Yoga: Common Injuries and Prevention

Sports Injuries: 

• From a recreational athlete to a pro, the most common reason for sport related injuries is overuse and abuse. Most injuries arise because athletes disconnect to their body. 
• The best prevention is to become aware of your body, its shape, how it feels, range in the joints, and its symmetry. Sports create asymmetries because they are one side dominant, it's your job (as a teacher) to recognize imbalances in your students, before they become an injury. 
• Here are top 10 most common sport related injuries and yoga poses to prevent them.

1. Hip pain
2. Hamstring pulls
3. Knee injuries
4. Shoulder pain
5. Low back strain
6. Wrist problems
7. Ankle sprains
8. Achilles tendonitis
9. Plantar fasciitis
10. Neck strain

Hip Pain

• Hip pain is due to a lot of stop and go movement like in soccer, jarring moves like in tennis, and pounding the ground like in running. The simplest tool is to keep the hip open in all directions. 
• Diagnosis: Lie on your back and relax completely. Make sure to release your legs and let them flop apart. Slowly lift your head without changing the positioning of your legs and take notice  which way your toes are pointing. Do they point in the same direction or does one foot point out and the other foot points straight? If they point in the same direction, that means one hip is completely relaxed. If they point in different directions that means the hip of the foot pointed straight up is tighter than the other hip and needs some attention. (etc)
• poses:

• Pigeon pose
• Frog pose
• Hero's pose
• Standing forward bend (modified with knees bent)

Hamstring Pulls

• Most hamstring pulls are from tight hamstrings. This muscle group and it is a group is the source of frustration for many athletes. They are so strong and thick it takes diligence and time to open them up. It will not happen over night.
• poses
• Standing forward bend with bent knees to protect the back
• Wall lean standing forward bend
• Plow pose
• Straddle forward bend
• janu, etc.

Knee Injuries

• Pigeon pose
• Pigeon with quad stretch
• Double pigeon
• Frog
• IT band series

Low Back Pain
One of the most common reasons for pain, stiffness, or limited range in the low back is tight hamstrings.  Since the hamstrings originate on the sits bones, if the muscle is tight it pulls down on the pelvis, tipping it incorrectly and causing you to compensate in order to be upright. Another reason for low back pain is weak abdominals.

• Seated forward bend
• Wall lean forward bend
• Seated twists
• Seated leg cross twist
• Boat/ boat pull ins
• Forearm plank hold

Yoga: anxiety and depression--practices

Practices: Based on the idea that anxiety and depression, which often co-occur in various relationships are all examples of hypersensitivity of the nervous system which causes to effects:

1. hyper-reactivity (either up or down)
2. disengagement (retreat from one's body and bodily experience)

Inside each of us, there's a mind-body communications network that contributes to the patterns of anxiety and depression. This network includes the autonomic nervous system, the enteric nervous system (also called the gut microbiome), the immune system, pain modulation pathways, and the connective tissue matrix.

Treatment Perspective: Reduce hyper-reactivity and disembodiment through practices that increase embodied awareness and internal control.

• asana
• in truth, any asana which challenges, but does not frustrate a student can work toward these joint goals. But the following postures tend to increase specific emotional and mental responses, so can be used to direct responses in clients:
• energizing (used when mood is low, energy is low, feelings of powerlessness
• backbends!
• any movement or action involving the upper body
• expanding the chest
• lengthening the spine
• uddiyana banda
• standing postures in extension
• eyes open
• rigorous practices which increase endorphins  and reduce stress hormones
• Grounding postures (used when mood is anxious, irritable, feelings of spiraling out of control)
• forward bends
• balancing
• mula banda
• standing postures in flexion
• closing the eyes or focusing drishti
• RESTORATIVE postures and practices.
• inversions (non-challenging)
• pranayama
• energizing
• bastrika
• kapalabhati
• ujjayi
• rapid breathing and breath holding on inhalation (kumbacka)
• adjusting the DESHA (for inhale)
• calming
• nadi shodana
• slow breathing and breath holding on the exhalation
• ujjayi
• adjusting the DESHSA (for exhale)
• Visualization and other meditative techniques (good for all mindfulness training/improvement of a sense of embodiment once symptoms of anxiety or depression are alleviated)
• breath awareness
• breath meditation
• breath visualization (including adjusting visualization to control the impact of breath)
• Nonattached observation techniques

Mindfulness is the ability to inhabit the body and be present with bodily sensation as it fluctuates from one moment to the next. Physical exercises that increase awareness of sensations arising from within the physical body can help people to feel in control of their bodies and re-inhabit themselves in ways that encourage feelings of control.

Classes/yoga practice should always move slowly and are geared toward increasing awareness inside the body. They must integrate breath with each movement, since the breath is the connection between the mind and the body. This is the key to teaching mindfulness and learning embodiment.

Additionally, because tension in our muscles and connective tissue, or fascia, amplifies nervous system activation, practice should release connective tissue and give people an experience of 'not depression' and 'not anxiety'.

This is the same with the pain response, people need to learn to experience NOT PAIN, inorder to gain a sense of embodiment and control over pain.

Yoga: Treating anxiety & depression---evidence

Studies suggest that this practice modulates the stress response.

• Since the 1970s, meditation and other stress-reduction techniques have been studied as possible treatments for depression and anxiety. 
• Yoga, has received less attention in the medical literature, though one national survey estimated, that about 7.5% of U.S. adults had tried yoga at least once, and that nearly 4% practiced yoga in the previous year.
• Many of the studies evaluating yoga's therapeutic benefits have been small and poorly designed. However, a 2004 analysis found that, in recent decades, an increasing number have been randomized controlled trials — the most rigorous standard for proving efficacy.
• Available reviews of a wide range of yoga practices suggest they can reduce the impact of exaggerated stress responses and may be helpful for both anxiety and depression. In this respect, yoga functions like other self-soothing techniques, such as meditation, relaxation, exercise, or even socializing with friends.

