Balance Pose of the Week: Zig and Zag

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Friday Q&A: Preparing for a Hip Replacement

Brooding Woman by Paul Gauguin

Q: It looks like I am scheduled to have my right hip replaced in two weeks. Have tried to work my way thru it for the past two years using alternate modalities without much luck. Any words of advice? 59 year old male in Portland.

A: From the sound of the first sentence, I sense a bit of ambivalence about the upcoming surgery from our reader. Can’t say I blame him, although I wish I had more information about why now is the time for the surgery. For some of us who do yoga and prefer to utilize alternative therapies as a first line approach to our health, we often can feel conflicted when the Western approach seems the one we need to try. If you are in this quandary, I recommend you check out Nina’s insightful post No Shame, Please (Western Medicine and Yoga are Complementary).

The most common reason for a hip replacement in an otherwise healthy adult without a history of osteoporosis or an acute fracture of the head of the femur bone is significant osteoarthritis or wear-and-tear arthritis with secondary pain that is becoming unbearable. Most of my patients and students who have found themselves in a position of worsening hip pain due to OA are usually told by their orthopedic surgeon to return for a hip replacement when they can no longer tolerate the pain or function normally with the pain. This is partially encouraged since the hip replacement has a limited life expectancy before it may wear out and need replacing—around 15 years of so. So your doc wants to have you wait as long as you can—within reason—so you are old enough at the time of surgery that you might be able to live out your life and not need said replacement of the replacement! 

As I said, I might feel a bit ambivalent about such a major surgery, as I always like the idea of keeping my body as intact as I can. However, hip replacements have become fairly routine and are overall safe procedures, although not without risks (as for any major surgery). It turns out your mind can influence the outcomes of surgery, so it never hurts to cultivate a positive attitude towards your upcoming surgery, anticipating a good outcome. There have been studies done looking at pre-surgery attitudes and outcomes, and it turns out that having a negative expectation, what researchers call the “nocebo effect” (as opposed to the more famous placebo effect), results in higher complication rates than are normally found. So, if you notice that your thinking around your upcoming surgery is trending on the negative side, consider employing the yogic concept of pratipaksha bhavana, or cultivating the opposite (although this is about healthy eating, see this for a general idea: Cultivating the Opposite). You can do this during your meditations between now and surgery day by using a mantra that reflects your desired outcome, such as “My hip is healthy and pain free,” which you can repeat mentally as you exhale during your meditation. 

Leading up to surgery, even if it is very soon, you could also be doing a modified home asana practice that avoids poses that worsen your particular hip pain, but that keeps all the other parts of your body flexible, strong, agile and balanced, so you head into surgery with a quality of physical and mental fortitude. Consult with a seasoned yoga teacher if you at a loss as how to do this on your own. 

Also, our in-house physical therapist, Shari Ser, has written about post-hip replacements and yoga in her post Total Hip Replacements and Yoga). So read that post over to get ready to employ your yoga tools along with the post-op physical therapy visits your doctor will likely assign for you. Shari has done such a thorough job of it that I don’t want to rehash this excellent post. I strongly echo her recommendation to work with an experienced yoga teacher following your surgery.

I’d add one more suggestion, however, to working with you pre-op attitude. You might see if you can speak with your physical therapist prior to surgery and ask them to describe some of the initial exercises they will have you start in the hospital or as soon as you go home. There have been studies that showed improved healing times and shortened discharge times from the hospital from surgical patients who were taught to visualize their exercises mentally in the days leading up to when their docs would OK them to start doing actual physical therapy compared to similar surgery patients who were not taught the visualized practices. As a yoga practitioner, you may find this sort of visualization easy to practice and beneficial in the same way as the study participants.

Finally, it couldn’t hurt to focus on the quality of gratitude, especially gratitude for the fact we have access to modern surgical technology that has the potential to return you to normal daily function of your hips and pain-free movement. I’d hope that in the same situation I could utilize all these ideas to improve my chances of a successful surgery and return to activity. All the best! 

