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8/7/2020

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Healing Yoga for Cancer: Neuropathy

 
Cheryl Fenner Brown, C-IAYT, E-RYT 500
This article also appeared in the Yoga U Online Wellness Blog, August 2019
Your nervous system is made up of two parts that relay information between your brain and the rest of your body, the central nervous system (brain and spinal cord), and the peripheral nervous system (all other nerves.  Neuropathy occurs when these nerves are damaged. Peripheral neuropathy, resulting from damage to nerves outside of the brain and spinal cord, can cause changes in sensation such as tingling, pain, numbness and weakness especially prevalent in the arms, legs, hands and feet. When it occurs in the lower body, there may be issues with constipation or balance when proprioceptive feedback from the lower extremities is interrupted. Symptoms may be different from person to person depending on which nerves are damaged and the severity.

Why Do Cancer Patients Get Neuropathy?

Unfortunately, neuropathy can be caused by all allopathic cancer treatments and unfortunately cannot be cured. Surgery causes neuropathy when nerves are disturbed and from the resulting inflammation. Radiation causes neuropathy when treatment damages nerves; neuropathy of the hands and arms is common in breast cancer patients who undergo radiation. Certain chemotherapy drugs may cause neuropathy, especially at higher doses. And the cancer tumor itself may press on nerves causing similar nerve damage and neural symptoms.

When sensory nerves are affected - those that control your sense of touch - you may feel tightness, discomfort when things touch your skin, numbness, an inability to feel temperature changes, tingling, burning, electric sensations, or pain in the hands in feet. You may even have challenges knowing where your hands or feet are in space (proprioception) which may cause difficulty grasping things or with your balance.

When motor nerves are affected - those that relay information between the brain and body - you may have trouble walking because the feet and legs feel weak or heavy. Not only balance, but coordination is compromised, and everyday activities such as dressing or using your phone may be impaired. And many patients report that symptoms continue to worsen months or even years after treatment ends. 

When autonomic nerves are affected - those that govern bodily functions - you may have trouble with blood pressure and body temperature regulation. Other issues may arise with swallowing and digesting food, or when urinating or defecating or with sexual function. It is important to inform your oncologist if you begin to experience any of these side-effects.

Yoga and Neuropathy

The good news is that there are many ways that yoga can reduce the suffering associated with neuropathy. The relaxation effects of breathing and regular yoga practice can help you learn to handle the distraction and discomfort of neuropathy. And the movement aspect of the practice can help to reduce the uncomfortable sensations you may be experiencing. There are also mudras that help to circulate the vital force of the body (prana)  and stimulate the extremities. In fact, several clinical trials are currently underway to explore the effectiveness of yoga to treat neuropathy in breast cancer patients.
​
Yoga Practice Tips
  • Do a little yoga each day to give yourself the time and space to heal, and to help make yoga a part of your life after cancer.
  • Stay mindful of the body and breath throughout the practice, and only move in a comfortable range of motion. If you become uncomfortable, dizzy, nauseated or breathless, stop immediately and rest for a few moments.
  • It is important to completely relax the muscles and rest in between active portions of each movement.
  • For this practice a yoga mat, chair, and a yoga block, blanket or pillow will be helpful.

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Repeat Intention with Vyan Vayu Mudra
​

Begin in a comfortable seated position with your hands on your lap. With your left hand, touch the tips of your thumb and middle finger together while extending your other fingers. With your right hand, touch the tips of your thumb and ring fingers together while extending your other fingers. Rest the backs of your hands on your thighs in Vyan Vayu Mudra. This gesture improves circulation to the extremities, enhances body awareness and promotes the flow of vital energy through the body.


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Bridge Flow (Setu Bandha Vinyasa)
 
This reclining bridge flow is a simple series of movements that may help to increase pranic flow and circulation. It is best done on the floor but can also be done on a bed.
 
  • Lie on your back with your knees bent and your feet on the floor, hips width apart.
  • As you inhale, press into your feet and raise your hips upward and your arms overhead. Either stop with the arms pointing directly upward or continue moving then towards the wall behind your head to a comfortable degree (as shown).
  • As you exhale, release your hips back to the floor and release your arms back to your sides. Try to land your hips and hands at the same time.
Repeat the entire sequence of movements at least five times, then rest for several breaths.