Taming the stress response

• By reducing perceived stress and anxiety, yoga appears to modulate stress response systems. 
• This, in turn, decreases physiological arousal — for example, reducing the heart rate, lowering blood pressure, and easing respiration. 
• There is also evidence that yoga practices help increase heart rate variability, an indicator of the body's ability to respond to stress more flexibly.
• In 2008, researchers at the University of Utah presented preliminary results from a study of varied participants' responses to pain. They note that people who have a poorly regulated response to stress are also more sensitive to pain. Their subjects were 12 experienced yoga practitioners, 14 people with fibromyalgia (a condition many researchers consider a stress-related illness that is characterized by hypersensitivity to pain), and 16 healthy volunteers.
• When the three groups were subjected to more or less painful thumbnail pressure, the participants with fibromyalgia — as expected — perceived pain at lower pressure levels compared with the other subjects. Functional MRIs showed they also had the greatest activity in areas of the brain associated with the pain response. In contrast, the yoga practitioners had the highest pain tolerance and lowest pain-related brain activity during the MRI. The study underscores the value of techniques, such as yoga, that can help a person regulate their stress and, therefore, pain responses.

Improved mood and functioning

• Questions remain about exactly how yoga works to improve mood, but preliminary evidence suggests its benefit is similar to that of exercise and relaxation techniques.
• 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.
• One uncontrolled, descriptive 2005 study examined the effects of a single yoga class for inpatients at a New Hampshire psychiatric hospital. The 113 participants included patients with bipolar disorder, major depression, and schizophrenia. After the class, average levels of tension, anxiety, depression, anger, hostility, and fatigue dropped significantly, as measured by the Profile of Mood States, a standard 65-item questionnaire that participants answered on their own before and after the class. Patients who chose to participate in additional classes experienced similar short-term positive effects.
• Further controlled trials of yoga practice have demonstrated improvements in mood and quality of life for the elderly, people caring for patients with dementia, breast cancer survivors, and patients with epilepsy.

Benefits of controlled breathing A type of controlled breathing with roots in traditional yoga shows promise in providing relief for depression. The program, called Sudarshan Kriya yoga (SKY), involves several types of cyclical breathing patterns, ranging from slow and calming to rapid and stimulating. (kundalini technique) One study compared 30 minutes of SKY breathing, done six days a week, to bilateral electroconvulsive therapy and the tricyclic antidepressant imipramine in 45 people hospitalized for depression. After four weeks of treatment, 93% of those receiving electroconvulsive therapy, 73% of those taking imipramine, and 67% of those using the breathing technique had achieved remission. Another study examined the effects of SKY on depressive symptoms in 60 alcohol-dependent men. After a week of a standard detoxification program at a mental health center in Bangalore, India, participants were randomly assigned to two weeks of SKY or a standard alcoholism treatment control. After the full three weeks, scores on a standard depression inventory dropped 75% in the SKY group, as compared with 60% in the standard treatment group. Levels of two stress hormones, cortisol and corticotropin, also dropped in the SKY group, but not in the control group. The authors suggest that SKY might be a beneficial treatment for depression in the early stages of recovery from alcoholism. Potential help for PTSD Since evidence suggests that yoga can tone down maladaptive nervous system arousal, researchers are exploring whether or not yoga can be a helpful practice for patients with post-traumatic stress disorder (PTSD). One randomized controlled study examined the effects of yoga and a breathing program in disabled Australian Vietnam veterans diagnosed with severe PTSD. The veterans were heavy daily drinkers, and all were taking at least one antidepressant. The five-day course included breathing techniques (see above), yoga asanas, education about stress reduction, and guided meditation. Participants were evaluated at the beginning of the study using the Clinician Administered PTSD Scale (CAPS), which ranks symptom severity on an 80-point scale. Six weeks after the study began, the yoga and breathing group had dropped their CAPS scores from averages of 57 (moderate to severe symptoms) to 42 (mild to moderate). These improvements persisted at a six-month follow-up. The control group, consisting of veterans on a waiting list, showed no improvement. Researchers at the Walter Reed Army Medical Center in Washington, D.C., are offering a yogic method of deep relaxation to veterans returning from combat in Iraq and Afghanistan. Dr. Kristie Gore, a psychologist at Walter Reed, says the military hopes that yoga-based treatments will be more acceptable to the soldiers and less stigmatizing than traditional psychotherapy. The center now uses yoga and yogic relaxation in post-deployment PTSD awareness courses, and plans to conduct a controlled trial of their effectiveness in the future. Cautions and encouragement

• For many patients dealing with depression, anxiety, or stress, yoga may be a very appealing way to better manage symptoms. Indeed, the scientific study of yoga demonstrates that mental and physical health are not just closely allied, but are essentially equivalent. The evidence is growing that yoga practice is a relatively low-risk, high-yield approach to improving overall health.

some references from above:

Brown RP, et al. "Sudarshan Kriya Yogic Breathing in the Treatment of Stress, Anxiety, and Depression: Part I — Neurophysiologic Model," Journal of Alternative and Complementary Medicine (Feb. 2005): Vol. 11, No. 1, pp. 189–201.

Brown RP, et al. "Sudarshan Kriya Yogic Breathing in the Treatment of Stress, Anxiety, and Depression: Part II — Clinical Applications and Guidelines," Journal of Alternative and Complementary Medicine (Aug. 2005): Vol. 11, No. 4, pp. 711–17.

Janakiramaiah N, et al. "Antidepressant Efficacy of Sudarshan Kriya Yoga (SKY) in Melancholia: A Randomized Comparison with Electroconvulsive Therapy (ECT) and Imipramine," Journal of Affective Disorders (Jan.–March 2000): Vol. 57, No. 1–3, pp. 255–59.

