Elderly student with hip replacement and bad knees

Check here for questions about Yin Yoga and hips. (Note: discussions about sciatica are in the Spine forum.)
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Joined: Sat Sep 23, 2006 2:25 am
Location: Vancouver

Elderly student with hip replacement and bad knees

Post by Bernie »

I recently recieved the following questions:
  • I have your book - The Complete guide to Yin Yoga and have been reading up on the Hip in the book as a guideline but I would still like more info please. I know you can assist me with some pointers and caution on some asanas with a client.

    She is an elderly lady and not at all flexible. She has had only the one side of hip replacement done but very long ago. She is now experiencing the other hip with problems and will need a hip replacement done soon as she says. She also has knee issues. Its very difficult for me to teach as Im not sure what to do with her

    My class plans are to I teach a Hatha class in the first 15 minutes and then I go into YIN for the remainder of the class of 60-70 minutes. Yesterday I was teaching 1 round of Sun Salutations and then noticed that she can't lift the right leg to step back into Plank so I got her to lower her knees into table top position and changed immediately the class sequence into a YIN Class for her. Childs pose for her was difficult even though I made use of bolsters and blocks for her so I changed again the pose but she was able to do Puppy Dog Pose.

    It seems I will have very limited poses to teach here, please can you assist me? Looking forward to hearing your advice. A.B.
Hello A.B.

First, there is a section on the Forum, Yin Yoga and Hips where I am posting this reply, with lots of stories and information about hip issues. I would encourage you to look through some of the posts here.

Secondly, since you are willing to look into books, I can recommended Dr. Lauren Fishman and Ellen Saltonstall’s books Yoga for Arthritis and Yoga for Osteoporosis. They have lots of suggested postures for a variety of patients, clients and students at various stages of disability. They use a chair, bolsters and blocks a lot.

Finally, for your situation: It sounds like you are not a restorative yoga teacher, or at least the class you are describing is not restorative yoga but a general Hatha class. That makes it challenging from the start: to teach a general yang class, even if only for 15 minutes at the beginning, while trying to customize a more gentle or restorative practice for one student requires a fair bit of experience and skill. It would be easier if you could convince your student to attend classes where the flow and postures are more geared towards her level of ability. The smaller your class, the easier it gets.

In any case, it is great that your student is showing up. And it is wonderful that you are looking for ways to help her. Don’t do anything to discourage her from continuing her yoga practice. She just needs to find the appropriate postures for her ever-changing body.

Ask what her physician and surgeon recommend. Are there certain movements they strongly advise against? Up until the last few years, most hip operations were done posteriorly which resulted in a cutting away of the capsular ligaments that limited adduction and internal rotation. Consequently, the surgeons would often tell there patients to avoid crossing their legs, as that would adduct the femur too much. Has your student had this warning? Is it still applicable? If so, avoid postures like Shoelace and twists with legs crossed and instead work to strengthen the butt muscles. If her surgery was more recent and in the current modern style, the incision was probably smaller and more anteriorly, thus these older caveats may not be required.

For the knees, again there is lots of advice in the Forum in the section Yin Yoga and Knees . Plus I have written articles on this topic such as Yoga for the Kneedy and Yin Yoga for the knees.

For the yang portion of your classes, she may still be able to do flowing postures, but not the full-on Sun Salutations. You can try the Mini-Sun Salutation, or maybe even the Golden Seed, although that might be too much for her. It is shown in the second edition of The Complete Guide to Yin Yoga. More accessible, more yin-like and maybe fun and yet still challenging for her is a Cloud Salutation. It will challenge her balance, which is important as she ages. Finally, check out the Pawanmuktasanas, especially those for the lower body. Consider some of these options for her as the rest of the class does the full Sun Salutations, or invite them to do these too.

So, lots of reading for you to do.

For the yin portion of your class, an alternative to Child's Pose is to do the shape while lying on her back: the upside-down Child. It is like Happy Baby. A strap may be necessary, but it is the shape basic shape. Puppy Dog is a nice variation if she can get into it. Reclining postures like Reclining Butterfly and Supported Bridge may be great. But for her knees, trying to get her to sit on her heels, even if she needs many blocks under her, may be the most therapeutic posture. As always — no pain, no pain! If any pose is too challenging, come out or at least reduce the amount of time in it. Finally, some wall poses may be ideal for her. Even if you don't have room for everyone in the class to get to the wall, set up one area just for her and have her do wall squat, which is another Child's Pose shape.

I hope this helps!
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