// Restorative yoga using yoga as a rehabilitation aid
by Claire Norgate
Teaching clients with pain is similar to teaching beginners, but
with a few additional points to take into consideration. Movements need
to be demonstrated more slowly and explained as an exploration of what
the body can do, rather than instructing the client to copy a position
and hold it. People with pain also tend to be more apprehensive about
the possibility of the yoga positions causing pain and worsening their
condition, so this concern needs to be addressed.
The body
has an amazing capacity for repair, and a positive approach and
teaching style can reinforce this. Acknowledge the injury, protect and
gradually explore it, but do not let the entire practice be focused
upon the painful area.
WARM UP
From the start, each participant needs to take ownership of their
practice and become self-responsible. The concept of harm-free practice
should be introduced from the start. More emphasis on a non-goal
oriented approach is an essential principle, and participants should be
encouraged to pay attention to how their body responds to movement. You
could suggest to participants that they drop expectations of themselves
and make no comparisons between themselves and others, or even between
their own performances from session to session. Let the class know that
it is normal for them to want to please you, their instructor, by doing
a great ‘looking’ pose, but that this approach can be detrimental to
their progress by keeping them focused on the teachers’ perspective
rather than their own.
MODIFICATIONS
Teach the poses from a part to whole method so that the client can
learn how to modify their injury or niggle without the distraction of
having to focus on total body alignment. Do this by encouraging lots
more modifications such as placing the arms down or on the waist for
warrior positions, no arms or arms in the eagle pose, using the wall
for balance. Focus on developing strength in healthy areas without
drawing attention to the area of pain. This is particularly important
in standing positions because there is so much going on in the body.
Encourage participants to keep their eyes closed as much as possible so
that the focus remains on them and they experience fewer visual
distractions. Let the class know that everyone will be doing their own
exploration and that in this particular class there is no emphasis on
everyone looking the same or even doing the ‘same’ pose.
When the body is in physical pain it usually dominates the mind’s
thoughts, which can lead to a lack of clarity. You need to keep this in
mind and give cues and directions in simple language. The initial cues
should focus on teaching the client how their body works and how pain
affects the whole system.
A body in pain will hold bones and muscles in rigidity and will breathe
in a manner which minimises the pain as much as possible. Additionally,
the sympathetic (fight or flight) nervous system will be hyperactive.
In this state the levels of the immune and healing systems are low.
Participants can be helped to recognise if they are in this state and
given techniques to acquire a more relaxed physical state. Using
gentle, quiet music throughout the class can aid relaxation.
Remember that no one can tell anyone how he or she feels in a yoga
position, so the degree to which each individual ‘pushes’ into pain is
therefore up to them. The participant might discover that they have
been holding back and that giving a little more effort or practicing a
deeper stretch brings relief. They will often need advice on what is
advisable to push into (short muscles).
Alternatively, they may discover that they have been pushing too hard
and need advice about what to exercise more care with (weak and loose
muscles). Clients often need to be directed towards identifying all the
body sensations of the position. Explain that muscles, tendons and
ligaments all feel subtly different when stretched, that muscles will
experience some local fatigue when developing strength and that this is
actually necessary for improvement.
If any of your class participants have hypermobile joints, explain to
them that what they think is a stretch may in fact be a ‘squash’ pain
from deep within the joint. Stretch sensations should only occur on the
joint angle that is opening and lengthening and not on the closing
side. You should also make people with hypermobile joints aware of how
their body will collapse into a position and teach them that strength
and control are more important than range of movement.
Therefore, to address these various concerns:
• Explain alignment, first from an identification perspective and then a corrective one.
• Teach the main posture patterns (sway/lordotic) and teach how to
recognise in self. Instruct that their pattern is probably going to be
reflected in all the yoga positions. This can be used as a guide on how
to make adjustments, what to stretch more deeply and what to go more
gently with.
• Explain how a forward-carrying head and protracted shoulders
contribute to just about all shoulder and neck issues, and introduce
the concept of winging scapula.
• Explain how pelvic position and hamstring/hip flexor length contributes to just about all lower back issues
• Explain how the habits are developed subtly over time and that
eventually posture changes need to be consciously performed outside of
the class
• Periodically pay lots of attention to breathing, in particular to
increasing breath length and depth. This will encourage the
parasympathetic nervous system to become more dominant. Initially focus
on slowing down the breath length during rest phases to magnify the
parasympathetic response. Eventually focus on breath length and effort
during all the different positions to discover where the body is weak
or guarding.
• Alternate periods of work and rest to warm the muscles and increase
the healing blood supply without overloading energy levels
• Acknowledge that as we age our bodies tighten up, our progress
becomes slower and recovery from relatively minor aches and pains takes
longer
• Generally, males are less flexible than females at any given age and women are not as strong.
TEACHING CONSIDERATIONS FOR DIFFERING FLEXIBILITY LEVELS
Remember that more flexible individuals can be at a disadvantage as
along with increased range of movement there is frequently a decreased
proprioception and a tendency to collapse into the joints. People that
are more flexible can overstretch, thinking they are doing it well
because the feeling of intensity in a deep stretch masks the
overstretching and further potential to collapse into the joints. And
importantly, because flexibility is joint-specific, most people will
have some flexible areas that need to be approached gently.
The teacher (especially if flexible) should remember that the tight
body often doesn’t initially enjoy the unusual movements and foreign
positions required in yoga. When they do stretch they often have lots
of natural strength and may push too far. These individuals need to be
taught to use less effort to achieve results while still enjoying the
process. The stiffness of their muscular-tendinous system easily
triggers the nervous system which sends messages of pain to the brain.
This means that they generally don’t enjoy the stretching component but
do like how they feel at the end.
Flexible people on the other hand usually enjoy the stretching process
and will often stretch too far. They naturally position themselves in
more ways throughout their day, tend to be more fidgety and are
constantly shuffling and changing positions. This means that exploring
movement is just more ‘normal’ for them than it is for tight-bodied
participants.
The underlying principle when considering rehabilitation is to keep the
musculoskeletal system as strong, stable and mobile as possible. The
more flexible person does not necessarily feel better than the tighter
one but balanced mobility can provide more symmetry and aid healthy
movement.
Claire Norgate, MEd
Claire has spent the past 25 years studying health and wellness and
has a passion for simplifying the complexities of the human body. Her
varied occupations, including those of midwife, yoga teacher and
academic have inspired her to share her knowledge with her peers.
Claire runs a successful personal training business, teaches group
fitness classes and develops instructor training courses.
NETWORK MAGAZINE • AUTUMN 2008 • PP21-23