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Tree Pose (Vrksasana)
​
This common standing pose is helpful for building body awareness, stability and balance.
  • Begin standing with your feet hips width apart and a yoga block between your feet on the lowest height. You may want to hold the back of a chair or table-top for greater stability.
  • Lean your body weight into your right foot, without cocking your hip out to the side and keep both knees straight.
  • Pick up your left heel, then step the ball of your left foot on top of the block and rest your left heel against your right inner ankle. Point your left knee 45 degrees forward so that your pelvis stays facing forward.
  • Press the ball of your left big toe down into the floor and stare at something that will not move to assist you calming your mind and focusing your balance.
  • Place your hands together at your heart and take several long slow breaths.
  • When you feel like it is time to come down, step consciously down, take a few moments to move the standing foot and leg around before changing sides.


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Warrior II Flow (Virabhadrasana II Vinyasa)

​Moving through variations of Warrior II (Virabhadrasana II) can also help with stability, proprioception, strength and balance. 
  • Stand with your feet wide apart. You may want to hold the back of a chair or table-top for greater stability.
  • Turn your left foot out 90 degrees and your right foot in 30 degrees.
  • Make sure your hips turn slightly to the left (but not all the way forward) so that your front knee can track safely.
  • As you inhale, reach your arms out from shoulders. 
  • As you exhale, bend your left knee toward the second toe of your left foot and come into Warrior II (Virabhadrasana II).
  • As you inhale, drop your right hand to your right thigh and raise your left arm diagonally upwards into Viparita Virabhadrasana II (Reverse Warrior II).
  • As you exhale, release your arms back into a parallel reach.
  • As you inhale, straighten your front knee.
  • As you exhale, release your arms all the way down to your sides.
Take several breaths between sides and leave feet stepped apart if possible, for more stability work.


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Alternate Nostril Breathing

Breathing alternately into the right and left nostrils can help to calm the nervous system which might make neuropathy symptoms seem less intense. It also increases communication between the right and left hemispheres of the brain to stimulate the central nervous system.
  • Begin seated comfortably and close your right nostril with your right thumb while inhaling in through your left nostril.
  • Then change nostrils by closing your left nostril with your ring finger and exhale through your right nostril.
  • Breathe back in through your right nostril, then change your fingers again and breathe out through your left nostril.
Practice this breath for 10 rounds and notice the physical and mental effects. 


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Body Scan

The body scan, or rotation of consciousness, is a guided sensory journey through the different parts of the body.  It increases body awareness, eliminates mental chatter, and engages the witness consciousness. You engage as many channels of communication as possible to keep the mind focused - auditory by listening to the teacher’s voice, speech by repeating the body part, visual by imagining the part externally, proprioceptive by feeling the part internally, kinesthetic by sensing movement from one place to the next. The scan connects the origin of the motor nerves in the brain to the ending of the nerves in each part. As you go through the rotation of consciousness, you are activating parts of your brain associated with parts of your body which in effect, relaxes the mind by relaxing the body. 
  1. Recline on a soft surface with room enough to lay with your legs outstretched (on a bolster of pillow if needed) and arms beside your body with your palms facing upwards. Try to stay awake without concentrating too intensely. 
  2. Listen to the following Body Scan meditation
  3. Or you can use the following pattern to guide yourself through the body scan that follows:
  • Right hand thumb … 1st finger … 2nd finger … 3rd finger … 4th finger … palm of the hand … back of the hand … wrist … forearm … elbow … upper arm … right shoulder … armpit … chest … waist … hip … groin … buttock … thigh … knee … calf … ankle … heel … sole of the foot … top of the foot … right big toe … 2nd toe … 3rd toe … 4th toe … 5th toe
  • Left hand thumb … 1st finger … 2nd finger … 3rd finger … 4th finger … palm of the hand … back of the hand … wrist … forearm … elbow … upper arm … left shoulder … armpit … chest … waist … hip … groin … buttock …  thigh … knee … calf … ankle … heel … sole of the foot … top of the foot … left big toe … 2nd toe … 3rd toe … 4th toe … 5th toe.
  • Move your awareness to the top of the head … forehead … right temple … left temple … right ear … left ear … right cheek … left cheek … right eyebrow … left eyebrow … eyebrow center … right eye … left eye … right nostril … left nostril … whole nose … upper lip … lower lip … chin … jaw … throat … right collarbone …left collarbone … right chest … left chest … heart center … upper abdomen … navel center… lower abdomen … right groin … left groin … the pelvic floor … tailbone … sacrum … right buttock … left buttock … the entire spine … right shoulder blade … left shoulder blade … back of the neck … back of the head … crown of the head.
  • Now take the body in parts … the whole right arm … the whole left arm … both arms together … the whole right leg … the whole left leg … both legs together … the entire torso … the face … the head … the body … the whole body … your entire body.


