time, than plunging in and risking injury and setbacks. Either yoga or Pilates will do you a great service. Find a teacher who knows and inspires confidence, a class that is nearby and at a time that you can manage. Consider taking a private class, just to give the teacher time to know your history, your limitations, and to teach you how to modify the postures that you will find in the group class. Most important of all is to stick with it!
If you can’t find a group class in your area, why not start one yourself? Find three other breast cancer patients – not too hard, sadly – and contact a teacher. Be pro-active and believe that this is a fundamental part of your healing journey. Om.
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.
Docufilia – ¿Programados para ser gordos?, Docufilia – RTVE.es A la Carta
Os invito a una charla…Tema: El magnesio
Dénia, sábado 1 junio, 2013: Jornada de Bienestar y Salud Dénia.
11:30 “Mejora su salud con magnesio”.
Estais todos bienvenidos!
My personal yog: To thine own Self be true
My personal practice has been suffering of late. Time, but also boredom, has kept me off the mat. Granted, I have been practising a lot of yoga of daily life, being aware, present, joyful, honest and patient. Well, most of the time.
Then I read this article, about how to be an inspiring yoga teacher, in which the author says:
When you give yourself permission to abandon the rules, to listen and truly explore and celebrate your body through the shapes and then share what you discover with your students, the movement becomes medicine. My partner and Laughing Lotus co-founder, Jasmine Tarkeshi, always says that to be a good teacher you’ve got to be a soul scientist. You truly must go into a laboratory and investigate your sacred self through your body, every single day.
Heck yeah! I need to remember that sometimes.
The system I know and teach is called Viniyoga. The central tenet of this system is “the yoga adapts to the person, not the person to the yoga”. It is a system that can be considered the peak of Krishnamacharya’s life’s work and investigation. I believe wholeheartedly in that core message and have iron faith in my teacher, Carmen, and my lineage (Krishnamacharya -> TKV Desikachar -> Claude Maréchal -> Christina S. de Ynestrillas -> Carmen Sánchez Segura). And yet, and yet…lately something hadn’t been quite right.
I embarked on the second phase of my teacher training, the “Post-Formation” last autumn. The format was different than the first part (once every two months, a residential weekend away) but the content built solidly on the earlier teachings. Perhaps a bit too solidly…more sutras? more posture analysis? etc…Boredom has always been my bugbear, so I knew I need not heed that little voice inside saying “something new…something new…go and find something new…”
What was putting me off? Boredom, yes. But more than anything, a distinct lack of joy was bringing the whole tone down. I felt the need to knuckle down for the seminars rather than blossom out. In the meantime, I had enjoyed the wonders of Stretch Therapy and the deep relaxation of Yin Yoga.
I began to doubt…was Viniyoga too limited? Are the postural compensations too often, too indulgent, not challenging enough? Why is it that those who practice Viniyoga seem to do so for a very long time without ever developing the stunning and deep flexibility that other lineages develop? Why do my teachers, who evidently know a lot about yoga and have practised for years not seem to smile, not seem joyful (with the exception of Claude) ? The questions rolled round my head and I found no answers.
The second, then the third seminars dragged on. One of the group dropped out. Doubt, head-scratching, the decision to stay.
Then, I read this article and realised something both simple and profound. Having completed the teacher training, having practised solidly since 1999, I had earned the right to innovate, create, both in my personal practice and in my classes. Of course, I had always done this, I know that I am creative when it comes to sequencing, bhavanas, important details. But, still, I limited myself.
I think I will grant myself a little more leeway from now on, find out how Viniyoga adapts to Rachel, not Rachel to Viniyoga.
I still believe that the training I am pursuing is the highest quality teaching I can receive here and now. It is I who needs to transform. OM. May you find your own path, too. The Guru is in you.
Musings: The unsung note
I had the great pleasure of returning to the stage this Thursday past. Yes, dear yogis, in my spare time I am a singer-songwriter.
I began this odyssey years ago. In fact, I could say that I have always been a musician. As child I played the oboe, and the recorder. I used to sit there with my tape recorder, registering a harmony to then play the melody on top. Too bad I only had one track! I gave up classical music, as most teens do, only to then buy a red Yamaha bass at the age of 18. I played in a band, and enjoyed mild local success, before shyness and nerves forced me off the stage. Life continued apace. I began writing more and more, diaries, poetry, laments, and soon, songs. It took me 10 years to buy a guitar and another four before I could tune by ear and play with some fluency. At this point, I bought my lovely Taylor 414CE cutaway and began composing the songs that I still play today.
How does this relate to yoga?
Vishuddah chakra and overcoming fear.
Singing is related to the throat (vishuddha) chakra. Mine was most definitely blocked. I used to speak in a whisper and was plagued by the sensation of something in my throat. (In TCM, this is called plum-pit throat and is related to the Liver Qi). I bought a couple of books (Finding Your Voice, Zen Guitar), took a workshop (The Healing Voice with Jill Purce), but, mostly, I just sang. Over and over, through smiles and tears. Overcoming my incredible fear, I took to stage in open mic nights and small gigs in and around London. It was terrifying but I knew it did me good. Still, the fear was being pushed down, not truly overcome. But, I think that in yoga we have to push past our fear, be brave and have great faith, in order to grow. So, that was one phase of my growth.