Khalsa SB. "Yoga as a Therapeutic Intervention: A Bibliometric Analysis of Published Research Studies," Indian Journal of Physiology and Pharmacology (July 2004): Vol. 48, No. 3, pp. 269–85.

Kirkwood G, et al. "Yoga for Anxiety: A Systematic Review of the Research," British Journal of Sports Medicine (Dec. 2005): Vol. 39, No. 12, pp. 884–91.

Pilkington K, et al. "Yoga for Depression: The Research Evidence," Journal of Affective Disorders (Dec. 2005): Vol. 89, No. 1–3, pp. 13–24.

Saper RB, et al. "Prevalence and Patterns of Adult Yoga Use in the United States: Results of a National Survey," Alternative Therapies in Health and Medicine (March–April 2004): Vol. 10, No. 2, pp. 44–49.

For more references, please see www.health.harvard.edu/mentalextra.

Hands, Wrists & Elbows

tennis elbow (tendentious)

• self palpation with wrist movements
• ice :( (hand squeeze hurts)
• stabilize upper arm and move forearm over (laterally) and squeeze hand
• same as above with hand turned back
• Laurie sequence

neck

• SUPPORT HEAD AND MAINTAIN DECENDED SCAPULA
• head mobility
• chin tucks as warm-up
• extensions (watch range)
• side bending with chin tuck
• avoid head forward posture
• head is too heavy (neck hurts)
• test: shoulders and head against the wall
• massage suboccipital and hold shoulders to extend neck
• with towel or hands support shoulder depression for extension

shoulders: Rotator cuff etc

four muscles with both move and support the shoulder joint. tests see if any of the four movements are impaired at all:

rotator cuff tear

1. lateral thumb down lift with resistance (empty can test)
2. drop arm test (self-test) to let down slowly
3. elbows at 90 degrees resistance in
4. lift away in internal rotation

impingement

1. lift are grab right shoulder and lift up
2. hawkins /kennedy test (funky chicken movement)
3. mears test: hold down shoulder blade, internally rotate arm and lift
4. moores test: externally rotate with them on their back. Lift arm over their head, then bring to ear and internally rotate (straight arm)

treatment:

stretching

• shoulder squeezes
• dd on a chair walking back and forward
• chest openers (doorway lean, 1 or two arms- variations)
• arms behind back
• heartbench variations

strengthening

• ustrasana superman/goal post/T/ reverse Y (lifting arms
• resistance band-external rotation elbows in/internal rotation
• chest opening

tendonitis

Scapula problems:

look to increase mobility in the shoulder blades

size

• head mobility
• chin tucks as warm-up
• extensions (watch range)
• side bending with chin tuck
• avoid head forward posture
• head is too heavy (neck hurts)
• test: shoulders and head against the wall
• massage suboccipital and hold shoulders to extend neck
• with towel or hands support shoulder depression for extension

Bursitis (inflamation)

NEEDS REST

McKenzie Approach

• centralize pain and then relieve it
• method
• supine: chin back

psoas

Is the psoas HYPER or HYPOtonic

psoas goes from T12 attaches to all the veribrae and disks and goes underneath the pelvis bilaterally. responsible for hip flexing and side bending ( inter-faces with iliacus)

Diagnosis

• look at tilt of pelvis...anterior or posterior?
• one knee in and one leg straight in supta pada gustasana---if leg will not go down it is a tight psoas. 
• more extreme openings in supta eka pada virasana
• knee drops in flexion with resistance

stretching psoas

• ajanay/ add side bend
• supta virasana
• supported and unsupported backbends
• thai pulls
• splits/supported splits on chair sitting or standing
• cogra with HIPS ON THE GROUND
• bounds backbends

strengthening

• chair marching
• standing marching
• with weights
• squats on ball prone/one or two legs
• knees in blankets on floor (or furniture sliders)

spinal/back pain

Lumbar Stabilization- builds core strength for back pain reduction

• supine
• just arms, just legs, alternater
• knees bent, neutral spine, engage ribs-setu bandha sequence
• steps
• lifts
• dead bug (kundalini)
• vipriti korani sequence
• leg lowering
• lifted leg extensions
• prone
• ustrasana variations with arms and legs
• knees
• arm and leg lift variations maintaining root lock and neutral spine
• balance
• planks (hands & forearms)
• side planks (variations ---bent knees)
• planks with rotation
• standing
• lunging & reverse lunging with root lock and neutral spine
• balancing with root lock
• ball work/chair work
• ball lifts prone
• crossed elbows to knees
• belly on ball/bolster
• leg lifts-closer to chest makes it harder, single double
• cobras
• cobras twisted
• hands/no hands/weights
• sitting on ball feet against wall variations

SPINAL STENOSIS

• stretches
• supine knees bent spinal tilts
• legs lifted bolster
• single and double leg hugs
• twists with feet on floor
• forward bends in chair with legs wide and feet pressed down
• flat backed forward bends/knees bent to start
• figure 4
• lunge on step with belly on thigh
• down dogs variations on chair

hips

Sciatica (pain radiating into you butt from impingement in L4/5)

• piriforims syndrome
• SI joints rotated
• herniated/bulging disc
• tests to tell what is causing sciatica
• straight leg raise with flexion (if pain is above knee-bad)
• slump test (seated with bad posture, raise leg & flexion)
• walk on heel/toes (L5 test)
• piriformis test
• sitting too much
• is it tender when palpated
• twist in flexion (is it tight-one leg straight)
• does external rotation hurt? with resistance?
• does abduction hurt? with resistance?
• spinal stenosis
• pain down both legs to the knees, better sitting and worse walking (shopping cart syndrome---can not stand up straight)
• Hip problems
• look at rotations, are they painful
• back pain can refer

Treating Sciatica

• piriformis syndrome

• stretching
• working toward lotus (everything you might do)
• figure 4, pigeon, pigeon on chair or bolster
• thai stretching
• massage
• ball, or massage in marichi A, or roller if you like them (with figure 4)
• strengthening
• abduction in butterfly opposite side on bolster
• rope wall