—Baxter

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How and Why Yoga Helps with Pain

by Ram

Self Portrait with Bandaged Ear by Vincent van Gogh

Say, a heavy object fell on your big toe, or you cut your finger while peeling vegetables, or you applied alcohol over a bruise, or while walking down the street you twisted your ankle and immediately let out a shout—in all these situations, you have experienced an unpleasant feeling due to a tissue damage. When something harmful or irritating affects a part of our body, there is a biological response to try to remove it. This response takes the form of the unpleasant feeling/sensation called pain (see Yoga for Pain Management). 

The International Association for the Study of Pain defines pain as “an unpleasant sensory and emotional experience associated with actual or potential tissue damage.” You may ask why should anyone experience pain? Well, pain is part of the body’s inherent protective mechanism to:

• motivate you to pull out from a damaging situation and prevent further damage to the tissue
• allow the damaged tissue to rest and begin the healing process
• avoid similar encounters

Thus, you may appreciate the fact that pain is beneficial in a true sense when, for example, your back sustains a blow and the injured tissues need care and protection. Individuals who suffer from congenital insensitivity to the pain response are easily injured and most of them die at an early age. On the flip side, pain is a major symptom in several medical conditions that can interfere with a person's quality of life and general functioning as well see Interview with Shari and Bonnie on Pain Management). In these cases, pain turns out to be the most common reason for individuals to visit their physician.

Several classes of pain exist based on the initial stimulus and the site of damage:

1. Nociceptive pain (pain due to excess heat or cold; pain due to mechanical damage as in crushing, tearing; pain due to chemicals: pepper powder in the eyes; alcohol on bruises), 
2. Inflammatory pain (pain associated with acute or chronic inflammation—see Chronic Inflammation and Yoga)
3. Neuropathic pain (pain due to damage to nerves as in burning, tingling, stabbing, pins and needles, etc.)
4. Pathological pain (pain due to abnormal function such as arthritic pain, fibromyalgia, headaches, etc.)
5. Cancer pain (Cancer pain is complex as it constitutes a varied combination of pain types)

Just like inflammation, the phenomenon of pain is generally transient, and recedes when the stimulus is removed or the damaged tissue has healed. In a perfect setting or perfect body, pain occurs just as it should when needed, and turns off when the stimulus is withdrawn and the tissue has healed. However, there are certain abnormal pathological conditions where pain is a constant feature and persists for a long time. This is chronic pain that lasts beyond the expected period of healing. Unfortunately, chronic pain brings with it other health issues including constant fear, worry, anxiety, depression, and memory deficits. It is unclear if chronic pain triggers these co-morbidities or vice versa.

The entire process, starting from the initial stimulus to the actual pain response and the waning of the pain, involves several specialized receptors, neurochemicals, and transmission of the pain information through specialized channels. For example, if you cut your finger while chopping vegetables, this response triggers numerous events: a) mechanical stimulation from the sharp object, b) injury to the tissue, c) release of certain chemicals at the site of damage, d) signals from damaged tissue and the chemicals stimulate nerve endings found in the skin, muscle, joints, bone and viscera, e) information travels from the nerve endings to the spinal cord, for suitable action to be generated. The end result is the damaged area gets flooded by various inflammatory molecules and chemicals, including Histamine, Arachidonic acid, and Substance P, all of which trigger the pain response. Furthermore, when these pain signals traverse through certain areas of the brain, they stimulate a set of autonomic responses resulting in increased heart rate and blood pressure, rapid breathing and sweating.

Several factors can influence the pain perception including:

Age. As brain areas degenerate with age, brain circuitry also diminishes, so older people have lower pain tolerance and face severe problems dealing with pain.

Gender. In general, women have lower pain threshold and a higher sensitivity to pain. This could be due to hormonal changes that may be modifying the pain perception system.

Memory. Our past experience dealing with pain can influence neural responses to the incoming pain stimulus. 

