Accepting Change

I was reared in a family that never scheduled routine check-ups and avoided seeing the doctor unless it was an emergency. I remember Dr. Yost being called out to our house for me three times in the ten years we lived in Lynnport. When I was seven I had a bad flu, when I was in fourth grade he pulled a large splinter from the back of my leg, and when I was in high school what started as a cold turned into something much worse. Each time my mother’s call to Dr. Yost was the last resort after all efforts by her to heal me failed. So I learned early on that you don’t call the doctor unless there are no other options. And a gazillion options are one click away. 

Following my families tradition I’ve avoided asking a doctor to examine my right hip and instead have designed my own treatment plan. What’s wrong with my right hip? What began as pain a few months ago has settled into unrelenting ache. It aches when I walk. When I climb stairs. When I sleep.

Instead I use heat. I use ice. I use over-the-counter NSAIDs and sleep with a pillow between my knees. My yoga practice is dialed down and until this week I shortened my long walks to brief strolls. I do core exercises to strengthen my back. I’ve added core exercises to support my back. But family traditions die hard and I’ve not seen a doctor. Although, to be fair, the physical therapist I work with ran some range of motion tests on my hip…so there’s that.

But with my medical degree from the University of Google, I assume it’s arthritis that’s plaguing my right hip. I don’t know that, of course, but I assume. And I don’t want to go to the doctor to have my assumptions confirmed and my current approach to treating the pain validated. While I’m blessed to have insurance it comes with a very high deductible which means a very high bill. So I am, for now, sticking to my ice and my heat, my NSAIDs, my mindful movement and my tummy crunches.

Here is the point of this long winded story:

While I continue to avoid seeking medical attention I’ve begun working on accepting change. Because isn’t that what’s really happening? My body is changing. This skin sack I live in, with all its bones and tendons and ligaments, nerves and muscles is aging. And my right hip is reminding me of that truth. 

I have nothing against growing old. I love watching my hair turn silver and I look forward to dispensing kitchen wisdom to any potential step-grandchildren that might show up in my dotage. I’m just not a fan of the baggage that comes along for the ride.

Like my achy hip. Which, by the way, is responding to my treatment plan.

Here’s some news you might use. Did you know yoga teachers have a higher than average incidence of hip replacement? I began teaching yoga almost thirty years ago. All those triangles and twists add up. Factor in the ego-driven yoga practice of youth and you might be looking at a titanium ball and socket joint before you collect social security.

For an interesting take, read this.


Do More! Bend More! Twist More!

I facilitate yoga classes for people in chronic pain. In the decade that I’ve been doing this work my teaching has changed, my attitude has changed and my body has changed. I love this work. It’s beyond rewarding to witness the transformation in people as they discover their capacity for movement and learn to trust their bodies again.

Some aspects of the work, however, are challenging. For instance, it’s difficult sometimes to convince students to ‘start where you are’. To lean into the present moment experience, to feel what they are feeling right now and to allow those feelings to lead the practice. But this challenge is not unique to students in chronic pain.

At times we’ve all abandoned what our bodies need in the moment in favor of our deep rooted goal-oriented mindset. Who hasn’t, at some point, embraced an ego-driven yoga practice? Who hasn’t attempted to show off in front of their instructor or maybe the person on their left, the one with the fancy Manduka mat, struggling with ardha chandrasana? Who among us hasn’t judged their practice through the lens of ‘I have to do more, bend more, twist more, achieve more?’ 

The Sutras remind us that we practice in order to ‘still the fluctuations of the mind’. And in order to still those fluctuation – in order to self-regulate – we must maintain a dedicated practice with no attachment to the outcome. So there is no room for pushing ourselves beyond our limits, no room for unreasonable expectations. There is no room for competition with others and no room for competition with ourselves.

We know that our physical practice is just one limb of this beautiful thing we call ‘yoga’ and that together, all eight limbs of yoga create the yoke that unites the body, mind and spirit. In other words, the dedicated practice called for in the Sutras is not limited to perfecting trikonasana. The forms we create with our bodies, the poses we flow through in alignment with our breath, will build stamina and flexibility. But their true intention is to build the strength we need to find stillness in meditation. An asana practice does not refine our physical body through exercise so that it is capable of doing more. It refines our body so that it might do less.

In your practice this week, what can you do to remain present with your body in this moment? What shift in thinking do you need to make in order to do less?


Is Gratitude over-rated?

I’ll be honest. The word ‘gratitude’ annoys me. Feeling grateful is wonderful, of course. I felt grateful this past Friday morning when I was awake early enough to see the brilliant sunrise in all her glory. But gratitude? It’s a trending buzzword and after awhile trending buzzwords relinquish their impact to the next buzzword that comes along. There’s plenty of joy to be found, however, in feeling grateful.