References
  • American Society of Clinical Oncology, “Nerve Problems or Neuropathy” Approved by Cancer.Net Editorial Board, 2018 https://www.cancer.net/coping-with-cancer/physical-emotional-and-social-effects-cancer/managing-physical-side-effects/nerve-problems-or-neuropathy
  • Journal of the American College of Surgeons, “Breast Cancer Patients’ Fear Exceeds Risk”, March 2013: Vol 216(3): 380-386.
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8/7/2020

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Cancer & Stress: A Calming Practice to Help with Anxiety

 
Cheryl Fenner Brown, C-IAYT, E-RYT 500
This article also appeared in the Yoga U Online Wellness Blog, July 2019
​
Anxiety is one of the most prevalent side-effects along the entire spectrum of the cancer journey. Nearly all patients will experience anxiety at one point or another including after receiving a diagnosis, anticipating and receiving treatment, affording treatment, anticipating recurrence, ending treatment and becoming a long-term survivor. For many the fear of recurrence is very real and something that does not diminish with time. While the rate of recurrence varies depending on the type of cancer from early treated breast cancer as low as 5% to glioblastomas and ovarian cancers approaching an 85% recurrence rate or higher, up to7% 0f patients develop a disabling fear of recurrence that severely impedes quality of life.

Stress, Anxiety and Cancer

Cancer patients may experience generalized anxiety or other diagnoses such as phobias, panic attacks, OCD, health anxiety disorders and PTSD. Symptoms of these may vary but include increased heartrate, shortness of breath, muscle tightness, heightened pain, insomnia, sweating, nausea, restlessness and irritability. Also, how patients feel about their stress and anxiety impacts how much the stress affects their physical and mental health. One study out of Harvard reported that those who had high levels of stress and believed stress negatively impacted their health had 43% increased premature death rates over those who did not believe their high levels of stress was harmful.

The Stress Response & Immunity

The stress response or commonly called “fight or flight” response turns off the parasympathetic nervous system and reduce bodily functions not necessary for immediate self-preservation. This includes the lymphatic system, which in turn slows the immune response. As far back as 1965 psychiatrist George Solomon published some of the first findings in the field of psychoimmunology studying the link between stress levels and immune responses.

When stress is perceived as harmful and chronic it can inhibit immune function. However, when stress is perceived as an opportunity to rise to a challenge, it does not. When we experience as stressful event, whether it is the diagnosis of a life-threatening disease, or something as commonplace as getting cut off in traffic, the body responds automatically by secreting stress hormones. One of these is cortisol which raises blood sugar and metabolizes white blood cells to provide energy for the “fight or flight” response. Unfortunately, when stress becomes chronic, cortisol levels remain high even during rest and this can decrease immunity by inhibiting T-cell production and our T-cells are what protect the body from invading viruses, allergens and from mutated cancer cells.

When a challenge is perceived adrenaline is also produced. Adrenaline increases blood pressure and heartrate to create a rush of energy so we can respond to the challenge. But over time, sustained production of adrenaline causes a higher than normal baseline to be set by the body which taxes the organs, increases insulin production, and keeps blood pressure high.

Tend and Befriend Response

Fortunately, our bodies have a built-in mechanism for stress resilience, the hormone oxytocin. Also secreted as part of the stress response, oxytocin protects the cardiovascular system from the effects of stress, it works as an anti-inflammatory and keeps muscles more relaxed. Emotionally, oxytocin encourages us to seek support from others and helps us to notice when others are struggling, and when we do, more oxytocin is released.

