Monday, February 25, 2019

Yoga and Advanced Aging, Part 2: Teaching in Assisted Living, Skilled Nursing, and Memory Care Spaces

Music, Dorrit Black, 1928
By Carey Sims


Carey will be presenting a workshop “Yoga and Advanced Aging: Teaching in Assisted Living, Skilled Nursing, and Memory Care Spaces” at the Accessible Yoga Conference in St. Louis, May 31-June 2, 2019.


Part Two: Safety, Presence and Connection

Understanding your population and the challenges students are facing in their bodies is essential for yoga techniques to be effective. That said, you will never know enough about every condition and everybody in the room. It’s simply not feasible. I make certain generalizations when teaching group classes in senior care spaces that guide my sequencing and help to keep my students safe. Depending on policy, I may not be able to ask certain questions, and even if I can, students may not know exactly what they should or should not do. I assume (my mother said to never assume, but in this case, I believe it’s wise) that some, if not many, of my students have trauma, back pain, high blood pressure, glaucoma, vertigo, osteopenia and/or osteoporosis, arthritis, knee, hip, and shoulder injuries/replacements, some degree of hearing loss, early stage cognitive decline, and balance issues. This is my baseline and is by no means an exhaustive list. Many other students have a stroke history, limb loss, Parkinson’s disease, heart failure, Cerebral Palsy, COPD, Multiple Sclerosis, visual impairment, ataxia, and the list goes on and on. This amount of variance can be scary and daunting, but don’t fret. Do your research on contraindications, explore what’s possible, and trust the yoga.

In the two articles I have contributed to the Accessible Yoga Blog, I have defined yoga as connection. I believe safety, presence, and connection are the cornerstones of a healthy yoga practice. One of the first things I do is learn my students’ names. As we interact more, I become attentive to their stories. Where they are they from? What is their favorite sports team? What are their hobbies? Who are their families? What was their former profession? We connect on a human level first and from there we may talk about an injury or illness, but I let them lead that discussion. My students have led incredible lives and have a lot of amazing stories to tell. Many times they are simply aching to share, but no one will take the time to truly listen. My teacher, Matthew Sanford, has a saying that he repeats a lot in his trainings, “If three things happen in a yoga class, yoga is the third most important.” If I can’t connect with you as a human being, what value can I offer you as a yoga teacher? When the teacher/student relationship fosters safety, presence, and connection, the class has the potential to become a healing space. 

In addition to learning names and taking time to truly be with our students, what guidelines should we follow when practicing yoga with this population? We will explore teaching the breath, cueing, and sequencing in a future post, but in terms of asana and movement, I avoid forward folds with the head lower than the heart (glaucoma, high blood pressure, vertigo). I am also cautious when crossing the legs and flexing the hip(s) beyond 90 degrees (hip replacement). Many of my students are in a perpetual state of spinal flexion due to years or forward-leaning movement patterns, gravity, and adjusting to a new life with a walker or a wheelchair. Emphasizing the importance of using the legs to support posture can be a game changer. I remind students to press down through their feet to support their spines about as often as I ask them to breathe.

With prevalent forward-leaning posture in mind, I focus a part of class on spinal extension. For kyphotic students, postures with a “lifted chest” or “long spine” will require a good deal of effort. Exaggerated flexion of the spine and deep twists are not part of my sequencing for this population. I am not saying that we should abandon these movements altogether; I am simply suggesting that we encourage them subtly. We want students to gently engage the muscles around the spine without compromising its structural integrity. Example: You might teach spinal flexion by having students give themselves a hug and asking them to notice the breath in the back of their bodies. By teaching with an awareness of the inevitable presence of osteopenia and osteoporosis, we can help students move safely, avoid injury, and help to improve their bone health. Remember we are talking about teaching group classes and we want the class to be safe first and foremost. In a one-on-one setting I might be willing to explore more.

Accessible Yoga trainings instruct how to teach true all-levels classes with different body types practicing various forms of asanas together in a communal space. But for this population, I encourage you to teach from the same orientation. Even if there are students who can physically do more than others, all of my students practice from a chair. I do occasionally have students in beds and I accommodate them. In these environments, if one student is doing something that looks very different (i.e. a standing asana), other students can feel inadequate or attempt an unsafe movement, and to me, the risk is simply not worth it. I try to understand what my students can manage and set them up for success. Continuity leads to accessibility. As explored in the first installment of this series, teaching in Assisted Living, Skilled Nursing, and Memory Care Spaces requires creativity and adaptability. The relationship between your students and yourself is the yoga. Creating a community is the most versatile tool in your yoga toolbox.


Carey Sims, RYT500, E-RYT200 lives in Charlotte, NC, where he teaches at NoDa Yoga and offers Chair Yoga at various senior living centers in the Charlotte area. He is a student of Adaptive Yoga pioneer Matthew Sanford (Mind Body Solutions, St. Louis Park, MN.) His mission is to use Yoga to help students explore their bodies in an accepting and non-judgmental way.

This article is part of a series exploring the practical application of yoga in Assisted Living, Skilled Nursing, and Memory Care spaces. Carey will share some of the challenges he has encountered teaching in these environments and offer practical techniques that he has found useful in sharing yoga with this population.

This post was edited by Patrice Priya Wagner, co-editor of Accessible Yoga blog and member of the Board of Directors.

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1 comment:

  1. I love this article so much! Thank you for writing it from your heart with such great insight, tenderness and skillful knowledge. I appreciate your heart to share as well as the editor of this blog for all their good work. This is such a great blog doing a wonderful service to others!

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