Wednesday, February 1, 2012

Scoliosis, fear, and disempowerment

I just read David Garrigues' latest post. I think I'm becoming a big fan of his. Maybe I will try to go study with him if I don't make it to Mysore soon. Anyway, in this post, David answers some questions from students about the practice. One student's question--and David's response--really jump out at me. This student was recently diagnosed with mild soliosis and carpal tunnel syndrome. The doctor told the student to quit Ashtanga as it places a lot of pressure on the wrist, and doing inversions "will only make... scoliosis worse." This student decided to write David to ask him if there is a way to continue practicing Ashtanga with these conditions.

David responds by suggesting various modifications for practicing with these conditions. He then concludes by saying:

"The essential ingredient is a love of ashtanga and in maintaining a steady devotion and trying to do the practice as accurately as your given circumstances allow... there will always be someone to tell you that you can’t do ……….. the list of possible things or activities or dreams is endless and so is the list of people who will tell you can’t do that something. Sometimes they may be right but equally sometimes they are wrong. And ultimately you have to decide how important something is to you. And when you’ve decided on that something that is important enough to you, you may need to guard and protect the heck of it in order to for it to remain a strong, positive force in your life. As people we can tend to be suspicious of what we don’t know about, and if on the surface something looks strange or exotic or very different from what we know or are used to, we can tend to form negative impressions of that thing. But our own fear and unwillingness to be open to new or different things can us cause to make wrong assessments of things and to unfairly judge what we don’t have enough information to be judging. I believe it would be a true waste for you to stop developing the ashtanga yoga practice that you have begun and love. If you practice properly there is a strong chance that ashtanga can help correct or at least minimize the negative effects of both of your problems better than any thing else that you will try. I have found that ashtanga applied properly, has huge potential for transformation and healing. Om! David"


David's response really speaks to me. For one thing, I also have mild scolosis. I've been diagnosed with it since I was in elementary school. And at least a couple of my yoga teachers have also spotted it: Eddie Modestini and Nicki Doane spoke to me after one of the sessions at their asana intensive on Maui in 2007 (which I attended), and asked me if I knew I had mild scoliosis (I said I did). They had spotted the curve in my spine while I was in Sirsasana. They didn't really suggest anything much more beyond that (they didn't ask me to stop doing inversions, which is why I'm still doing them today :-)), although Eddie did say that doing more backbends will help my condition in the long run. Anyway, I have this suspicion that if anybody had told me at any point that I needed to stop doing Ashtanga because of the scoliosis, I probably would have gone ahead and continued doing it anyway, knowing the sort of person I am.

But David's response also spoke to me because it highlights something I have been feeling very strongly for a while now. It seems to me that very often, expert knowledge and specialized training (in this case, medical training) have the effect of closing the mind of the individual who has received that training, accentuating the very human tendency to be suspicious of and form negative impressions of things we are not familiar with. It is probably not an exaggeration to say that many highly-trained experts operate from a place of fear rather than openness, automatically rejecting that which is strange or counter-intuitive to them.

But perhaps we can't blame people for having this attitude. After all, seen from many angles, the daily practice that Ashtanga requires is very strange and counter-intuitive to many people. This morning, for example, I had to wake up earlier than usual in order to do my practice and make it to campus for a meeting at 8:30 a.m. As I sat in the conference room waiting for the meeting to begin, I couldn't help wondering what the reactions of the other people present at the meeting would be if I had told them that I had spent two hours breathing, bending myself into certain shapes and standing on my arms as well as my head before I came to the meeting... I guess what I'm trying to say is that doctors are ultimately ordinary people plus some specialized training. And that specialized training may or may not prepare them to deal productively with things in their patients' lifestyles that they find unfamiliar or strange. So it is perhaps natural that many doctors, when confronted with such unfamiliarity and strangeness, would default to that "if it puts you in an unfamiliar or uncertain place, it's probably bad for you, don't do it" mindset.

Please don't get me wrong: I'm not telling anybody to stop seeing doctors. But David's student's encounter with the doctor brings up a feeling I have been having for a while now: It seems to me that, more often than not, the medical establishment in this country tends to disconnect and dis-empower individuals from their bodies. Rather than helping the patient to find out how best to work with a particular condition given his or her lifestyle choices, values, and things he or she holds dear, doctors often seem to just default to saying something along the lines of, "Take this pill or undergo this procedure, and you will be better. And don't do this or that." For instance, some time ago, I had a diabetic friend who was taking medication daily for his condition, as prescribed by his doctor. When I asked him what that medication was supposed to do, he said he didn't know! Which strikes me as very strange: If you had a particular condition, and somebody was asking you to put a certain substance into your body, wouldn't that person at least have a responsibility to tell you what that substance was supposed to do in your body? Or maybe it didn't occur to my friend to ask. Yeah, I suppose that's possible too. In any case, if my friend's experience is indicative of the state of physician-patient relationships in general in this country, then it seems to me that medicine as practiced in this country suffers a serious flaw: There does not seem to be any attempt to further engage patients as people, and help them to better understand and care for their bodies and minds given who they are as individuals. Doctors just see patients as machines that can be fixed with this or that drug or procedure. Which leads to a state in which people feel more disconnected from and dis-empowered with regard to their own bodies, and become ever more dependent on supposed health experts to tell them what is right and wrong and good and bad. I don't think this is a good way to go.      