Particularly for women, the “tend and befriend” response is tied to higher levels of oxytocin and causes us to ‘tend’ to those around us who are in need, and ‘befriend’ by seeking out social support. Better stress outcomes can be expected when patients have emotional and social support in place including support groups, therapy, education and wellness communities including yoga class communities, especially yoga classes for people managing cancer. Perhaps this speaks to why more women tend to seek out social support systems when undergoing diagnosis and treatment for cancer.

How Yoga Helps Anxiety

The good news is that yoga and other mindfulness practices modulate the stress response by lowering heartrate, blood pressure and respiration rates, and increasing heart rate variability which is an indicator of how well the body responds to and recovers from stressful events. More and more studies are being conducted showing the positive impacts of consistent yoga practice on mental and emotional well-being in cancer patients. Specifically, yoga has been shown to improve mood states, symptom reduction, stress reduction and improved quality of life. Besides improving these measurable health markers, yoga can lead to a sense of empowerment and mastery over the body and mind which can be an important factor in reducing stress and anxiety.

What follows is a simple sequence of yoga practices including setting intention, a mudra for anxiety, a simple sound practice to help calm the mind, a supported version of Balasana (Child’s Pose) to help you draw awareness inward and a calming pranayama practice. Done together these practices can help you to cope with the anxiety caused by diagnosis, treatment or survivorship and allow you to feel more like yourself.
​
Yoga Practice Tips
  • Do a little yoga each day to give yourself the time and space to heal. Make yoga a permanent part of your life after cancer.
  • Stay mindful of the body and breath throughout the practice. Only move in a comfortable range of motion. If you become uncomfortable, dizzy, nauseated or breathless, stop immediately and rest for a few moments.
  • For this practice a yoga mat and blanket and two or more bolsters or pillows will be helpful.

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Setting Your Sankalpa with Anjali Mudra

Intention setting, or creating a sankalpa, is an important first step toward using yoga as a healing practice. It serves as a reminder of your goals during this time.
  • Begin sitting in a comfortable seated position with your palms together at your heart. This is Anjali Mudra (prayer gesture) and helps to draw your awareness inward.
  • Take a few deeper breaths and recall your current challenges. Recognize that challenges are opportunities for growth and healing.
  • Begin to imagine the best possible outcome for your current situation, setting aside any feelings of doubt that arise.
  • Allow your sankalpa to arise formed into a simple statement phrased in the present tense beginning with “I am … ”, or “My … ”. If you find it difficult to create an intention at this time, use the statement “I am calm and worry-free.” State your sankalpa silently three times and trust that it will manifest with patience and repetition.  


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Adhi Mudra for Anxiety
 
Adhi translates to “first” because this mudra is the first mudra we do in the womb. It is a self-soothing gesture and comforts us during anxious times. Adhi mudra draws the excess mental activity down into the body where it can be processed and grounded. I also call this one of the “sneaky” mudras because you could easily hold your hands in this position during a difficult conversation and no one will know that you are doing something to ease your anxiety.
  1. Hold your thumbs in the center of your palms and wrap your other fingers lightly around each thumb.
  2. Rest the knuckles of the hands downward on your lap.
  3. Soften your shoulders and release your forearms.
  4. Hold this gesture for a few minutes and notice how it feels, then release the hands.


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Vowel Spiral
 
Using your voice to create a shift in your mental state is a powerful tool to combat anxiety. This practice uses simple vowel sounds that cause vibration in specific parts of the torso and head. As awareness is drawn into these areas, the mind can be freed from circular thinking that might cause anxiety. As you chant, focus on what the sound feels like in the body, how the vowels sound, and how smooth the tone is. You may notice breaks and warbling in the tone if your mind wanders or if your exhalation is not smooth. Work to smooth out the tone and make sure that you stop sounding before you run completely out of breath, so you are left feeling relaxed, not breathless and rushed.
 
Chanting simple sounds is one of the fastest, most effective ways to center the mind and emotions. When you are anxious you can imagine that your cells are vibrating in dissonance at an atomic level. When you chant, you bring your atoms into resonance and harmony and you can truly feel the difference almost immediately. Give it a try!

