Hypermobility on the mat: some pointers for teaching yoga to with people with Ehlers Danlos / Hypermobility Syndrome

These suggestions for working with yoga students with Ehlers Danlos / Hypermobility Syndrome (ED / HMS) are written in response to the many requests for help and advice I receive from teachers of hypermobile students. They are neither exhaustive nor gospel. They are personal experience rather than expertise. I have been practising yoga with Ehlers Danlos (Hypermobility Type) for 32 years and have experienced many different attitudes and approaches from teachers. In the last decade, I have also been fortunate enough to teach many students with hypermobility.

While teachers with a normal mobility range are sometimes, understandably, anxious about how to work with hypermobile students in a beneficial way, most of the principles for teaching hypermobile people are also good practice for working with all students, so hypermobile people are easy to integrate into a general yoga class. Individual techniques for individual postures are outside the scope of this writing, but pretty much any principle for alignment and physical integrity you have learnt is potentially a great tool for hypermobile students. Feel free to use it. The following are some general possibilities to explore.

• Many beginning students share the popular view of yoga in our culture as the cultivation of flexibility. Frame physical practice as a movement towards balance and integrity. For some students this will mean working on strength and stamina; for others it will mean focusing on loosening restrictions in fascia and muscle. This approach will also serve your stiffer students, who may feel that they are ‘bad’ at yoga because they are not flexible.

• Guide hypermobile students to release (micro-bend) the insides of their elbows and the backs of their knees so that they are not supporting themselves by ‘hanging’ in their joints.

• If you are familiar with spirals, use them to guide alignment – as far as I can tell, it is impossible to spiral correctly and hyper-extend knees and elbows.

• Guide students to draw their limbs into the sockets rather than pulling them out. The general principle is to draw back into the centre rather than extending to the extremities. If you teach a vinyasa style, bandhas are key here – and generally very helpful for hypermobile people.

• In a hypermobile body, overworked and very flexible muscles often compensate for tight, contracted ones. Look out for this and suggest ways in which the student might rebalance, by stretching the tight places and strengthening the over-extended ones.

• Educate students about edge as a range of possibilities. Hypermobile people, by definition, have difficulties with proprioception and may need guidance to be able to feel the softer edges on the spectrum. If a hypermobile student consistently chooses a hard edge, be aware that this may be because it’s the only edge they can feel, rather than concluding that they are an aggressive practitioner.

• Be prepared to adjust the hypermobile student’s alignment, in the same place, in the same way, again and again. Because of the proprioceptive deficit that is integral to hypermobility, most hypermobile students will need to feel the new alignment many more times than a non-hypermobile student in order to embody it.

• Offer only one verbal / physical adjustment at a time, even if there may be many things in an asana that you feel need attention. Proprioceptive challenges make it difficult for hypermobile students to integrate multiple or complex changes into their body and they will quickly get overwhelmed by too much information.

• Refer students to the internal – energetic, somatic, psychological – dimensions of yoga. Remind them that the intention of physical practice is to create a simulacrum for life, in which our habitual patterns (samskharas), so naturalised as to be transparent to us, can become opaque, and once visible may be worked with consciously. Physical practice is simply an opportunity in which yoga may occur; it is not itself yoga.

• In making physical adjustments, focus on helping the student to feel the dynamics of the posture rather than increasing the amount of stretch in it. Adjustment focused on stretch puts hypermobile students at high risk of injury.

• Be aware that wide range of motion is only one aspect of hypermobility and that ED / HMS is one of a group of overlapping conditions. A hypermobile student may also be experiencing:

Dyspraxia.
Dyslexia.
Dyscalculia (difficulty with numbers and sequences).
Dysautonomia / POTS (disregulation of the autonomic nervous system: so they may feel faint coming up from head-down postures, and dizzy in head-back postures).
Fibromyalgia / chronic pain.
Chronic fatigue / general need for more rest than usual.
Irritable Bowel Syndrome.
Eating disorders / self-harm.
Higher than usual rates of anxiety / a sensitive nervous system that easily gets stuck in fight, flight, freeze / low-level PTSD.
Austism Spectrum Disorder / Asperger’s Syndrome.

• Be aware that while developing strength is desirable for hypermobile people, ED / HMS is a genetic condition of the collagen. While muscle strength can compensate to some degree for lack of tensility in the fascia, it can never create the kind of stability that is inherently present for non-hypermobile people (i.e. people with normally coded collagen). This compensatory form of stability is not automatic and must be consciously turned on and maintained. For this reason stabilising their body can be physically and mentally exhausting for hypermobile people.

