Download CS2: cervical arthritis, by Ellie Mark

A.is43andsufferingfromcervicalarthritis.Heexperiencesalotofstiffness,tensionand
occasionallypainintheneckandshoulders.Hetakesnomedications,playsalotoffootballandalso
boxes.Heisnewtoyoga.Hisjobismainlysedentaryandonacomputer.
RESEARCH:
Althoughsmallerthanthosefurtherdownthespinethecervicalvertebranotonlyprotectthespinal
cordandsupporttheweightoftheheadbutalsoallowawiderangeofmovement.Ahealthy
cervicalspineisveryflexibleandhassomedegreeoflordoticcurve.Thefacetjointsaresynovial
(encasedinacapsulecontainingsynovialfluidwhichprovideslubrication).Thejointsurfaceis
coveredwithcartilagethatlessensfrictionandit'sthebreakdownofthatcartilagethatisassociated
withcervicalarthritis.
Osteoarthritisaffectsthejointsandiscommoninpeopleoverfifty(duetodegenerativewearand
tearonjoints)butcanalsofoundinyoungerpeople.Symptomsvarybutusuallyincludealotof
stiffness(particularlyinthemorningswhenthejointshaven'tbeenmoving)andoftenswelling
aroundtheaffectedjoint.Itcanbeextremelypainfulandprogressquicklyandinothersstaymore
stableorprogressslowlywithage.Itcanbecausedbyinjuryorwhenajointcomesunderalotof
stress.TheCartilagebetweenjointsgetsworndownandbonebeginstorubagainstbone.Thiscan
causepainandlossofmovementinjoints,inflammation,weaknessandpossiblemusclewasting.
Musclesaroundthejointwillbebecomeverytight.Insomecasesbonespursbegintoformaround
theaffectedjointandpeoplemayneedsurgerytoremovethem.
Themostcommonadviceistokeepmovingthejointsgentlytoincreasebloodflowandhelprelieve
pain.Massagecanalsowarmthemusclesandencouragethemtoloosen.Strengtheningthemuscles
aroundthearthriticneckjointisalsoencouragedtoimprovegeneralpostureandlessenpressure
there.
Themusclesoftheneckaresomeofthemostoverusedinthebody.Togetherthoseatthefrontand
backprovideposturalsupporttothecervicalspineandworktofindthecorrectbalancefortheskull.
Cervicalarthritiscancausetheheadtoloseitssupportfromthenecksocanbecomepulledforward
anddownwardbygravity.It’sthenverypainfultothenkeeptheheadmoreuprightandbalanced
andneckmovementincertaindirectionscanbecomeslimited.Themusclesoftheneckandupper
backworkextremelyhardtosupporttheforwardanddownwardpulloftheheavyhead.It’svery
commonthenalsotoseeanexaggeratedkyphosisinupperback.
Thetrapezius,alargesuperficialmuscleoftheupperbackandneckconnectswiththebaseofthe
skull,theupperspineandneck,theclaviclesandalsotheshoulderblades.Itholdstheshouldersin
place,workstoliftanddroptheshoulderblades(withthehelpoflevatorscapulae)andcanmove
thenecksidewaysandback(extension).Formanypeopleitcanplayadominantroleinsupporting
theweightoftheskullonthespineandposture.
Thisisalsotrueofthelevatorscapulaewhichextendsfromthesideofthenecktotheinnerupper
shoulderblade.Itturnstheheadtosideandliftsanddropstheshoulderblades.It'ssometimes
knownasthe'stiffneckmuscle'asitworkssohardandgetsverytight.
In'intelligentyoga'PeterBlackabysuggeststhatthedeeper,smaller'local'musclesoftheneckand
upperback(spleniuscapitusandcervice-alsooriginatingatthebaseoftheskullandconnectingto
thespine)aremorepreferableforthejobofstabilisingthespinethantheselargersuperficial
muscles.
