// 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.
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.
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