• Be aware that yoga is very often not easy for hypermobile people. In fact, ED / HMS presents many additional challenges in asana work. These may include chronic pain, difficulty in stabilising the body due to lack of fascial support, limitations in proprioception (which, together with stability issues can make balance very difficult), dysautonomia (which may cause faintness, dizziness, a racing heart and unusual fluctuations in body temperature), frequent dislocations and injuries (which may require a longer healing time in a hypermobile body), and difficulty in building muscle mass.

• Avoid framing the holding of a posture as a feat of endurance. A hypermobile student may lack the fascial tensility to hold a standing posture for what would be a normal period of time for other students, even when they have good muscle strength. Holding beyond their comfort range may not increase the student’s stamina but may cause muscles to go into spasm, and tendons, ligaments and fascia to become inflamed and over-stretched.

• If you teach a yin style, be aware that for some hypermobile people an optimal yin stretch may be one to two minutes, and extending the hold time may result in damage to tissues. The appropriate duration will vary from person to person, and for the same person in different postures. Encourage students to track their own edge and emphasise that it is always OK to come out of a posture. The optimal hold time is not five minutes but when you feel ‘cooked’.

• Be extra-mindful of your own projections. Hypermobile students sometimes receive projections related to the teacher’s own desire to be flexible, and may be inappropriately praised or criticised as a result. Remember that hypermobility is not something that the student is doing; it is something that they are being. There is no choice or agency involved in being hypermobile; it is simply a genetic condition.

• If you are teaching a student who regularly dislocates (and may also be able easily to put themselves back in joint), keep teaching towards stability and avoid communicating any sense of fear or horror you experience in response. Be aware that this kind of dislocation is an everyday occurence for some hypermobile people and for them may not be a big deal.

• If your student is not aware that they have ED / HMS, it may be helpful to let them know that you cannot diagnose, but that you think they may be hypermobile. Many beginning hypermobile students struggle enormously with balance and stability, and may be having other unexplained health problems. It can be very useful for them to know that there is a reason for this. Explain simply and without drama, and offer as much information as they want to receive. For some students this will be a lot, for others little.

• Offer help to stabilise, strengthen and align the student’s extension rather than asking them to pull back out of it (or not to go so far). This way you are offering them something more rather than taking something away. Most students will be responsive to this approach.

• Be aware that for all sorts of reasons, hypermobile people do need to stretch. We all do. Unstressed tissues are degenerating tissues.

• If your student is an experienced yogi, by all means offer suggestions for change, but be mindful not to sweep in and reconfigure their practice for them. Remember that the practice is the student’s. Because of the proprioceptive deficits involved in hypermobility, most hypermobile people receive limited information about where they are in space and where their body ends. As a result, control over their own body may be an issue for them and they may feel threatened by any suggestion that you are trying to take over. If your student appears resistant to your suggestions, consider this as a possibility and explore how you could work with them more collaboratively. A style that supports what they already know and adds value to how they already practise will generally be well received. Be aware, too, that hypermobility sometimes attracts a surfeit of technical imput. You may or may not be giving the experienced student something new. Enquire and offer rather than impose.

• Some people with ED / HMS are housebound wheelchair-users, others are elite dancers, gymnasts and circus performers. In a yoga class, some hypermobile people will easily be able to enter physically challenging postures and will travel swiftly through progressive yoga practices such as astanga vinyasa, becoming adept practitioners of advanced series. Others will be dogged by injury and chronic pain. One possible reason for this disparity is that ED / HMS is in fact not one but a group of many different genetic variations in the collagen. As genetic testing becomes cheaper and easier to carry out, more of these variations are being identified. Avoid evaluating hypermobile students on their physical performance. An ED / HMS student who is often injured may not be weaker or more pushy or more inconsistent in their practice than another who sails easily through increasingly more challenging sequences of asana. They may simply each have a different genetic variation in their collagen.

In general, hypermobile students try really, really hard, love working with their body and are a joy to teach. Trust your instincts, and honour and enjoy this opportunity to explore together.

I offer occasional workshop days on ED / HMS for (non-hypermobile) yoga teachers and for hypermobile yoga practitioners. For more information see http://www.movingprayer.co.uk or email jess@movingprayer.co.uk.

For general information about  ED / HMS see:

A Guide to Living with Hypermobility Syndrome, Isobel Knight, Singing Dragon, 2011.

‘Living with Hypermobility Syndrome’, Rebecca Allen: http://www.huffingtonpost.co.uk/rebecca-allen/living-with-hypermobility-syndrome_b_3379363.html.