  1. Begin sitting in a comfortable position on the floor on a folded blanket, or in a chair.
  2. Take a few moments to breathe naturally and allow your inhalations to flow down into your lower abdomen.
  3. Bring one hand to your lower sternum, inhale naturally, then as you exhale chant an “Ahhh” sound (like ‘father’), noticing vibration in your mid-chest.
  4. Move your hand to your upper sternum, inhale naturally, then as you exhale chant an “Aaa” sound (like ‘way’), noticing vibration at your heart center.
  5. Move your hand to your belly, inhale naturally, then as you exhale chant an “Ooo” sound through very round lips (like ‘donut), noticing vibration at your navel center.
  6. Move your hand to your forehead, inhale naturally, then as you exhale chant an “Eee” sound (like ‘free’), noticing vibration in your skull.
  7. Move your hand to your hip point, inhale naturally, then as you exhale chant an “Uuu” sound (like ‘noodle’), noticing vibration in your pelvis, legs and feet.
  8. Move your hand to the crown of your head, inhale naturally, then as you exhale chant an “Mmm” sound, noticing vibration at your crown.
Repeat the entire sequence two more times beginning and ending with the “Ahh” sound at the heart center. Observe how the vibration spirals from the heart outward toward the crown and pelvic floor.


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Balasana (Supported Childs Pose)

Coming into a fetal position can feel like a balm for frayed nerves. It enables you to turn your awareness towards the internal landscape of sensation, breath and thought and away from the things outside of yourself that may be causing anxiety and stress. However, this pose can be difficult if the knees or hips are not comfortable in deep flexion. If you have access to bolsters or pillows, you can support your hips, thighs and torso so that Balasana (Supported Child’s Pose) can be maintained for several minutes in comfort and relaxation.
  1. Place a folded blanket on your mat so you have something soft to kneel on.
  2. Straddle one bolster as if you were sitting on a horse.
  3. Place the second bolster perpendicular to the first in front of your knees.
  4. Lengthen your torso forward so that your chest and belly are resting on the bolsters.
  5. Turn your head to one side and rest your forearms on the floor or support your forehead on the backs of your stacked hands.
  6. A third bolster may be helpful to place on top of the first two if you are not comfortable folding your torso forward into Balasana (Supported Child’s Pose). You want to place your torso so that your hips are at or below the level of your head. Additional bolsters can be straddled until you are comfortable.
  7. If this version of Balasana (Supported Child’s Pose) is not comfortable, or you don’t have access to props, feel free to recline on your back with your knees drawn into your chest. It is the same posture in a different relationship to gravity.
  8. Rest here for several minutes and practice breathing in and out in a slow and relaxed way.
  9. Return to a seated position as soon as you begin to receive messages from your hips or knees that you need to come up; never stay past the point of comfort. 


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Rechaka Kumbhaka Pranayama (Exhale Retention)
​

Conscious breathing is a simple yet effective way to shift your mindset when you are worrying or feeling anxious. It is an amazingly powerful tool that is always there for you when you have a few moments to focus on your breath. Bringing awareness to a slow, relaxed exhalation will activate the parasympathetic nervous system helping to reduce the effects of anxiety by reducing stress hormones, heartrate and blood pressure. The practice of lengthening the exhalation can increase the stress-reducing effects even more.
  1. Recline comfortably with support under your head and knees if needed. Your blanket or pillow will come in handy here, or simply leave the knees bent.
  2. Close your eyes and feel your breath moving smoothly in and out of your nostrils.
  3. Place your hands on your lower belly and as you inhale, notice if there is a natural lifting of the abdomen, and a gentle softening of the belly on the exhale.
  4. Take a normal length inhale, then slowly begin to lengthen your exhale by one or two beats. You do not need to count your breath but try to make the exhale slightly longer than your inhale.
  5. This should only be done at a comfortable speed and pace, never to the point of breathlessness or frustration.
  6. After five or so breaths with a longer exhalation, notice if there is a natural pause at the end of the exhale where the breath rests.
  7. Inhale, long slow exhale, and then pause where the breath is neither moving in nor out.
  8. Allow that rest to last for a few beats, then continue breathing.
​
Repeat this pattern for several minutes, then return to your normal everyday breath pattern.  


