IT IS HOPED THIS PAGE WILL OFFER TEACHERS TO ASK QUESTIONS AND HOPEFULLY GET A RESPONSE FROM OTHER TEACHERS.
	WE WOULD LIKE ALL TEACHERS AND STUDENTS TO READ THIS PAGE ON A REGULAR BASIS AND ADD THEIR COMMENTS
	BASED OF PERSONAL EXPERIENCE OR COLLECTED DATA
	Q. I have a student in my class that had a pulmonary embolism last year. Are there any prohibitions?    from:  windellow7@bt.com
	Answer 1.   [From a Yoga teacher in ER]    I’ve had a pulmonary embolism. It is a life threatening 'event' and  a blood clot can have a devastating effect on the lung. Even as a pulmonary embolism starts to occur, the body begins to react to cope, and the unaffected lung attempts to take over the breathing function/process. If you survive a lung or part of a lung [usually a lobe] is lost, people can make a good recovery and the undamaged lungs simply compensate for the loss.. I do not find any or the Pranayama techniques a problem or any postures. Has anyone anything to add on this query ?
	Q. There is a condition known as Sleep Apnoea which can occur with some people during deep relaxation. It can cause seizures. Has anyone come across this during relaxation in a yoga class ?  ....   from    Lewis Berger fotppv@aol.com
	Q. I have had a query from someone whose husband has a breathing disorder, and his doctor suggested he tried Yoga breathing practices. He is only using 40% of his lung capacity! Can anyone offer any advice on this query  .... from Sue Burton
	Q, A friend of mine has been encouraged to hold her baby upside down by holding onto his thighs in a baby yoga class. She herself has very loose flexible ligaments, are there any possible risks to her child?
	Your comments most welcome, thank you ...  from Karen Clake
	Q. I have a potential student who has Downs Syndrome. Please advise any prohibitions and precautions.     from: nan-brewer17@virgin.com
	Answer 1. One of the main prohibitions with people suffering from Downs Syndrome is that they can often have a muscular-skeletal weakness in the top three cervical vertebrae. Inverted postures that put any strain on the neck are prohibited and there are possibly good arguments against taking the head back in postures like cobra, etc. Has anyone anything to add on this query ?
	Q. Any suggestions regarding a student who has Marfan's syndrome. Any advice ~ any prohibitions and precautions.     from: sep-pagetter3@opendoores.com
	A.1  People that have the genetic disorder Marfans' syndrome are often rather tall and usually have longer arms and legs than average and they will often find even simple balance difficult ~ the use of a chair or a wall into help simple balances is suggested.. Kyphosis is very common and very little flexibility in this area of the spine. Postures like Savasana can be difficult and the head and upper back will need a lot of support ~ blocks, meditation stool, etc, to support the head and upper back. There are often problems with the aorta. People that have this genetic disorder usually know their limitations and will modify postures themselves. The student/teacher relationship is important and good feedback is essential. from Gill Johns
	A.2. My young nephew has Mafrans syndrone and his condition affects wherever there is elasticity in his body. His tendons & ligaments are very elastic making all his joints very mobile, the walls around his arteries are very elastic so are liable to stretch. If his artery walls (particularly the aorta) stretch too much they will become thin and leak or burst. He has yearly scans to measure the size of his aorta and takes beta blocker medication. I really don't have the medical knowledge to say if inversions should be a precaution but would think your student should check with their GP first. I would also be very careful not to over stretch with the yoga practice but work more on building strength, particularly to support the vulnerable joints. I would also be very careful not to let the knees overextend (push back) when standing. My nephew could perform any yoga posture that involves flexibility with ease (and without practice) but will have to work on his strength when he becomes older to protect his joints. Yoga balance is difficult because his feet are just too elastic to provide a firm base. He is tall, with long limbs,  large feet and a cheeky smile. All this sounds quite frightening, but really makes little difference to his daily life, he plays football etc with his friends without any problems........ from Karen Clarke
	Has anyone anything to add on this query ?
	Q.   I have a 43 year old lady in my class who up until 3 months ago was a regular attendee and fairly fit and strong. Due to incorrect lifting she now has a slipped/ruptured lumbar vertebrae leading to sciatica problems. After weeks of treatment her Chiropractor has instructed her to attend Pilates classes to quote "strengthen" her core. She would rather return to yoga. However (a) she is still in much discomfort and (b) can hardly lift one leg. I have my own views on what she might do yoga wise. BUT I'd really appreciate input from any teachers who have had experience with this very common ailment.      from: Lez Gray
	Has anyone anything to add on this query ?