Getting it together: yoga for newcomers

It may be that you have joined a yoga class to get fit. This is the first step onto the mat for lots of people these days, and like all beginnings it is a worthy one. If you continue to practise regularly, however, you will begin to notice that while you may be experiencing benefits to your general fitness, there is also something bigger, deeper and more mysterious going on.

The Sanskrit word yoga is usually translated as ‘union’. BKS Iyengar (one of the great modern teachers and practitioners of yoga, and the founder of the Iyengar yoga system) describes this as ‘integration’; in other words, accepting and owning all the parts of ourselves. In the context of yoga, this integration is not only personal but also transpersonal: it entails experiencing and embracing our part in the universe, and experiencing the numinousness of that whole, which includes us and is so much bigger than us.

It’s important to understand that the physical postures of yoga are just a scaffolding. They are not themselves yoga. Yoga is the process of whole-person awakening that happens through engaging mindfully with the scaffolding of the postures. ‘Mindfully’ means that you notice what you are experiencing as you move through the postures, being aware of sensations, emotions, thoughts, energy moving, memories arising … and, just noticing, let them be.

Every yoga class should really come with a big bold WARNING sign and a lot of exclamation marks. Yoga is a dangerous practice. If you practise regularly and sincerely, it will transform your life from the roots up. You may be impelled to change anything and everything from your diet through your closest relationships, your job, where you live, and what time you go to bed and get up in the morning. The physical alignment you have been working with in trikonasana, parsvakonasana and all those other postures with difficult Sanskrit names are practice for this. You are being drawn into alignment with your truest purpose in life. There is often discomfort, confusion and a sense of disorientation in realignment. You will probably be familiar with this from your yoga class too. Transitions like this are not always easy or welcome. Many people stop practising yoga when they begin to feel the pull to shift position in this way. Ultimately, however, you are being moved towards your greatest integration, health and well-being.

Our ability as yoga practitioners is marked not by whether we can sit in lotus position or stand on our head for ten minutes, although working towards these things may be part of the scaffolding, but by our capacity for engaging with these transitions kindly and steadfastly, offering compassion to all our human silliness, and patience to our reluctance. Mr Iyengar says:

Yoga allows you to rediscover a sense of wholeness in your life, where you do not feel like you are constantly trying to fit the broken pieces together. Yoga allows you to find an inner peace that is not ruffled and riled by the endless stresses and struggles of life. Yoga allows you to find a new kind of freedom that you may not have known even existed … Ultimately … there is a serene core of one’s being that is never out of touch with the unchanging, eternal infinite. (Light on Life, xiv)

Good luck with your practice.

Light on Life, BKS Iyengar, Rodale, 2005

Looking both ways

Here I am starting once again by announcing that I’m 48. My age feels important just now. Right here, in the middle of my life, I find myself, like double-headed Janus, looking both forwards and back. I’m still leaning into the new, still learning, still acquiring physical abilities, still going to places I haven’t been able to access before in my body, getting stronger, releasing more restrictions; but at the same time I’m facing into the time of dissolving. I experience more pain; there’s more wear and tear in my body; there’s less and less certainty of what I will and won’t be able to do on my mat on any given day; I have to offer more respect to the crazy wisdom teacher of my body. At 48, I’m about to crest the summit, and what comes next is dropping onto the downhill slope, the path of letting go.

I’m not yet ready to abandon the physical aspects of my astanga vinyasa practice, and I may not be for a very long time to come, but my practice has had to become more responsive to how I am in the moment. If I’m stepping onto my mat with the intention of practising a particular series, I always have that structure in my mind, but what emerges from my body may be more of a creative interplay with the structure than a straight reproduction of it. Sometimes it looks pretty much 100 per cent kosher. Other times it really doesn’t. I don’t have a huge amount of control over that, nor can I predict how my body will be on any given day. Nor am I interested any more in imposing a rigid structure on my body; I’m more engaged by how my body is in relation to the structure, where it meets it, where it doesn’t, where it needs to go off on its own therapeutic loop, and what that loop looks and feels like.

All of this has prompted me to wonder how, as Mysore-style astanga teachers, we can hold space for practitioners in the phase of dissolving. Perhaps other astangis have less of an issue with this as they age: because I have Ehlers Danlos, my body has always been full of anomalies, and it is even more so now. Nevertheless, as astanga vinyasa matures in the West, there are going to be more and more of us working with it as a practice of disintegration of the body, letting go of physical capacities, and readying ourselves for death.

