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Yin Yoga and Heart Problems and students with Diastasis Rect

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Joined: 23 Sep 2006
Posts: 1130
Location: Vancouver

PostPosted: Sun May 26, 2019 1:23 am    Post subject: Yin Yoga and Heart Problems and students with Diastasis Rect Reply with quote

I recently receive the following questions:
    Bernie I'm loving all your books and dedication to our learning as teachers. Are there any contraindications when using yin with heart patients? I have a student who's had a stent put in and another with an angioplasty. Also for Diastasis Recti? Thanks for all your work in this area.
    Bless you, Anna

Hi Anna

Thanks for your kind words. You have asked two unrelated questions so let me address each separately.

1) Is Yin Yoga contraindicated for students with heart conditions? In general, I would say “no”, because this is not an aerobic class and there are very few inversions which may lead to increased blood pressure (only exception is Snail pose, so avoid that one.) However, as with all things in yoga, we are not doctors or therapists so the best answer is — what does your student’s health care professional say? She will know the student much better than you. I would be surprised, however, if there were any concerns. Indeed, usually for heart patients, activity is prescribed, so yoga in most forms should be good. In Yin Yoga, although we are not exercising the heart directly, we can affect the heart energetically through stimulation of the heart and pericardium meridians. Upper body work (as described here) may be added to the practice. Start easy and see how it goes and how your student reacts. If no problem, then increase the time in the postures or add other variations.

2) Diastasis recti, also called diastasis linea alba, is a separation in the fascia along the front of the belly. This can happen during pregnancy, but can also happen in men, especially for those who overly work their abs. The weakness in the fascia may allow the internal organs to protrude, given a strange, almost pregnant look to the belly. Yin Yoga will not be helpful in fixing this, and it may make matters worse. I would suggest your student skip any backbends which tend to open the front of the belly. That area is already weakened and needs to be strengthened, not stretched. Generally, the only way to fix this is surgically, however, there are some therapists who have found that this diastasis can be fixed non-surgically through strengthening the transverse abdominus.

In the International Fascia Congress of 2012, Diane Lee (a physical therapist in the Vancouver area) made a presentation on this topic. Here is what I wrote about this in an article at that time:
    Many pregnant women may create a tear in their linea alba, especially after multiple pregnancies. The linea alba is the connective tissue running down the middle of the abdomen that joins the front stomach muscles together (the rectus abdominis.) This tear is known as a diastasis rectus abdominis (DRA). It is caused by the long held stress of the baby pushing against the stomach wall. The question raised is – it is a good idea for pregnant students to increase this pressure by doing backbends (yin or yang)? To be safe, should we suggest no backbends at all during pregnancy? But surely that would be overly cautious and would rob many women, who are not at risk of DRA, of a lovely backbending session. How should we decide when someone is at risk or not?

    Diane Lee discussed the occurrence of DRA for pregnant women and a man who did 400 sits up every day for decades (he tore his linea alba apart.) When this happens, the stomach organs start to push through the stomach muscles and create a pregnant looking pouch in the belly. With each new pregnancy the risk of a DRA occurring increases. What does this mean for yoga in general and yin yoga in particular? Should pregnant women avoid backbends, especially the deepest ones? It would be interesting to hear from students about their experiences. I don’t think that a blanket dogmatic statement such as “never do backbends when you are pregnant” will serve all women well, but certainly it may not be a good idea for some. The question is, how to know when a women is at risk or not? Who should avoid backbends while pregnant? [The answers to these questions are unknown and needs to be considered on a case-by-case basis.]

Well, after writing all that, I came across more of Diane Lee’s work here.
    It is well established that transversus abdominis plays a crucial role in optimal function of the lumbopelvis and that one mechanism by which this muscle contributes to intersegmental (Hodges et al 2003) and intrapelvic (Richardson et al 2002) stiffness is through fascial tension. Diastasis rectus abdominis (DRA) has the potential to disrupt this mechanism and is a common postpartum occurrence (Boissonnault & Blaschak 1988, Spitznagle et al 2007). Universally, the most obvious visible change during pregnancy is the expansion of the abdominal wall and while most abdomens accommodate this stretch very well, others are damaged extensively.

    It is apparent from both the research evidence and clinical experience that the biomechanical, and physiological affects of pregnancy and delivery can have a non-optimal impact on the fascial support system of the abdominal canister. Optimal strategies for function and performance depend on the integrity of the articular, neural, myofascial and visceral systems that can be influenced by psychosocial and systemic physiological factors. Not all women with diastasis rectus abdominis require surgery for restoration of full function; however, some do. If a postpartum woman fails to:

    1) progress in their exercise program
    2) regain painfree function
    3) regain urinary continence, and

    has noticeable stretch damage to her abdominal wall associated with a diastasis of the rectus abdominis, a complete biomechanical and ultrasound assessment of the myofascial component of the abdominal canister is warranted. A complete assessment of your abdominal wall function is available at Diane Lee & Associates.

Well, there you go. I hope some of this helps!
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