Whether for acute or chronic pain, interventions include pain relievers/killers, including over-the-counter medicines like acetaminophen, nonsteroidal anti-inflammatory drugs (NSAIDs-Advil, Motrin), or prescription painkillers that are opium-like powerful drugs. Is there an alternate way to overcome pain, especially chronic pain? There are several studies that report the benefits of yoga in curbing pain. Yoga helps in the following ways: 

1. Yoga asanas trigger increased flow of oxygen to the brain and muscle tissues that improves energy levels and sense of wellbeing.
2. Yoga asanas help to release muscle tension and stretch the muscles thereby reducing the intensity of the pain
3. Yoga asanas can create more mental clarity thereby decreasing the level of perceived suffering
4. Yoga stress management practices, including meditation, focused relaxation, and relaxing asanas, help you cope with stress that can have a feedback effect on improving pain.

Furthermore, in animal models, research studies show that physical activity and a socially enriched environment reduce pain behavior. Similarly, studies in humans reveal that the practice of meditation and/or yoga reduces pain perception. Patients with chronic pain have accelerated, age-associated gray matter loss and decreased insular connectivity. The gray matter together with the associated insular areas plays important roles in emotion, perception, motor control, and self-awareness. It is not clear if pain triggers the gray matter loss and insular connectivity or vice versa.

In a recent study Insular Cortex Mediates Increased Pain Tolerance in Yoga Practitioners, a group of researchers concluded that yoga may prevent age-related gray matter loss and also increase intra-insular connectivity, thereby increasing the pain tolerance. The research study involved 14 experienced yoga practitioners and 14 individuals who did not have any practice of mind-body techniques (individuals were matched for gender, age, body mass index, left/right handedness, education, and exercise level other than yoga). The cold pain tolerance test involved immersing the hand in cold water until they could no longer tolerate the cold pain. The researchers conducted brain-imaging scans to examine the structural and functional differences in gray matter and white matter between the two groups. They also noted the strategies adopted by the individuals to tolerate the pain. The results were not very surprising: 

1. Yoga practitioners tolerated cold pain more than twice as long as the non-yoga individuals.
2. Researchers found a significant difference in gray matter volume in brain areas associated with pain processing, pain regulation, and attention.The increase in gray matter volume was associated with increases in the insular connectivity that correlated with the higher pain tolerance
3. Yoga practitioners had increased white matter (this would indicate extension of nerve fibers and improved nerve signaling). 
4. Yoga practitioners used various cognitive strategies to withstand the pain (such as observing the pain sensation but not reacting and using breath-relaxation techniques to accept the sensation) while most non yoga individuals were unable to think of such strategies. 

While definitive causal conclusions cannot be made, it is worthwhile to note that regular, long-term yoga practice seems to help individuals to deal with unpleasant sensory and emotional experience associated with pain. Take home message: Yoga In, Pain Out!

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Featured Sequence: Challenging Agility Practice

by Baxter

A while back I shared a basic agility practice with you. Today, I’d like to up the ante by having you try some different dynamic sequences and modifying one classic one, the Sun Salutation. Because agility involves both accuracy of movement and speed (as well as flexibility, strength and balance!), I am going to suggest that you try each dynamic sequence slowly at first, for a few rounds, to get your accuracy down. Then, gradually, over the course of several practices, start to move with a little more speed. Be sure to reasonable with yourself. You are not trying to become bluegrass fiddle champion of the yoga world. Just gradually work on going a bit faster with each round, without sacrificing your precision. 

And certainly, with all these poses I am suggesting for today’s sequence, feel free to do any of them statically first to get the alignment clearly into you body and mind. 

Challenging Agility Sequence 

1. Dynamic Reclining Hip Stretches, 3 rounds.

This vinyasa is a great starting place, as you get to do it lying down.

If you don’t have any lower back issues, feel free to take the twist a bit deeper if it feels good. Try to get more precise in linking your breath to the movements. See Dynamic Reclined Hip Stretches for more details on how to do this sequence. 