I mostly practise on my own, mainly because, for me, practice is primarily about the intimate relationship between me and myself. But there are also times when I want to share in the energy of the group breathing and moving together, and I’m finding it difficult to find spaces where it’s possible for me to do this without harming myself or compromising the truth of my physical experience. In some ways I understand why this is so. In any Mysore practice space there are usually many people who are still establishing and embodying the structures. I know from my own teaching, that it can be difficult to keep these people on course if there are others in the room following their own choreography. It can be hard to know from the outside why a person is doing what they’re doing. It’s easy to make judgements, to assume that they lack self-discipline or are being disrespectful. And sometimes this may be the case. But if we don’t allow space for experienced practitioners in the dissolving phase in our Mysore spaces, it seems to me that we are offering a skewed, one-halved version of astanga vinyasa, one that is about youth, about physical ability, about attachment to forms.

I don’t have a simple solution to these complexities. However, if you’re a Mysore-style teacher who feels able to hold the complexities, I’m always looking for places to practise that feel safe and respectful.

Namaste!

On the edge

When I was young (it feels funny to write that, but I’m 48 now, and some things have changed), I was drawn towards the furthest edge, the place where the sea meets the sky, the distant horizon. Sometimes it felt like the knife’s edge. I lived in extremes, out on a limb, fully extended, in all senses, including physical practice. Part of this for me was an attempt to feel my own edges, and I believe this is connected to my hypermobility, since the receptors relating to stretch and physical position don’t give the same feedback in a hypermobile body that they do in bodies with normal-range tissue density. It’s hard to feel where I end and where I begin. It’s only as I’ve grown older that I’ve learnt to lean into the middle ground, and still now I would say that I don’t feel easy there.

I have battle scars from my time on the far edge. But do I regret going there? I cannot in honesty say that I do. I am reminded of words I heard in a play a few weeks ago: ‘Perhaps young men need to fight.’ And perhaps when we are young we need to push our bodies, we need to take risks. Boxers, skateboarders, ballet dancers, gymnasts, freerunners … Inhabiting the physical extreme may just be what young people do.

I preface these reflections on edge in this way because I don’t want to pathologise myself or anyone else who has pushed it as far as it will go; I want to witness all the possible orientations to edge rather than decree that any one is correct. But do I teach this kind of edge to students? Do I advocate it? No, I guide them gently away from the cliff edge and into the middle ground.

If we set out to boil hatha yoga down to the bones, the principle of edge would probably be one of the things left at the bottom of the saucepan. It’s crucial to practising with awareness. When we begin yoga, particularly in the dynamic forms, many of us don’t have much of this kind of awareness. Working on the edge may be synonymous for us with going to our limit. It’s in the nature of astanga vinyasa, because of the escalating physical challenges it presents, to attract people who like to dance on the brink of the precipice. It may be only when injury or exhaustion forces us to re-evaluate our practice that we begin to question the wisdom of habitually hanging on by our finger-nails. As we start to explore our physical, psychological and emotional experience more subtly, we may discover that the brink is not the only edge, that in fact there is a spectrum of edges, each one representing a different degree of intensity.

Eric Schiffmann describes the multiplicity of edges like this:

Each pose has a ‘minimum edge’ and a ‘maximum edge’, as well as a series of intermediary edges between these … [The maximum edge] is the point where the stretch begins to hurt. It is the furthest point of tightness beyond which you should not go. If you were to force yourself beyond this point, you would definitely be in pain and might hurt yourself or pull a muscle. The minimum edge is where you sense the very first sensation of stretch, the very first hint of resistance coming from your muscles.

He suggests that we can approach each succeeding edge as a gateway. Once we have fully experienced the sensations at a particular gate, we may pass through and onto the next. The intention is not to race through the final gate, but to be as present as we can to the threshhold where, moment by moment, we find ourselves. In other words, edge is not one place or a single arrival; it’s never discovered, mapped, done and dusted. Edge is an ongoing process, an endless dance of shifting experience. Nor is the edge really separate from us. There’s no thin black line out there against which we in here pit ourselves. Edge is intrinsic, a unique product of the interplay between our individual body and psyche with a particular asana in a particular moment in time.

For me, now, the edge is a place where, moment by moment, I experience some kind of physical, and/or psychological, and/or emotional expansion. In other words, something is happening. Something might be a memory or a feeling surfacing into consciousness; it might be a knot of matted fascia releasing; it might be a new technical ability coming within my grasp. Now I often see edge not as the furthest out but as the place between. If I force my body, if I approach my practice with more or less subtle aggression, I create physical, mental and emotional contraction. Everything tightens, closes in. This happens quite literally: force is experienced by the body as trauma; contraction is the body’s physical response to trauma. If, on the other hand, I am complacent, sluggish, too comfortable, I create a different kind of contraction, one that results from a kind of entropy. Again, this happens quite literally. Fascia contracts if not stretched regularly; muscles waste if not used. The edge between these two places is the not-too-much-not-too-little location where expansion is possible – in body, mind and bodymind.

