Catherine: Good morning, I am glad to be here and excited to provide this course. I hope that everyone can take some part of it and bring it directly into their treatment. My first question I am going to ask is how many of you practice yoga? Great, there are quite a few of you. Having a foundation of your own yoga practice makes it much easier to incorporate this work into your treatment. What I wanted to do here with this course was give you the tools to begin immediately bringing this into your treatment practice.
Demographics
Yoga has become the thing and everyone is doing it. Yoga students are finding that they want to expand their knowledge, and the number of students in yoga teacher training programs have increased. We are seeing yoga teacher training programs pop up everywhere. I really feel that, as occupational therapists, bringing yoga into our treatment plan is an incredible benefit to all of our clients in all age demographics.
Figure 1. Age demographics.
Clients in their 20's, 30's, and 40's primarily are coming because of injuries, stress reduction, and obesity. Their tendency is I want to be fixed. I want to functionand be active again. Coming into the 40's, 50's, and 60's we start to see the repetitive motion and injuries. Lifestyle patterns, accidents and sports injuries have begun to wear on the body. Primarily, we are hearing, "I want to be me again." Moving from the 50's into the 60's, people are starting to look at winding down their careers, looking towards retirement and the future, and they are starting to seek balance between work, activities, and their relaxation. The older population starts to look for something more. What brings more value to my life other than the paycheck? The primary focus here is "I want to be healthy." They may look at their parents, who are in their 80's and 90's, and seeing their level of activity, may want to seek a better level of function. We still want to be running, dancing, skating and playing into our 80's and 90's. When we start looking at populations who are in their 70's, 80's and 90's, we are seeing joint replacements, arthritis, and decreased balance. These clients are seeking a mild form of exercise. Yoga is perfect at this age as well.
Considerations
Now keep in mind that the primary focus here is how to build your class. You have your group every day, but you want a well rounded class. For those of you who are not familiar with yoga, you might just have a vision of everyone bending over and touching your toes. There is so much to yoga beyond just the physical movement patterns which are called Asana's. We want to build our classes to touch all the aspects of the individual.
Across Age Groups
First we are going to look at issues across all age groups. All age groups are concerned with diagnoses, diseases, cancer, heart, and addiction. Back pain is significant as are work related injuries. Often, the back pain comes from our lifestyle. Everyone is sitting at their computer or sitting in their car causing tight hips, tight back muscles, and of course stress. Stress is caused through work, family, and relationships. Just turn on the TV if you want to add a little stress to your life. We want to focus here on "I want to be healed/healthy."
We need to look at the age groups that are coming into our classes. We want to learn how to build and deliver a class that acknowledges and meets all of the differences. Within a class, I can have students who are aged 17 up to 80. I had a class that had a 17 year old granddaughter, mother, and great grandmother all in the same class. You can easily adjust a class to meet those needs. With some understanding, you can pull together the course components and figure out how to present it.
One of the things we are not going to cover today is anatomy. We already know the body and anatomy, and this is why OTs are so great in this practice. We also know symmetry and the mind body connection. The sister science of yoga is called Ayurveda. Ayurveda is considered the constitution of the body. This is another course altogether. We also know body processing; auditory, visual, and experiential processing. Yoga looks at all aspects of the being.
Yoga Energy Theory
Now we are just going to touch really briefly on yoga energy theory. In yoga, and as I said the sister science Ayurveda, the philosophy is that there is energy that runs through the body at different levels. Now if that energy at some point is blocked or hindered, it is going to create illness and lead to pain and disease. If we are able to move the body in all directions through all planes and joints, the energy will flow freely and you will have health. And as we know as OT's, that is mental, physical, spiritual health. If everything is moving smoothly and you are physically active, you may not have minor depression. Of course, major depression goes much deeper than that. But, staying active can help you ward off some of the minor conditions as it helps connect the body. Movement at all joints brings in lubrication. Lastly, yoga focuses on the breath and visualization. Many years ago when I was working on a pulmonary unit, we were teaching all of our clients to inhale before movement, exhale with the movement. Inhale before reaching for the cup of coffee, and exhale as you are engaged in the activity. We also taught the purse lipped breathing. These are examples of yoga, combining breath with motion. The definition of the word yoga is union. As we work through a yoga practice, we want to look at all the ways we can bring union. If we can combine breath with movement and meditation with the breath, and then add in some form of spirituality, we begin to connect all aspects of the being together. This is what is unique about yoga.
Movement in All Planes
Primarily in an Asana practice, the physical motions, the Asana, the physical practice of yoga, we want to see movement in all planes. These are:
- Flexion and extension
- Abduction and adduction
- Lateral bending
- Circumduction
- Rotation
- Supination and pronation
- Dorsiflexion and plantarflexion
- Inversion and eversion
- Protraction and retraction.
Keep in mind is that we want to see all of these movements in all of these planes occur at all joints within a full practice. If you think about it, it could seem overwhelming. But as I walk you through the Asanas and the movement patterns, I think you will see just how simple it really can be. With just a handful of Asanas and a 45 minute class, you will get every joint and every motion of movement. I am also going to constantly come back to connection of the breath with the movement. That is so vital. Most of you know, we have clients who are continually holding their breath, thus teaching breathing practices is of utmost importance.
Building the Practice
Let's say we want this to be a one hour practice.
Figure 2. Building the practice breakdown.
