Breathing in a Healing Relationship

Photo credit Nick Webb,license
Photo credit Nick Webb, license

“A healer/client relationship is just that, a relationship; a partnership at best, and like all relationships its success is the responsibility of both parties.” Those are the words of Dr. Alexes Hazen.

Those words got me thinking. As a yoga teacher, I am always faced with a student who has a few particular, physical issues they wish to address, and of course, physical therapists and doctors are called upon exclusively to help a patient cure a specific physical malady; therefore, why not take this opportunity to blog about how we three in the healing arts view the healing partnership? I am once again consulting with my colleagues Dr. Alexes Hazen and Tamar Amitay, MSPT to share with you our insights, hopefully resulting in some good healing advice.
First and foremost, we are all in agreement; you need to LIKE your chosen partner and feel that they LIKE you. It seems ridiculously obvious, I know, but I myself have been in relationships with teachers who I knew were masterful at what they did, and I was eager to learn from them, but when I looked back I found myself saying, “I never felt like they really liked me.” How terrible that was for me. I never want anyone to have to make that discovery down the line. Without this basic element I was never going to fully benefit. No matter how masterful the teacher, doctor or therapist, genuinely liking each other is essential to a fully functional, healing relationship.

The patient/student must feel that the healer has their best interests in mind from the onset and the healer must feel that the patient is ready to responsibly embark on the course of therapy. Even when we show up for our annual check-up, or when taking a class, we still need to bring our whole selves to the examining table or the mat. We are always, all of us, in process, and we need to show up with an alertness that says, “I have an idea of where I am right now and I’m looking for guidance and help so that I may move forward.” It’s always a good idea to check in with your intuition. Once you have checked in with your own feelings and have decided to give this particular practitioner a try, then also be ready to keep your side of the rapport active. Questions are an important part of receiving help; it’s very self-empowering, it deepens the work and both sides benefit. Again, this seems to be an obvious point, but it has been my experience that many people assume that they don’t know enough to ask questions and so they mistakenly allow their role to be passive. This is a big mistake. It is imperative that the patient, client or student continue to participate all through the healing process; the information could be vital to the outcome. If we give too much power to the authority figure we will never experience the self-empowerment that comes from being in a good partnership and the rewarding self-growth that follows. Most of us who have been fortunate enough to benefit from a great healing partnership are grateful for the lessons that the challenge presented to us and are all the wiser for the wear.

Unfortunately, things are not always that easy. Alexes tells me that patients sometimes come to the experience having been burned before; maybe they have had a wrong diagnosis in the past or maybe a loved one has been mistreated by the medical system, and so they don’t trust, “and why should they?” she admits. Or conversely, perhaps the doctor is having trouble trusting the patient because she senses non-disclosure of an important factor; for instance, the patient may have a habit they are embarrassed about — an eating disorder, a drug habit, alcohol abuse. Perhaps they are too ashamed, mistrustful or closed to reveal the whole picture; this can completely stymie the success of the doctor and so in turn the provider can’t really help. And we as healers come with our own set of worries and blocks, says Alexes. “Sometimes a healer has failed in the past, so they worry, will they fail again?” Ah, yes, vulnerability. If we lose our ability to be vulnerable we stop growing and we stop being effective as professionals. We are not supposed to be perfect, just honest with our patient/students and ourselves. Or as Tamar so beautifully described it, “nonjudgmental, mutually empowering, authentic and compassionate.” I know that my past challenges and failures have afforded me the lessons that I needed to be as good as I am today. If I do not continue to welcome my failures because I fear falling from some commercial success then I will eventually become stagnant and I will no longer be useful. Remember, the practitioner is in process too and although they should have the skills necessary to help you, they must be allowed the space to keep learning or they will be ineffective. Remember we are growing with you; this is one, important way we continue to get better at what we do.

On the subject of pain, Tamar pointed out that the successful management of pain on the path to healing is actually influenced by the quality of communication at the initial encounter. At the first meeting the PT has the opportunity to establish a bond with that patient. That bond will affect their attitude and their willingness to trust, comply and adhere to the treatment. It seems that being supported is unburdening and can reduce pain because it reduces stress. We all agreed that offering a clear plan for correcting and healing the issue is actually the beginning of the healing process. Tamar also made it very clear, however, that even with a good start, a patient who does not follow through with both lifestyle recommendations and prescribed home exercises should also not expect full rehabilitation.