A round includes doing it on both the right and left sides. I recommend you do at least 3 rounds. Once done, roll over on to your side, sit up, and come to Hands and Knees position. 

2. All Fours Pose to Downward-Facing Dog (Adho Mukha Svanasana), 6 rounds. 

Starting in Hands and Knees position, move your hands one hand-length forward of your shoulders. On an inhalation bring your spine into a Cow arch. Then, as you exhale, turn your toes under and lift up briefly into Downward-Facing Dog pose, allowing you knees to stay a bit bent the first time. On your next inhalation, bring your knees back to the floor, keeping your hips over your knees and once again move into the Cow arch (your arms should be angled forward of your shoulders about 30 degrees). As you exhale once again, return to Downward-Facing Dog pose. 

Continue this dynamic pattern, which I sometimes refer to as Dynamic Dog (sounds like a yoga super hero!), for at least six rounds of breath. After returning to Hands and Knees position, rest in Childs’s pose (Balasana) for a few breaths before coming up to standing. 

3. Sun Salutations (Surya Namaskar), 4 rounds. 

In our easy agility practice, I had you doing an easier version of Sun Salutations. Today I’d like to offer a more challenging variation. Instead of doing Cobra pose (Bhujangasana), try replacing it with Upward-Facing Dog pose (Urdva Mukha Svanasana). Here are two versions of Upward-Facing Dog: 

The first version has the toes left turned under as they would be in Plank pose, which I find very efficient if I am only going to inhale directly into Upward-Facing Dog pose from Downward-Facing Dog, and then exhale right back to Downward-Facing Dog. The second version has the tops of the feet on the floor, which requires that you roll onto the top of the feet as you come into Upward-Facing Dog, and flip back onto the balls of your feet as you go back to Downward-Facing Dog. 

On the rounds you do this variation, I recommend you stay in Upward-Facing Dog for 2-3 breath cycles. Do at least 4 rounds of Sun Salutations. 

4. I Walk the Line Pose, once on each side. 

This is one of my new balance practices. Here is the video for you to review if you wish.

Start at the back of your mat on with the left side of the long edge of your mat. Step your right foot half on and half off the long edge. Now walk down the edge, half on and off, alternating feet until you come to the front of your mat. Then, walk backwards the same way. This part of the journey is much harder, as you cannot see where you are going and must rely more on the sense of touch of your foot to stay on the edge of your mat. When you get to the back, step off for a moment, then slide to the right edge of your mat and start the process again with your left foot first. 

5. Dynamic Tree-to-3 Pose, 3 to 6 times on each side. 

This is another one of my new balance practices. Here’s a video for you to review if you wish. 

Take this one slow at first and get faster gradually. Start in Mountain pose (Tadasana). 

Over one to two breaths come into full Tree pose (Vrksasana) standing on your left leg with your right foot up.

From Tree pose, let your arms come by your sides, bend your left knee slightly and release your right leg alongside your left, keeping the knee bent and your right foot off the floor. Now, begin to tip your torso forward into Warrior 3 pose (Virabradrasana 3), extend your right leg back and keep your arms along your sides. 

Let this all happen over a few breaths. Then slowly return to Tree pose without letting your right foot touch the floor. After staying for few breaths in Tree pose, bring your right foot down into Mountain pose. Then repeat the pattern two or more times on the same side (with your right foot up in Tree pose). 

After finishing the right side, switch to doing the same sequence on your left side (standing on your right leg with your left foot up) and repeat for the same number of times you did on the first side. Eventually you will work towards inhaling into Tree pose, exhaling into Warrior 3, inhaling back to Tree and exhaling to Mountain, repeating this pattern 6 times on the right, followed by 6 times on the left. 

7. Downward-Facing Dog Pose (Adho Mukha Svanasana) to Side Plank pose (Vasithasana), 2 times per side. 

For this dynamic sequence, start in Downward-Facing Dog pose. 

Inhale into Plank Pose. 