DrChrisJennerreferstothesyndromeof'guarding'beingcommontosufferersofarthritisofthe
spine.Musclesaretensed(andthebreathheld)infearofpain.Thisbringsmoretensionandpain-
musclescanbuilduptoxinswhiletensedthendon'tgetreleased).Thisiswhyincreasingbloodflow
towarmthemusclesandrelaxthemishelpful.
Therearephysiotherapyexercisesthataresuggestedtostretchtheneckandrelievetension.These
aredesignedtomovetheneckinalldirectionsandkeepmobilityintheneckjoints.
HOWCOULDYOGAHELP?
-GentleyogacouldhelpA.tokeepmobilityinhisneckandincreasebloodflowtothejoint.
-Movementscanbepracticedlittleandoftenathomeorevenwork.
-Itwillhelpintegratemovementthroughthethoracicandcervicalspinetocounteracthabitual
overuseofhisneck.
-Regularpracticewillimproveposturewhichmyresearchshowsisabigissuewithcervicalarthritis.
Itcanwakeupandstrengthenthedeeperneckandbackmusclesthatmaybebetterforpostural
support.
-Thefocusonusingthebreathtoreleasewillhelpaddressanyunhelpfulholdinginthebodythat
causespain.
-Workingwithgravity(dogposes,supportedforwardbends)willcreatespacebetweenthejoints.
Theneckisvulnerablesoanyyogapracticedneedstobecarefulandinnowayworsenanexisting
condition.Wearepronetoholdingtensionintheneckandjaw,especiallywhenconcentrating-this
couldbeboughtintoayogapractice.
Tobeginwewilltrytofindacomfortablerangeofmovementsintheneckfromsupported
positions.Iwillincludeasanasthatloosentheshouldersandupperbackasawhole.
IwillbefollowingtheadviceofMaryStewartonarthritisandbeginandendeachsessionwitha
goodrelaxationwithawarenessofthebreath.
SESSION1-60mins
Supine-Kneesbent/legslong,sighingbreaths,guidedrelaxation.
Takingarmsupandwide.Headrolling.
Reachingintoeachhandtowardsceiling,droppingarmsdowntocrossthebody.-Gentlerocking.
Headsamedirection,headoppositedirection.
Roundedcatmovements.
Takingeartosameshoulder,then'waggingtail'intoexploringsidebend.
Droppingoneelbowtorotateupperspine.
Child
Dogprep-rockingbackoverheels,dog.
Sequencingbetweendogandchild
Tadasana,breathawareness
Small'yes/no'movementsofhead.
Armswings.Takingarmswidetothesides,elbowssoft,thenunfurlingandlettingthemswingagain.
Uttanasanacirclingshoulder-bladesforwardwithgravity.
Tadasana.
Eaglearmsprep/eaglearms.Takeintogentletwistinupperspine.
Dogposetowall
Trikonasanaprepslidinghandsalongthewall(noforwardbend)
Shoulderrollinginsitting.
Gentleneckstretches-chintochest,eartoshoulder,rotating.
Uttanasana,squattoground.
Sittingleaningtochair,handsrestingonbacksofshoulders.
SetuBandha
Supinetwist(sidepositionstart)
Savasana
REVIEWPOINTS
-Usedachairtopropthelegsaslyingwasuncomfortable.Thetightnessintheshouldersalso
shortenedhisnecksousedafoldedblanketbeneaththeskull.Althoughbyeyeheneedsmoreliftit
becameuncomfortable.
-gentleneckmovementswerecomfortablethoughthestretches(particularlysidebendingtheneck)
verystrong.Thiseased.
Westayedwithpreparatorystagesofcowandeaglearmsasshouldersverytight.
Nextwewilltrygentleextensionmovementsinspine.
Supinetwistshekeptmovingasshoulderhoveredhighfromtheground.
SESSION2
(60mins)
Supine:headsupported,kneesbent,apanasana.
