Embodying the Restorative Practice in the Pancamaya Model

Restorative yoga provides a balance between physical and mental that allows the individual to manage stress and anxiety through the supportive use of props that allow you to hold the pose for longer periods of time with ease.  A restorative yoga sequence typically involves a handful of poses, supported by props and retained for five to twenty minutes. Restorative poses include light twists, seated forward folds and gentle backbends and inversions. A lot of restorative poses based on the teachings of B.K.S. Iyengar. You get the benefits of deep, passive stretching while learning the life skills to reflect and rest. Lives are lived at such a fast pace, a restorative practice allows you to manage your nervous system and move into the parasympathetic nervous system, a slower paced system. As you practice restorative yoga, you develop an expanded awareness of self and introspection. There is a profound oneness on a universal level of consciousness while feeling safe and nurtured.

Introduction

To maintain a sense of center and balance in our lives, we must work with all the layers of the Pancamaya model. At one point in our healing history, we thought we could treat human beings by applying the biomedical model of health thus treating purely biological factors while excluding psychological, environmental and social considerations. Research has shown over the years the interplay of biological, psychological and social considerations, while this is a new way of thinking in western medicine; it is not new in yoga teachings. As the ultimate goal of yoga is to have freedom of sukkah (movement/ease) and freedom from dukkha (suffering/pain), yoga therapy is a safe place to start to explore our physical body, energy body, learning body, the body of belief and our bliss body. Restorative yoga by nature is a receptive practice, and that receptivity can guide you toward a healthy state of being. When you are in passive postures feeling supported by the props you release the grip of muscular and inner tension, become spacious and receptive, and are exploring what happens when you slowly release your habitual holding patterns. Our curiosity grows and we question, what am I left with? Can I accept this new space within my body, mind, and spirit?

Personal Practice of Restorative Yoga

During my therapeutic practice with Margareta Ewald at Mind Body Balance, I experienced four restorative poses which were crocodile, hero, supine Tadasana and mountain brook. She used the yamas with each posture. In crocodile, she used ahimsa (non-violence), hero asteya (non-stealing), supine tadasana Aparigraha (non-coveting), and mountain brook sayta (truthfulness). She matched mantra and color with each pose as well. In Crocodile “I softly surrender” with the color gold. Hero the mantra was “I control my health” with the color green. Supine Tadasana “I can let go of what does not serve my greater good” with the color yellow. For mountain brook “My truth guides me” with the color blue. She mainly focused on equal ratio breath throughout the practice.

 I spent approximately ten to fifteen minutes in each pose. In hero pose, I used two bolsters and a chair. One bolster was under my bottom between my legs, and one bolster was on the chair, and my hands grabbed onto the chair. In supine tadasana, my feet were against the wall, a blanket under my knees, a sandbag on my femur bones and neck roll. In crocodile, I had a blanket folded in fours that started under my last rib and covered my belly with a rolled mat under my ankles. In mountain brook pose I had a bolster under my knees, a folded blanket under my ribs and a neck roll. This sequence appeared to focus on the chakras of three (Manipura), four (Anahata) and five (Vishuddha). Her use of the yamas allowed for me to relate to my world immersed in ethical guides that were faithful to my inner wisdom.

I feel the practice followed the Pancamaya model. There was the physical practice of the poses – annamaya physical body to be nourished. The incorporation of equal ratio breathing allowed for the –pranamaya energy body to be fed by my life force. The use of chakra and color- manomaya, learning body, to focuses my feelings and emotions that I felt. At times I felt sadness, complete surrender, and joy. The use of the mantra-vijnanamaya body of belief allowed me to focus the patterns of mind onto one right design that supported my greater good. The multitude of tools used allowed my expansion of self –anandamaya body of bliss as my sense of self-grew beyond my minds limited boundaries.

 Restorative Plan of Care for Anxiety

Anxiety is a normal reaction to stress and can help us be alert to dangers. Anxiety disorders differ from daily nervousness and involve more fear. The American Psychiatric Association state that roughly twenty-five million Americans suffer from anxiety disorders which often cause feelings of panic, fear, and intrusive thoughts and may result in interrupted sleep difficulty, functioning at work, disturbances in relationships and physical symptoms.  Various things contribute to anxiety disorders such as genetic, environmental, psychological and developmental factors. Stress and trauma play key roles in the development of anxiety disorders and triggering of symptoms. Anxiety disorders general have imbalances of the SRS (stress-response-symptom), ANS (autonomic nervous system), HPA (hypothalamic-pituitary-adrenal axis), overactive SNS (sympathetic nervous system) and underactive PNS (parasympathetic nervous system). These imbalances affect the client’s emotional regulation, perception, cognitive function, social relationships and the following systems- cardiovascular, respiratory, gastrointestinal, neuroendocrine and immunological. Yoga Therapy (YT) bottom-up and top-down mechanisms may ameliorate pathophysiological processes that contribute to anxiety through sympathovagal balance and increase the release of GABA (gamma-aminobutyric acid). (Khalsa, 2016)