22 comments:

  1. Really great post, Nobel.

    "I guess what I'm trying to say is that doctors are ultimately ordinary people plus some specialized training. And that specialized training may or may not prepare them to deal productively with things in their patients' lifestyles that they find unfamiliar or strange. "

    I could not agree with you more. My fairly recent foray into the health care system led to some very similar revelations. It is disconcerting how willingly patients surrender their own well-being to the hands of doctors (fallible humans with medical training) who know/care so little about the individual's needs and lifestyle.

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    1. Yes, Megan, it is disconcerting and sad indeed. Add to this picture the presence of big pharmaceutical companies pushing their drugs on patients through doctors, and the picture becomes even more disconcerting. But I suppose this is why we need the practice now more than ever, to free us from fear.

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    2. Hey Nobel

      It IS hard being an allopathic doctor, for all the reasons above and medicolegal considerations as well.

      Thank goodness for the Practice to help free all of us from fear!

      My suggestion is to choose your medical practitioners wisely and carefully, it could take some time to find the right fit..much like commiting to and trusting a yoga Teacher

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    3. Thanks for sharing, Min. Yes, I can see how it is really hard being an allopathic doctor. Just so you know, I am not writing this post to trash allopathic doctors or allopathic medicine. I'm just trying to report my own observations and thoughts as accurately as I can.

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  2. as a health professional (not a doctor, a speech therapist) and a long time yoga practitioner, i bristled a little at this post. Mostly to the generalization in that 'most medical professionals'... which may not actually be the case- how do you know this? What I've observed having worked and studied in the health profession across Canada (four provinces), is that attitudes and openness differ between provinces. Mostly due to social, cultural and educational factors, but also age of the medical professional as well.

    What I would say- is that I have a general (sadly actually) distrust of GPs.... If I had any sort of physical condition (acquired or congenital), I'd tend to consult someone who's an expert in how our bones,muscles,ligaments and physical body works- a physiotherapist. Who would have a better idea how ashtanga could impact that person's particular physical condition.

    But then, I have had several experiences of GPs having more difficulty with interprofessionalism (ie making appropriate specialist referrals), and as the patient it's very important to advocate for your own health. Which also means- describing to your physician (or medical health professional) what exactly is involved in the ashtanga practice and knowing when a more specialized referral would be better for you. (like requesting a referral to a PT).

    Just a few thoughts :)

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    1. Thanks for sharing, Eco Yogini.

      "Mostly to the generalization in that 'most medical professionals'... which may not actually be the case- how do you know this?"

      I don't. Which is why I make a conscious effort in my post to say things like "if my friend's experience is indicative of...", in order to make it clear that I am aware that I may be generalizing. Which probably does not make it okay for me to generalize, but that's a different story...

      Thanks for sharing your experience with GPs. And yes, I do agree that it is very important to advocate for one's own health.

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    2. Hi
      Thanks for sharing, everyone
      Just to stir the pot a little (hala hala);)), Eco Yogini,

      Yes, I do agree that even in Australia , attitudes of medical practitioners do vary according to State, age and even suburb

      I actually find that an excellent yoga teacher (read, 20 years or more of experience, Iyengar or Ashtahga based) for PRIVATE one on one lessons have helped my patients more than many physiotherapists (where is mula bhanda? )

      I have a chronic neck injury and have been informed by many a physio, osteopath and chiro NEVER to practice headastand, but with patience, good instruction and hopefully a bit of mindfulness, I still do it..

      Anyway, over time, I have learnt and continue to learn to laugh at myself, can't take all this illusion too seriously

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    3. Thanks for stirring up some hala hala, MIn :-) I really find your story of working with chronic neck injury very inspiring. I'm sure you must have also gained so much body awareness through your journey of practice, working with your body as it is.

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    4. yes- of course all good points. Knowing yourself is key.
      What I would prefer to see, however, is a discourse of 'together' work as opposed to 'us vs them'. Which- and perhaps that wasn't Nobel's intention, or yours, is the impression I get from this post.
      I believe that other professionals have valuable information to add to the care of the patient/person as a whole. Learning to work well together requires trust on both sides.
      When the discussion revolves around 'how western medical professionals are narrowly focused, don't understand yoga, don't respect yoga practictioners, don't value US'- it's an 'us-them' discourse that is not conducive to collaboration.