• SI JOINTS (ligaments get stretched out and one or both get rotated
• tests
• pain tends to be on one side
• common in pregnancy (relaxin)
• hips uneven
• one leg longer
• supta badha (one leg each or figure 4 supta) or bolster work
• anjanay on back or feet
• pelvic push on side
• contralateral pain with alternate knees to chest
• SI joint will hurt!!!!
• push on sacrum is a release, or squeeze hips from sides when they walk
• correcting SI imbalance
• supta badhakonasana with belt
• belt around sacrum tight
• wall squats with block
• herniated disc (want symptoms to be centralized to L4/5)
• backbends!!!! McKensie, cobra variations
• with bolster or pillow to start
• sphinx, cobra, seal
• sacral pressure
• elevate hip where pain is if it is one sided
• belt with over-pressure
• half butterfly with bolster or not
• supine variations on blocks
• single leg with sand bags
• supine twists with hips centralized
• supine butterfly with weight
• bolster on side (rolls)
• side flexion with bolster under feet
• rope wall
• PREVENTION/change in lifestyle
• avoid sitting ever
• don't round your back in forward bends
• do not bend and twist with hips unstable
• full sit ups suck/ with twists worse
• do not lift heavy shit
• dont sleep in flexion
• SLEEP ROLL

TEST for weak muscles in the hip

• thai stirring
• supine flexion with resistance
• side abduction with resistance
• side adduction with resistance
• prone lift with resistance/straight or bent knee

Hip Strengthening

• wall squats with straps and blocks
• setubandha with strap and blocks
• uttkatasana with block
• leg lifts with/out weight
• abbduction and adduction w/without weights with lifts
• side steps with resistance (dynaband)---standing work hips are always center of gravity
• standing hip rotation with resistance kicks

Knees

Diagnosis:

1. ACL (stops bone from moving forward) anterior cruciate ligament

• injuries caused by planting foot and twisting knee (unstable)
• lockmans test-secure femur & pull forward (25deg)
• anterior draw test (90deg) palpate joint

1. meniscus tear test (cartledge)

• Thesaly test: hold wall stand on one leg and twist (pain?)
• pain along joint line
• is there full extension?
• does it "click into place"?
• prone, bend knee & push through hell as you turn it

1. innervation

• straight leg lift -ostrasana or supine
• leg straightening in dandasana
• leg straightening sitting
• bridge
• prone knee bend (flexion)
• bow pulling (flexion)

2. lunging

• chair lift/block
• skandasana
• weight transfer

3. squats

• with chair (up to 60 deg)
• with block support

Meniscus rehab?

1. isometrics (creating tension without contraction) -maintained
2. side leg lifts/outer and inner
3. isotonic: creating contraction through movement

Arthritis of the knee

1. mulligan technique ---helps tibia turn inward with flexion (lunging on a chair)-no pain (flexion)
2. mckenzie technique ---straighten leg/pressure on and pressure off (thai technique) (extension)
3. strengthening
1. straight leg raises (isometric)
2. straight leg raises with external rotation (isometric)
3. setu bandha on a chair (starting with isometrics)
4. shallow squats

Adaptive Yoga: Living with Cancer

https://www.cancer.org/latest-news/for-breast-cancer-survivors-life-is-better-with-yoga.html
http://img.delivery.net/cm50content/19439/65697/LP/2-0/Section2.html?utm_campaign=breastcancerupdate&utm_medium=email&utm_source=fullserve-20140806-corpcenter-breastcancerupdate-breastcancerupdate&utm_content=acxiom
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4386006/

Post Surgical Considerations
Post Chemotherapy and Radiation Considerations

Physical Activity and the Cancer Patient

Research has shown that exercise is not only safe and possible during cancer treatment, but it can improve how well you function physically and your quality of life.
Too much rest can lead to loss of body function, muscle weakness, and reduced range of motion. 

Ways regular exercise may help you during cancer treatment

• Keep or improve your physical abilities (how well you can use your body to do things)
• Improve balance, lower risk of falls and broken bones
• Keep muscles from wasting due to inactivity
• Lower the risk of heart disease
• Lessen the risk of osteoporosis (weak bones that are more likely to break)
• Improve blood flow to your legs and lower the risk of blood clots
• Make you less dependent on others for help with normal activities of daily living
• Improve your self-esteem
• Lower the risk of being anxious and depressed
• Lessen nausea
• Improve your ability to keep social contacts
• Lessen symptoms of tiredness (fatigue)
• Help you control your weight
• Improve your quality of life

Goals of an exercise program

During treatment

There are many reasons for being physically active during cancer treatment, but each person’s exercise program should be based on what’s safe and what works best for them. It should also be something you like doing. 

Certain things affect your ability to exercise, for instance:

• The type and stage of cancer you have
• Your cancer treatment
• Your stamina (endurance), strength, and fitness level
• The goal is to stay as active and fit as possible. People who were very sedentary (inactive) before cancer treatment may need to start with short, low-intensity activity, such as short slow walks. 
• For older people, those with cancer that has spread to the bones or osteoporosis (bone thinning), or problems like arthritis or peripheral neuropathy (numbness in hands or feet), safety and balance are important to reduce the risk of falls and injuries. They may need a caregiver or health professional with them during exercise.

After treatment

When you are recovering from treatment

Many side effects get better within a few weeks after cancer treatment ends, but some can last much longer or even emerge later. Most people are able to slowly increase exercise time and intensity. What may be a low- or moderate-intensity activity for a healthy person may seem like a high-intensity activity for some cancer survivors. Keep in mind that moderate exercise is defined as activity that takes as much effort as a brisk walk.

When you are living disease-free or with stable disease

During this phase, physical activity is important to your overall health and quality of life. It may even help some people live longer. There’s some evidence that getting to and staying at a healthy weight, eating right, and being physically active may help reduce the risk of a second cancer as well as other serious chronic diseases. More research is needed to be sure about these possible benefits.