Studies suggest that remembering what brings us joy and recording those moments of gratitude in a journal benefits our mental and physical health. The deliberate act of shifting our energy toward the positive rather than nurturing our habit of catastrophizing the difficulties we encounter builds our emotional resilience and reminds us that living is a group experience. In other words, reflecting on the shared experience of Friday’s sunrise is healthier than reflecting on the shared experience of the pandemic.

Another reason why the word ‘gratitude’ annoys me is this: sometimes the concept just feels too big. It’s difficult for me to winnow down all the moments in my day for which I might be grateful. Am I grateful for the morning cup of fresh-pressed coffee my partner Ben brought to me while I stayed in bed? Sure. Am I grateful for the purrs of contentment my cat Bruce shares when we cuddle? Of course. Am I grateful for the roof over my head? Without a doubt. But while the simple act of opening a journal and creating a daily gratitude list of well-meaning gestures, happy accidents and unexpected outcomes might remind me of the good in life, it fails to satisfy the yearning I feel in my heart to understand how acknowledging these moments feeds my soul.

How can we add depth to the act of recognizing the positive in life? 

In yogic philosophy we study Patanjali’s Sutras. In the Sutras, Patanjali describes five Yamas and five Niyamas. The Yamas describe restraints to practice: non-harming, truthfulness, non-stealing, moderation and freedom from grasping. The Niyamas are a collection of five virtues: cleanliness, contentment, self-discipline, self-study and surrender. Anchoring the contemplation of gratitude in the fourth Niyama self-study (‘svadhyaya’ in Sanskrit) encourages us to explore the nature of gratitude. It supports our understanding of how we express our gratitude as we walk through life. With that understanding we can more fully embrace those moments for which we are grateful. 

If we want to add a deeper dimension to our gratitude practice we can turn to Naikan – the Japanese practice of introspection. When we practice Naikan we ask three simple questions:

  • What have I received?
  • What have I given?
  • What difficulties have I caused?

The questions might focus on a relationship, a situation, an individual or even an event. For example, if I choose to practice Naikan with my focus on Ben then the questions I ask are:

  • What have I received from Ben?
  • What have I given to Ben?
  • What difficulties have I caused Ben?

The obvious fourth question, “What difficulties has Ben caused me?” is ignored. It is human nature to shine a spotlight on that question. It is, however, through the examination of our answers to the first three questions that we discover aspects of ourselves we didn’t know existed. We learn more about our relationship to gratitude. We move toward enlightenment.

When we open our journal tonight, how will self-study or a Naikan practice influence how we consider gratitude? What would happen if we chose to frame a Naikan practice around those things in our life that cause pain? 


Zoom Zoom Zoom

By the time we’re allowed to resume our ‘old normal’ we’ll be so efficient and comfortable with online gatherings that we may not want to. That being said, my technological prowess is, at times, limited. Hence the Great Zoom Snafu this week. To avoid it happening again (and if you weren’t there you didn’t miss too much) I’ve created a new meeting ID and passcode for Morning Flow, our Monday, Wednesday and Friday class that meets at 8:00 AM PST:

Morning Flow_ Yoga with Mimm

I’ve had several requests to add a more gentle class that meets a little later in the morning. My new class, Movement & Breath, begins on Monday, August 3rd at 9:30 AM PST. This class is a good choice for anyone who has limited mobility, has chronic pain or is recovering from illness or injury. Modifications and variations of poses will always be offered to keep everyone comfortable and safe:

New Class!

 

All of my classes are donation based – please feel free to join any class I offer no matter your current situation.

 


Yin Yoga and Chronic Pain

IMG_2289Day One: The fear is obvious. Something in their eyes. The slow, shuffling steps. The wariness as they drag bolsters and blocks from the shelves. Attempts to muffle timidity with parchment thin bravura and the fierce slap of a fresh sticky mat hitting the floor don’t work. I know how they feel. I’m afraid, too. I’m as afraid of hurting them as they are of being hurt.

When practice begins a woman whispers, “I can’t get to the floor.” I offer a chair. Ten minutes later a man grumbles and stands in order to walk off a spasm’s flair. I encourage the group of six to have open boundaries; to roam and move as needed. But at the same time I want them to look for stillness. But they won’t find it. Not yet.

Asana demonstrations are met with disbelief and so I use a soft tone and gentle words to coax their worn bodies into shapes. I offer support with pillows and props. When they discover that what I’m asking them to do is not impossible after all their fears – and mine – begin to subside. Within a few sessions confidence has taken a tentative hold as pain is accepted not as the victor but as something with which one might co-exist.

