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Day: January 25, 2020

What I Learned from Teaching Yoga at the Veterans Hospital

By Amy Satterfield for Yoga Medicine®.

In my career as a yoga teacher, I’ve had the great honor and opportunity to work with police officers, active and retired military, and firefighters. My experience actually started at a self-defense gym where I practice as well as taught yoga and group fitness classes. The training was high level self-defense and combat practices, and injuries were common, which is where my journey began.

Almost daily, one of these men and women would come to me, the yoga teacher, to ask what exercises or stretches they could do to help their injury. At that time, I often didn’t know. It was this knowledge gap that prompted me to seek answers on the therapeutic benefits of yoga, and this is what ultimately led me to Yoga Medicine®.

It seemed like the more I studied, the more I was presented with people to help but I still didn’t have the answers. Each person came with a new question, giving me new subject matter to study. In this process, I found myself teaching yoga to veterans at John D. Dingell Veterans Hospital in Detroit, Michigan. It was during this experience that I learned the in’s and out’s of teaching yoga to people with mental and physical trauma.

Each day began with a security check-in and a walk through the hospital to the pain clinic. This is where my teaching and my learning would start. Some days I would have advance notice of who I was seeing and what conditions they needed help with. Almost everyone had some combination of post-traumatic stress disorder (PTSD), traumatic brain injury (TBI), anxiety, and depression in addition to a whole host of physical and mental limitations, disabilities, and injuries. I taught both privately, one-on-one, behind closed doors in my own exam room in the pain clinic as well as group classes in a hospital waiting room that was temporarily turned into a makeshift yoga studio.

My one-on-one sessions began with an intake. I would ask a pre-set list of questions then take the client through a variety of exercises to determine their level of physical ability. Between our first and second session is when I would formulate our plan and study the conditions that I was being presented with. Our second session is when the work began. In many individuals, we were able to break significant ground in a very short period of time by simply focusing on breathing techniques. As a matter of fact, many of the people I had the opportunity to work with were able to come off of some of their medications for anxiety, depression, and even pain as we progressed in our sessions. This of course is the optimal result in a perfect scenario! Not all scenarios were quite that perfect. 

Here’s where I’ll tell you the story of Rose (name changed to protect privacy.)

When I was at the VA Hospital, the yoga program was relatively new and it was part of the comprehensive pain management program. Attendance was required if it was prescribed by their doctor. As a result, many people I saw definitely didn’t want to see me and some were there to fulfill this requirement so they could access their medication for pain, anxiety, or depression.

Each morning when I arrived, I would get a list of who I was seeing from the reception desk.  I would walk into the waiting room, state the name of the client and they would come back with me to the room and we would get started. This was not the case with Rose. The morning I met Rose began as normal. I said, “Rose, we’re ready to see you now.” There were plenty of people in the waiting room, a few females, but no one answered. I called, “Is there a Rose here?” No answer. No big deal, people were often late so I went back to my room, waited 10 minutes, then tried again. Rose was not present. Often when working at the VA, the people I was supposed to see wouldn’t show up, either out of defiance, lack of transportation, or many other reasons. I began to think this was the case with Rose. I went out a third time and still had no response, so I went back to my room and began to process the “no show” paperwork. 

About a minute later there was a small knock on the door. I looked up and it was a woman from the waiting room. She said, “I’m Rose.” She was looking at the floor in a manner you would consider timid, but her words came out very angry. I said hello to her and asked her to sit down at the desk to begin the intake. She came over but would not look at me. I asked her the standard intake questions, many of which she stayed silent for. I attempted to begin the physical portion of the intake, but Rose would not stand. I told her in order to create a customized program for her, we needed to complete the intake. She paused briefly then said, “So, we’re done here then.” I told her we could be and she stood to leave. Her next appointment with me was three days later.

This session with Rose went much like the first. In the room where I did the intake we had a small yoga practice space set up. The space itself was very clinical, but we did the best we could. We had a yoga mat, bolsters, blocks, straps, and even a few plants to soften the space. While Rose agreed to come down to the floor and sit on the yoga mat, she refused to lay down. She also would not close her eyes. So instead, our session began with a creative breathing exercise made on the fly using counting and our hands. We would begin with clenched fists since her fists were already clenched. I asked her to breath in for the count of 4 and clench her right thumb in as tight as she could, then I asked her to release and straighten her thumb as she exhaled for the count of 6. We continued on with all 10 fingers. After her hands were open, Rose actually looked at me for just a moment. After that we were able to get through a small amount of physical exercises (neck stretches, side bends, twists) but our session didn’t last the full hour and she left early. Still, something had definitely shifted. As she left she said, “See you next week.”

The following week Rose missed her session. I was disappointed but as I mentioned, this happened often at the VA. The next scheduled session was a few days later, and I hoped but didn’t count on Rose being there. When I walked out to the waiting room that day, I was pleasantly surprised to see her there. She followed me to the room and we began as we had the first time. Clenched fist breathing. When we finished, she said she was interested in doing more this time, but she didn’t want to lie down. Instead, we practiced some standing postures and some basic modified sun salutations. The following weeks looked much the same, each week progressing in postures and Rose’s willingness to try more. There was little eye contact and definitely no savasana, but Rose was beginning to trust me and with that trust came healing.

Each week I would notice in Rose a softening. When she came to me initially, her demeanor, posture, and attitude were very protective. She still carried with her an air of hypervigilance in the lobby and the walk to our room, but when the door closed, it was almost as if her hard outer shell began to melt away. I had 6 weeks of sessions with Rose, seeing her two times a week, the prescribed amount of time the VA would allow and pay for. Occasionally they would extend but more often than not, the client “graduated” to the group classes after 6 weeks.

