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!!!

Yoga and the Endocrine System – Peace in the poses

A mandala
A mandala in shades of yellow

The practice of Hatha Yoga uses postures, breath and mental focus to bring about peace.  By peace, we refer to the physical peace derived from flexible muscle and joints, free of pain, good quality sleep, proper oxygenation brought about by correct breathing and mental restfulness, a state of alert calm, wakeful quiet.
There are scientific studies being done on the effects of yoga on the endocrine system – the hormones.  This is very promising work.   For a long time, people have tried to tie yoga nadis to the nervous system, and it is certain that some parallels can be drawn between nerve plexi and the chakras.  But this will never give the whole picture of just why a sustained hatha yoga practice, over years, brings about such overall good health and humour.

The Endocrine System

The endocrine system is composed of glands, organs and the substances they produce, known as hormones.   Hormones are secreted or excreted in miniscule quantities, but they have far-reaching effects.  Any woman who has ever taken hormonal birth control or even had a period knows this.

HPA Axis

Of great interest to those working with breast cancer is the so-called HPA axis, or Hypothalamo-Pituitary-Adrenal axis.  This is basically a cascade within the endocrine system in which one gland signals another.  The HPA helps control our reactions to stress, among other things.  The hypothalamus and the pituitary glands are nestled beside each other, and the link between the nervous system and the endocrine system is right here.  Basically, the hypothalamus secretes hormones that cause the pituitary to secrete hormones.  The hypothalamus receives information from the brain stem, that is, information from our body.  The anterior pituitary gland is where the hormones are secreted, and has been found to be activated by GABA.   Pituitary hormones then signal the adrenal glands, where cortisol is produced.

HPG Axis

There is yet another hormone axis called the HPG axis, or Hypothalamo-Pituitary-Gonad axis.  This axis signals and controls the sex organs.  The majority of breast cancer patients are menopausal or peri-menopausal at diagnosis, and those who are still menstruating have their periods suppressed in a bid to reduce oestrogen production.  The crux of the matter is the the Hypothalamus signals the Pituitary and this released two hormones, LH and FSH.  FSH does the final conversion of androgen to oestrogen, but LH helps produce the androgen, which coverts to oestrogen.  This process uses an enzyme called aromatase, and you may have heard of aromatase inhibitors, a class of drugs used in breast cancer patients with hormone-sensitive tumours.


One of the hormones that is of interest to yoga practitioners is cortisol.  Cortisol is produced in the adrenal glands and secreted into the blood.  Almost all cells of the body have cortisol receptors (these are like antenna or tunnels on the cell walls and they all the cells to transport the cortisol into the cell, where it can exert its effect.)  So, if you have high cortisol levels, you may see a wide range of effects in the body, including:

What is cortisol?  In it’s normal function, cortisol helps us meet life’s challenges by converting proteins into energy, releasing glycogen and counteracting inflammation. For a short time, that’s okay. But at sustained high levels, cortisol gradually tears your body down.  Cortisol is one essential we can’t live without.  But too much of a good thing is not healthy.
Sustained high cortisol levels destroy healthy muscle and bone, slow down healing and normal cell regeneration, co-opt biochemicals needed to make other vital hormones, impair digestion, metabolism and mental function, interfere with healthy endocrine function; and weaken your immune system.
Adrenal fatigue may be a factor in many related conditions, including fibromyalgia, hypothyroidism, chronic fatigue syndrome, arthritis, premature menopause and others. It may also produce a host of other unpleasant symptoms, from acne to hair loss.

Here is a summary of the scientific studies substantiating the fact that the practice of Hatha Yoga reduces blood cortisol levels.


Another hormone of interest to yoga practitioners is GABA (Gamma-amino butyric acid). Low GABA levels in the brain are linked to anxiety and depression.  Anyone who has had cancer treatment knows that depression is rarely far away.  In my opinion, it is a very natural reaction to the physical trauma of treatment and the emotional trauma of facing your own mortality.  But depression cannot be allowed to continue unchecked, and the practice of Hatha Yoga helps regulate mood.  For example:

In a German study published in 2005, 24 women who described themselves as “emotionally distressed” took two 90-minute yoga classes a week for three months. Women in a control group maintained their normal activities and were asked not to begin an exercise or stress-reduction program during the study period.
Though not formally diagnosed with depression, all participants had experienced emotional distress for at least half of the previous 90 days. They were also one standard deviation above the population norm in scores for perceived stress (measured by the Cohen Perceived Stress Scale), anxiety (measured using the Spielberger State-Trait Anxiety Inventory), and depression (scored with the Profile of Mood States and the Center for Epidemiological Studies Depression Scale, or CES-D).
At the end of three months, women in the yoga group reported improvements in perceived stress, depression, anxiety, energy, fatigue, and well-being. Depression scores improved by 50%, anxiety scores by 30%, and overall well-being scores by 65%. Initial complaints of headaches, back pain, and poor sleep quality also resolved much more often in the yoga group than in the control group.


