Are Your Clavicles Where They Should Be For Pain Free Movement?

Yoga and Your Health Savings Account

Did you know that with a physician’s letter of necessity you may be able to use your health savings account to pay for yoga? Yes, it is true, but you’ll want to check with your plan first.  What is a letter of necessity?  It is a written statement from your physician stating you would benefit from yoga due to a specific medical diagnosis.  The evidence is growing that yoga is beneficial for a wide variety of diagnoses including back pain, anxiety, depression and high blood pressure (National Institutes of Health, 2016). The National Institutes of Health (NIH) is also funding research to study how yoga may affect many additional diagnoses and health problems such as diabetes, HIV, immune issues, arthritis, menopause, multiple sclerosis, posttraumatic stress disorder and smoking cessation.

While at Creighton University, I co-led a study researching yoga for smoking cessation.  Unfortunately, our study did not have balanced participation, and we cannot claim any statistically significant results.  However, what we did find is that people were very attracted to the idea of using yoga to help them quit.  Many reported they were not actively planning to quit smoking, but when they saw the idea of using yoga they were motivated to try and joined our study.  Many of our participants had no yoga experience at all. When we followed up with our participants, many reported they were still doing some form of yoga and most frequently used the relaxation and breathing practices they learned in the study. It is exciting that the NIH has seen enough value in this idea that they are continuing to fund studies!

Is yoga right for your health problem?  You should talk to your physician.  Then, find someone who knows yoga and has knowledge about your health concern. Some movements are unsafe for specific conditions. There are many styles of yoga available. Some types are very intense requiring a high level of fitness while others are very mild and appropriate for even the most inflexible and out of shape among us. Some styles are very fast moving and fitness based while others focus heavily on meditation and slow movement. The key to improving your health is to find the right match.

In the field of occupational therapy, we have a saying to describe our goal in designing therapy for our clients.   Our clients should be successful yet challenged with all their therapeutic tasks. Finding this balance helps our clients challenge their skills without over frustrating them.  This is precisely the balance you should strive to achieve with your yoga practice.  Finding a level and type of yoga practice where you feel successful leads to a sense of satisfaction.  If you feel challenged, you are more likely feel the task is doing something positive for you and you are likely to be motivated to continue. When you find the right match, you will be able to see your progress and seeing progress feels great.

As an occupational therapist and yoga instructor, I love teaching yoga to people with all fitness and experience levels.  It is important to me to know why someone is attending my yoga class.  Is it for fitness, a specific problem, weight loss or management, stress management or something else? Knowing this information helps me make sure class has a little something for everyone.  Doing a one to one yoga session allows me to tailor the entire session to that individual, matching their needs and fitness level to each pose and the flow of session to create the just right challenge.

I have worked with people who have extreme difficulty getting down to the floor and back up again. They feel they can’t attend a regular yoga class because of the frequent transitions.  Designing a yoga class where we do all standing poses or all floor poses was ideal for this person.  We also built in the process of going to the floor and up as part of the session.  This movement is an essential skill as we age.  I have also worked with people with specific injuries they thought prevented them from doing yoga.  A woman with a chronic toe problem was ready to give up, but we were able to find a way for her to transition her poses without putting undue pressure on her right big toe.  She was thrilled to regain her yoga practice reaping the benefits without the fear of re-injury.

So, does it make sense to spend your healthcare dollars on yoga?  That is up to you.  You are in charge of your health. If you decide the answer is yes, find a yoga teacher and style of yoga that matches your needs.  Talk to your healthcare practitioners, your friends, explore websites and call yoga studios.  Take the time to find the right match.  When you find the right match you’ll feel the just right challenge.




National Institutes of Health (2013). Yoga: In Depth. Retrieved from NIH National Center for Complementary and Integrative Health

Explaining the Fascial System and Myofascial Release

How do I explain the fascial system and myofascial release to my clients?  More or less something like this…

The fascial system is not extremely well understood but the research is starting to emerge.  You will not see this system have its own chapter in a textbook as you do other systems such as the muscular, circulatory or nervous systems. However, with all the research being done in recent years I will predict that within the next decade it will be better understood and deemed worthy enough to be granted its own chapter.

Part of the reason for fascia being poorly understood is that our primary understanding of it has been developed through autopsy and dissection.  It is the stuff that has to be cut through to get to the good stuff.  Many of our tissues look and function very differently when they are in a living being versus a non-living being. Fascia is also difficult to see on our typical imaging systems. Therefore, medical professionals make judgments on what can be seen and pay less attention to what cannot.

With our current technology, we are better able to study fascia in a living being and are better able to understand its many roles.  We know its primary role is to support. Imagine the fascial system as filling in space in the body between the muscles, bones, organs, etc.  Imagine a nerve running from the neck down into the arm. When it is moving from one muscle to another is it not just hanging out unprotected in open space inside the body.  The fascial system supports it.  It is the same idea with the circulatory system.  Arteries and veins are supported as they move from one are of the body to the next by the fascial system. Imagine the fascial system as being loose and having open space like wet gauze fabric but three dimensional.  This three-dimensional system spans the entire body from head to toe supporting everything.  It is very fluid when healthy so our structures can glide freely within it.  We are also learning another role is to support the body during functional movement.  There are layers of fascia connecting muscle groups that work together to help us move fluidly and hold us together are we do fast, heavy, large movements.  This is an important protective feature.