Lastly, both parties need to acknowledge that good therapies and medical interventions are always holistic. Very often the student/patient comes in for one issue only to find that this health issue stems from an imbalance or dysfunction in another area entirely. The holistic aspect of healing is something most people are still surprised to discover and reluctant to accept. It has been my experience that even in today’s world where the word holistic is so common, most still struggle with the concept of holistic cure. It could be that when we are in pain and we are suffering we are desperate for a magic bullet that can make a specific problem disappear. The truth is that the body is such a systems of checks and balances that a problem in one area, usually (or in my opinion always) comes from somewhere else. And of course there is always an emotional component to injury and healing. Successful healing is incumbent upon the patient accepting the holistic perspective. Actually, the compartmentalization of our bodies is a trap and a pitfall that often leads to problems. If we are having trouble in our hips and we are not able to embrace the fact that our hips are being affected by the positioning of our walking feet then we will have trouble being a good partner in healing. Conversely, if a doctor is treating only the hip without opening up the patient to the fact that that problem is stemming from some imbalance, then the problem will not have been truly addressed and will reoccur.

The subject of responsibility, when it comes to the healing arts and sciences, is wrought with issues. “It’s not a dictatorship; it’s a relationship that must be built on trust,” says Dr. Hazen. Oh, I love this statement. So many people still walk into yoga classes leaving their own powers of intuition at the door along with their shoes! I wonder sometimes if students even ask themselves if they actually feel safe or if they can trust a particular teacher. It seems that many just walk in, lay the mat down, and assume that they will be taken care of completely. We all have some level of understanding as to the state of our bodies and when we enter the doctor’s office, PT or yoga studio we need to bring that understanding with us. I would always advise my students, as would Alexes and Tamar, do NOT negate the importance of what you already know about your own body and the importance of a continuing education. Unfortunately, as much as I cringe at the thought of it, most people still suffer from an authority figure idolatry. I have been in way too many yoga classes where it seems everyone has fallen under the unhealthy spell of a popular teacher, philosophy or trademark. All the great teachers of yoga consistently remind us that “the guru is in you” and yet we still are seeing the disillusionment and suffering that comes from the crash and burn that follows the fallen idol.

Again, at its best, the practitioner/client relationship is like any good partnership — it must be based on warmth, trust, openness and mutual respect. If the relationship lacks those basic ingredients it is doomed to fail.

My final advice on the subject of course is this: Check in with your breathing. You can always trust your breath, so take the time to notice. Are you breathing easier under the care of this person? If the answer is an unequivocal YES, then you are most definitely involved in a healing relationship.

Breathing, Manual Therapy and Breast Cancer Recovery

Photo credit Dendroica cerulea, license

It’s breast cancer awareness month, and Dr. Alexes Hazen, a breast surgeon at NYU Langone Medical Center, Tamar Amitay, of Thrive Physical Therapy, and I have come together once again to send out an important message about breast cancer rehabilitation. After any surgery (removal of lymph nodes, chemotherapy, radiation, post mastectomy and/or reconstructive procedures) it is crucial that a therapeutic program of breathing and manual therapy be initiated quickly to prevent Lymphedema.

Lymphedema is any condition or procedure that damages your lymph nodes or lymph vessels. There are physical therapists like Tamar who are trained in lymph drainage therapy and they are emphasizing the importance of early intervention as well as the importance of teaching their patients how to practice deep breathing. Studies show that manual therapy coupled with deep breathing have proven to be essential components in the prevention of irreversible lymphedema, and early intervention is crucial! Tamar warns that during tissue healing, there is approximately a two week period of acute inflammation; treating a patient when they are at this latency stage of lymphedema can improve the transport capacity and prevent irreversible lymphedema.

As a breast reconstructive surgeon who works in tandem with oncologists and radiologists, Alexes points out that while surgery and radiation are necessary, they are a traumatic assault on the body. She points out that although a patient may not develop lymphedema, all patients’ lymphatic and venous systemns are disrupted from these processes, at least temporarily. Treating and dealing with the swelling that results is a very important part of getting back to normal. Alexes strongly believes that early physical therapies can reduce the swelling and greatly speed up the process of recovery.

Ideally, two weeks after surgery, patients should begin a program with a physical therapist and initiate a deep breathing practice to help promote lymph circulation and drainage. Deep breathing stimulates the thoracic duct and in doing so strengthens the patient’s ability to purposefully aid the return of the lymph to the venous system. Learning how to strengthen the pumping effects of our breathing system increases a breast cancer patient’s chances for optimum recovery. By knowing how to connect to diaphragmatic breathing, one becomes better and better at producing the full, deep breaths that aid our venous system in the movement of blood and lymph fluids. Healthy full inhalations cause pressure within the thoracic cavity, and the movement of the diaphragm acts as a piston so that upon the exhalation, your fluids get a strong push back towards your heart. The enhancement of this automatic movement is important to the health of us all, but to someone with a compromised lymphatic system it must become a skill. More and more health issues are making us aware of the importance of mind/body control. The breath connects our minds to our bodies and is a great partner in times of health and a vital partner in times of healing. Tamar, Alexes and I, all believe strongly in mind/body awareness education. We all believe that learning how to breathe well is an important component in the treatment of lymphedema and I created the app Breathing Lessons so that people can become skillful at using their breathing as a health promoting and self-healing tool.