Control of the diaphragm
Another phase of my work was taking control of my diaphragm muscle. The diaphragm is fundamental to the singer. My yoga teacher gave me a short personalized practice in which I did krama in the exhale. This means, the exhale was broken up into two or more parts, and then the breath retained with the lungs empty. For the first time in my life, I could actually locate my own diaphragm. My colleague Santi, a fantastic osteopath, adjusted my diaphragm and pericardium, loosening the tendons and leaving my breath much freer.
Control of the perineum
By now, my voice was vibrating nicely in my chest and abdomen. It was mellower and sweeter and easier to control. But, still, on the high notes, something was missing. In my ongoing reading – I am voracious, and practically only read on theme – I came across a few lines in The Anatomy of Hatha Yoga by H. David Coulter.
A famous conductor…once shouted…”No! No! Squeeze it in – push it up!” He may not have known it, but he was telling them to seal off and control the anatomical perineum – the base of the pelvis -and thereby cultivate what we have been calling abdominopelvic energy. All trained singers have learned that the purest and richest sound originates from this region. In the language of singers, the base of the body “supports” the voice.
Wa-hey! that’s the secret. On the high notes, all that perineum work I’d been doing in yoga would pay in by holding my voice up in a clean, sweet note. Hallelujah!
Believing in myself
Yoga teaches us that within each and every human being there is a tiny spark of Divinity. We don’t need any mediators when we talk to God because God is within. When we first learn, then internalize this, our faith in ourselves grows and grows and we begin to value ourselves for who we are instead of what we do. Through yoga, I realized that my music, my words, my beliefs and my message are not only valid but beautiful and even Divine. And having that behind me, I take the stage with courage and honesty, and never try to emulate the music or sound of anyone else. This is freedom. And now, the fear is not being suppressed. It is no longer there. I offer it all to God with the simple mantra, Ishvara Pranidanah.
There is karmic cleansing here. My grandfather went down to London in the 1920’s and played his clarinet in the earliest SoHo jazz clubs. From my limited research, there was only a handful of jazz clubs in the UK at that time, so both he and my grandmother – they met on the jazz scene – were well ahead of their time. They married, and moved up to Yorkshire where dreams of jazz music were replaced by granite houses and the family woolens mill. A frustrated musician to the end of his days, Grandsir, as well called him, would get drunk on G&Ts and pull out the clarinet at Christmas, even as his dentures popped from his gums. My mum sang. In the choir, in Gilbert and Sullivan productions, in the singalong Messiah every Ottawa Christmas. My father was the greatest music fan. He wept and danced and collected music. His LP collection filled the basement of a huge Saskatchewan house by the time he died. I come by it in honestly. Music is in my blood. But yoga helped – and helps – me realise it in a sane and safe way.
When our karma (work) and our dharma (lifepath) unite, we find liberation (Kaivalya). Let yoga guide you towards Self-realization. And don’t think for a moment that Self-realization means isolation in an ashram. For some, maybe, but not for everyone. Sri Aurobindo’s contribution to modern yogic thought was the idea that liberation can be found here and now, in daily life, not only when the soul leaves the body. Be happy here and now. Bless y’all.
Well woman massage
I have spent the past 11 years of my life as a professional massage therapist, and 8 of those dedicating myself to the gentle art of Manual Lymphatic Drainage (MLD). MLD is a very gentle and highly specific massage technique that is used in cancer rehabilitation. Many who opt for allopathic cancer treatments such as radiotherapy and surgery are left with impaired lymphatic drainage in the affected area. This manifests as swelling known as lymphedema (sometimes lymphoedema).
In massage training, touching of the breast is generally verboten. In MLD it is an integral part of the treatment, especially in women who have had lumpectomies, mastectomies, radiotherapy, reconstruction (implant or TRAM). I consider myself an expert in the treatment of breast conditions.
Drawing from my massage training, I have always emphasized the importance of the abdominal massage. Deep abdominal massage is used in many healing modalities including, but not limited to, Tui-Na, Mayan massage, modern Osteopathy, Ayurvedic massage, and Swedish massage. MLD includes very important abdominal work, but the touch is light, as it is in all aspects of the technique.
In hatha yoga, we learn and teach techniques to release the diaphragm muscle, deepen the breath and connect with the muscles of the pelvic floor.
I propose to you a Well Woman Massage:
- Hatha yoga to stretch the body and deepen the breath, connecting with the perineum and diaphragm.
- Deep abdominal massage, back massage (lest we forget that the abdominal obliques and the hip flexors originate in the spine)
- MLD for abdomen and breast.
Women have special physical needs not seen in men – hormones and hot flashes and pregnancy and childbirth and breastfeeding and, and, and…If you feel it’s time to care for yourself the way you’ve always wanted to, please feel free to drop me a line. Treatments available in Altea, Benidorm and Teulada. For treatments booked in April 2013, I offer a 5% discount on the normal price of €60. This is a two-hour program.