The American Cancer Society recommends that cancer survivors take these actions:

• Take part in regular physical activity.
• Avoid inactivity and return to normal daily activities as soon as possible after diagnosis.
• Aim to exercise at least 150 minutes per week.
• Include strength training exercises at least 2 days per week.

A growing number of studies have looked at the impact of physical activity on cancer recurrence and long-term survival. (Cancer recurrence is cancer that comes back after treatment.)

• Exercise has been shown to improve cardiovascular fitness, muscle strength, body composition, fatigue, anxiety, depression, self-esteem, happiness, and several quality of life factors in cancer survivors. 
• At least 20 studies of people with breast, colorectal, prostate, and ovarian cancer have suggested that physically active cancer survivors have a lower risk of cancer recurrence and improved survival compared with those who are inactive. 

Living with advanced cancer

Some level of physical activity can improve quality of life for people with certain types of cancer, even if the disease is advanced (has spread to many places and/or is no longer responding to treatment). But this varies by cancer type, physical ability, health problems related to the cancer or cancer treatment, and other illnesses. The situation can also change quickly for a person with advanced cancer, and physical activity should be based on the person’s goals, abilities, and preferences.

Precautions for cancer survivors who want to exercise

During and shortly after cancer treatment

Always check with your doctor before starting any exercise program. This is especially important if your treatments can affect your lungs (such as the chemo drug bleomycin or radiation to the chest), your heart (such as the chemo drugs doxorubicin or epirubicin), or if you are at risk for lung or heart disease. Be sure you understand what you can and can’t do.

• Do not exercise if you have a low red blood cell count (anemia).
• If you have low white blood cell counts or if you take medicines that make you less able to fight infection, stay away from public gyms and other public places until your counts are at safe levels.
• Do not exercise if the level of minerals in your blood, such as sodium and potassium, are not normal. This can happen if you have had a lot of vomiting or diarrhea.
• Do not exercise if you have unrelieved pain, nausea/vomiting, or any other symptom that causes you concern. 
• Do not exercise above a moderate level of exertion without talking with your doctor first. Remember, moderate exertion is about as much effort as a brisk walk.
• If you have a catheter or feeding tube, avoid pool, lake, or ocean water and other exposures that may cause infections. Also, do not do resistance training that uses muscles in the area of the catheter to keep from dislodging it. Talk with your cancer team about what’s safe for you.
• To avoid skin irritation, people getting radiation should not expose skin in the treatment area to the chlorine in swimming pools.
• If you feel very tired and don’t feel up to exercising you can try doing 10 minutes of light exercises every day. (Later we will discuss fatigue and exercise in more detail.)
• Stay away from uneven surfaces or any weight-bearing exercises that could cause you to fall and hurt yourself.
• Do not use heavy weights or do exercise that puts too much stress on your bones if you have osteoporosis, cancer that has spread to the bone, arthritis, nerve damage, poor vision, poor balance, or weakness. You may be more likely to hurt yourself or break a bone.
• If you have numbness in your feet or problems with balance, you are at higher risk for falls. You might do better with a stationary reclining bicycle, for example, than a treadmill.
• Watch for swollen ankles, unexplained weight gain, or shortness of breath while at rest or with a small amount of activity. Let your doctor know if you have any of these problems.
• Watch for bleeding, especially if you are taking blood thinners. Avoid any activity that puts you at risk for falls or injury. If you notice swelling, pain, dizziness, or blurred vision, call your doctor right away.

Things to think about when planning an exercise program

• Talk to your doctor before you start any type of exercise.
• Start slowly. Even if you can only do an activity for a few minutes a day it will help you. How often and how long you do a simple activity like walking can be increased slowly. Your muscles will tell you when you need to slow down and rest.
• Try short periods of exercise with frequent rest breaks. For example, walk briskly for a few minutes, slow down, and walk briskly again, until you have done 30 minutes of brisk activity. You can divide the activity into three 10-minute sessions, if you need to. You’ll still get the benefit of the exercise.
• Try to include physical activity that uses large muscle groups such as your thighs, abdomen (belly), chest, and back. Strength, flexibility, and aerobic fitness are all important parts of a good exercise program.
• Try to include some exercises that will help you keep lean muscle mass and bone strength, like exercising with a resistance band or light weights.
• You might want to include exercises that will increase your flexibility and keep the range of motion in your joints.
• Always start with warm-up exercises for about 2 to 3 minutes. Examples of warm-up exercises are shoulder shrugs, lifting arms overhead, toe tapping, marching, and knee lifts. End your session with stretching or flexibility exercises. Hold a stretch for about 15 to 30 seconds and relax. Remember to breathe when you stretch. Examples of stretching are reaching overhead, deep breathing, and bending over to touch your toes so that you relax all the muscle groups.
• Exercise as you are able. Don’t push yourself while you are in treatment. Listen to your body and rest when you need to.

Cancer and fatigue: When you feel too tired to exercise

Most people with cancer notice that they have a lot less energy. During chemotherapy and radiation, most patients have fatigue. Fatigue is when your body and brain feel tired. This tiredness does not get better with rest. For many, fatigue is severe and limits their activity. But inactivity leads to muscle wasting and loss of function.

An aerobic training program can help break this cycle. In research studies, regular exercise has been linked to reduced fatigue. It’s also linked to being able to do normal daily activities without major problems. An aerobic exercise program can be prescribed as treatment for fatigue in cancer patients. Talk with your doctor about this.