A good clinical example of how breathing, manual lymph drainage and exercise can help breast cancer survivors is the treatment of axillary web syndrome or cording. Physical therapists can and should educate patients about threshold symptoms such as heaviness, aching, fatigue, numbness and tingling — warning signs that the patient is overdoing. Cording can occur both when patients are fearful to move their arm or overzealous (and ignore those warning signs). Normal movement can be restricted due to pain, surgical scar adhesions and/or postural dysfunction. Protective posturing, and increased lymph fluid backup, result in thin cords of engorged lymph fluid down the arm and into the breast. Overdoing it can also result in fluid backup and cording. Together, breathing, manual lymph drainage, ROM and gentle stretching can resolve cording, or at the least prevent it from worsening.

Tamar says:

Breathing is a huge component of what I do. I always start and end a manual lymph drainage session with deep breathing exercises. I then have patients perform their ROM and strengthening exercises. Their home programs consist of checking in with their breathing on a daily basis, as well as ROM and postural exercises; I also always teach them some relaxation techniques.

Tamar has basic rules for her prescribed exercise programs:

  • Start with breathing
  • Do simple exercises first and then progress to more challenging exercises
  • Work at slow to moderate speeds.
  • Weights should NOT weigh more than 5 to 8 pounds
  • Start with fewer reps, no more than 10, and then build up to three sets of 12-14 reps
  • Stretches should be performed, but slowly and without pain

Always end with breathing.

Upon discharge from physical therapy Tamar encourages her patients to continue working with a knowledgeable Yoga or Pilates instructor. The focused breath work of Yoga and Pilates helps with postural re-education and may help with lymphatic clearance.

It’s a Balancing Act

Photo credit Steve Hardy, license

The issue of brain hemisphere dominance is still being argued among the scientific community, but there is one thing that everyone agrees on: It’s not that simple. We can’t assume that one is right-brain dominant because they might prefer to paint a picture than work out a mathematical equation, but I still think there’s something to it. I have had to develop my masculine side in order to succeed in my career, while some of my girlfriends have told me that motherhood was in no way second nature to them. As a yoga instructor, when it comes to balance, I’ve often asked myself: Could the balance of our bodies represent the balance in our lives?

When it comes to our bodies, one thing is for sure: We are a delicate balance of opposing forces. I tell my students, think “puppet on a string, like a marionette.” Our skeletons were meant to find support and strength from our muscles without sacrificing range of motion and flexibility. Not an easy achievement as we move through our lives emotionally and physically. Everything affects us. Everything can potentially throw off this delicate balance. There are many balancing acts going on in the body, but for starters, lets consider our right and left sides.

Do Your Really Know Your Right From Your Left?

Sure, you may know your right from your left, but how well do you understand how these two sides work together and what this valuable knowledge means for your health and wellbeing? The simple act of walking is abundant with health benefits that can be multiplied if you are mindful of your opposing sides. Jonathan FitzGordon, a Brooklyn-based yoga teacher who developed The Core-Walking Program, is passionate about the balancing of our left and right sides. “The body is a self-healing machine meant to regenerate itself through proper movement,” FitzGordon says.”A body that walks successfully through life uses both sides of the body in opposition. When the right leg moves forward, the left arm moves forward as well, and this essential action is missing from the movement patterns of so many people!”

The science of brain hemispheres as it relates to motor activity would indicate that balancing your right and left sides harmonizes both your body and your brain. Through his corewalking program, FitzGordon is helping his students understand the importance of knowing what their left and right are doing because he says, “when the muscles working in opposition are balanced well on both sides of the body, the resulting twists of the skeleton help the flow of our synovial fluid, a secretion that is essential to our joints. The body that moves well is constantly toning the nervous system through the twist of the spine and the coordination of the opposing left and right sides of the body. A well-moving body has a well-oiled nervous system which in turn keeps the brain happy and healthy.”