Cultivating an awareness of how we relate to edge is important in the immediate sense because it enables us to practise without injuring ourselves physically (and without giving up and going to eat chips). Beyond that, though, our relationship with edge on the mat has everything to tell us about how we meet with edge in our life. If we reflexively back away from challenge in yoga practice, choosing postures that we find easy and non-threatening, remaining in the shallows emotionally and physically, this is a reflection of how we will pitch our edge in life. Likewise if we practise yoga constantly on the verge of pain, at the outer limit of our endurance, our flexibility, our capacity for emotional presence, this will be the edge we choose in the rest of our life. Many of us go on habitually redrawing the same patterns in the sand and wondering why they never look any different. By giving attention to these patterns in the laboratory of our practice, we become gradually more able to recognise them in life, and as we learn to recognise them, we can slowly begin to choose new trajectories.

Astanga vinyasa involves a process of dynamic surrender. ‘Dynamic’ means hanging on in there, offering the best of our energy and our sense of direction. It means staying awake. ‘Surrender’ means letting go into the reality of exactly what is in each moment – which may be that we don’t have much energy, we’ve lost our way and we’re falling asleep. Learning to walk this edge skillfully requires a lot of practice – which is why we practise every day. The more we practise, the more we find there’s space around the edge to play. We develop finesse and audacity. We may choose to take a risk, not out of inner compulsion but because danger is a facet of human experience and so we include it in our exploration.

My favourite image of edge is Philippe Petit wire-walking between the Twin Towers. I guess he was out on a limb there. He certainly had finesse and audacity, and once, after all the planning that almost never came off, he actually made it onto the wire, there was a sense of expansive, ecstatic ease. For me, this moment represents the point at which the edge dissolves and we find ourselves abiding in the still point at the centre, suspended in pure presence.

The Spirit and Practice of Moving into Stillness, Erich Schiffmann (Pocket Books 1996).

‘Progress’

Practise, practise, all is coming.

When we start to practise astanga vinyasa, most often we are concerned with the scaffolding. That is, with physical technique – with alignment, bandhas, jump-through, jump-back, strength, stamina, flexibility and so on. This is appropriate, because until we have built the structure, we cannot inhabit the house. Often, though, we translate this priority for engaging with some basic principles into the belief that there’s somewhere ‘we’ (usually meaning ‘our body’) have to get to – and as soon as possible. We construct ‘somewhere’ according to whatever we feel our own physical deficits to be. So the nirvana of arrival may be stretching our hamstrings, losing weight, jumping back without touching down, getting into a more challenging variation or a more advanced posture, being able to do padmasana, sirsasana, urdhva dhanurasana … and so it goes on.

Generally, though, over the months and years, our attitude gradually starts to shift. We become more engaged with what’s happening now than what with might (maybe) be happening sometime soon. We begin to dwell more often in the reality of the moment. This shift begins to happen when the yoga mat becomes home, a place we need to go to every day in order to re-find ourselves. It is therefore an outgrowth of a regular self-practice (and something that cannot result from attending no-matter-how-many classes). It’s not dependent on a teacher. No teacher can give us this; we already possess it and only need to uncover it in ourselves.

When we are engaged with practice in this simple, regular way, ‘progress’ is no longer something that we reach for, but something that occurs, quite ordinarily and routinely, when a space opens up and we move, quite ordinarily and routinely, into that space. Space opens out of the act of stepping onto our mat, with a willingness to be present (and a willingness to be present to our inability to be present), day after day. It may manifest as a tiny increase in strength or flexibility. It may manifest as a little more capacity for abiding through difficult emotions. It may manifest as the opportunity to catch sight of the place that bores us, frightens us, brings us so much joy we just can’t bear it, and, for a second, look it in the eye. It may manifest as the growing tendency to get onto our mat even when the loudest voice in our head is telling us that there isn’t time and our life is too busy. It may manifest as injury and the need to find new ways, both physical and psychological, of being in our practice – and the willingness to look for those ways rather than roll up our mat and have a break.

Progress can look like going backwards. It takes a certain bigness of mind to embrace this kind of progress – and it’s the bigness of mind that makes the difference, the bigness that recognises the prince in the frog. The miraculous thing is that, even in what appears to be a setback, spaces are always opening out. We just have to be able to see them and expand into them – and with time and practice, this way of responding becomes our natural impulse.