	A.1  Every back problem is individual and a one to one is the ideal solution here to discover what postures are suitable. As a generalisation for prolapsed disc - gently does it! and it depends entirely on the severity of the prolapse and the stage of recovery. If early stages and quite severe - rest in semi supine or prone are the order of the day and then progress from there. Would be very happy to correspond with this enquirer if it would help. I have 13 years experience now of treating back problems. .....   Namaste ......  Vonnie
	A.2. I think the chiropractor probably said to her 'she must strengthen her core structure'. Essentially meaning strengthening the abdominal muscles to support the back, Core Structure has been the 'in-word' for the last few years with exercise professionals. The chiropractor is probably one who has experienced yoga classes where little work is done to strengthen muscles ~ emphasis on flexibility - which is a recipe for disaster. Hatha originally [and still does] meant 'forceful'. Some yoga teachers do not understand the ageing process and the need to keep good muscle tone and build up strength. The work that Drs like  Fenham in the 70’s and Skilton in the 90’s have been preaching goes unheeded in many yoga circles. Essentially they have said simple load bearing excises will increase bone density, strengthen muscles, reduce the risk of falling and that many problem concerning weakness & muscles with older people come from disuse atrophy [ people don't use their muscles and the muscles waste faster than they should ]. The one thing that 'real Pilates' should do is to strengthen the core structure. Yoga should do this but not the way a lot of teachers 'teach'  ..... P. Feltch
	A.3  There have been two very good articles in the B.M.J. and the Scientific American which we can't publish due to copyright restrictions. If anyone thinks it worthwhile we could précis these and publish their views on the site. Note: the articles do not give specific treatments but talks about Back Pain causes and general. A summary of the article that appears in the BMJ can be seen on the University of Warwick web site.  .....web admin
	A.4  [From the web administrator ]  A few years back, the Wheel produced a Support Leaflet [which was approved by National Back Pain Association ]. The problem of distributing this through classes is one of costs. This website is ideal for getting stuff like this out to teachers. If anyone is reasonable at doing pen and ink drawings we could get this support leaflet onto the site  [ANY OFFERS ? ].
	Has anyone anything to add on this query ?
	Q.   Please does anyone have up to date medical advice with regard to a student with hip joint replacement?   I was surprised that her doctor has told her not to do forward bends.
	from: Vonnie Bloom
	A.1 The problem is that there are several types of hip replacement ~ although they are all based on a ball and socket action. I have had students in my classes with hip replacements and they all did forward bends without any problems. However, they were told not to do adduct the leg [move the leg across the body or even cross the legs].
	The law of averages says that with some four hundred teachers in Eastern Region, we must have people in classes that have had hip replacements. What do other teachers think ? ............ j.cain
	A.2 Lez Grey writes: My mother had a hip replacement earlier this year. What was interesting was the physiotherapy that started immediately. This involved both adduction and lateral extension whilst holding onto a support rail. The main don't  was to have the leg high than her bottom when sitting. This would obviously bring about a fulcrum that could lead to dislocation at the acetabulum. I think after an initial period of recovery (doctors advice) a modified paschimotoasana using a block to sit on (or even on a chair) would achieve similar benefits to uttanasana.  ......... lez grey
	A 2  [From the web administrator ]  This like the previous question is one where we need to share and build up knowledge.
	A.3  A person with replacement hips may work on forward bends as long as the movement is done slowly. Avoid any position that can cause strain such as crossing the legs, full twists and Surya Namaskara is definitely contraindicated........ Margaret Weston
	Q. I have a student in my class that suffers from Stress Incontinence. I know this can be a common problem with some women during and after pregnancy. Has anyone any sugges-tions regarding exercises/treatment, etc ?     from:  boniikind7@bt.com
	A. 1. Re the teacher enquiring about 'Stress Incontinence' , I think it would be most useful to practise pelvic floor exercises/mula bandha. Also there is a very good little book out titled 'Women's Waterworks - Curing Incontinence' by Pauline E. Chiarelli.   This book is one of the set books I used during my Yoga for Pregnancy training course with Wendy Teasdill, and I would recommend it to all teachers, as it is such a common problem, not just in pregnant women.  There is also an Association for Continence advice, at 380-384 Harrow Road, London W9 2HU, which has a helpline, 091 213 0050 (Mon-Fri - 2.00-7.00pm)
	from: Linda Beach
	Q. Brittle bones are common in older women. Has anyone personal knowledge of this condition and any prohibitions they have found or know about.
