Tuesday, October 25, 2011

Ashtanga practice and chronic medical conditions: Some thoughts

In a recent interview that was published on Elephant Journal, David Robson answers a few common questions about Ashtanga Vinyasa Yoga. One of these questions is:

"ii. You need to be physically fit already to practice Ashtanga, fact or fiction?

David: It is a demanding practice and I don’t believe anyone should start by doing the entire primary series. To just do a led class, I think it could be pretty hard for most people and most beginners. Things like age, overall health, strength and flexibility may impact how quickly someone learns the practice, but these factors become insignificant over time. You have to take the time to let your body adapt to the practice and you gradually build up at your own pace. The mysore-style teaching format is really the perfect way for a beginner to learn yoga, as it starts from scratch and develops according to the abilities of the individual. I totally believe that anyone can practice and take benefit from Ashtanga Vinyasa Yoga."

I think David's response is short and sweet, and gets to the gist of what Ashtanga is about. But as I was reading his response, something else occurred to me: What about people who come to the practice with chronic medical conditions? I'm thinking of conditions like lupus, asthma, diabetes, certain heart conditions, HIV/AIDS, etc. Personally, I'm confident that a regular Ashtanga practice done at a pace that is appropriate to the condition of the individual would help with these conditions in the long term. However, from my own experience with working with a few such individuals, I have discovered that in such cases, the problem isn't so much a physical problem as a psychological one: The individual concerned may not readily see the value of committing to a practice that takes time to develop and deliver results. This is especially problematic when the individual expects yoga to be a therapy that can specifically and quickly target his or her specific ailment almost like a laser beam, and improve (or at least significantly alleviate) the condition quickly.

But as David mentions, in order for Ashtanga practice to be effective, you have to do it regularly, "take the time to let your body adapt to the practice", and gradually build the practice up at your own pace. In other words, as we Ashtangis all know, the practice is not a quick fix for anything: One has to have patience, and the results will come when they do. But in my limited experience in working with people with chronic conditions, it seems to me that such individuals tend to expect results fairly quickly. And really, who can blame them for that, given the suffering and anguish they have already gone through with other treatment modalities, and given a western medical culture that promises quick fixes and straightforward solutions for practically everything under the sun ("take this drug, and you will be better right away", or "undergo this or that procedure or surgery, and that part of your body will soon be good as new")? I could be wrong about this, but I don't think Ashtanga practice can credibly promise to, say, lower one's blood sugar by x number of points, or fix that heart condition that one has been suffering from for so many years within x number of months. As I said, I could be wrong about this, but I just don't think that Ashtanga's therapeutic effects always manifest themselves in this immediate way.

If I am right about all this, then there seems to be a disconnect between what Ashtanga practice can do, and what individuals who come into the practice with certain chronic conditions expect from the practice. To put it very bluntly, these individuals have expectations that Ashtanga practice may or may not be able to fulfill. And I don't mean this in a bad way: I believe we all have expectations in one form or another going into almost everything in life. It's part of what it is to be human to expect clear-cut results from our investments of time, effort or money. The trouble, as I see it, is that Ashtanga does not deliver on our expectations in a linear, straightforward manner, and I suspect that the last thing that individuals who come into the practice seeking relief from chronic conditions want to hear is that the practice takes time to manifest results.    

As of right now, I don't know how to go about bridging this disconnect. Maybe I need to find a way to "sell" the benefits of Ashtanga better, instead of just telling people bluntly that things take time. I don't know.


  1. This is an interesting post. I would like to give it some thought and respond further. I think you are both right and wrong. It's a lot like traditional psychoanalysis, in that the path itself, the effort to improve, is the "answer," or the immediate benefit. How one uses that resource to improve concrete problems is an individual thing, like one's individual unique body or mind. But there's more. I say this as an ashtangi flirting with a chronic condition. The practice has helped me but hasnt totally "fixed" the problem. It has ameliorated it and has put me in a better physical and psychological place to deal with it.

  2. I'm going to toss an ember to this mix, and add that sometimes we even acquire an injury we did not have before we started the practice. And as I heard it said today by an advanced student/teacher " injury can be a great teacher" . I am not I hope everyone understands, advocating or insisting on injury as a learning method and certainly would discourage badge of courage injury talk. I am saying that Ashtanga creates an intimacy and a familiarity with your capacity for movements that is to me comparable to speaking a new language which is unfamiliar to those who are not studying it.

  3. i think there is no reason for you to "sell" astanga differently. all people who start the practice should be familiar with the potential physical intensity of the practice that could develop over time. however, as one of my first teachers said - it is not about how fit you are and how far are you in your practice. what is important is that you are very focused and in the present while you are doing however short/ long your practice is; no matter if you can reach your toes or not. being on the mat with oneself is what counts and what brings calm to the mind which will then help people (with chronic ailments as well - as anonymous nicely said). ~ ivana

  4. Restorative yoga! BKS Iyengar was pretty sick when he started doing yoga with Krishnamacharya. Pattabhi Jois was healthy when he started. Notice how the two gurus teach different styles of yoga? I seriously don't think Ashtanga is a one size fits all style.

    If one learnt Ashtanga and *then* got sick, it may be possible to modify the asanas for oneself. I'm not sure if it works the other way around (for the very sick I mean).

  5. Interesting as usual Nobel. I had a guy comment in Facebook that he took on ashtanga AFTER hip replacement, he saw it as a way to get better. He has been practicing for a while now.

    Guess what I mean is that it is all, EVEYRTHING, very individual oriented. It comes down to yoga and to the gunas, our tendencies. I think the yoga works, pretty much any style, if the person is open to it... no matter what the condition, no matter what the style...