      I see this as the challenge between meshing the valuable knowledge and wisdom tha yoga can bring with the western medical system.

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    5. "I see this as the challenge between meshing the valuable knowledge and wisdom tha yoga can bring with the western medical system."

      Very well said, Eco Yogini. In total agreement here.

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  3. So many people i have known want the doctor to just "fix" them with a pill or operation rather than put in the work of losing weight, exercising, changing lifestyle.

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    1. Unfortunately, Martha, I think that what you say is true. Many people who suffer from chronic conditions prefer quick fixes over more sustainable long-term strategies.

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  4. My impression of the health system here (the US) is that as long as they can keep you coming back for more treatments/drugs, they will. I'm thinking about seeing an osteopath for the chronic soreness in my lower back, something that a year's worth of chiropractic treatments has yet to heal, and am appalled at (1) how much it costs and (2) that it's not covered by any insurance plans. Probably because osteopaths are so effective the system can't keep squeezing money out of you!

    Sorry, for sounding so skeptical but healthcare is the reason why I hate living here.

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    1. "My impression of the health system here (the US) is that as long as they can keep you coming back for more treatments/drugs, they will."

      Sadly, I agree with you on this.

      I hope you find a good body-worker to help you with your lower back soreness soon. Here's a very amateur suggestion: Have you tried to see if holding certain postures for slightly longer (8 to 10 breaths) on certain days has any effect on the soreness? Maybe if you experiment with holding different groups of postures for longer durations on different days (one day hold forward bends longer, one day hold backbends longer, etc.), you will be able to isolate the postures that relieve the soreness, and the postures that aggravate the soreness.

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  5. Thanks for the suggestions Nobel. Urdhva Dhanurasana really aggravates it, just doing 3 of those is excruciating so dropbacks are on hold until UD is no longer a chore. I do stay for 7-8 breaths in the seated postures, esp Paschimottanasana and all the Janu variations. This helps to tease out the fibres and reduces stiffness, but once I get into UD, I always get a painful knot deep inside my right hip that tells me that it's there. I'm working on relaxing the glutes and shifting the weight into the upper back, but it's going slowly, as with everything else in the body....

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    1. It's good that you seem to have a pretty good idea of what is presently hurting you, and what is not. Has your chiropractor been able to identify what exactly is bothering your lower back?

      I have a hunch that it may also be helpful in UD to (1) work on engaging the adductors to rotate the inner thighs inward, and (2) work on bringing the shoulders directly over the elbows. Relaxing the glutes by itself may not accomplish the intended effect of bringing the backbend from the back body into the front body. Do all this make sense?

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  6. I give my doctor a lot of credit. She tells me what has to happen, shares her concern if I can't solve the problem in my preferred way, and we work toward a solution together. I am grateful. And i am also fortunate to have a teacher for mysore ashtanga who has patiently worked through all my (different) back injuries with me, showing me the way forward when I thought I couldn't do it. I am blessed.

    But I would like to say that i don't like the (disdainful from disciplined ashtangis) assumption in some comments that people who have medical conditions often just want someone to fix them. This reveals a lack of compassion. I would say that sadly some people have not learned that they have any control over their lives or their bodies, and in many cases their life experiences have reinforced their powerlessness. They may not be "unwilling to put in hard work" but deprived of opportunity, control, or power to develop true autonomy.

    Back in the old days of early feminism we used to understand this, but it also applies to many people raised in abuse, poverty, rigidity, or illness.

    Count your blessings everyone and don't be so quick to judge.

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    1. Thanks for sharing, Anonymous. It's great that you have a good doctor and a great mysore teacher who help you to heal in their own ways.

      And yes, I do my best not to be quick to judge.

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  7. nobel, I actually don't think you were being judgmental, but I picked up that judgment a bit in some of the other comments.

    Just thinking of my mother's struggle with weight and associated disease and the judgments of others. I wish she had had more power and respect in her life and am sad that people added to her struggles by blaming her.

    We all need to try to remember to look through the eyes of others. Goes with the yoga I think--or it should.

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  8. This comment has been removed by the author.

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    1. Oh, it is there! But I can't see the previous comment!:B Here I go again !:B
      https://vimeo.com/116183082

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    2. Dear Nobel, thanks for sharing! I was sharing a little testimony, I made this video one day before my slight car accident, and yesterday the orthopedist didn't tell me about the "scoliosis" the techologist mentioned...But I will continue with yoga and contemporary dance, including uyghur dance in which I move my neck...Thanks for continuing being connected to share the healing of our bodies!

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