Читать книгу Yoga Therapy as a Whole-Person Approach to Health - Lee Majewski - Страница 59

Yoga therapy evaluation of physical wellbeing starts the moment the client enters the office, as keen observation can provide immense clues about many aspects of their health. We look at the body type (endomorphic, ectomorphic, or mesomorphic) and deposition of body fat (apple, pear, or hourglass body forms). This enables us to have a better understanding of the constitutional aspects of the individual (dosha), and helps in the selection of practices as well as the adaptations that may be required for different body types. Taking it even further, body mass index (BMI) may be evaluated by measuring weight and height and calculating it in kg/m2. This objective measure is always useful as it gives a clear baseline for pre and post comparisons, and also gives us a clue to metabolic and cardiovascular risks that increase proportionately with BMI.2 Medical practitioners are always more comfortable with yoga therapists who speak their language and use standardized metrics. So it is always better to indicate BMI rather than just saying, “My client is overweight,” “They have a huge tummy,” or worse, “They have a huge stomach.”

The need to obtain consent for physical examination is something that cannot be stressed enough, as no yoga therapist should ever touch their client without clear verbal or even preferably written consent. This should be obtained in the initial stage itself, as later it may take a nasty turn, especially if the client is not satisfied with the results of their therapy. This warning percolates into the practices and hands-on assistance that may be given by the therapist in the sessions. Many people are very sensitive of their personal space, and we need to respect this.

During the focus on the physical aspects of the client, it is important to create a constitutional (dosha-based prakriti) analysis by an inferential approach. Individuals with a movement-predominant constitution (vata) usually have a thin and light frame. They often complain of sudden bouts of fatigue. They typically have dry skin and hair with cold hands and feet. When this becomes imbalanced, they may complain of weight loss, constipation, joint pain, muscle weakness, restlessness, and indigestion.

Individuals with a metabolism-predominant constitution (pitta) are usually of medium size and weight and complain of early greying, baldness, or thinning hair. They claim that they can eat anything and usually have a warm body temperature. When in balance, a lustrous complexion, abundant energy, and a strong appetite manifest, but when out of balance, skin rashes, burning sensations, excessive body heat, heartburn, and indigestion predominate.

Large, soft eyes are often the first thing we notice in clients with a cohesion-predominant constitution (kapha) who manifest smooth and radiant skin with thick abundant hair. When kapha is in excess, they tend to be overweight or obese with fluid retention. The signs and symptoms of allergies often manifest on the surface of their body.

It is desirable that therapists obtain sufficient competency and the necessary skills of observation and manual palpation to assess the client’s spine for any abnormalities such as lordosis, kyphosis, or scoliosis. This would also include an assessment of gait through observation of the length and pace of steps, stiffness of body, swiftness, unequal weight bearing, swing of the arms and legs, as well as an open or closed stance.

They should watch for any tremors in the body region such as the limbs, and note their duration, speed, severity, and presence at rest or during movement. In the yogic perspective these tremors are an externalized manifestation of internal emotional and mental imbalances (angamejayatva). Disharmony at a higher psychic level induces imbalances in neurochemical transmitters and psychophysiological pathways, resulting in these physical tremors. Through the slow and steady practice of asana we can help our clients attain a better state of inner balance (sthria-sukham), and this may help them to transcend the pair of dualities (dwandwa) that are viewed as the essential cause of these tremors.

Therapists should be observant of any lumps and if found, their presence should be noted, with details of the region, size, shape, consistency, and tenderness. The client may often know of such masses of tissue and may already have been getting treatment for them. If it is a new finding, such information should be shared through professional referral with a healthcare professional for further medical evaluation.

Yoga therapists should be conversant with the basic clinical signs of anemia such as fatigue, pale conjunctiva, skin and tongue, as well as observing brittle nails and any shortness of breath. Anemia is often a cause of breathlessness and a rapid heartbeat, as well as fatigue, and hence this initial finding enables us to better understand issues that come up when we consider alterations in physiological function.

Diet plays a vital role in health and disease, and therapists should obtain details about the type of food and frequency of eating as well as the nature of the food taken. A word of warning: although yoga stresses the need for a life-enhancing (sattvic) diet, we must not be judgmental about the client’s choice of food, and listen to them patiently. Once we get the information, we can slowly make appropriate suggestions about changes that can be brought into their life, depending on their cultural, social, and religious value systems. In the process we should understand the situational aspects of the client’s life, and find ways to change what is within their means and reach. A commonsense approach to diet having appropriate levels of fiber and adequate nutritional benefits obtained from seasonal local produce is often more beneficial than any “hard and fast” approaches that only result in no one ever following them! Sensible statements such as, “Eat to live; don’t live to eat” and “What you eat becomes you, so be careful what you eat” are more useful than loads of advice. Perhaps a most often overlooked factor is how we eat, how much we eat, and when we eat. Changing the “fast food on the go” to mindful eating, the regularity of meals, and eating to two-thirds of capacity is also important. Finally, appropriate levels of hydration are also very important—at least 2 liters of water should be consumed daily to make sure that we keep our body hydrated.

Joint mobility and stability requires thorough observation. Therapists should evaluate the range of movement and note the presence of any limitations, hyper-mobility, or instability, looking for pain, swelling, redness, raised temperature, tenderness, and the presence of any deformities or scarring. If any abnormalities are present, a detailed inquiry should be made into its history and manifestation, with a stress on the factors that aggravate or mitigate the issue.

All of these observations should be substantiated with taking a detailed history, either in a passive, receptive manner or a focused one. A passive manner means letting the client talk about their physical problems as they will. A focused enquiry is when the therapist guides the conversation towards verifying the observations they have already made.

Pain is something that is very personal, and therapists must never doubt it when a client talks about it. However, its severity can always be determined by asking probing questions about how it affects the individual’s day-to-day life and also whether it impacts their quality of life and so on. We must not forget that more often than not, the client would have consulted numerous healthcare professionals before coming to us.

This is especially pertinent if no one had been able to find a specific cause for the client’s pain, as they may start to become very defensive about it, and at times may be in a state of confusion. Professor K.R. Sethuraman3 often talked about medically unexplained symptoms (MUS).4 He reiterated that the client definitely had symptoms impacting their life, because otherwise they would not have sought help from a healthcare professional in the first place. However, many of these MUS are psychosomatic in nature, and a “cause” is often not readily found after initial investigations.

It is often useful to ask the client to demonstrate their physical issues by asking them to stand up or stretch their limbs, or by showing you where the issues manifest. This gives them a sense of empowerment because they are involved in the process. It helps us understand how aware they are of the body. Becoming aware of the body, emotions, and mind is one of the principles of yoga therapy itself.