	A. 1. There are a number of articles and books on this subject. The BWY teacher Margaret Graham produced an excellent boo, which now published through BWY  called Keep Moving-Keep Young.  Bone Loading by Ariel Simkin and Judith Ayalon  was one of the first books on the subject and a good introduction. Other books are: Yoga Builds Bones by Jan Maddern and also Exercises for Stronger Bones by Joan Bassey and Susan Dinton. Bone Loading is also know in medical circles as Musculoskeletal Loading there are a number of papers on this some you can get on the internet see the reports from the 12th Conference of the European Society of Biomechanics. There are sites dealing specifically with osteoporosis www.nos.org.uk and www.osteofound.org and also a number of yoga sites dealing with osteoporosis: www.yogabasics.com/articles/Osteoporosis, www.beingyoga.com/Yoga_ and_Osteoporosis.  As far back as the mid 70's doctors like Dr P.H. Fentem, [department of Physiology, University of Nottingham],  were advocating exercise to combat osteoporosis, but some of us weren't listening. There are many factors that can cause osteoporosis and the commonest is a change in hormone production ~ in women it is a lack of oestrogen often due to early menopause ~ in men low levels of the male hormone, testosterone (hypogonadism). Conditions like immobility can give rise to osteoporosis ~ along with diseases such as liver and thyroid problems, myeloma and mal-absorption problems, etc. We have a couple of handouts in the teachers support section covering some aspects of osteoporosis [More are welcome]......  web admin
	Q. There is a condition known as Sleep Apnoea which can occur with some people during deep relaxation. It can cause seizures. Has anyone come across this during relaxation in a yoga class ?  ....   from    Lewis Berger fotppv@aol.com
	Q. I have had a query from someone whose husband has a breathing disorder, and his doctor suggested he tried Yoga breathing practices. He is only using 40% of his lung capacity! Can anyone offer any advice on this query  .... from Sue Burton
	Q. I have a male student in one of my classes, about 35 years old who played a lot of football when he was younger.  He has a problem with his knees and is unable to bend forward and keep his legs straight.  If he tries it gives him considerable pain behind the knees.  I obviously suggest to him that he should keep the legs bent, but he may have damaged his ligaments and tendons.  Can anybody suggest anything that may help him to overcome this problem   ...................   from  Lynne Everett
	A. 1. The things that limit us on forward bends [most of the time] are the hamstrings and as flexibility is a genetic quality[inherited ], he may simply have inherited tight hamstrings. Activities like football do not help and often tend to tighten up that area and in most well run clubs now, they will do a lot of stretching after training.  There are several books I would recommend that might prove useful. Bob Anderson and also Paul McNaught-Davis book both called Stretching are quite good and in the archives, the article by R.A.Butler is good. Sport injury books are often useful regarding exercises for recuperation. There is a website www.sportsinjuryclinic.net/cybertherapist/injurylist.htm that might give advice 'from a distance'. There are many books on treating sport injuries ~ most of them are expensive, i.e.; books by Christopher Norris or Roger Bartlett are recommended. If there is pain behind the knee it might be the condition Baker's Cyst which is giving the pain at the back of the knee and on the medial side. If you know of any yoga teacher/sports therapist /physio-therapist that could give him a P.N.F. test it might show what his natural potential and limitations are in the hamstring area.     ............... john cain
	Q. Pregnancy & Yoga: What are Precautions and Prohibitions during relaxation?  Are there certain postures that should be avoided?  I've been told that lying in Shavasana puts to much pressure on the heart?  However, I've been in classes where ladies have been told to relax in Supta Baddha Konasana.  In some books the relaxation postures are those lying on your side.... from June Mitchell-Roberts
	A. 1. Lying on the back during pregnancy pushes the weight of the uterus and baby down-wards, which compresses the vena cava, the main vein which brings blood from the organs back to the heart.  This compression and restricted blood flow can be felt in the mother by breathlessness, dizziness or tingly legs.  The blood supply to the placenta is also affected.  Lying with the legs bent relieves the pressure, as does lying with the legs up the wall.  A wedge can also be placed under the right hip to further free up the vena cava return.  After 30-34 weeks pregnancy, lying on the left side of the body is said to encourage O.F.P. (optimal foetal positioning), and from this point, lying on the right side or on the back should be avoided for any more than a few minutes at a time. Pregnant women should spend little time on the back, even with knees bent, and should be told to roll over off their back and onto their left side every few minutes, however early they are in their pregnancy, to get them into good habits.  