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Savasana (Relaxation Pose)

It is important to give yourself a few minutes at the end of your practice to rest in stillness and silence so that the gifts of the practice can be fully integrated into your body and mind.
  1. Recline with your legs extended and feet relaxed to sides. 
  2. Rest your arms to the sides and turn your palms to face the ceiling. 
  3. You may use support under your knees for low back pain or add a folded blanket under your head. Relax here for at least 5 minutes. 
​When you are ready to sit back up, take your time rolling over to your favorite side, resting there for a few moments while you repeat your sankalpa from the beginning of the practice. Then use the strength of your arms to press yourself back up to a seated position. Namaste’


References
​
  • Primeau, A., (2018) Cancer Recurrence Statistics, Cancer Therapy Advisor https://www.cancertherapyadvisor.com/home/tools/fact-sheets/cancer-recurrence-statistics/
  • National Cancer Institute (2019) Adjustment of Cancer: Anxiety and Distress (PDQ®)-Patient Version https://www.cancer.gov/about-cancer/coping/feelings/anxiety-distress-pdq#_336    
  • Velikova G, Selby PJ, Snaith PR, et al. (1995) The relationship of cancer pain to anxiety. Psychother Psychosom 63 (3-4): 181-4.
  • Keller, A., Litzelman, K., Wisk, L. E., Maddox, T., Cheng, E. R., Creswell, P. D., & Witt, W. P. (2012). Does the perception that stress affects health matter? The association with health and mortality. Health Psychology, 31(5), 677–684. doi:10.1037/a0026743
  • Mukherjee, S. (2010) The Emperor of All Maladies: A Biography of Cancer. Scribner.
  • Dess, N.K., (2000). Tend and Befriend: Women tend to nurture and men to withdraw when life gets hard. Psychology Today, https://www.psychologytoday.com/us/articles/200009/tend-and-befriend
  • Harvard Medical School (2008, updated 2018) Yoga for anxiety and depression: Research suggests that this practice modulates the stress response. Harvard Health Publishing, https://www.health.harvard.edu/mind-and-mood/yoga-for-anxiety-and-depression
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8/7/2020

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Cancer & Yoga: A Sequence to Help with Lymhedema

 
Cheryl Fenner Brown, C-IAYT, E-RYT 500
Yhis article also appeared in the Yoga U Online Wellness Blog, May 2019
 
One of the most distressing side-effects of cancer treatment is lymphedema, a swelling of the extremities caused by damage to the lymphatic system. The lymphatic system is part of the immune system and consists of nodes, vessels and organs that transport lymph throughout the body. Lymph transports white blood cells through lymph nodes which are grouped in the throat, underarms, abdomen and groin. These nodes store cells that help to fight infection and filter the lymph before it returns to the bloodstream. If cancer treatment damages or removes lymph nodes, lymph builds up in the surrounding tissue causing painful swelling, or lymphedema.

During breast cancer treatment, lymph nodes are often removed and tested for cancerous cells. The symptoms of lymphedema may occur immediately or up to 5 years after treatment. According to one survey, between 50-75% of women who had lymph nodes removed as part of breast cancer treatment worried about developing the condition while less than 20% developed the condition (1).
Patients with lymphedema can experience a range of symptoms besides swelling of the limb and digits including pain, limited range of motion, increased risk of infection, sensitivity, hardening or thickening of the skin. (2) Lymphedema treatments include manual lymph drainage, elevation of the affected limb, compression garments, breathing exercises and movement. (3)

