In 2020, there will be an estimated 2.2 million people living with an amputation in the United States.1 Among those living with limb loss, the main causes are vascular disease including diabetes and peripheral arterial disease (54%), trauma (45%), and cancer (less than 2%).1 A study done in 2008 found that nearly half of the individuals who have an amputation due to vascular disease will die within five years which is higher than the five-year mortality rates associated with breast cancer, colon cancer, and prostate cancer.2 These startling statistics indicate that this special population faces immense physical, mental, and emotional challenges and yet these individuals are widely under-represented among yoga practitioners. Although participating in yoga asana can be very challenging for amputees, simple modifications can open the door to a life changing modality. Continue reading to find out how you can get involved as a yoga instructor and what you need to take into consideration when working with this population.
Before you reach out to potential amputee clients, you need to seriously ask yourself if you are a good fit for working with this population. Safety is especially important for these clients, so these questions will help you gauge whether or not you’re prepared:
- Are you familiar with chair yoga techniques?
- Are you knowledgeable of how to assist a client who needs to use a wall for support in even the most basic poses?
- Are you physically strong enough to help individuals of varying capabilities move in all directions?
- Are you comfortable discussing and addressing emotional health?
If your answer to any of these questions is “NO,” this does not mean you can never work with these amazing clients. It just means you may need more time to prepare. If you answered “YES” to all of these questions, it’s time to find your first amputee client!
Connecting with Clients
Sometimes it can be challenging to find people in this demographic that are interested in yoga because they’ve always thought yoga wouldn’t be accessible to them. I’ve found success with reaching out to support groups, asking current clients and students if they know anyone that would be interested in your services, and offering free or donation-based workshops. Simply putting the word out there will launch you in the right direction.
Working with Your Client
To protect and fully support our students, we need to be adaptable to their ever changing needs. In my experience, starting with a detailed evaluation of posture, daily mobility, and mental health is key to fully understanding their current situation. Continue to evolve your approach as your student’s needs change. Do not assume that your student wants to use their prosthesis during their practice or that you can address the “same” prosthetic condition the same way. Every single body and mind are different, so you must treat every client individually.
Here are three considerations I’ve found useful to keep in mind while creating a program for an amputee client.
- First, every amputee has been through some type of trauma in association to the limb loss. If you don’t address the mental aspect of the condition, then you are leaving out a huge portion of their healing journey. It may be weeks before they are ready to move through any yoga asanas.
- Second, limb loss will cause imbalances in their posture. This is a great place to start once they are ready to be mobile in your sessions. Focus on level hips and shoulders with healthy spinal curves.
- Third, myofascial release can be a game changer! Traditional stretches may be limited or not very useful. Try using myofascial release for a targeted approach. Furthermore, myofascial release can be beneficial in the beginning stages before movement is accessible.
Preparing for the Unknown
Throughout your journey together, you will navigate territory that is new to you and often your client. Be patient, caring, and ask their opinion. As an amputee, your client will be very aware of their strengths and weaknesses. Therefore, they are a wealth of knowledge during these roadblocks. Ask for feedback on how they are feeling and what is not working – ask early and often! Armed with this knowledge, you will be able to continually modify their program to maintain their gradual progress.
When dedicated care is provided and modifications are explored, big changes can happen! Working with the amputee community has been some of the most rewarding and challenging work I have ever done as a Yoga Medicine Therapeutic Specialist. Their condition may be physical, but the practice of yoga can improve many aspects of their life well beyond the physical.
- Ziegler‐Graham K, MacKenzie EJ, Ephraim PL, Travison TG, Brookmeyer R. Estimating the Prevalence of Limb Loss in the United States: 2005 to 2050. Archives of Physical Medicine and Rehabilitation 2008; 89(3):422‐9.
- Robbins JM, Strauss G, Aron D, Long J, Kuba J, Kaplan Y. Mortality Rates and Diabetic Foot Ulcers. Journal of the American Podiatric Medical Association2008 November 1, 2008; 98(6):489‐93.