Stephen Porges and the Polyvagal Theory shows stress can impair the ability to trust and form close, loving relationships. Yoga practices increase PNS and HRV (heart rate variability) and supporting the social engagement systems. The vagal nerve stimulation enhances the release of oxytocin. Yoga increases trust, bonding, and reconnection with Self. Anxiety entails misappraisals of cognitive malfunctions, impaired integration, failure of higher brain centers to modulate over-reactivity of lower centers and stress response, and misappraisal perceptions of danger far in access of presenting reality. While using bottom-up methods in yoga, it circumvents in intellect and activating interoceptive pathways to both higher and lower centers can resolve anxiety and restore impaired cognitive function. (Khalsa, 2016)

An individual presenting with anxiety may be experiencing shallow rapid breath, heart palpitations, excessive worry, vata dosha imbalance, migraines, intestinal problems, obsessive thinking, dizziness, insomnia, and nausea. The overall treatment plan would be to use chanting (sa, ta, na, ma) belly breathing (using a sandbag in C.R.P. –constructive rest position for weight training diaphragm breathing) or balancing equal ratio breath (viloma) to shift from SNS to PNS (pranamaya kosha). Reframing strategy would help in welcoming anxiety symptoms as messengers and recognize them as changing sensations and perceptions. Unpleasant feelings warrant deeper exploration to a root cause (vijnanamaya kosha). Starting with active asana, pala mudra (core quality of reducing anxiety) (LePage, 2014) and moving into a restorative practice (annamaya kosha). The language that the YT uses would be to keep the mind engaged with gentle mindfulness instructions often and exploring svadhyaya (self-observation) woven into the practice (manomaya kosha) and ending with a twenty-minute side lying Savasana with a Yoga nidra meditation (anandamaya kosha).

The asana portion follows Rolf Sovik protocol for anxiety starting with an active series of movement which entails lateral flexion with the rationale of opening intercostal muscles to assist breathing (restorative revolved head to knee pose, chair, two blankets or basic side lying stretch pose, four stacked blankets). Tree pose to practice balance and build confidence (restorative supine tree, wall, strap, blankets as needed). Wide-leg-forward-fold pose with head on the block to quiet the effects of the brain (restorative seated wide-angle pose, blanket and bolster).  Rolling-like-a-ball for twenty reps to massage the spine and playing with inversion in a fun way. Seated twist pose to work with breathing that is restrictive or tight using it as a practice to remedy anxious feelings (restorative revolved knee squeeze pose, bolster and two blankets). The last active pose would be shoulder stand at the wall for thirty or ninety seconds to build comfort in inversion (also wheel over a physio ball works or stacked bolsters). Moving into supported legs up the wall (wall, bolster, two blankets) to get use to the idea of being upside down and ending in restorative crocodile (three blankets) to witness the breath in a safe manner. “Inversions are a powerful way to visit a place of anxiety free living” – Judith Lasater.  Each restorative pose can be held five to fifteen minutes depending on the goal you wish to reach.  (McCall, 2007)

The overall rationale for this practice is to pick a middle road between vigorous and restorative. Moving right into a therapeutic practice when someone is in a high level of anxiety can increase their agitation, therefore having some moderate movement, in the beginning, allows for settling into calming and grounding practices of breath work and restorative asana. This practice was also breath heavy because disordered breathing plays a significant role in both the production and maintenance of anxiety symptoms.  The poses allow for breath awareness into the abdomen, creating a gentle massaging effect that increases circulation and lengthens the exhalation slowing the breath rate helping to reduce anxiety. Apana vayu the downward moving current of energy was activated as well as gently opening the first and second chakras to build on safety and self-nourishment. With greater tranquility we can witness fearful thoughts, and as the symptoms of anxiety decrease, we experience sensations of wholeness.