Relaxation and sleeping should always be on the left side (cushion under the head, another under the upper/right bent knee), particularly from 30 weeks onwards, as O.F.P should be heartily encouraged.  Other precautions and prohibitions to be aware of in pregnancy are: ? Do not retain the breath at any time.  Focus on the exhalation and breathe slowly. ? Do not practice anything which is uncomfortable or does not feel right. ? Avoid standing for long periods of time or hold standing postures for too long - practice  dynamic postures instead of static.  ? Shorten the stance in standing postures. ? Yoga practice should no longer be strenuous/ raise the heart beat. ? Do not overstretch into a posture, as your ligaments are naturally softer during pregnancy. ? There should be no pressure felt on the abdomen at any time during the class.  ? Do not lie on the stomach. ? Be aware that pregnant women can feel emotionally more vulnerable and therefore be cautious with guided visualisations or mental images in relaxation states. ? Finally, remember the student is ultimately responsible for the care of her own body and baby, however a pregnant women in a general yoga class is not as ideal as a yoga for pregnancy class  ............ Rachel Barrance
	The following two questions were put to Dr Ruth Gilmore at a recent[2006] IST Day
	Q.1.  I'm a Wheel teacher and have always stuck to the advice to students that inverted postures were not to be used by high blood-pressure students.  Recently, at an In-Service Training day, it was suggested by the DCT running the day that, as long as blood pressure was controlled, there was no need to keep students from inversion. Could you let me have your advice on this, please.... Kay Russell
	DR Gilmore's response [reply reproduced with her permission]
	A.1.  This is a tricky one.  "Controlled" can mean different things, some people are well-controlled and others not.  Also, when HBP[High Blood Pressure] has developed there is likely to be some degree of associated cardiovascular disease (arteriosclerosis), so inverting may not be wise as it puts the brain's blood vessels under strain.  I recommend that people with HBP should do "legs up the wall", or if they are "controlled" and want to do half shoulder-stand (viparita karani) then they can, but only for a short time.  I prefer them not to do full s/s and not headstand, as I don't think it's necessary to do these - one can do a balanced practice without them.
	Of course, we must remember that a proportion of people with high BP remain undiagnosed (it has no symptoms and is often only picked up by being measured as a routine part of a visit to the GP).  Thus we can have people with high BP in class and not know it - we can only advise on the basis of what we know.
	Q.1  An acquaintance, not a yoga student, has a condition in the lower back that has led to a nerve root (L5/S1) becoming compressed. He had surgery to decompress it. It has simply served to move the problem to L4/L5 and he now gets discomfort in the left lower back and the left calf... Kay Russell
	A.1. It sounds like this person has sciatic nerve problems, but it is difficult to know whether the pain is due to this, or to other factors.  Sometimes (fortunately rarely) the nerves become sensitised by the operation and produce a sensation of pain in the brain for no reason.  This may be linked with some psychological situation - was he expecting a lot from the op?  Does he really want to be better - sometimes people actually don't want to lose their invalid status.  Is there a lot of pain in his life?  One of the worst cases of "failed" back surgery I know was on so much prescription medication she became addicted to their morphine content.  She was in un-relievable pain for over 2 years, then went to the Priory for drug rehab.  The physiotherapists there showed her that she could move without drugs.  Now she says "Yes, I still hurt, but I don't suffer".  She now realises that much of her pain was due to her domestic situation, with conflict and problems abounding.  Now she is tackling these, the back is no longer a problem.  This may not be the situation with your person, but it's worth bearing in mind.  Of course one is not judgemental, if it is this way, he does not do it on purpose, but as a coping mechanism.  Anyway, whatever the cause, I suggest that you recommend a gentle holistic approach, focusing on pain management by developing the witness within and learning to relax into the pain.  Teach him to use the breath to quieten the mental state, and see what happens.  He will either comply and probably improve, or he'll not stick with it, in which case you can suspect that there are deep psychological factors working, and that yoga is not going to help with these at present, the time is not right for him.
	Q.1  Can anyone offer any help/suggestions/advice on appropriate postures/pranayama for an acquaintance I know who has kidney problems and is on dialysis?  Her doctor has said that yoga would be beneficial although she finds it difficult to stretch in the mid-torso area.  She is not current attending a yoga class, as she cannot find one locally, although she has some experience of yoga.  .... Angie Punaks
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