Yoga and Lymphedema

Unlike the circulatory system which has the pumping heart to move blood through the vessels, the lymphatic system relies on the body’s movements to circulate lymph. The deep diaphragmatic breathing and simple repetitive movements of the hands, arms, neck, torso and hips that are involved in many forms of yoga all help the lymph to flow optimally. Yoga also helps to increase range of motion and strength which can help to counter the impact of lymphedema, so long as the yoga is practiced slowly and gently.
There are a few yoga poses that are contraindicated for those with lymphedema; handstand (adho mukha vrksasana), forearm balance (pincha mayurasana), downward-facing dog (adho mukha svanasana), headstand (sirsasana), shoulderstand (sarvangasana), and plow (halasana) all put too much pressure on the arms, shoulders and neck and should be avoided. If the lower extremities are affected, poses that create too much compression on the legs should also be avoided such as lotus (padmasana) or child’s pose (balasana) with deeply bent knees.
​
Yoga Practice Tips
  • Do a little yoga each day to give yourself the time and space to heal, and to help make yoga a part of your life after cancer.
  • Stay mindful of the body and breath throughout the practice, and only move in a comfortable range of motion. If you become uncomfortable, dizzy, nauseated or breathless, stop immediately and rest for a few moments.
  • This sequence includes movements that mechanically squeeze and stretch the armpit, abdomen and groin areas to stimulate lymphatic flow.
  • It is important to completely relax the muscles and rest in between active portions of each movement.
  • For this practice a yoga mat, chair, and blanket or pillow will be helpful.

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Intention with Anushasana Mudra

One of the tools of yoga is practicing mudras which link the physical and energy bodies. Here use Anushasana mudra to activate vyana vayu, the pranic current theat moves from the center of the body towards the extremities and supports lymphatic circulation.  
  • Begin in a comfortable seated position.
  • Rest your hands palms up on your knees.
  • Make a soft fist and extend your index fingers strongly outward.
  • As you hold this mudra imagine that your inhalations draw energy inward from the periphery toward the center of your body
  • As you exhale imagine energy expanding outward from the center of your body toward the edges.
  • Recall your intention and repeat it three times silently or use the intention “My immunity is strong”. 


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​Reclining Floor Flow
 
The reclining floor flow is a simple series of movements that massages the lymphatic structures in the armpits, abdomen and groins. It can also alleviate pain in the hips, lower spine and shoulders. This practice can be done on the floor or on a bed.
 
  • Recline with your legs extended. As you inhale, raise your arms over your head to a comfortable position.
  • As you exhale, draw your right knee towards your chest.
  • On your next inhale, draw your right knee out and open your left arm out from your shoulder.
  • Exhale and pass your knee across your body to your left hand and rotate your pelvis and lower spine to the left, turn your head to the right.
  • Inhale and bring your leg and torso back to the center and extend your right foot upwards, clasping your hands behind your thigh.
  • Exhale and draw your knee into your chest.
  • Inhale and return to the starting position with arms extended over your head, and your legs long on the floor. Take a few breaths of rest here.
Repeat the entire sequence of movements with your left leg, alternating sides up to five times each. Be sure to rest for several breaths between each set of flowing movements.


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Cat/Cow (Marjaiasana/Bitilasana)
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This common series of poses is a simple way to move energy and lymph throughout the torso and can be done kneeling on the floor or seated in a chair.
  • For the kneeling variation, pad the knees with a folded towel or blanket and bring your knees under your hips and hands just in front of your shoulders. If the wrists are uncomfortable, press the fists into the floor with the thumbs forward.
  • From a neutral spinal position exhale and draw your belly in, round your back and release your head to look at your knees; this is Cat pose. Stay here for a few breaths and feel the stretch of your spinal muscles and the gentle compression of your organs.
  • As you inhale begin to lengthen your pubic bone away from your navel and lift your heart, look forward being careful not to overarch your neck; this is Cow pose (shown). Stay here for a few breaths feeling the even extension of the spine.
  • Begin to move with your breath, exhale into Cat pose, inhale into Cow pose, then relax into center for a few moments of rest.
  • For the seated variation inhale into Cow pose, place your hands on your hips, draw your tailbone and shoulder blades back, stretch your abdomen forward, and lift your heart with your gaze going toward the ceiling.
  • Exhale into Cat pose, draw your belly in and round your entire spine, release your chin towards your chest while you reach out and cup your knees with your hands.
Continue to move and breathe for 5 more rounds. Be sure to rest for several breaths between each set of flowing movement.