 Restorative Plan of Care for Back Pain

Back conditions include structural and functional disorders as well as lumbopelvic spine and thoracic pain. Low back pain (LBP) is the most common and while specific causes such as discogenic pain, spinal stenosis is roughly fifteen percent of all back pain. LBP is categorized by the length of the illness acute LBP is up to eleven weeks of pain, chronic LBP is anything exceeding twelve weeks. Non-specific LBP is better approached with a biopsychosocial approach rather than the traditional biomedical paradigm as it allows for a more appropriate understanding.  Biomedical is a better approach to rule out things such as cancer, infection, compression fracture and abdominal aortic aneurysm. The multifaceted practice of yoga and using the Pancamaya model which parallels the biopsychosocial model may be important in the management of LBP.  LBP often appears to somaticize with life stressors.  Therefore the effects of yoga can be contributed to increased physical activity, enhanced body awareness, and reduced maladaptive movements, correction of postural strain and relief of physical and mental stress. (Khalsa, 2016)

An individual presenting with back pain may present with symptoms of weakness; problems with bladder and bowels; persistent aching or stiffness, sleep disturbance; sharp localize pain; pain is radiating from low back to buttock to back of thigh, calf, and toes; and to an inability to stand straight without muscle spasms. Back pain the impediment in which causes pain is a vata dosha imbalance because vata is responsible for all movements in the body. The overall treatment plan would be the breath of joy, hands on heart/belly while breathing, nadi shodana,  chant (Om Mani Padme Hum – the jewel is the Lotus- represents both the direct experience of peace and the desired to share peace with others).  Breath is part of the stress or pain response which is the easiest to consciously change by doing breathing practices, it interrupts the stress or pain response reducing stress and making you feel better (pranamaya kosha) using a gratitude journal, feeling gratitude in the body as a whole and specific body area (vijnanamaya kosha).  Mudra Anudandi with the core quality of back pain relief (LePage, 2014), asana used will be gentle movement with restorative movement (annamaya kosha). The language that the YT uses would be to keep the mind engaged with gentle mindfulness instructions often and exploring svadhyaya (self-observation) woven into the practice (manomaya kosha) ending with a fifteen-minute meditation such as body scans and loving kindness. (anandamaya kosha).

The asana portion follows Judith Lasater’s protocol for back pain which starts with a gentle movement practice into a restorative practice of yoga.  It starts with cat/cow flow for twenty repetitions, into tail wag for five times each side, quadruped twist for five times each side, locust/flight fundamentals three to ten times with a supine pigeon for seven to ten breaths per side.  Then moving into hanging dog pose (using a door, block and strap) to allow the feeling of letting go that brings relief to those with LBP, this pose puts the long muscles of the back in traction using gravity to relieve the habitual postural effects. Supported half-dog pose (use a table or Pilates Cadillac and stack blankets long ways to desired height) gently stretches the muscles along the spinal column and reduces stiffness. Supported Backbend (bolster and 2 blankets) reflects the way a healthy back moves during daily activities improving flexibility being the antidote to slouching. An elevated twist on the bolster (bolster, neck roll and blanket) stretches the external rotator muscles located deep in the outer hips as well as the latissimus dorsi. This pose does multiple functions, stretches the small muscles of the spine, a little inversion which places the lower back in traction, and the back bend helps to release tension on the intervertebral discs. It improves the lungs and diaphragm function and stimulates the kidneys. Supported child’s pose (bolster and two blankets) provides a counterbalance stretching the lower back, relieving shoulder tension and quieting the mind. Basic relaxation pose (chair, sandbag, neck roll, and blanket) with legs on a chair with a sandbag on the belly relaxes the muscles and organs of the abdomen as well as the muscles of the lower back while refreshing the legs. All restorative poses can be held five to fifteen minutes depending on the need. (Lasater, 1995)

The overall rationale for this plan is to release tension from the back and support optimal posture. This practice is designed to direct breath awareness into the entire back, release tension, and increase circulation to the back muscles and to enhance awareness that increased movement supports the optimal alignment of the spine. It balances prana and apana vayus while opening the first five chakras. Over time the practice facilitates relaxation and sense of relaxation that is helpful for back pain. As the individual develops greater trust in the healing, a connection with true Self-deepens naturally cultivating a sense of wellbeing allowing the body to source positive feelings.

Discussion

Yoga therapy is not a talking practice it is a contemplation practice. Suffering becomes functional for our awakening; our pain becomes our grace. Think of the ocean and a wave as they are one, the wave gets puffed up but then it dissolves as we learn to get out of our way; we are just water and full of love. For when we allow our self the permission to experience any pose from within our inner wisdom it is good enough to erode residue that no longer serves us, this is an effort with ease. Restorative yoga gives us the grace to slow down, to listen to our inner wisdom which is the quietest voice within each of us.

References

Khalsa, S.B.S., Cohen, L., McCall, T. B., & Telles, S. (2016). The principles and practice of yoga in health care. Edinburgh: Handspring Publishing.

 

Lasater, J. (2011). Relax and renew: restful yoga for stressful times. Berkeley, CA: Rodmell Press.

 

McCall, T. B. (2007). Yoga as medicine: the yogic prescription for health & healing. New York, NY: Bantam.

 

Page, J. L., & Page, L. L. (2014). Mudras for Healing and Transformation (2nd ed.). Sebastopol, CA: Integrative Yoga Therapy.

           

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