Once there, as efficiently as you can, exhale and swivel your feet to the right as you shift your weight onto your right arm, turn your chest towards the left edge of your mat, and take your top arm toward the sky. For this version of Side Plank, do not stack your feet (see photo). If you’re not already practicing Side Plank Pose, see Featured Pose: Side Plank Pose.

From Side Plank pose, reverse your steps by inhaling back to full Plank pose and exhaling back to Downward-Facing Dog. Next, do the series on your left side, doing Side Plank pose with your left hand on the floor. Then, repeat the sequence one more time on both right and left sides. 

If you need to take more time initially in each position, do so, and then gradually work towards the faster version. 

8. Reclined Cobblers’ Pose (Supta Baddha Konasana) for 5 to 10 minutes. 

Finish your practice in resting in Reclined Cobbler’s pose, as shown with two blankets and two blocks in this photo or as shown with more props in this video. See Featured Pose: Reclined Cobbler's Pose for further information. 

Set a timer and stay for 5-10 minutes, releasing the dynamic, agile movements of the active part of practice and coming back into a calmer, quieter state before moving back into your day. 

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A Declaration of Independence!

by Nina

Centennial of Independence by Henri Rousseau

In my old post What is Healthy Aging, Anyway?, I wrote that Baxter and I believed that “healthy aging” had three aspects to it: compressed morbidity, independence, and equanimity. Today I thought I’d focus on independence, on what it means and how yoga can help you maintain your independence as you age.

When medical professionals talk about maintaining independence, they usually focus on our ability to keep living in our own homes and take care of ourselves as long as possible. So they tend to focus on basic daily self-care activities, such as dressing, going to the toilet, getting up and down from a chair, doing light housework, and so on. But Baxter and I think there are two more important aspects to staying independent. 

The first is the ability to continue to do the activities we love (which I wrote about in my post Being Able to Do What You Love) for as long as possible. This can include activities that we think of as being primarily physical, such as cycling, hiking, doing construction projects, or gardening, but it also includes activities that get us out of the house and into the world, such as attending concerts and theatre, art exhibits, and poetry readings, or joining family and other social gatherings. Finally, being independent means being able to continue with doing the work that gives shape to your days and allow us to keep our intellects fully engaged, whether that means writing poetry and playing music, keeping up with a law or science career, or teaching in your area of expertise.

Beyond doing what we love, another quality of life that makes life worth living as we age is dedicating ourselves to a cause beyond ourselves. According to Josiah Royce, a Harvard philosopher from the early 20th century, the cause could be large, such as one’s family, country, or a principle, or small, such as the care of a pet. Atul Gawande says in his book Being Mortal, “The important thing was that, in ascribing value to the cause and seeing it as worth making sacrifices for, we give our lives meaning."

This concept fits well with karma yoga (see Altruism (Karma Yoga)), which can include community activities, such as, volunteering a food bank or an animal shelter, teaching low-cost or free yoga, or helping people learn to read and write. And Ram has written that caregivers, who give their time to family members, are true karma yogis (see Caregivers: The True Karma Yogis). 

Obviously, if basic self-care is all you are physically capable of, you’re going to be missing out on many of these activities. So for a truly independent life, you’ll need a combination of physical skills, including strength, flexibility, balance, and agility. A regular asana practice—even one that is modified over time—will help keep you able bodied, rather than sliding into the stiffness and weakness that results from a sedentary lifestyle. But rather than just doing any old yoga, such as Restorative Yoga all the time, we believe that focusing specifically on the four essential physical skills is the most effective way to maintain your independence. Although we’ve written about the four essential skills individually, we’ve never addressed them together (at least not so I can find them). So today I’m going to give a quick overview of each one along with a link to a post where you can find more information.