Tips to reduce fatigue:

• Set up a daily routine that lets you be active when you feel your best.
• Get regular, light-to-moderate intensity exercise.
• Get fresh air.
• Unless you are told otherwise, eat a balanced diet that includes protein (meat, milk, eggs, and legumes such as peas or beans).
• Drink about 8 to 10 glasses of water a day unless your doctor tells you not to. Even more fluids are needed to prevent dehydration if you’re exercising intensely, sweating, or in a hot environment.
• Control your symptoms, like pain, nausea, or depression.
• Keep things you use often within easy reach to save energy.
• Enjoy your hobbies and other activities that give you pleasure.
• Use relaxation and visualization techniques to reduce stress.
• Balance activity with rest that does not interfere with nighttime sleep.
• Ask for help when you need it.

Effective exercise

To make your exercise effort most effective (give you the best results), it’s important that you work your heart. Notice your heart rate, your breathing, and how tired your muscles get. If you get short of breath or very tired, rest for a few seconds, and start exercising again as you are able. When you first start, the goal is to exercise for at least 10 minutes at a time. Go slow at first, and over the next few weeks, increase the length of time you exercise. Be careful if you’re taking blood pressure medicine that controls your heart rate. Your heart rate will not go up, but your blood pressure can get high. Ask your doctor, nurse, or pharmacist about this if you’re not sure about your medicines.

We don’t know the best level of exercise for someone with cancer. The goal is to have your exercise program help you keep up your muscle strength and keep you able to do the things you want and need to do. The more you exercise, the better you’ll be able to exercise and function. But even if planned exercise stops, it’s good to keep being active by doing your normal activities as much as you can.

Keep exercise easy and fun

The key is to keep your exercise program simple and fun. Exercise and relaxation techniques are great ways to relieve stress. Reducing stress is an important part of getting well and staying well.

Tips to help you stick to your exercise program

• Set short-term and long-term goals.
• Focus on having fun.
• Do something different to keep it fresh. Try yoga, dancing, or tai chi.
• Ask for support from others, or get friends, family, and co-workers to exercise with you.
• Use charts to record your exercise progress.
• Recognize and reward your achievements.

Starting an exercise program can be a big task, even for a healthy person. It may be even harder for you if you have a chronic illness, especially if you weren’t used to exercising before your diagnosis. Start slowly and build up as you are able. If you were exercising regularly before you were diagnosed with cancer, you may need to reduce the intensity and length of your exercise sessions.

Let exercise provide you with its benefits. Remember, exercise helps:

• Prevent muscle wasting
• Reduce treatment side effects
• Improve your fitness
• Improve your quality of life

Add physical activity to your daily routine

Here are some ways to add physical activity to the things you do every day. Remember, only do what you feel up to doing.

• Walk around your neighborhood after dinner.
• Ride your bike.
• Mow the grass, or rake the leaves instead of using a blower.
• Scrub your bathroom.
• Wash and wax your car.
• Play active games with kids, like freeze tag, jump rope, and the games you played when you were a kid.
• Walk a dog (one that can be controlled so that you don’t trip or get pulled off balance).
• Weed your garden.
• Take a friend dancing, or dance in your own living room.
• Use an exercise bike or treadmill, or do arm curls, squats, lunges, and crunches while watching TV.
• Walk to lunch.
• Park your car in the farthest parking space at work and walk to the building.
• Use the stairs instead of the elevator or escalator.
• Get off the bus several stops early and walk the rest of the way to work.
• Make appointments for yourself in your daily planner for 10-minute walking breaks.
• Form a walking club of co-workers to help you stay motivated to walk during the workday.
• Wear a pedometer every day and try to increase your daily steps.

Cancer survivors may need to exercise less intensely and increase their workout at a slower rate than people who haven’t had cancer. Remember, the goal is to keep up as much activity as possible. Keep it safe, keep it fun, and make it work for you.

Adaptive Yoga: RA (Rheumatoid Arthritis)

http://www.arthritis.org/living-with-arthritis/exercise/workouts/yoga/yoga-benefits.php

Adaptive Yoga: Chronic Fatigue

https://www.youtube.com/watch?v=7UlLFRFJ-aM

Adaptive Yoga:Fibromyalgia

NUTSHELL: Gentle sustained, supported stretching in conjunction with anxiety relieving pranyama and visualization. 

• external force
• you assisting
• sandbag
• no head back

In 1990, the American College of Rheumatology created a map of 18 “tender points,” or places on the body that are most often tender to the touch in people with fibromyalgia. A person who feels pain in 11 of the 18 tender points probably has it.

• While the exact cause of fibromyalgia is still a mystery, science is beginning to shed light on the disease. “There are genetic risk factors that make it more likely that you will, under certain circumstances, develop a chronic pain disorder like fibromyalgia,” says Leslie Crofford, an expert in the disorder and chief of rheumatology at the University of Kentucky in Lexington. A person may be born with a risk factor, but it will remain dormant until it’s activated by something like a car accident, a repetitive-motion injury, or osteoarthritis, Crofford says.
• Stress is also a trigger. Yovanovich suspects that stress ignited her own fibromyalgia. When she first fell ill, she was struggling in a bad marriage, working at a challenging job, and finishing an advanced degree, all at once. “I was surrounded by stress at work, home, and school,” she says. “There was no escape.”
• People with fibromyalgia process pain differently from those without it, due to a kind of hypersensitivity of the nervous system. For instance, pressure that feels mildly uncomfortable to the average person often feels painful to someone with fibromyalgia. “Basically, the volume control on pain is turned up as high as it will go,” Crofford says.
• Yoga’s ability to shift the nervous system out of the stress response and into the relaxation response is vital to people whose central nervous systems are sensitive and naturally hyped way up, says Crofford. It also acts directly on the very muscles where fibromyalgia pain occurs. “Think of it like having a writer’s cramp in all of your muscles at once,” says Jacob Teitelbaum, medical director of the National Fibromyalgia and Fatigue Centers. First the muscles shorten, then they get stuck in the shortened position, and eventually they hurt. (The tender points are often located where cramps commonly occur.) “One of the beauties of yoga for people with fibromyalgia is that it returns muscles to their normal length,” he says.

http://www.webmd.com/fibromyalgia/news/20101014/yoga-eases-fibromyalgia-pain#1

One of the few certainties about fibromyalgia is that it affects everyone differently, and a yoga practice should reflect that. Some people may want to follow Yovanovich’s path, bringing awareness back into the body with meditation and pranayama before starting an asana practice. Others may benefit from going to a restorative yoga class. 

