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Month: May 2016

The Art of the Yoga Intake Interview

Joy Esler, AP, MMQ, RYT shares the SOAP method for conducting effective intake interviews. These intake interviews are key for new clients, but also for your case study requirements for the 500HR and 1000HR training modules. Learn the art of assessing clients and making a treatment plan below.

Intake Interviews for New Clients & 500HR or 1000HR Case Studies

As part of the 500 hours and 1,000 hours Yoga Medicine Training, teachers are required to complete one case study for every module completed. Included in this case study is an intake and evaluation using SOAP. SOAP (Subjective, Objective, Assessment, Plan) is a note taking technique used by health care professionals to document client information.

S is for Subjective

Firstly, the S of SOAP represents information from the client related to his or her chief complaint. To gather this information, a common acronym is used which is known as OPQRST. An explanation of OPQRST follows.

  • O is Onset or when and how the chief complaint occurred
  • P is Palliation or what makes the chief complaint better or worse. Examples may include, yet are not limited to, activity, posture, palpitation, and rest.
  • Q is Quality or the type of sensation experienced. Examples may include, yet are not limited to, sharp, dull, ache, tingling, radiating, and numb.
  • R is Region or the area of the body affected
  • S is Severity or the pain on a scale of one to 10
  • T is Time or when the chief complaint occurs. Examples may include, yet are not limited to, morning, day, afternoon, night, all day, and chronologically how the chief complaint has changed.

Additionally, the Subjective portion may include other symptoms; previous and current treatments; medications and supplements; surgeries; review of the body’s systems including heart, lungs, digestion, urination, reproduction, and eyes, ears, nose and throat; and aspects of one’s health and lifestyle such as sleep, energy, water, diet, temperature, stress, work, family, and emotions.

O is for Objective

Secondly, the O of SOAP represents information based on the teacher’s observations of the client. These observations may include posture; Active Range of Motion (AROM); palpation areas of tenderness, inflammation, and trigger points; and tests of Resisted Range of Motion (RROM), Passive Range Of Motion (PROM), and yoga poses.

A is for Assessment

Thirdly, The A of SOAP represents information from a referring healthcare practitioner and the related medical diagnoses. The Assessment portion also comprises the yoga focal points, and why those yoga aspects have been incorporated.

P is for Plan

Lastly, The P of SOAP represents multiple components. Some of these components are the focus of the yoga session including key poses, alignment points, and cues; the frequency and length of yoga sessions; and the recommended self-care, and home yoga and / or meditation practice. Additionally, the Plan portion identifies the client’s comments or response to the session; any referrals or recommendations to health care practitioners; and the plan for the client’s next session.

Tips for Interviewing

Yet, how does one effectively interview a yoga client for this intake and evaluation? We use 10 tips to practice the art of interviewing.

  • Ask one question at a time
  • Use clear, simple, open ended questions
  • Maintain eye contact while writing the notes
  • Write the client’s responses using their words not yours
  • Be present
  • Be a compassionate, non-judgmental listener
  • Use this as an opportunity to build rapport
  • Do not be reactive with your facial expressions or words
  • Remember that people just want to be heard
  • Be open to the client changing the order of your prepared questions as the client responds to other questions
  • Use blank paper or the Yoga Medicine Intake form to record the information

Ultimately, as Yoga Medicine Teachers, we are operating on two levels during this intake and evaluation. We are on one level asking questions and taking notes, and on another building rapport. And our resulting SOAP notes have dual purposes. First is to provide an accurate record of the client’s current situation, and the second is to benchmark for the client’s progress.

About the Author

Joy is a Licensed Acupuncturist and Chinese Herbalist, Master of Medical Qigong, and Registered Yoga Teacher.  After experiencing dramatic healing with acupuncture, Joy decided her life’s path was to help people on their own road to health and healing.  Joy completed her Master’s Degree in Acupuncture and Chinese Herbs.  Since then, she has offered holistic services, yoga, and workshops at her active business Lotus Center of Healing, LLC.

In 1999, Joy began to practice yoga.  After several years of practicing yoga, she started to teach yoga in 2002.  Joy is certified in Kripalu yoga.  In 2015, Joy completed her 500-hours Yoga Medicine Teacher Training.

Currently, Joy is working on her Doctoral degree in Medical Qigong – the eldest Chinese medicine modality.  Her dissertation focuses on how mental, emotional, and spiritual levels impact one’s health, and the ability to heal oneself or not.