Strength. You need physical strength simply to get out of bed, stand well and move about your home, community, or work space in easy fashion and to carry what you need to take along with you. Even more strength is needed for more demanding physical practices, such as participating in athletic activities. You can use your asana practice to cultivate upper strength, lower body strength, core strength, and bone strength. Maintaining strength also helps you stay healthy, as maintaining muscle strength helps combat sarcopenia and promotes joint health, and maintaining bone strength helps combat osteopenia and osteoporosis. See Yoga for Strength: An Overview for information.

Flexibility. You need flexibility to maintain range of motion in your joints, allowing you to move your limbs and spine with ease so you can reach or twist as needed. Being flexible also helps you move smoothly and gracefully, rather than stiffly and awkwardly, allowing you to feel more confident in your body. Maintaining flexibility also helps you stay healthy, as flexibility preserves the range of motion in the joints, fostering joint health and improving arthritis symptoms. You can use your asana practice to cultivate flexibility in both your upper and lower body. See Yoga for Flexibility: An Overview for information.

Balance. The ability to balance is crucial for preventing falls, a serious concern for older people. It also allows you to move easily over uneven surfaces, whether that’s a cobblestone street or a mountain path, and to walk up stairs. You can use your asana practice to cultivate several different aspects of balance, from increasing proprioception (your awareness of where you body is in space) to improving your ability to focus. See Yoga for Balance: An Overview for information.

Agility. Maintaining agility increases your reaction time in the real world, preventing injuries and allowing you to participate in activities that require coordination and speed. Even something as simple as walking along a crowded city sidewalk (have you ever walked through the streets of New York on a weekday?) requires significant agility, not to mention dodging rude drivers. And, of course, skillful activities like dancing require even higher levels of agility. Moving in and out of your poses with your breath, linking poses together into simple or complex vinyasasa, and working on transitions into and out of static poses all help foster agility. See Yoga for Agility for information.

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Finding My Lost Dog: Yoga After a Mastectomy

by Shanna Nasche

I was diagnosed with breast cancer and in February 2014 I had a double mastectomy. At age 54, the mastectomies were my first major surgery. As any of us yogis know, our breath—including basic breath awareness and simple, calming forms of pranayama—is the practice we can always turn to, so my breath was my regular companion during the various tests and while waiting in pre-op. As a yogi, who temporarily on medical leave, one flame that flickered within me was the desire to return to my physical practice. I mentally visualized Adho Mukha Svanasana (Downward-Facing Dog pose) as my goal. For me, finding my lost dog meant an open chest, shoulders, armpits, and straight arms, none of which I could access after surgery. I couldn’t even shrug my shoulders! I’ve never been motivated by the repetitious nature of lifting weights or the thought of 100 sit-ups to tone my muscles. But Vinyasa yoga offers me creativity, freedom of movement, and a spiritual aspect to taking care of my body. 

For those of you going through a similar journey (or who are teaching people recovering from this surgery), I’ve recreated a summary of my physical journey with recommendations for initial poses after the breast surgery. As you practice, you should not feel pain but might notice a pulling or stretching sensation. Please review this or any other plan for exercise with your surgeon, especially if you’ve experienced complications, began reconstruction using tissue expanders, or had lymph nodes affected by surgery. 

First Things First

While drains remain, walk at a comfortable pace as much as an hour a day (less if you did not exercise regularly prior to surgery). Moving helps the body heal, increasing blood flow and oxygen. Don’t do any weight bearing or lifting with the arms but reach outward (with the remote!), upward (to wash your hair), or behind you to put on a jacket. Avoid letting others do what you can do for yourself, even if it takes longer. Use deep breathing to reduce physical tension and to gently expand the chest muscles. Practice engaging the muscles used to shrug your shoulders, possibly rolling them up and back several times a day. As you release the shoulders, imagine your shoulder blades pulling down toward your waist. 

Approximately 10-14 Days After Surgery

Begin light stretches at this time (even if drains remain). Walking your hands up a wall is the best post-surgery “asana,” and officially recommended by all experts. 