I really could write all day, but my daughter will get mad at me, and Sunday is Sunday.  I will leave you to think about this:
Hatha yoga reduces blood cortisol, stimulates the vagus nerve and just darn well calms us down.  The brain stem recognises our altered physical state and sends this information to the Hypothalamus.  The Hypothalamus says to the Pituitary “all is good, settle down”.  The HPG and HPA axes find homeostasis and we establish a feedback loop of calm and settledness.  To any scientists reading this, I know it sounds facile.  But I think that your research – and our practice- will lead us to this conclusion.
In the meantime, keep practising.  We find peace in the poses.  Om.

Read on…

For your reading pleasure, a few curated links to articles discussing Yoga and the endocrine system.

A few links about yoga and breast cancer

I am out of town, so will just offer a brief Sunday update of a few links:

Poses for Breast Cancer Survivors
Happy reading!

Yoga for breast cancer

My path until here, from here on…

Weaving the strings of our lives together into a coherent pattern, our unique tissue, might be the best objective we can strive for in this life.
I am a Gemini.  I have a lot of interests.  At times, it seemed as if they might pull me to pieces.  Yoga.  Guitar.  Nutrition. Travel. Family life. Tattoos.  Bodywork.  Sexuality.  Languages. Crochet. Technology. Parties. Books. Clothes. Shall I continue to list?
In the language of yoga, tapas is the burning up of impurities.  In practical terms, it is the shedding of that which distracts us from the path.  This can include things like divesting oneself of excessive possessions, losing excess body weight, severing ties with people who do us harm, and shedding activities that only serve to distract.  Tapas comes along quite naturally, when practice is continuous and conscientious.
I have written of tapas before in this blog.  It is something that has occupied my mind for some time.  I was quite certain that some of my, uh, stuff, needed to be bidden goodbye.  But, when the process is motivated by rajas – the energetic guna, the one that I tend to have in excess – the shedding is likely to be excessive, and possibly lead later to regret (a swing into the opposite of rajas, tamas, the heavy guna).  When the process of tapas is sattvicsattva being the balanced, calm guna – then it is filled with gratitude, awe, thankfulness and joy.  (btw:  the gunas are the three qualities of matter, as postulated in the yoga theory that I have studied.  rajas-tamas-sattva are found in matter and mind, only pure spirit is nirguna, without these qualities.  It is a bit hard to explain in few words.  If you don’t get it right now, don’t worry, there is plenty of time to learn.)
I think, I believe, that  I have reached the point in which the strands of my various interests begin to weave together to form a special tissue.

Yoga therapy for breast cancer rehabilitation.

I began working in breast cancer rehab in 2005.  I had qualified in Manual Lymphatic Drainage and, with some trepidation, began treating oedema.  Then, later, lymphoedema.  It was scary.  The first scars, the first radiation burns, the first time a patient developed metastasis, the first patient to die.  It was a path that demanded a lot of me both as a therapist and as a person.  To stand in front on one person after another and reflect back their fears, doubts, triumphs, to stop getting angry at intransigence and inability to change, to understand that an experience of facing death does not automatically change a person, that the fear of changing habits that are ingrained is stronger than the fear of dying.
I feel that MLD therapists have a different relationship to our patients than do oncologists or radiologists or plastic surgeons.  We all share a therapeutic role, but the fact that MLD is usually applied outside of the hospital setting and the therapy lasts at least an hour and may be ongoing for years means that we develop a true relationship with our patients.  This can be taxing, especially when they relapse, or die.  But it is also rewarding in the sense that friendship is always rewarding.  People are interesting, their stories are interesting.  I have learned more about modern European history by listening to my patients than I ever could have studying in University.
The ongoing tête-a-tête with death stimulates a need for answers, for ways to reflect back to these women some ideas about what the bloody hell is going on here, anyway???  I was already contemplating all this, and from a young age.  Death and dying fascinate me in the way that only a person with a huge zest for life can be interested in them.  Without fear.   I am a Gemini.  I like opposites.  I have fit three lifetimes into my first 42 years. I can’t wait to see what the next 80 years bring!
Yoga is the path I chose in my quest to find the answers.  I has helped me enormously.
And so, I chose to teach yoga to my breast cancer patients.  Simple as that.
So, from now on, instead of blogging about this and that, I choose to blog about yoga therapy for breast cancer rehabilitation.  Sounds pretty good, eh?
I ought to get organising my categories then, yes?  If you have any suggestions for a blogroll, would you please be so kind as to comment?  Many thanks and a big, fat om.

Angel in a Circle
Angel in a Circle