Up to seventy-five million Americans endure persistent chronic pain. According to statistics from the National Institute of Health the cost of chronic pain in medical expenses, lost income and lost productivity is more than five hundred billion dollars per year. Chronic pain is too often either untreated, under-treated or masked by drugs leaving 42% of patients with symptoms so severe they are unable to work and up to 63% unable to engage in activities those of us who are pain-free take for granted.

I began teaching yoga to chronic pain patients at Feinberg Medical Group in Palo Alto, California in 2010. FMG offers a Functional Restoration Program that is an interdisciplinary outpatient management approach for patients with persistent pain. The goal is for patients to acquire the skills needed to facilitate the behavioral changes necessary to restore function and to improve the quality of life. This is achieved through an individualized curriculum of exercise and psychotherapy, group wellness classes, stress and medication management, the development of relaxation skills and – of course – yoga.

The men and women entering the program have no yoga experience and are burdened by the consequences of chronic pain: low self-esteem, appetite and sleep disturbances, a sense of powerlessness, hopelessness and depression. My job is to find a way to move them beyond these states and to help each patient build a new relationship with their body.

But these are individuals whose pain has become like a brick wall separating them from health and wellness. They don’t want to know about gunas or gurus, Sanskrit or sutras. At least not yet. What they want is to feel better. The practice has to be personal. Clear and immediate. Achievable.

I ask myself, “What is it that I can I do, right now, to help?” My answer is simple. Build trust. Build trust in the process. And build trust in me.

I was introduced to Yin Yoga in 2009 by a student who had attended a Sarah Powers workshop in nearby Menlo Park. She described a practice that was deceptively challenging but deeply soothing. Intrigued, I attended my first Paul Grilley workshop a few months later and by September of the following year had been certified to teach Yin.

Yin Yoga applies stress to the connective tissue: fascia, tendon, ligament and even bone. Intellectually this might feel counterintuitive, and indeed we can all agree that over-stretching any tissue whether it’s muscle tissue or connective tissue will be injurious. But a mindful Yin practice does not overstretch – it gently stresses and unwinds. It doesn’t require tremendous strength or flexibility and yet it delivers profound physical and mental release. A Yin practice asks the body to open to the discomfort of the pose and to accept the stillness required to maintain the pose without grasping or grabbing either physically or mentally. Working to an appropriate depth for the appropriate amount of time gives the connective tissue, the heart and the spirit space to open and, in a sense, breathe.

At first they are resistant, as unyielding as their bodies. I talk about the importance of our intentions. I remind them that what we have is this moment and this body and this one constant – change. But if we want to see change in our bodies we have to listen to what our bodies are trying to tell us about pain and healing.

We alternate between a manageable Hatha practice that includes chair yoga and longer held floor poses. They find the silence of Yin a challenging aspect of the practice. I ask the group to watch their breath and the sensations they experience. We manage for sixty seconds one week, ninety the next. And then, eventually and collectively, it begins to work.

A few months later a young client stops me after class and with tears in her eyes thanks me.

“I don’t know what we did but it held for three hours.”

This is a woman with cervical pain and radiculopathy so severe she can not lift her arms. But during our practice she found the strength to be fully present and subsequently experienced Yin’s benefits. Michelle remained relatively pain-free for the remainder of the afternoon. In this population, that is considered a victory.

I’m not suggesting Yin cured her. All the components of FMG’s Functional Restoration Program work together to support healing. What happened during one Yin practice on a rainy afternoon is that a beautiful young woman discovered wellness was possible. Within a few months she had returned to school, returned to driving and was attending a weekly Hatha yoga class.

For chronic pain patients, Yin teaches trust. Clients demonstrate this trust in the questions they ask and in the confidence they have in creating their own modifications during our practice. They know the difference between challenge and pain, moderate stress and injurious stretch. Our work is slow and they appreciate the opportunity to explore and release, to hold and to melt.

Clients enter into a six to eight week commitment with the Functional Restoration Program at FMG. During that time new clients will enter while others graduate to the Aftercare Program. The “rolling” nature of participants contributes to the program’s success. New attendees are unofficially mentored by clients who have been in the program for a number of weeks. Patients nearing the end of their training will look in the nervous eyes of a new client and say, “I used to be you. But now look at me. Look at what I can do. You’re going to be able to do this, too.” And then they lift a bolster from the shelf with ease. They pick up two blocks and one strap. The slap of the sticky mat as it unfurls on the floor is a reassuring sound. As they lie down I see them slip into stillness as they settle into another hour of Yin.