• Shoosh Lettick Crotzer, the author of Yoga for Fibromyalgia, recommends that beginners do a gentle practice that enhances relaxation and that they avoid strenuous poses until they know they can move into them without triggering a pain reaction. 
• Crotzer suggests yoga styles that focus on alignment, relaxation, or therapeutics, such as Iyengar, or Viniyoga. She also advises working with instructors who have at least 10 years of teaching experience and letting them know before class about your condition, so they can be ready with appropriate modifications.

Easing the Pain

• People with fibro-myalgia often have chronic tension in the upper back, shoulders, and neck—places where 10 of the 18 tender points are located. All three areas are easily targeted with a few simple yoga poses. 
• Garudasana (Eagle Pose), because it stretches the muscles around the shoulder blades in the upper back,
• Bhujangasana (Cobra Pose) extends the back while opening the chest as well as gentle head rotations to relieve tension in the large muscles on the sides of the neck.
• Stay warm, because cold can tighten muscles; move slowly; breathe into painful areas; and work both sides of the body evenly to maintain balance, even if the pain is only on one side.

Healing Breath

• People in chronic pain often default to short, shallow breathing, which can set off the body’s fight-or-flight response and trigger the release of stress hormones like cortisol.
• Breathing deeply counters stress by stimulating the vagus nerve. Running from the brain to the diaphragm, the vagus nerve activates the parasympathetic nervous system. That’s why breathwork is crucial for people with fibromyalgia

If you are like me and many others in this fibro journey, mornings can be the worst part of the day because of morning stiffness. If you do desire to integrate yoga into your early morning routine, there are a few things you can do to prepare for a pleasant experience.

Take a warm bath, put on warm exercise clothing, and layer clothing to adjust with varying temperatures. Anything you can do to make your environment and experience more balanced is of benefit.

You may find productive for fibromyalgia and yoga is right before your evening meal, around four or five o’clock. Or, to really help you achieve a deeper sleep, practice right before bedtime. Just be gentle as too much activity at night can hinder sleep.

Develop a consistent yoga workout. Five or 10 minutes a day will be more beneficial for you than doing 20 minutes every other day, or 60 minutes once a week. Make it a part of your daily routine and don’t allow anything to deter that.

Consider it part of your morning ritual even if you vary in the degree of impact based on your level of pain. Increase yoga practice time as you are able.

Find something pleasant to focus on while you’re practicing yoga: a favorite picture on the wall, a decorative focal point or a window — anything that invokes positive thoughts.

Don’t practice yoga in your normal “work” environment where you might be looking into your kitchen thinking about cooking breakfast, or near your laundry area where there are clothes to be folded. Your place should be a quiet peaceful place with no distractions. Yoga’s full benefit is the ability to concentrate on what you are experiencing in your body as well as your mind.

Your thoughts need to be clear during yoga practice. Below are some of the things you should be concentrating on:

• Your breathing. Take long, deep complete breaths through your nose.
• Focusing on one spot. Stare at a spot directly in front of you, or whichever direction your head is pointing for the posture.
• Your body’s alignment. Be aware of what your body is doing. Is it balanced, equal on each side? Are you using the proper form for the pose?
• Sensations in your body. Are your muscles tighter on one side than the other? Are you feeling a good, comfortable stretch or are you pulling on your muscles too much?
• Tightened stomach and Kegel muscles. This is a little harder to accomplish but well worth the effort. You may only be able to hold these for a second of each pose at the beginning but keep trying to hold them longer.

Begin your yoga practice with warm-ups and end with relaxation for best results.

Safety Measures

• Don’t compress either the lower back or the neck into a backward bending position. If you have neck or back problems this will help avoid injury.
• Don’t lock your knees when bending forward in either a standing or sitting position. This will help prevent pulling on your lower back.
• Cushion your knees with a pillow under them if kneeling on them hurts. You can also put a pillow under your bottom, and over or between your feet when kneeling to take some stress off the knees.
• Be aware of poses and your health. If you have high blood pressure, sinus problems or are menstruating, do not practice upside-down postures.
• Never force anything or push until you feel discomfort. If a posture is hurting you, ease up or stop. The one exception to this may be foot pain as the feet are often weak and tight. Keep trying to work them if possible.
• Listen to your body and go with what it will be able to do — it will let you know what you can and can’t do from day to day. If you have a day where you are unable to do any of the yoga exercises due to pain or a flare-up, it would be of benefit to still find a quiet place to sit and clear your thoughts and exercise your mind as you prepare for your day.

Fibromyalgia and Yoga

Introduction to Yoga

Get your body moving again. Fibromyalgia and yoga are a great combination for easy stretches, careful strengthening,plus relaxation techniques. Improve your mind, body, sleep, and more.

Be sure to check with your doctor about starting any exercise program. Things like high blood pressure and back, neck, and knee problems can be adverse conditions for certain yoga exercises. I'll do my best to let you know which exercises can be harmful for which conditions.

One of the oldest forms of organized exercise, yoga dates back over 5000 years.

A terrific aspect about fibromyalgia and yoga is that there are hundreds, maybe thousands of different poses, called postures, which provide variety. It's pretty difficult to stick with an exercise routine if you're bored.

Yoga also helps integrate your mind and body, creating a healthier you.

It is important to perform yoga postures for the whole body, not just postures that target a certain area or problem. Everythings connected.

The form you use during a posture is more important than how far you can go into a posture. Yoga is not a competition with others. It is for you to discover yourself and your abilities.

Practice yoga on an empty stomach at least 2 hours after eating. Popular times to practice yoga are at sunrise or sunset and before bedtime.