Joy’s strengths lie within her open heart and that she is truly a joy with an infectious laugh.  She utilizes multiple modalities to support her clients’ healing including acupuncture, Chinese herbal medicine, lifestyle and nutritional guidance, medical qigong and yoga.  Joy provides individualized treatments and education that promote the body, mind, spirit, and heart to heal itself.

Transition to Teaching Private Clients

Rachel Land shares her story of how she transitioned from a group yoga teacher to a private yoga teacher. Then, she offers some advice for those looking to do the same.  She is a graduate of our 500HR Teacher Training program.

Rachel Land practicing her yoga outdoors. She has transitioned into teaching private yoga classes and offers advice for you to do the same.

How I Started Teaching Private Yoga Classes

I became a yoga teacher because of my interest in health and wellness, a natural extension of my own practice. But I didn’t imagine how the role would evolve – how it would open me up to some of the most rewarding experiences of my life.

When I first qualified, all I wanted to do was teach big group classes, challenging poses, and fancy flows. But about a year into teaching, I noticed that I wasn’t actually getting to teach very much. I was leading plenty of classes, but struggling to balance the safety of new students with the need to maintain momentum in the class flow. It seemed almost impossible to go beyond that to help experienced students explore nuance in their posture and alignment. I often spent time after class with the students I had wanted to help but hadn’t been able to.

My First Client

Around this time, one of my group class students (also a personal trainer) referred my first private yoga client to me. The client had fractured T11 & T12 and previously had a serious impact injury to her right hip. She was still in some pain and was slow to move between standing, sitting, and supine. No way she was doing sun salutations!

To be honest, I was terrified. I was fit and healthy with no personal experience of injury rehab, no specialist medical or therapeutic training. I had, in fact, absolutely no idea what I could do with this client that wouldn’t hurt, let alone help her!

Fortunately, she had been working with a yoga teacher already and had a simple program of postures to work through. All I had to do was observe & correct her alignment.

We worked together regularly, and because I hadn’t designed her program I asked lots of questions about what she felt in each pose. We started to leave out postures that felt less useful and add in postures that seemed more useful. I took photos and videos to show her what I saw, and they became a powerful record of her progress. She experienced less pain, she moved and breathed more easily.

Building my Clientele

My client was so excited about her progress that she invited a friend with neck pain to join our sessions in the hope that the friend would continue on with sessions of her own – which she did.

This is when I committed to ongoing training with Yoga Medicine so that I would have the tools to start a yoga program from scratch. Each time I went away for more training, I told students and friends that I was going to learn the skills I needed to offer better private sessions.

Over the years, the referrals have rolled in – some for just a session or two, but others became regulars. I now spend as much time teaching private sessions as I do group classes.

How to Make the Change

So how do you transition from teaching groups to one-on-one?

1. Start somewhere.

Plato said, “The beginning is the most important part of the work”. My first client was pure luck – a referral from a student who knew of my interest in alignment – but all my private work has stemmed from this experience. You need to get a foot in the door, and it might mean offering free or reduced rate sessions, to begin with. So put the word out, approach existing clients with injuries, or even friends, with simply the offer of being able to better help them and get the ball rolling.

2. Don’t be intimidated.

When you start working with injured clients, you might wish you had the knowledge of a doctor or PT.

But it’s actually very grounding not being an expert because it keeps you in a humble place. The focus is less on the theory you know and more on your unbiased observation and enquiry into what the client feels. Recovery often starts as soon as a client feels seen and heard.

You might be surprised how useful your skills as a yoga teacher are here – how to direct a student’s mindful attention to a specific area, how to recognize stress or strain and encourage relaxation, how to see and acknowledge all types of progress. These are the skills your student needs from you, as opposed to their medical experts.

3. Be aware of your limitations.

The flip side of not being an expert is that you need to be clear about your scope of service. If your client is working with a medical expert it’s a great idea to get the client’s permission to consult with them for expert guidance when required. Become part of a team working for your client’s full recovery.

If they aren’t, feel free to suggest that they do before you work on the injured area. If nothing else, it’s a great way to build trust both in your relationship with your client and with the health professionals in your area. There is always useful work that you can do safely in the mean-time – relaxation, visualization, breath-work – and you’d be amazed how simply reducing stress around an injury can reduce pain.

4. Share what you learn.

Once you’re working with clients and enjoying it, tell your friends and your existing students. Each time you head away for training, spread the word that you’re building the skills to work more effectively with clients one-on-one.

Once you’ve had a chance to integrate what you’ve learned, run a workshop to share it with others – this might be the opportunity for someone to recognize that they need help working on that area further, or to think of a friend that does.