Relaxationpose-feettoachair.Guidedrelaxation
Gravitypose,armsonly,crossingarmsacrosschest,rollingacrossupperback.
Setubandha
Dogprep,circlingshoulders,rockingbackoverheels
Dog.
Child.Elbowsmovingforwardalittleandhandsinprayerposetowardsceiling.Takehandsforward
andwideandliftingheadfrombetweenshoulderblades.
Allfours-catmovements.
Sphynx(headrestingonhands)
Child
Dog
Uttanasana-circlingshoulderbladesforward
Tadasana-breathawareness,shoulderdropping/rolling
Cowarms,eaglearms.
Tadasana,-closingeyes,weightshifting,circlingfeet
Tinytreepose
Standingtwists-takingarmstothesides
Trikonasana
Widelegforwardbendtochair,gentlyturningheadeachsidetostretchtheneckthenrelease
forward.
Supinetwists,savasana.
REVIEWPOINTS
-A.feelshisspinelengthenandrelaxoncehisheadissupportedinsupinenow.
-Child'sposeweaddedfoldedblanketundertheheadforcomfort.
-Trikonasananeededbottomarmonfrontlegforsupport.Prepworksbetteratmoment.
-MovementsonallfoursareeasiesttoseeclearlyandIwasabletousehandsontoencourage
integration.Inextensiontheneckwasoverworkinginitspatternsoweusedthelevelofhisgazeas
guidance.
-insphynxIexpectedminimalmovementintheneckaspredicteddiscomfort(andfearofpain).
Pleasedtofindnopaininextensionbutheoverusedtheneck(asmyresearchsuggestedmightbe
hispattern).Wewillkeeppracticingthis.
I'dliketotrycobrapreparationsnextsession(justpushingintoeachhandandrolling)
SESSION3-60mins
Relaxationpose.Handstobelly,ribcage,abovethehead.Verballeadbodyscanning.
Headrolling.
Littleboat
Simpletwist.
Child-Gentlypressingforeheaddownandrollingacrossforehead.
Takinghandsforwardofshouldersandpressintohands-rollingforwardontohead(hipscomeup),
thenexhalinghipsdownandheadtoneutral.
Dogtochildsequences.
Child-slidinghandsforward,gentleextensioninspine.
Catmovements(takinghandsforwardmovingtogentleextendedcatpose)
Prone-armsouttoside,turningheadeachway,relaxingshoulders.
Sphynx
Pronepreparationsforcobra-pushingdownintoeachhand,rolling.
Child.
Threadtheneedletwist.
Dog
Uttanasana
Tadasana,breathawareness.
Armswings-wholespinerotating.
Eaglearms.
Standingtwistsusingchair:Firstwithoutarms(handsrestingonsamesideshoulder).Repeatwith
armsgentlyextendingtoside
Dogtowall-turningheadeachside.Droppingheaddown.
Widelegforwardbendwithbelt
Rollingupthewall.
Supinetwists.
Supine,armscrossingbody.
Savasana
REVIEWPOINTS
-beltloopverywideforforwardbend-strongintheshouldersbutfeltgood.
-usedhandsonforsphynxtohelprelaxtheshoulders.
-forthreadtheneedletwistwehadtokeeptheweightwellbackoverhips.Hisnecklooked
awkwardinthispositionthoughfeltok.
-hadtodemonstratetherollingcobraprepashefounditdifficulttounderstandthemovement.
-keptrollingupwallminimalandbeganwithbodyscanning,breathawareness.
-A.commentedhefelthisupperbackhad'moved'aftersession.
AshespendsalotoftimesittingatworkIthinklearningtositwellandishelpful.Hefeelsstrange
whensittingtallbutusedthebackofchairtosupporthisbase.Infuturesessionswecouldinclude
sittingpracticesuchasdandasanawithabelttobringawarenesstothesitbonesandsittingtaller.
SUMMARY
IfeelIhavegainedconfidenceinworkingwiththisconditionthroughresearchandexperimenting.