Centering and Grounding
We are going to start with the first 10 minutes looking at centering and grounding. Are you connected to the earth? Are you connected to the moment? Are you here in this room today ready to do this practice, or are you out worrying about the car that just broke down, or an issue that is going on in the family, or who is your next client. Are you centered and grounded? Or are you thinking about your next client? Do you have enough time to finish this? Are you worried about how this class is going to work? If you are not centered and grounded, that carries over and reflects into your client's thoughts as well. Keep in mind, as we teach and lead a group, we are also receiving. We are participants as well as leaders. We also gain benefits from this.
Warm Up
During the warm-up, we are gently coming into movement and beginning gentle rotations. As you do any kind of physical activity, warm up gets the body moving and getting the body to understand that this is going to be different.
Strength/Balance
This is the core of the class or what everyone sees as yoga. These are things like lifting a foot into the air, bending over touching the toes, Warrior One pose, Warrior Two, etc. The actual Asana's are postures in the strengthening and balancing portion. This is about half of the class. After working through the practice, through the Asana's, you want to provide an opportunity to cool down.
Cool Down
The cool down includes slower movements or more holding patterns.
Rest
Cool down is followed by rest or shavasana.
Reflection
Lastly, there is reflection. It is wonderful if you can provide a few minutes of discussion so that your clients can talk about what they have experienced and how it is been for them. It is also a wonderful time to encourage continuing a practice or creating their own practice. It is very important that an individual do this on a daily basis and begin to own the practice. It is not just something we lead them through. Yoga is not just coming to the yoga class Tuesdays and Thursdays at 10 o'clock. Yoga is a practice. We always call it a practice because it is something that continually needs to be practiced and can always be practiced to a higher level. This is especially true when working in a rehab facility, treatment facility, or in a gym teaching a yoga class.
Modify, Modify, Modify
You can always modify for structural issues, stress symptoms, diseases, or sensory limitations. If you have been to a yoga studio, you will see a pile of bolsters. Like in any PT/OT clinic, all of your bolsters, pillows, blocks, and straps become very important when being able to modify for a class. I have done classes with the extremely healthy yoga elite who are in their 20's and 30's, and perfect physical condition. Modifications can be used with this population as well. Modifications are not just used for a limitation or an injury. A modification can take yourself deeper into the practice. For example, if you are doing something like a long legged sit and you cannot reach your toes, even if you are 28 and a runner and you are in great physical condition, you still want to use a strap because it can help you draw deeper into the stretch. Modifying is not a punishment. It is not saying that you are less than. It helps you to continually improve your practice. As instructors we need to know this. And if we are comfortable with our modifications for our practice, our clients are going to be more willing to modify. What we need to do in modification is identify the issue and the need for modification. Describe the adjustment and modification to better support the pose. We are going to go through this. We are also going to guide the individual through the movement so they can have their own experience. It is not about putting the client or the student into a posture, but rather guiding them so that they can find the experience themselves so they can learn what that stretch feels like. They can learn that if they turn their ankle just a little bit they can find that alignment.
Chair Yoga
For chair yoga, breathing exercises and chest opening are vital. Chair yoga is for everyone. You do not have to be in a wheelchair or be chair bound. A chair can be a wonderful support and encourager to anyone's practice. Breathing exercises are always important, but chest opening for someone who is wheelchair bound is vital. This is opening the chest, drawing the shoulders back, and expanding the lung capacity. We need to also bring in eye exercises and verbal directions. Typically our clients who are seated all day have low energy. By doing repetitive movement through the yoga practice, it will increase energy. We will see that as an example with the sun salutations. Standing poses and poses that encourage lengthening of the spine are also critical. Finally, we can work joint issues and range of motion at all joints even in seated postures.
Questions
Figure 3. Example of chair yoga practice.
The first question is can you get them out of the wheelchair? Can you get their feet on the floor? Have a selection of different chairs if possible. If it is not possible to get the client out of the wheelchair, how do you modify the wheelchair for increased support? Some of us who are a little older, who have been practicing for a while, remember the movement in the nursing homes to get people out of the geri-chairs. Where they had had their feet suspended in the air for years and were disoriented. When we started putting their feet on the floor, sitting them more upright, increasing weight bearing into their feet, we found that they were able to connect better with what was going on around them. They were not as disconnected, they were not as delusional. This was due to connecting with the floor.
When you put your class together, you are looking at starting off with centering and grounding. Can you connect them to the earth by getting their feet to the floor. We then want to work on conscious breathing with visualization. I am going to give you one specifically that I love.
This is followed by warming up. You can do some eye exercises, head and neck rolls, and shoulder rolls working down to the hands and fingers. Then, you move down the legs to their feet. This is a general moving and warming of the body.
Once the body is loosened up a little bit, you can move into your core practice of strength and balance. The core areas are the shoulder girdle and hips. In my opinion, all issues come from the hips. This is not necessarily true, but in my practice, I see a lot of decreased hip movement due to constant sitting that causes a plethora of issues. In our strength and balance practice, we want to be look at chest opening with lateral bends, spine stretches with bending, hip openers, leg stretches, twists, and rotations. We will go through each one of these.
At rest, we want to work on slowing the breath and bringing in a guided meditation. This is wonderful. This is followed by a moment of reflection, a time to come back into the day with some gentle stretching. Have the clients reflect on their time, what it did for them, and what they did not like. You always want to thank them for coming to the practice. We are going to go through each of these sections now. What I hope to give you is an actual practice you can use. You can print this out and use the handouts. You can directly model every moment of this.