5. Build a referral network.

I was lucky enough to have lived in a small town for almost a decade before my teacher training; people knew and trusted me. But even if you’re new to town you can tell your group class students, your friends, and health professionals that your passion is private work, that your training is focused in that direction. Even staying behind after class to offer tips to students can create a bridge to let them know that you offer private sessions if they’re interested in exploring further.

6. Be patient; good things take time.

Just as you didn’t become an amazing group class teacher overnight, it will take time to build a private client base and learn how to work with them effectively. But if you put in the work, humbly and patiently, you might just find yourself changing people’s lives for the better… including your own!

About the Author

Rachel Land is a full-time Power, Vinyasa and Yin yoga teacher based in Queenstown, New Zealand.

She started practicing Hatha yoga as a teenager. She found it helped her to challenge her strong healthy body, then move beyond it to a place of calm and clarity. It took 20 years, a Business Degree, and a stint in corporate marketing for that initial interest in yoga to spark the idea of something more. In 2011 Rachel finally became a Yoga Alliance registered teacher.

Since then she has completed courses in Anatomy & Physiology, Nutrition, Sports Training & Development, Mentoring and Yin Yoga, as well as starting to work her way through a 500-hour yoga teacher training with Tiffany Cruikshank and Yoga Medicine.

But the best way to truly know a teacher is to meet their students. Some of Rachel’s students are strong vinyasa yogis aiming to deepen their personal practice. Others come for the slower, more subtle exploration of Yin yoga. And her therapeutic private yoga students want to learn how yoga can help them feel stronger, more stable, and more serene. Whether they attend group classes, workshops, retreats, or private sessions, the common denominator is lively curiosity; they come to learn – about alignment and anatomy, and about themselves.

As a teacher, Rachel aims to both spark and satisfy that curiosity. She takes her role seriously but takes herself lightly.

You can connect with Rachel via email, her website, Facebook, and Instagram

Lower Back Stretch for Desk Workers

Rene Lynch for The LA Times has Tiffany Cruikshank show off an easy lower back stretch that is perfect for those who work at a desk all day.

Tiffany Cruikshank LA Times Stretch

This Is The Best Way To Stretch Your Back After Sitting In A Desk All Day

Here is the perfect fix for your back if you sit at your desk all day. Yoga Medicine founder Tiffany Cruikshank says this easy, gentle yoga pose can help with that. “This is a great pose to do at the end of the day… It releases a tense, tired back and helps with an overall sense of stress relief – something we can all use.”

Click here to watch Tiffany’s LA Times video of this simple 1-2 minute stretch that will release the day’s stress.

Reposted on May 21st by Current Reportage, Follow News, Ooyuz and associated article on Simple Most.

Health Tips for Summer with #FitnessGoals

#FitnessGoals writer Joni Sweet shares some key health and happiness advice from dozens of experts and fitness gurus, including YogaMedicine’s own Tiffany Cruikshank.

Meditation Tiffany Cruikshank

Countdown to Summer

The countdown to summer is on! Sun and sand are just around the corner. But don’t worry, there’s still a ton of ways to improve ourselves—both inside and out. Dozens of fitness gurus, health wizards, and nutrition maestros to reveal their 50 best tips for ready for summer. Check out these tips to have your best summer yet.

Click here to scroll through Joni’s list of top 50 health and happiness tips (or click here to skip straight to Tiffany’s meditation advise #33).

For more on meditation, pick up a copy of Meditate Your Weight by Tiffany Cruikshank.

The Neurobiology of Pain and Yoga as its Medicine

As Yoga teachers, we will often have students who struggle with pain. It is not our job to diagnose or treat. However, it is our role to support, nurture and protect the student from suffering.  As well as facilitate a place for growth of the physical, psychosocial and spiritual being. This can feel like an impossible task when pain is a complaint. Especially when the pain is one that is persistent, irritable and sensitive. We all know students with these pains the ones that are made worse by “everything” and made better by “nothing”. My purpose with this article is to shed just a little light on the topic of pain and the neurobiology behind it.

Neurobiology of Pain

The human body and brain are directly connected through the nervous system. Containing 400 different nerves that if stretched end to end would extend 45 miles. These nerves sit at a resting level of excitement, ready at every moment to communicate necessary information from the peripheral (body) to the central system (brain). Each nerve contains a series of receptor sites. These sites are specifically sensitive to changes in the internal environment such as mechanical, chemical, temperature and touch.