Stand with your arm on the effected side at a 90 degree angle to the wall. Walk your hand upward and hold for about five breaths (3-5 sets). Repeat about 3 times day. As your shoulder opens, move your hand above your head along the wall and inch the outer edge of your foot closer. A fully extended arm with hip touching the wall is the final pose, which may take several months to achieve. Ask permission to move your arm higher than your shoulder from your surgeon, often approved around two weeks. Use breath awareness or an extended exhalation for each of the stretches with the goal of releasing tension in your body as you hold the stretch. 

The next stretch requires reaching your elbow behind your body. You can grasp a strap (or a towel) in one hand and take it behind your back (arm straight or slightly bended). The other hand reaches behind to grab the other end of the strap. Walk the hands toward each other along the strap. Allow your shoulder blades to move toward each other. Don’t arch your back, and allow your tailbone to move toward your heels. Turn your palms away from the body. Over time, you may be able to interlace your fingers behind your back. 

This photo shows an advanced version with heels standing on the strap (looped), hands grasping the top of the strap (palms out). Elbows move toward each other as your chest opens over time. As your body allows, your elbows may bend slightly, pointing straight behind. 

The third stretch uses a strap or towel in both hands (try gripping with palms up and down). Reach your arms in front, in line with your shoulders or lower if needed (review video). 

Raise your hands (arms straight or slightly bent) upward toward ceiling until you reach the edge of your flexibility. Keep your arms no higher than shoulder height until the drains are removed. Keep your spine long with your tailbone pointing toward your heels and your lower ribs stacked below the others. 

You can also do these lifts on your back with knees bent and soles of feet on the floor. Arms above your head can be helpful to reduce swelling if lymphedema is a concern. Another option for this stretch is to face the wall and walk your hands upward, inching closer to the wall as your body allows. These stretches are pre-cursors to Child’s pose (Balasana) and Downward-Facing Dog pose.

End with a restorative pose with the arms out to the side and your elbows bent in Cactus arms (in line with shoulders) or in the shape of a “W” if your elbows need to move lower (toward your hips).

This photo shows elbows touching the ground but that is unlikely in the beginning. If they don’t easily touch the ground, support your elbows and hands with blocks, blankets, or pillows, and allow gravity to open your chest instead of force. Relax in this pose at the end of your stretches, reducing the height of the props over time as your body allows. Once you can easily rest your elbows on the floor, another option to further open the heart and shoulder areas is to place a rolled blanket under your spine (keeping the back of your pelvis—the sacrum—on the floor) As you regain your range of motion, continue these or similar stretches at least once time a day to help reduce scar tissue around the incisions. 

In the Classroom

Each body heals at its own rate. Complications will likely extend your healing “schedule.” I returned to an official class (specific to cancer patients) about three weeks after surgery. I started with chair yoga. Without the ability to place much weight on the arms, I felt clumsy trying to move around on the mat. Stay with gentle versions of the stretches outlined above. My surgeon released me for physical activity five weeks after surgery, encouraging moving and stretching to reduce scar tissue. My first attempt at Downward-Facing Dog was around that five-week mark. My spine resembled an old gray mare, curving like a “U” in the middle to accommodate the tightness in my shoulders and chest. It helped to bend my knees, but my arms tired quickly, keeping me from holding the pose more than a few breaths. But despite my limitations, it was healing to return to my mat. I was thrilled! The photo at the beginning of this post shows my latest version, which I estimate at four to six months to achieve. 

In addition to the overall goal to regain range of motion, consider Downward-Facing Dog pose as a yoga “carrot” to visualize your healing after breast cancer surgery. 

Shanna Nasche, RYT-200 is a Yoga Bridge instructor and a student at Yoga Bridge. Yoga Bridge is a 501(c)(3) nonprofit that provides evidence-based coping strategies to complement medical treatment for cancer and recovery. They offer free and low-cost yoga programs to all people affected by cancer. Students are part of a nurturing community where they find relief from fatigue, muscle weakness, and stress. Yoga Bridge also offers teacher trainings in yoga for cancer twice a year. Email yogabridge@hotmail.com for more information.

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