Yin Yoga for AS
Connective tissue, or fascia, is at the heart of ankylosing spondylitis (AS). Until recently it has been an under-researched area of study in Western medicine, but that is changing. In AS, inflammation leads to serious changes in the structure of the spine. These changes are mostly in the vertebral joints. These are in between your vertebra, which are the small bones in the spine. Bone spurs (also called spondylophytes) develop in the connective tissue of the joint, leading to pain and less ability to move. Lowering inflammation with medicines is very important to limiting joint damage. But, just as important is exercise of connective tissue between flare-ups. This increases the health of this tissue.
How movement helps tissue
Physical therapists work with connective tissue in a few ways. My personal favorite is exercise. Through my yoga training, I was delighted to learn about yin yoga, a style that focuses on exercise of connective tissue. I have found it so valuable that I have begun to use it into my treatments for patients. Typically, we think of exercise as it relates to skeletal muscles or the heart - riding a bike for 20 minutes or completing 10 sun salutations. While there is no doubt as to the virtue of these forms of exercise, it’s not the only type we should be doing.
Keeping tissue healthy
Traditional forms of exercise involve repeated contraction and relaxing of muscles. Healthy exercise of connective tissue involves applying responsible levels of sustained stress. In exercise, some stress actually helps tissue stay strong. This is done via traction, compression and torque. These terms, which just mean moving in all types of ways, create improvement in the strength and structure of the connective tissue. Increased lubrication is also stimulated by exercise, which in turn makes moving easier. The key here is to find a balance. Too much stress leads to trauma and injury. Practicing movements over weeks and months can lead to greater flexibility.
It’s best to begin yin yoga with the help of an experienced practitioner who is familiar with your individual body. Too, keep in mind that what may feel good for others may not feel good for you. Consult a wellness practitioner like a physical therapist and most importantly listen to your body and notice what feels right. Here is a taste of yin yoga ...
Start with bringing awareness
Start in a comfortable seated position; a chair can be great or use a cushion on the floor. Have a timer handy. Close your eyes and notice what you feel in your body. Understanding how you feel before and after an activity provides access to your body’s innate wisdom. Taking a few slow, deep breaths can help to bring your awareness from the outer to the inner world.
In the chair or on the floor, bring your feet together and let your knees to fall to the side. Set the timer for one minute. Allow gravity to draw your head toward your feet as your spine rounds. Give your muscles an opportunity to relax. Use cushions under your chest to provide the optimal level of support. Try to find a balance between inviting sensation without being aggressive. If you notice a melting, go with it. If you find you have gone too far, add an extra pillow for support. When the timer sounds, slowly move to sit upright. Gently sway your knees from side to side a few times. Notice what you feel.
Place a folding chair against a wall (to avoid sliding). Scoot to the edge of the chair with feet flat on the floor. Set the timer for one minute. Place your hands on the chair next to your hips and slowly walk them back towards the wall. Stay here, or if this feels too comfortable (remember you want to feel a responsible level of sensation), start to lift your heart towards the ceiling. Allow your head to draw back; if you have any neck issues, keep your chin tucked toward your chest. Alternatively, kneel on the floor with hips resting on heels. Set the timer for 1 minute. Place your hands on the floor next to your feet and slowly walk them back behind you. Stay here, or to increase sensation lift your hips toward the ceiling. Again, your head can draw toward the floor or tuck into your chest. When the timer sounds, come to a comfortable, upright, seated position. Stay here for at least one minute. Bring your attention inward and notice what is happening. If these exercises feel beneficial, you can gradually increase the holding time up to five minutes. You may notice that this creates a mental exercise as much as a physical one.
Fascia and AS
Fascia is a web that connects all parts of our body, encapsulating every nerve, muscle, blood vessel and organ. Researchers are just beginning to understand this part of our bodies, but you can learn much yourself by exploring your own bodymindfulness. You may want to consult a physical therapist who specializes in connective tissue, or take a yin yoga class. Regardless of your path, I hope you will continue to honor the wisdom within.
Other than back pain and fatigue, what is the most common symptom that AS patients experience?