To the surprise of many, no nerve in the body or brain contain receptors specific for pain. Instead, the nerves are armed with something called Nociceptors directly translated these are danger receptors. Nociceptors will fire along with the other receptors if any of the changes detected are severe enough that the body has a potential of harm. The nerves will send the messages of sensation to the brain via the spinal cord. The brain receives the messages and interprets it with a series of complex events involving multiple cortical regions to determine if said event is indeed dangerous.

If the brain believes that danger is imminent, then a painful experience will be expressed. If the brain decides this is not a place that requires action, pain will not be produced. This might sound confusing but it is really no different than the process used by all of our senses. For example, you do not have vision receptors in your eyes. You have light receptors. It is the brain that produces the visual experience. Evidence has shown us that nociception is neither required nor enough for pain to occur.

Case Study

Have a look at this simplified case example. A 48-year-old female student comes to you for a private session with the report of shoulder pain.

Her pain has been present for multiple months and she cannot recall a mechanism of injury. She has seen doctors and therapists and they have all told her nothing is actually wrong with the shoulder. Maybe bursitis or tendonitis but her MRI is clear.  She has been offered injections and medications but has declined. She is choosing an alternative path.

You applaud her for this and begin your yoga medicine intake. Her range of motion and strength appear normal. Her resting posture is quite good. The mechanics during standing asanas are good. Chatarunga alignment is good. Hmm, but she is in pain and many of the motions you ask her to perform are done with a grimace and apprehension.

At this stage, you might begin to wonder if you can actually help her. You can, with just a little bit of knowledge. I would recommend requesting permission to discuss her case with her primary care provider to know you have all the necessary medical facts.

Reminders About Pain

All individuals with pain can benefit from these bits of knowledge.

  1. Pain Is Normal
  2. Pain is simply the body’s alarm system
  3. The role of pain is to communicate actual or perception of threat
  4. Pain commands action in order to promote survival
  5. Pain, regardless of how long it has been present, how severe it is or if an injury has occurred or not, is always an output of the brain or central nervous system
  6. Tissue damage is neither sufficient nor necessary for pain to be experienced
  7. Hurt and harm are not the same.

Assessment

You then as a yoga teacher are not protecting the shoulder in this scenario but rather the central and peripheral nervous systems. In medical terms, this individual could most likely be classified as someone who has central sensitivity, not mechanical dysfunction.

You might be thinking, great, but what do I do with that??

Energy goes where attention is given. You need to facilitate a place of safety for the nervous system. Knowledge of the human pain system comes first (see the 7 points above) then you put it into practice.

Treatment

How’s this for a practice starter?

Have her place one hand on the belly and one hand on the heart and begin to breathe a little deeper.

This simple act can be like a self-hug, assuring the nervous system you got this, and there is no need to suffer or protect. After creating a greater sense of awareness and connection to her breath, you could begin a gentle seated meditation. Bringing in the ability to be aware of a variety of sensations without the need to react to them. Visualization of movements or positions of the arm that tend to elicit pain can be utilized to practice this idea of observing the sensation without reaction and with the security of mind that harm is absolutely not present even if hurt is.

Once these steps are mastered, transition your client into a moving meditation or asana practice. Remember to keep the conscious presence on the breath and let the body naturally begin to take shapes. If sensations of discomfort present themselves, challenge her to come back to the practice of observation, awareness of safety and letting go of the need to overprotect.

Following these 3 simple steps can begin to desensitize the nervous system:

  1. Return to the breath
  2. Awareness of safety
  3. Movement without the need to protect,

It should not take too long to see a shift in the student’s pain patterns and complaints. It may take a long time for the pain itself to completely resolve but the functional ability and movement tolerance will progress with gentle facilitation.

For further reading I recommend, Explain Pain, Butler and Moseley. And Therapeutic Neuroscience Education, Louw and Puentedura.

by Marnie Hartman, PT, DPT, CSCS, RYT.

Basics of Meditation: Busting 4 Common Myths

A Foreword from the DIY Active Editor: We have a sneak peek inside a truly great book! This excerpt is from the book Meditate Your Weight: A 21-Day Retreat To Optimize Your Metabolism And Feel Great, and really breaks down the basics of meditation, and how meditation could be the missing piece to your health puzzle. Be strong physically and mentally!

Meditate Your Weight - Amazon

Some Myths About Mediation and the Truth

Though meditating is simpler to do than many believe, it is also a mysterious process— how does it work, exactly? Even scientists are not exactly sure, but they’re getting closer. That mystery sometimes causes a bit of a PR problem for meditation, but I’d love to clear up a few of those misunderstandings.