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​Child’s Pose to Extended Hero’s Pose (Balasana to Utthita Virasana)
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Moving from Child’s Pose (Balasana) to an extended spinal position mobilizes prana, or vital energy in the body and can help to activate stagnant lymph.
  • Begin in an all-fours position and as you exhale release your hips back towards the heels into a crouched position or child’s pose (Balasana). Only go back as far as your knees will comfortably allow.
  • As you inhale lift your head and chest, press your hips forward. Raise your hands to your heart, place them on your head, or reach your arms overhead into Extended Hero’s Pose (Utthita Virasana) as shown.
  • Then as you exhale, fold forward placing your hands on the floor or release back into Child’s Pose (Balasana) if that feels comfortable.
  • Take a few moments of rest before inhaling back into Extended Hero’s Pose (Utthita Virasana).
As you repeat this flowing movement five times with the breath, notice how you alternately stretch and compress both the groin, abdomen and armpits to encourage lymphatic flow.


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Three-Part Breath (Dirga)
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Breathing deeply is part of traditional lymphedema treatment as it increases the movement of the diaphragm and massages the lymph nodes located deep within the abdominal cavity. The full yogic breath, or Three-Part Breath can be practiced while seated in a chair or reclining on the floor or bed. I often imagine the breath like an elevator car moving up and down along an elevator shaft as I practice this pranayama.
  • As you inhale notice a lifting, buoyant sensation in your torso. As you exhale notice a downward flowing sensation. Maintain these subtle directions as you continue.
  • Inhale breath from your pelvic floor up to your navel; exhale the breath down to your pelvic floor.
  • Then inhale from your pelvic floor up to your lower ribs. Exhale the breath down from your ribs to your pelvic floor.
  • Then inhale from your pelvic floor up to the top of your chest as if your breath was being poured into your torso and filling you from to bottom to the top. Exhale and release your breath back down to your pelvic floor. It may be helpful to lightly touch the upper chest to provide a bit of feedback for the breath as shown.
Repeat for several more rounds of breath, then release any control over your breath and rest for a few moments, noticing the effects. Remember to stop and rest if you feel uncomfortable or breathless.


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Instant Maui
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Elevating the legs encourages lymphatic drainage back toward the torso and is very easy to do at home. Some doctors recommend that the legs be elevated above the heart for at least 30 minutes 3-4 times a day for maximum benefit (4). Take care when positioning your body to be sure that your feet are elevated above your knees, your knees above your hips, and your hips above your heart to ensure excess fluid travels back toward the torso where it can be re-circulated into the blood stream. This posture is also mild inversion that provides a change in our perspective encourages deeper breathing, energy absorption and relaxation.  Find a piece of furniture in your home such as a soft chair, sofa seat or ottoman to use for support.
  • Recline in front of your furniture support and press your feet onto the edge of the seat.
  • Lift your pelvis and place a block, pillow or folded blanket under your hips. The prop should be between the waistband of your pants and the tailbone. If it is too high or too low, it will not feel comfortable so find that sweet spot where your sacrum is parallel to the floor.
  • Rest your arms slightly away from sides with the palms facing up.
  • If the hips are elevated, it is best not to use a pillow for the head. If you have un-medicated high blood pressure, nausea, or this position makes you feel dizzy or uncomfortable, remove the prop out from under your pelvis and rest with the hips flat on the floor.
Rest here for fifteen to thirty minutes, feel free to set a timer if you are concerned that you might fall asleep. 


Even though lymphedema can be an uncomfortable side-effect of cancer treatment, these simple yoga practices can boost immunity, release tension, increase lymphatic drainage and help the body to find more balance. Happy practicing and namaste’.

References
​
  • Journal of the American College of Surgeons, “Breast Cancer Patients’ Fear Exceeds Risk”, March 2013: Vol 216(3): 380-386.
  • “Lymphedema”, Mayo Clinic, 2019, https://www.mayoclinic.org/diseases-conditions/lymphedema/symptoms-causes/syc-20374682
  • Zuther, J., “Yoga for Lymphedema”, Lymphedema Blog, (2017), http://www.lymphedemablog.com/2017/03/02/yoga-for-lymphedema/
  • Stearns, R. H., “Edema (swelling) (Beyond the Basics), 2019, UpToDate, https://www.uptodate.com/contents/edema-swelling-beyond-the-basics#H17
 
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