ThefactthatA.hasbeguntofeeladifferenceinmuscleslooseningaftereachsessionisalsoasign
thatwehavebeenworkingeffectivelyintheshortterm.Mymorelongtermfocusofcorrecting
posturehoweverisgoingtobeamuchlongerjourneyandisgoingtoneedregularpracticeovera
longerperiodfromA..Atthisstageheiscommittedtocontinuingasheisworriedabouttheimpact
thearthritiscouldhaveonhisqualityoflifeashegetsolder.
InthesesessionsIhadspecificobjectivesinmindandthismademyplanningcompletelydifferent
fromwhatI'musedtoforageneralclass.Theprocesshasbeenreallyhelpfulasithasmademehave
tothinkclearlyaboutwhatmyreasonsareforincludingparticularasanasorpranayamaandeditout
thosethatwouldservenorealpurposeforA.atthemomentorcouldevencauseproblems.
Interestingly,whenIapproachedthisprojectIwasanticipatingitbeingdifficultformetoslowA.
downfromhisusualwayofapproachinganything'exercisey'butthathasnotbeenthecase.Infact,
whenwereviewedthesessionstogetherhetoldmethathefelthecouldhaveevenspentlongerin
someoftheposesormovementsashesometimesfeltthingswereonlyjuststartingtomoveand
'stretch'aswemoved.It'sbecomeclearthatforA.,theappealofyogaisverymuchaboutreleasing
tensionandrelaxation.Practicingintheeveningswhenweareapproachingrestwashelpfulfor
settingthetone.
AsanewteacherIwouldlovetorelyonfirm'yes'or'no'blanketanswersinrelationtowhenand
howtousepropsorhowtomodifyaposture.Thisexperiencehasmademerealisethatwhile
knowledgeisinvaluable,eachcasewillbedifferentandcanchangeandIneedtostayopentothat.
It’salsoopenedmyeyestowhatbenefitsotherstudentscouldgainfromusingsupportfromthe
wallorachair.
IthasalsomademeawarethatbeforetakingonastudentwiththiskindofconditionsIwould
suggestaprivatesessionbeforecomingtoageneralclass(wherepossibleofcourse).Inthese
sessionswithA.itwastheresultofongoingdialogueandtryingthingsoutthatmadethemwork
well.Italsohelpedhimtohaveabasicideaofwhichpropstouseandwhenandhowhemight
adjustcertainposturestosuithimforwhenhecomestomygeneralclass.However,mypersonal
feelingisthatthesekindoftherapeuticsessionsaremostbeneficialforhimatthemoment.
TherearemanymorevariationsofmovementsthatIlookforwardtoteachingA.overthecoming
months,manyofwhichwouldfocusonlosingtensionthroughminimalmusculareffort:-supine
bridgeposepreparation,supine'wheel'preparation(pushingintoeachfoot,rolling,anchoringa
hand,rollingetc.),rollingupthewallintohalfshoulderstands).
Pranayamatoreleasetensionsinthefaceandjawwouldbenicetotryinthefuture-forexample
yawningbreathorlionbreath.
BIBLIOGRAPHY/RESOURCES
Intelligentyoga-PeterBlackaby,outhousepublishing(2012)
Yogapracticehandbook-ChloeFreemantle,Stillpublishing(2012)
Yoga-MaryStewart,'teachyourself'(2003)
Yogaover50-MaryStewart,Little,Brownandcompany(1994)
Thetherapeuticyogakit-CheriClampett,BiffMithoefer,HealingArtspress(2009)
NeckandBackPain-DrChrisJenner,HowToBooks(2011)
TheAnatomycolouringbook-Kapit/Elson,BenjaminCummings(2001)
Anatomyofmovement-BlandineCalais-Germain,EastlandPress(1993)
www.nhs/conditions/arthritis
www.spineuniverse.com
www.arthritistoday.org
www.patient.co.uk