therapeutic yoga

The Yoga Therapist & Cancer Care: Special Cautions

The health status of a person with cancer can change frequently, particularly for those in active treatment, so it is critical to assess and reassess at each visit. The cautions that follow are not intended to be an exhaustive list but a starting place for you. These are some critical issues faced by people with cancer that impact health and safety when doing yoga.

• Cancer affects the immune status of patients, making them more vulnerable to illness and infection. It is important that the space you use as well as mats and props are clean before anyone with a compromised immune status uses them. I encourage clients in this situation to bring a clean sheet or blanket from home to put under them so they do not have direct body contact with the floor. Encourage students in a therapeutic class who have any symptoms of cold, fever, flu, or any other active infectious condition either not to come to class or to create as much physical distance as possible between them and anyone with low immunity. Remember, cancer patients’ immune status can fluctuate wildly from week to week.

• Along with compromised immunity, people undergoing treatment can have low blood platelet counts (which can lead to bruising and bleeding). Avoid props and ties that apply direct pressure to the skin because they can cause bleeding depending on how they are used.

• People undergoing treatment (and sometimes people with more advanced disease who are not having treatment) will often have a port or central line. These are devices placed in the chest so that drugs can be delivered directly into a vein. This is done to reduce insertion of needles into the hands and arms and to reduce inflammation that certain drugs can cause in the peripheral veins of the extremities. These devices can remain in for months. Some doctors advise their patients that there are limitations on certain physical movement if you have one of these central lines or ports. The typical limitation that is related to yoga is to avoid placing the head beneath the heart—no inversions, standing forward bends, and so on, including downward-facing dog pose. On the other hand, some physicians say there are no restrictions. It is important that your client/student understand their doctor’s directions. If the client doesn’t know, always err on the side of caution.

• Cancer can often spread, or metastasize, from its original site to other organs (including the bones). A client may or may not know if they have cancer in their bones or if their disease has spread to another site (metastatic, or Stage IV, cancer). If they do have metastatic disease, check with them about whether their type of cancer can spread to the bones (they may not know). If they have any tumors in their bones, you’ll want to know where. Also, bones may be radiated as part of treatment. If so, the client may be vulnerable to fractures—typically in the spine, pelvis, or ribs—because the bone is weakened and no longer has structural integrity. So avoid anything that stresses the bones: bound or closed poses, anything that uses leverage or torque (e.g., seated twist, bound triangle, bound side angle, and most hand-to-bigtoe variations). There can be situations where the bones are so weakened that anything that stresses the spine in extension or flexion can be risky. As above, this is dependent on the individual. When in doubt, I make the practice extraordinarily gentle until there is some medical guidance.

• If your client/student has a known tumor present, he/she should avoid putting direct pressure on the tumor. Clients often have discomfort in the area of the tumor, and that can be self-limiting. For instance, prone poses such as cobra can be a problem for people with pelvic or abdominal tumors.

• Some clients will be taking steroids. Steroids can cause mood shifts (often depression), weight gain, and physical and/or mental agitation so that it is hard to stay focused on anything and/or to keep the body still. Sleep is often disrupted or very difficult. In addition, steroids use can result in being immune compromised, so use the same precautions described above.

Lymphedema is a condition that arises from removal of lymph nodes, resulting in fluid accumulation (typically in the arms or legs) because the lymph drainage system is no longer working correctly. Most often this condition is seen in breast cancer patients, but it is not limited to them. This condition can vary greatly from patient to patient, but generally, avoid long holds of poses that extend the impacted limb overhead. It is best to move in and out of such a pose briefly and avoid stays. Also avoid direct weight bearing on the affected limb. Because of the variability of this condition, it is best to consult with the client’s physical therapist. One last point on this condition, sometimes you the teacher or therapist may notice that a part of a limb looks swollen. If so, ask the client/student about this and make sure they are getting appropriate medical treatment. Lymphedema left untreated can be quite serious and is sometimes unnoticed by the client. This condition can also occur a long time after treatment has ended.