This protective role is important in everyday activities but becomes crucial during an impact such as a motor vehicle accident or a fall. During an impact, the fascia’s role is to contract and hold tissues together and resist separation of the tissues. Normally the fascia is a hydrated fluid system that allows other tissues to glide within it.  During impact, it tightens up to hold structures together.  A helpful analogy is the game of Red Rover. In this game, kids form two lines by holding hands.  A kid from the opposing team runs toward the line and tries to break through.  The kids holding hands are like fascia.  They tighten up, contracting their bodies to prepare for impact and prevent the line from breaking apart.  If the force is too great, the line breaks. Our bodies, like the Red Rover line, can take a significant impact without breaking apart thanks to our fascial system.

So, if the fascia tightens to support us when there is an impact, why doesn’t it go back to normal after the injury? In a healthy system, it does. During an impact, this normally fluid system contracts and squeezes out the fluid then becomes very rigid. Over time in a healthy system, the fascia slowly regains its fluidity as the surrounding tissues heal allowing everything to glide normally again. The problem is that most of us are not living the ideal healthy lifestyle. We are far too sedentary.  We don’t get great nutrition.  We don’t drink enough water. We don’t get enough sleep. After injuries we are told to rest.  We assume protective postures. We take medications that numb us. We are fearful of returning to our regular activities. In the worst case scenario we undergo surgical interventions which also cut through the fascial system triggering more tightening of the system.

When the system is unable to return to its more fluid state it continues to tighten.  There is a slow pull through this three dimensional system. This can cause pain and discomfort in areas that are far from the original injury.  Pull on the bottom of your t-shirt and notice the tension at each shoulder.  The angles are different but there in tension in each.  This is another useful analogy to understand the pull in this system. The tightening also reduces the space for tissues such as nerves and blood vessels to glide through causing pain and decreased blood flow which is crucial for the health of all our tissues and normal functioning of the body.

What can be done? The fascia must be coaxed back to its more normal state. Through the technique of myofascial release (MFR), a slow sustained stretch is applied to the restricted area of the body.  This low load stretch encourages the fascia to open up, pull fluid back in and return to its normal state.  Yet another analogy.  Imagine a sponge. When you wring it out, all the water is forced out.  If you hold it that way it will eventually dry out and hold the twisted shape. If you set it in shallow water, some of the sponge will soak up water but much will remain dry and twisted.  If you gently untwist the sponge and slowly pull it as open as possible it will absorb more water.  The job of the therapist is to gently untwist the fascia and encourage it to soak up as much fluid as possible.

The client has an important role both during the MFR treatment and after.  During the treatment, their primary job is to breathe.  I teach every client to breathe with their diaphragm.  It continually surprises me how little movement of the diaphragm is present when I evaluate breathing in my clients. I explain to them how important it is for them to practice this method of breathing both during treatment and in their everyday life.  Along with breathing, I ask them to focus. They need to focus in on what they are feeling and stay present with what is happening in their body.  Some clients prefer to chat during a session.  This is ok as long as they can also feel.  If I sense they are not, I ask them to focus in during at least part of the session. I don’t want to change who they are but I do want them to learn to feel.  Learning to feel a restriction and a release helps them learn to manage their bodies outside of a session.

Outside of the session, the client’s role is to maintain the progress made in therapy.  They must maximize their wellness behaviors.  This includes making sure they are drinking plenty of water, eating healthy food, working on their posture, and integrating more movement and stretching into their daily activities. These changes don’t need to be made all at once.  Even small changes can make a huge difference during the healing process.  For example, if the client usually does some simple stretching to help the aching in their neck, they can learn to hold stretches longer to mimic the MFR technique.  They can adjust their stretches to choose stretches that maximize what their body needs. Ideally, the therapist helps the client identify opportunities for change that will maximize their healing process.  I try to ask them to make a small change or add a new stretch after each session.  Layering on a new strategy or stretch a little at a time helps clients see the benefits of each.  When the benefits are seen the change is more likely to become permanent. I will often have clients come back and ask what else they can do at home. These changes help to hold the gains made in therapy and continue with more forward progress during additional MFR sessions.

I try to gauge their interest and provide more or less depending on how they are responding to the information.  I always let them know they can ask questions anytime.  I want them to fully understand what is we are doing and why.

The Art of MFR

The practice of MFR is both science and art.  Having knowledge of the body and its intricate systems is important.  Awareness of diagnoses and their related symptoms and precautions increases safety during treatment.  An understanding of the interconnectedness of how the brain affects the body and the body affects the brain is key.  This knowledge along with training and experience creates skill.  A skill to feel tissues and movement within the body.  This is where the art begins.  Listening with your hands as well as your ears.  Communicating with the patient and encouraging them to share what they feel.  Helping them to listen to their fascial voice.  We often begin a session where the client feels the most discomfort which may be pain or may be tightness. Everyone describes what they are feeling differently. After each release, the client is encouraged to share what they felt. Sometimes they feel sensations such as tingling, warmth or pulling in areas of the body away from where we are working.  This is the fascial voice.  It is the body sending a signal telling us to work there. If they don’t feel the sensation I use my skill and senses to determine where to go next.  This is based on a combination of my knowledge of the body and where I felt the lines of pull in the body during the previous technique.  After treating people for 25 years I have learned to appreciate the uniqueness of each person who trusts me with their body and mind.  I am continually amazed at how the body speaks to us and guides the work.