Myth: “Meditation is a spiritual practice.”

Truth: Meditation is, first and foremost, a mental practice.

Meditation is not voodoo. Meditation is not New Age or mystical. Yes, meditation has been used in many forms in religious traditions and cultures throughout history and throughout the world—but the act of meditating isn’t inherently spiritual.

At its core, meditation is a means of training your mind. It has direct physiological effects on the brain and nervous system that can be studied in the lab, tracked by sophisticated fMRI brain scanners, or analyzed with a blood test, stethoscope, or heart rate monitor. In fact, over the last twenty-five years, more than three thousand studies on meditators have been conducted at some of the most respected research institutions in the world, including Harvard, Yale, Stanford, and the universities of California,  North Carolina, and Wisconsin, among many others. The conclusion from these studies is very clear: Meditation helps people lead healthier, happier, and more fulfilling lives.

Myth: “Meditation just doesn’t work for me.” Or: “I can’t meditate.”

Truth: Meditation works for everyone, and everyone can do it.

I hear it all the time: “I can’t meditate—it  just doesn’t work for me.” Imagine  if a baby who was just learning  how to walk tried to take a step and fell down, then turned around  and said, “Sorry, Mom and Dad—this  walking thing just doesn’t work for me.” Silly, right?  But meditation is like walking—it’s an activity we learn to do in very short spurts,  then continue to practice and improve upon for the rest of our lives.

Once you’ve mastered  the basics of walking, you can go in any direction  you’d like—you can run the fifty-yard dash in gym class, you can train  for a 5k, you can become a marathoner. Or, like many people, you might just stick with basic walking to get you through  your days. But the core mechanics  involved in each of these activities is exactly the same: You put one foot in front of the other, and you move forward.

Meditation is just like that.  You might just do three minutes a day; maybe you will work up to twenty. You might fall in love with it and decide to dig deep and do a retreat. But at an elemental level, no matter where you find yourself currently,  you are a meditator. From the very first moment you sit, take a breath, and  notice  that  your  mind  is wandering,  you’re  already doing it—you’re meditating.

Myth: “The real type of meditation is [X] – and if you don’t do [X], you’re not really meditating.”

Truth: Any type of mediation is “real”; No one type is better than another.

When  we start  meditating,  a common  trap  is to get caught  in thinking  we have to follow a specific type of meditation.  When  I first got into meditation back in the early nineties, people were very specific about it. I heard all kinds of dictums:

  • You can’t be sitting  on a chair—you  have to sit on a cushion.
  • Your legs need to be in this position.
  • You have to have your right thumb  on top and your left thumb on the bottom.
  • Your right heel must be in front.
  • Your spine has to be right over your pelvis.
  • You have to chant this or think about that.

All  of  these   might  be  helpful   suggestions   to you—or not. To use meditation to reach your health goals, there are truly no absolutes of this kind. What works for you is what works for you. It doesn’t matter if you do a visualization, or count your breaths, or simply take a moment to close your eyes and be still while riding on the bus—all of these are just tools, and all of them  are forms of meditation. Anytime you take a moment to just sit there—voilà, you’re meditating.

And that’s the ultimate  goal of meditation: that, with  practice,  you will get to a level of comfort  in which you can just tip back into that same relaxed, focused mental space on the drop of a dime, anytime you notice that you’re getting stressed. By developing your meditation skills, you become able to step out of the stress loop and remain  cool, calm, and collected as often as you’d like.

If you’re drawn  to one specific method  of meditation,  that’s  great—stick  with  what  works for you. From a scientific perspective,  and for the mind and body, there are many “right” ways to do it.

Myth: “You have meditate for twenty minutes or more, or it’s not worth it.”

Truth: Any amount of meditation can make a difference in your life.

The length of time you spend meditating  is absolutely secondary to frequency. If you have to struggle and force yourself to stay still for twenty minutes, you’re not going to get the health benefits  that  you would simply sitting for five minutes and just paying attention to your breath. The effort you expend to sit in that spot longer than your tolerance can take will stimulate a stress response in your nervous  system. I would so much rather you meditate once a day for three minutes than once a week for twenty.

Yes, that little time  really  does  make  a  difference. One study found that as few as five minutes of meditation a day for four weeks significantly reduced…

Want to finish the rest? Click here to get your copy of Meditate Your Weight today!

Click here to view the original article on DIY Active.

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