At the end of our final private session together, Rose agreed to try savasana. It was definitely out of her comfort zone, but she even closed her eyes. Our savasana lasted only about a minute, but I couldn’t have been more pleased with the progress we made. Rose said she would attend the group sessions and that I would see her the following week. In the weeks after our private lessons, Rose did come to the group classes from time to time, however the setting was not ideal because it was not private and the feeling of safety that she needed was missing in this setting. Still, she attended, was more communicative than when we first met, and even talked often to her fellow students in class.

What I learned from teaching yoga to Rose, many others at the VA, and subsequently working with first responders are some very important lessons that I’ve summarized below:

  • Be patient: Yoga is often times far beyond one’s comfort zone. Their training is to always be hypervigilant, meaning it can take them longer to relax and be present.
  • Adjust language: Words that are oftentimes used in a yoga class, such as “corpse pose,” can be a trigger word for those people who are faced with death on the job. Be mindful of the names and cues you use while teaching and adjust when appropriate.
  • Prioritize the student’s boundaries: A teacher’s presences should be supportive and respectful, and this is paramount when working in a community with higher rates of PTSD and trauma. Some helpful tactics are to announce your presence if you are moving around the room; observe personal boundaries by asking permission before adjusting; and prioritize your words over physical touch.

4 More Common Poses That Require Greater-Than-Average Mobility

Senior Yoga Medicine® teacher, Rachel Land, examines four familiar poses, explains why they won’t look the same for everyone, and offers practical tips for customizing your practice. To explore five other common poses, see her previous article, 5 Common Poses That Require Greater Than Average Mobility.

We know that people come in all shapes and sizes, have varied proportions, and have diverse lifestyles and habits. Yet somehow when we step onto our yoga mat, we seem to forget about these differences and expect everyone to achieve the same shapes and angles in every pose. 

Textbook alignment in many yoga poses, even those considered basic or foundational (such as the examples below), requires more than average mobility. But “average” is a mathematical concept; none of us are truly “average.” Generally, we may be more or less mobile than average. We may have greater range of motion in our shoulders, and less in our hips. Or we could have muscle tension stemming from our posture, work environment, or sport that reduces our mobility on one side compared with the other. 

Because we are all unique, it makes no sense to push our bodies toward a theoretical ideal of each yoga pose. So why not treat our practice as an opportunity for exploration and inquiry—a chance for each of us to get to know our unique configuration of joints, muscles, and fascia a little better.

Let’s examine how “average” range of motion compares with the range required for the “traditional” versions of a few more common yoga poses.

1. Warrior I 

Warrior I (virabhadrasana I) creates a strong standing base from which to lift up our focus and energy. It stretches the hip flexors of the back leg, opens the chest, and lengthens the latissimus dorsi over the side ribs. Given that this foundational pose is key to every surya namaskar B, you would think it would be widely accessible. But, while reaching the arms directly overhead can be a challenge for some bodies, what keeps many of us from achieving traditional alignment in this pose is the range of motion required in the back ankle joint. Grounding the back heel while simultaneously squaring the hips forward isn’t comfortable, or even possible, for many students, and the challenge increases as the front knee bends more deeply. Because the alignment many of us strive for in this pose exceeds the ankle’s normal range of motion, no wonder it challenges so many of us.

The breakdown:

2. Warrior II 

Warrior II, virabhadrasana II, is a stable, purposeful, and powerful standing pose. With both feet solidly grounded and arms at shoulder height, this is one of the more accessible poses on this list—provided we observe the normal mobility limitations of the hips. 

However, “textbook” alignment—the front knee bent at 90 degrees and tracking straight forward while the hips face the side of the mat—requires significantly more mobility, especially in the front hip and back ankle, than most bodies allow. As in warrior I, the range of motion required by the back ankle increases as we bend the front knee more.

The breakdown:

3. Cow Face Pose

The combination of movements involved in cow’s face pose (gomukhasana) makes it an efficient stretch for multiple areas of the body. The arm position accesses almost every muscle in the chest and shoulders, including common culprits for chronic tension (the triceps, latissimus dorsi, and deltoids). And while many yoga hip openers involve hip abduction, gomukhasana brings the legs across the midline of the body. However, the complexity of this pose also explains why it is challenging for so many of us—even if one aspect of the pose is accessible, we may find it difficult to achieve traditional alignment elsewhere.

The breakdown:

4. Bow Pose

Heart-opening backbends are a potent counter to life’s tendency to draw our shoulders forward and compress our chest. For that reason, they can benefit both our posture and our breathing. Prone backbends can be even more helpful, as lifting the head and limbs against gravity strengthens the neglected posterior body. Bow pose (dhanurasana) fits into this category. But because the arms and legs are connected, it requires significantly more mobility than alternatives like cobra (bhujangasana), or locust (salabhasana).
 
The breakdown:

Whether or not we realize it, we each already find our own unique pathway to every yoga pose. Our bodies are more adaptive and resilient than we may know, but there are limits. For each person, there is an end point to the range of motion in every joint, and we are more likely to confront that point in yoga poses than in other daily activities. That holds true even with those poses considered foundational. That knowledge should change our physical practice, allowing us to let go of the theoretical ideal. Better to instead show up on our mats with open hearts and open minds, curious about where our practice may take us.

Read the original article on Yoga International.  

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