I’m sure you don’t have any trouble with the cue “step your right foot forward” — however, have you ever thought about how you do that very same movement on the other side? Discovering you are stronger on one side or that you have more freedom on a certain side is valuable information. Each cerebral hemisphere contains a map that controls mainly the opposite side of the body. Awareness is how we use that map in order to improve our mind/body connection. We stimulate both sides of the brain when we work on the balancing of our left and right sides. If you are devoting any time and effort to a movement class, whether it be yoga, tai chi, or kick-boxing, it would be worth your while to understand something about how your right and left sides function. Do you habitually stand with your weight on one foot? Do you favor a certain hip when you sit? If so, it’s likely that you are taking these habits with you to the gym. In yoga class one must pay attention in weight bearing poses like plank and downward dog: Is one hand or foot bearing more weight? Do you notice any difference in the way your left or right foot is working to support you in a squat or a chair pose? If a tense shoulder blade, is being held slightly higher in your back it may never cause you pain, but if you are lifting weights at the gym continuously there’s a good chance that one day it will.

Your two sides have be doing a more or less harmonious dance since you were wiggling inside your momma’s belly. We all start out life with a unique way of organizing and moving our bones. Our uniqueness over time turns into ideal or less than ideal habits. Some of the ways we become imbalanced are obvious, like a right foot that is turned out when standing or walking; others are more subtle, one hip slightly higher than the other. Discoveries such as these enable you to start working more intelligently or maybe require some professional help. You may even realize that that recurring headache always starts at a particular side of the head and so you can try to become aware of any tension on that side. The ability to direct relaxation techniques such as breathing, self-massage and visualizations to a specific area of the body is a wonderful skill. Getting to know the particularities of your right and left side can facilitate health by restoring and maintaining the natural flow of body and breath.

Balance Through Breath

The yogi sages were well aware of the effectiveness of the breath and its power to balance and heal. It too works in a contra-lateral pattern through the right and left nostrils. Alternate nostril breathing has long been recommended for its calming effects because it brings us to our center where there is stillness. Balance is soothing. Balance is what we are all trying to maintain in all aspects of our lives. The nostrils like the body are deceptively symmetrical. The left and right are not carbon copies of each other placed on the opposite side. Working with a gentle breath along this delicate, soft tissue helps to harmonize the dualities such as yin/yang, female/male, creativity/intellect. My breathing workshop and the application that I designed, Breathing Lessons, are my way of giving people a means to enhance awareness in order to restore balance through a natural breathing pattern.

Balance Lost And Found

Amy McGorry of Thrive Physical Therapy studio in Manhattan is always working to help people to restore balance. Amy says:

Body imbalances are a set-up for potential injuries. When balance does not exist between right and left sides you can often see a muscle imbalance developing. An imbalanced system is an inefficient system that leaves people at risk for injury. For example, a right-arm-dominant, overhead-throwing athlete at rest, often has a right shoulder that is positioned more forward than the left. It’s common to see muscles adapt to repetitive motions. Differences in muscle length and strength in the case of this athlete led to pressure in the shoulder joint and twisting in the upper back region with subsequent compensation running down the spine into the pelvis.

Tamar Amitay, the clinical director at Thrive, says:

Symmetry is something we strive for with posture. When one side is being used more than another, a muscle imbalance may turn into improper rotations leading to a faulty pulley system that can affect the entire spine.

These days many fitness classes, yoga classes and sports warm ups are designed to balance and strengthen our right and left sides, but many teachers have no time to, or just don’t bother to do the teaching that creates this awareness. Workouts and sports can become so focused on outward results that the importance of balancing can be gravely overlooked. All physical activities should be at least partially a practice in mindful movement. Perhaps it is time for a “mindfulness movement” movement. Let’s challenge the popular term physical fitness. What does that even mean? That your butt is perfectly sculpted? That you can run the quarter mile in record time? So many people are still being lured into the gym by the promise of an improved physique but few learn how to move properly and that ignorance often leads to injury. I realize that a class on the details of proper alignment is not as fun as Zumba, but the upside is that once body awareness is obtained, it stays with you forever, and what’s more it will make your Zumba class more effective and much safer.

The “mind-body connection” is a phrase we hear so often these days, I fear we may be losing sight of its meaning. There IS no REAL structural health without an understanding of how our bodies move in space. We were designed to maintain a harmonious relationship between our opposing sides with a calm steady breath that fuels their every action. A lifetime of benefits can be gained by this kind of knowledge and work. My students are always grateful, when they find that, more than just a workout, they’re getting a complete re-education in the ways they use their bodies. Although it hasn’t been proven, who knows, maybe there is such a thing as brain hemisphere dominance. Perhaps working intelligently with the body is making our weaker side stronger both physically and metaphysically. Maintaining a healthy mind and body is a lifetime journey, but in the meantime, all of us could stand to get to know our left and right a little better.