  6. I am VERY interested to see the results of rigorous research on the effects (physical and mental) of ashtanga vinyasa yoga. What I mean by rigorous research are randomized trials where a control group with no practice or a light yoga practice is compared to a group that begins the ashtanga asana practice. What response variables would be measured and how would they be measured? One could use survey instruments, brain wave monitors, track recovery from illness, monitor chromatin methylations states, blood oxygen level, and rates of neural impulses. Only the imagination, money, and will limit the possible avenues of research. I am interested in the results of this research mostly out of curiosity. The results would not influence me too much as to whether or not it is worthwhile to continue spending hours a day on the mat because I enjoy the practice and learn something from it everyday. I may also miscalculate or expect too much benefit from the practice. How does it really translate into daily life? I suspect that any personal change comes very slowly, non-linearly, and only when attention and care are brought to the matter on or off the mat.

  7. I relate to this post on so many levels.. I just started practicing Mysore-style Ashtanga a month ago; and it went from an "easy" practice, to a downright fear of going back there every morning. I have chronic pain from an ankle injury and overcompensation on such side of my body.I just didn't know it yet! At the beginning; practice seemed to help and open and bring warmth to areas of pain. Now~ Practice hurts... every single day. Only in that specific hip and leg.

    I have figured out; through the practice; that my condition has been chronic for years! I just never paid attention to it enough to listen to it say: "this is what I've been trying to tell you along. You were hurting me!" ;) So although I do not have any autoimmune diseases (that I know of); I do feel that Ashtanga, like any other style of yoga should be practiced with the mindset that change can and will happen... wether it is a "neg" or "positive" change; when we move, our bodies begin to talk more than they do when we are stagnant. If we listen carefully, it becomes easy to judge what our next step should be. Thank you for the wonderful post.

  8. Thanks for sharing, Anonymous. I like your analogy with psychoanalysis, the idea that the path/process itself is the immediate result, and that everything else is almost a by-product of that process. I think this expresses what Ashtanga practice does very well.

    I see the value of long-term randomized trials. I went through a period when I was really passionate about this idea, and was really eager that there would one day be such trials which document clearly and beyond the shadow of a doubt the practice's healing powers in medical terms. But I am now much more ambivalent about this. One reason is because whatever the results of such a trial are, I will still continue to do my practice, so I doubt it will have much of an impact on me on a purely personal level. Another reason is that there is a sense in which such studies miss the point: As you mentioned, any progress or change the practice brings about usually occurs non-linearly, and the biggest benefits of the practice are spiritual and quite intangible: They come in the form of changes in one's worldview and outlook on life and mortality, and I'm not sure that such changes are quantifiable.

  9. sereneflavor, I totally hear and agree with the idea that injuries acquired after starting the practice can be a great teacher. Several years ago, at a yoga conference in Miami, a senior teacher even went so far as to say that one should not trust a teacher who has never been injured. But this, I understand, is a very delicate topic. Given the current medical/therapeutic climate, which basically says that "Injury=bad", it is too easy to construe something like this as badge of courage injury talk. Which, in a sense, it is: If it is true that you can only trust teachers who have worked through injuries themselves, doesn't the very fact that the teacher has had and worked through (or with) injuries confer something (I don't know if this thing is a badge or something else) on that teacher? Just wondering.

  10. Thanks for sharing, Ivana. Yes, definitely: Simply showing up on the mat and doing whatever one can with as much presence as possible is everything. Everything else, as Guruji would say, is coming.

    Interesting, Yyogini. It may be true that Ashtanga is not a one-size-fits-all practice if one expects a complete beginner with certain medical conditions to, say, do the entire primary series (or even the entire standing series) during the first class. I believe that with skill and experience, a teacher can modify the practice to work for anybody.

    That said, I also think that Iyengar and/or restorative yoga is very effective at addressing diverse medical conditions.

  11. Claudia: My sentiments exactly. And experiences such as that of the guy who commented on your Facebook page and your own healing process with Lyme disease confirms this :-)

    RV, thanks for sharing. I have been through periods of knee and back pain in the practice, and I suspect that although these injuries are "new" in the sense that I have not consciously known of their existence in my body before, they are also "old" because they are basically ways the practice brings to light certain existing imbalances in my mind/body; imbalances which I had not noticed before. I have also recently begun to realize that if I listen enough to these parts of the body with my entire being, I can judge what the next step should be. Thanks for sharing your thoughts on this.

  12. My take on it is that it all depends on how we've been raised to view 'progress'. Western medicine is all about solving the disease quickly, at whatever cost, and we have in turn come to expect 'quick fixes' for our health. If you look at more traditional forms of medicine, like TCM or Ayurveda therapies, they take a slower, longer-term view of health which is counter-intuitive to the western perspective.

    David Roche said something similar recently, about our attitudes towards progress and the Ashtanga practice: that sometimes we need to 'go backwards' before we can move forward. In my view, progress in yoga is not linear, more circular....like the concept of swara you shared with us recently.

  13. Hello savasavaaddict, I agree that how one has been raised and socialized plays a big part in one's views of progress. It sounds like you had a great workshop with David Roche. I will check out your posts about it soon. I have been behind on my blog reading :-)

  14. " ...in working with people with chronic conditions, it seems to me that such individuals tend to expect results fairly quickly!"

    Brilliant observation!

    I never thought of it like that before, but it suits all my observations perfectly well, both within yoga and otherwise. It suddenly made me understand a dear friend of mine with severe arthritis who is so reluctant to change her diet even though wrong diet may be a major culprit giving her so much pain in the first place.


  15. Thanks for sharing, Roselil. I'm happy you find this post useful :-)