Working with people with cancer can appear overwhelming, and as I write this I am reminded of the remarkable complexity involved. But that said, begin with yourself: are you interested in this work? Do you have the training and support you need? If the answer to these questions is affirmative, then an amazing world may open up for you. People with cancer are often ready and available for work at each level of the panca mayas (koshas), and profound change is possible. I love this work. Perhaps surprisingly, it is not draining and in fact feels mutually nourishing. If you want to know more, you can contact me directly.

This article was first published in Yoga Therapy Today (a publication of the International Association of Yoga Therapists).

Thanks to Olga Kabel at SequenceWiz and @SequenceWiz for republishing sections of this article on her guest blog.

More about yoga for chronic pain

My last blog post generated questions about the chronic pain video that was attached. What kind of yoga did Linda do? How much did she practice? Here is some context for her remarkable story.

Linda has been a yoga student in one of my weekly classes for quite a number of years. As she describes in the video, she arrived in pain and usually felt better when she left – the pain was eased physically and she was also more relaxed. The benefit, however, was not sustained, and she was plagued by chronic pain in multiple joints as well as neck and spine pain. This led her to be concerned about her condition as well as fatigued from managing her life with pain as a constant companion.

In the summer of 2012, I challenged the students in one of my classes to start a brief (and I really mean brief) daily home practice. I created what we affectionately called the "10-Minute Practice" because I assured them they could do it in 10 minutes or less. I created a stick-figure diagram with breathing instructions so they would have a guide to practice with at home and we reviewed it in class. It has 3 postures! A video version is below.

A number of students began to practice it daily and Linda was among them. She noticed that it helped diminish her morning stiffness and it also helped her feel centered to start her day. Interestingly, within a couple of months Linda decided to go on a diet, something she had not been considering previously. Over the next 20 weeks, she lost 25 pounds and she has kept them off ever since! The combination of daily yoga practice and weight loss seems to have markedly changed Linda's pain.

As Linda and I were talking about this blog, we both wondered if it was her daily yoga practice that created the right environment for her to embark on her diet. Her successful discipline in doing this 10-Minute Practice helped build her will and remind her that she could take on and follow through with new activities for self-care!

My Viniyoga Journey

I had been practicing Yoga for many years when I happened into a Viniyoga class at my transplant center in Seattle late in 2001. I was quite ill and felt extremely sick and I had no idea exactly what this Yoga was – it seemed like not much was happening. But at the end of the class I felt profoundly still and filled with a sense of calm and balance that did not match my external circumstances at all. I knew then, that if I survived and could create the opportunity to learn more, I would.

I have been studying and practicing Viniyoga with Gary Kraftsow since 2004. I know it has been an essential element in my own healing, and I see the amazing impact a Viniyoga class or home practice can have for my students.

So What Is Viniyoga

Our view is…the breath is the primary tool through which you will be able to access what’s actually happening in your body. It’s the primary tool to activate change in your structure at a deep level, and it’s the primary tool to link your conscious awareness to the process of change.

So think of the breath as an internal flashlight, microscope, viewfinder, that helps you discover what’s going on.

Gary Kraftsow, Founder  and Director of the American Viniyoga Institute.

Viniyoga implies differentiation, adaptation, and appropriate application. It is a school of Yoga developed by my teacher, Gary Kraftsow, based on the teachings transmitted to him by T. Krishnamacharya and T.K.V. Desikachar of Madras, India.

Viniyoga asana is distinguished by the following:

  • Breath is the medium for movement in asana and we adapt the pattern of breath to create different effects.
  • We emphasize function over form in asana and we use the science of adaptation to achieve different results in postures.
  • We move in and out of poses not just holding in a static position.
  • We employ a sophisticated art and science of combining sequences of different orientation, length, and intensity to match the intention and context of each practice.

Viniyoga draws from the many tools of Yoga, not just asana, so a class experience will always incorporate breath awareness and some kind of guided relaxation or meditation and often chanting. Your experience in a class is not just that of using your body. Even in a class setting, each student can discover his or her own potential and connect with that sense of interior well-being which is available to each of us.