For those of us with fibromyalga, mornings can be very stiff. You may find that taking a warm bath, then putting on warm sweats (even double layers in cooler tempuratures) will make it easier to practice in the morning.

The other time you may find productive for fibromyalgia and yoga is right before your evening meal, around 4 or 5 o'clock.

The last time that can really help you achieve a deeper sleep is right before bedtime. But, be careful. Too strenuous of an activity at this time of night can ward off sleep for hours. Just gentle, slow yoga at this time of day is best for fibromyalgia and anyone.

Next is,

How Long Do I Practice Yoga for Fibromyalgia?

I can tell you from experience that just 5 or 10 minutes a day will be more beneficial for you than doing 20 minutes every other day or 60 minutes, once a week. 

It's making the commitment that you are going to make it a priority for yourself. Make it part of your routine and don't let anything throw you off of your routine. Tell yourself that you can't get dressed or you can't eat breakfast until you exercise. This starts the day off right.

As you start to feel the benefits of yoga (possible after only one session!) you will naturally want to add a little more time to your yoga practice, working up to 15, 20, or 30 minutes a day. An hour would be great, but I try to be realistic.

How Do You Get Real Benefits  for Fibromyalgia from Yoga
in Just 5 or 10 minutes a Day?

First, try to find a quiet place where you will not be interrupted. I realize this can be difficult with kids, I have two boys. If you can wake up a little earlier, before the kids, you will find that the loss of a little sleep will not bother you as you gain the benefits of yoga. And I know this is hard to believe since you're already sleep deprived, but it will get better.

You may like to have something nice to focus on while you're practicing yoga. A favorite picture on the wall or a pretty towel or quilt thrown over a door will do just fine. Just don't try doing yoga while you are staring at the basket full of clothes to fold or a pile of clutter you've been meaning to take care of.

It will make concentration that much harder and not being distracted is a big key to yoga and it's mind/body benefits. You need to concentrate on so many things going on with your body, that your mind is able to clear.

The constant chatter that goes on in your brain has to stop in order to concentrate on these aspects:

1) Your Breathing - Take long, deep complete breaths that first fill the bottom of your lungs, then the middle, then the top. In exhaling, this is reversed - empty the top of the lungs first, then middle, then the bottom of your lungs.Breathe through your nose, it's a natural filter. In an advanced breathing technique, you partially close off the throat so that there is a breathing noise as you inhale and exhale. This strengthens the diaphram, which pulls air into your lungs.

2) Your Eyes Focusing on One Spot - Stare at a spot directly in front of you (or whichever direction your head is pointing for the posture).

3) The Alignment of Your Body - Be aware of what your body is doing. Is it balanced, equal on each side? Are you using the proper form for the pose?

4) The Sensations in Your Body - Are your muscles tighter on one side than the other? Are you feeling a good, comfortable stretch or are you pulling on your muscles too much? During a balancing pose, feel the body sway slightly and how you and your body correct the balance. Feel your blood give energy to your body as you move.

5) Tightened Stomach and Kegel Muscles (the muscles on your pelvic floor that you use to stop urinating) - These are a little harder to accomplish but are well worth the effort. You may only be able to hold these for a second of each pose at the beginning but keep trying to hold them longer. Start by tightening the stomach muscles on your exhale to push out the used air and allow more fresh air in. Then as this becomes easier, try holding your stomach and kegel muscles in while inhaling. This will work your lungs more as the diaphram cannot expand downward with your stomach muscles tightened. Your rib cage will expand on each breath. When you hold your kegel and stomach muscles while performing yoga postures, you will feel a warmth come over your body due to the increased effort. When you get warmer, your body becomes more able to stretch and change it's shape.

Begin your yoga practice with warm-ups and end with relaxation, for best results.

If You have Neck or Back Problems, Yoga can help

(And who doesn't, right?) Don't compress either the lower back or the neck into a backward bending position, in order to avoid injury.

Don't lock your knees (holding them rigidly tight so they cannot bend) when bending forward in either a standing or sitting position. This will help prevent pulling on your lower back.

Cushion your knees with a pillow under them if kneeling on them hurts. You can also put a pillow under your bottom, over or between your feet, when kneeling to take some stress off the knees.

If you have high blood pressure, sinus problems, or are menstruating, do not practice upside-down postures in yoga.

If a posture is hurting you, ease back on it a little, or stop it altogether. With fibromyalgia and yoga you should only move into a posture until you feel a mild sensation. Never force anything or push until you feel discomfort. The one exception to this may be foot pain as the feet are often weak and tight. Keep trying to work them in the future if you are unable to exercise them at this time.

If you have increased shooting pain the next day, you know you did too much and must take it easier the next time you are able to practice yoga. This is common when starting yoga with fibromyalgia. Do not feel like you have to make progress every day. Some days will be tighter that other days (like when those cold weather fronts are coming through).

Listen to your body and go with what it will be able to do that day. This is very important for people with myofascial pain or fms. If you don't follow your body's signals, you may end up with a lot of pain for a couple weeks.

If you are in a lot of pain and unable to do even the simplest yoga stretches, visualize yourself doing the exercises. It's amazing how this works! You will still feel some benefits and be able to get back to actually exercising sooner.

Practice your yoga for fibromyalgia barefoot on a thin carpet or hard floor with a mat. A carpet that is too thick will make it difficult to balance and be grounded.

I've made these Fibromyalgia and Yoga Lessons with only Standing Yoga Postures. This way, you do not need a mat. Also, when I started yoga, it was too painful for me to lie down on my back since pressure on the trigger points, especially at the back of my pelvis, created too much pain.

You can also find cotton mats. There's new mat that has a microfiber side that wicks away moisture while the other side sticks to the floor.

Find 5 minutes a day and check out the Fibromyalgia Yoga Lessons here: Standing Yoga Posture Lessons