Practice ideas for an injured client?

Yoga Discussion General Yoga
#1

I’m working with someone who was in an accident and suffered compression fractures in T5-T7 vertebrae- the doctors have said he’ll permanently lose a few millimeters of height and have a slight stoop, and, more upsettingly, lifelong back pain. He also tore the ulnar collateral ligament in his left thumb and has had surgery to repair it. This means that, in addition to needing to be very gentle with the spine, we can’t put much weight in his hands or wrists. Resting on his forearms, like in Dolphin, is also not possible due to the cast from the surgery (but we’ll try again when the cast is removed).

So far we’ve been working with gentle breathwork, and gentle spinal twists, cat-cow, and side bends all from a seated position. This has been pretty useful for pain management and getting a little bit of blood flowing, but he’d like to add in something a bit more challenging. Any suggestions?

#2

It would be germane to know how long ago the accident occurred and what age the student is. Since there is still a cast I presume he has not been released from medical care (cleared) and so moving forward has to take that into consideration. Though I can’t tell from the post whether the thumb and spinal injuries were from the same incident.

presuming this is recent…

Students that are healing from a trauma have greater efficacy when the nervous system is parasympathetic. Ergo the practice, however it is constructed, should be such that this is facilitated.

The diet should be altered to take in only those things which support healing. Foods that are yin in the body would be very helpful. If there is inflammation - which is likely after a surgical procedure, then protocols for reducing inflammation in the body should be applied.

The four major things I would provide to such a student are;

• gentle pranayama - how and when to do it
• traction for the spine using the Wall Rope system
• changes in diet to support healing
• meditation to move light and color to the areas needing healing

Side bends can be done in traction but are otherwise ill-advised as they open one side of the spine while closing off the other side thus placing undue strain on nerve roots.

Again presuming this is recent the challenge is to not be challenged and rest the body so that it may heal. Energy taken away from that process - be it to process coffee, digest red meat, or wrap your ankle behind your neck, is energy stolen ([I]Asteya[/I]) from the immune system when it needs it the most.

#3

The injury was about 3-3 1/2 months ago (late December), and the surgery to repair the thumb was roughly 6 weeks ago (late February). The two injuries were initially sustained at the same time, although the thumb is now recovering from surgery rather than the original injury. So, at this point, inflammation is not a huge concern, but moving stagnant energy is.

He has been cleared by his doctors for exercise. He finds that flowing movements really help with pain management, so we’re hoping to come up with some vinyasa-style sequences for him to mix in with the longer holds. I am not Iyengar-certified, so I cannot provide him traction with wall ropes, but I may suggest this as an additional practice.

As far as side-bending goes, we would never sacrifice length in the spine to bend further. His physical therapist has also prescribed a (different) gentle side bend. Can you elaborate on that warning? Are you saying it’s ill-advised specifically from those managing pain from a thoracic spine injury, or in general practice? Side bends as part of the six movements of the spine make up an important part of my personal practice as well as my teaching, so I’d like to know as much as I can about any counterindications.

Additionally, any standing or prone positions you could recommend would be really helpful!
Thank you.

#4

I don’t like to break in on the excellent advice being offered by Inner Athlete. However, just a small thought. In a yoga context, “a bit more challenging” would also mean “with greater awareness of body, breath and the mind”. That can be done with the poses you are already offering. Try to coordinate the movements with slow ujjayi breath. This will awaken prana and that will promote healing. Stay within the pain-free ROM, always, because pain and relaxation don’t go together and awareness will be lost. Gentle breathwork is fine. Guided meditation (e.g. yoga nidra) is too.

#5

@all
Understand that these things and their efficacy can vary from person to person, moment to moment, ailment to ailment AND that there is always more than meets the eye - which is why they are assessed, instructed, and overseen by a trained instructor. Please do not misinterpret this as medical advice or as a statement that these things work for every person with a compression fracture in the spine.

@ lifebloomyogini

I understand this on a deeper level now. Thank you so much for the clarification. Often I have to have things spelled out for me in order to absorb them.

I’d tend to begin with a supine rather than prone position. Generally speaking it is less intense for the spine.
However if prone is the choice then Makarasana and Shalabhasana [I]could[/I] be done. The question remains whether that serves a student with 4 month-old compression fracture in the thoracic spine. I personally would not do it until at least 9 months post-trauma.

In the supine position we have a Stiff Person’s Series we teach in Purna Yoga and that’s where I’d start. I am reticent to even mention it as it is difficult to convey through this medium and it isn’t the sort of thing one finds on google.

Some standing postures would be okay presuming the student has strength in the legs to bear the weight of the body AND has/employs the proper actions AND doesn’t continue to deepen the posture to the point of muscle exhaustion. Most students bear their body weight with their spine (which is why there are standing poses in the first place) and this would agitate the nervous system in a healthy student and exacerbate issues in the spine for those with pre-existing conditions.

Vira II, Vira I (hands at waist, hands at wall, back heel lifted), Parsvakonasana (at the wall with forearm on thigh), Trikonasana (with two blocks on the right side and a strap from the top of the door on the left), Vrksasana (at the wall), Utkatasana, Parsvottanasana (hands at the wall).

I am well aware there are expressions of asana practice in which side-bending is common, routine, repetitive, and daily. And I make no assertion that it is for me to say otherwise for anyone other than myself (and those who come to study with me). If it serves one’s living (dharma) then that is all that matters.

And so as not to create a large wake I’d like to state it this way:
In Purna Yoga we do not teach side bending (for most students). The risks of doing so far outweighs the benefits and as teachers it is a prime directive that we place safety first.