3 important keys for amputation and yoga therapy

yoga CITTA vrtti nirodah

Dealing with my personal issues as well as assisting others is firmly based on the Yoga Sutras. Nothing draws attention to the fact that identifying with the body or the mind is the path to suffering more starkly than losing a bit of your body and storm of emotions that goes with it. The Sadhana Pada – the second chapter of the Yoga Sutras — is my text book for dealing with all of these issues.

It requires considerable reflection and skillful means to guide a person so they see that their life isn’t defined by their body or the various thoughts that appear in the mind from time to time.

Now, I can write in general terms about yoga, limb loss and restricted mobility but not much good will come off this without explaining how to apply it'. Nor do I want to give the idea that it is possible to avoid any reality.

That's why I'd like to start with reflecting on Patanjali's yoga sutras and especially the verse: yogas citta vrtti nirodah — ‘Yoga is stopping the whirlpools of the mind’ (My own translation).  I think that sutra is tattooed on the back of my eyelids now. Everything I do is based on it. This is my bias and what I write should be understood from that perspective.

3 IMPORTANT KEYS FOR AMPUTATION, PHANTOM LIMB SENSATIONS AND YOGA THERAPY

The experience of phantom limb sensations are related to neural pathways. Pathways are being re-established after limb loss but without help will often re-establish existing patterns i.e., if you don’t do something to guide the process you’ll get what you had before – but then without the matching limb. This may cause confusion and frustration. Important keys to start with:

1 :: Start early, the sooner after amputation the better

2 ::  From denial towards acceptance

3 :: Work with kindness and friendliness (towards the whole self, including the amputated limb)

Start early

Soon after my leg was amputated — which showed to be the ideal time — I started my yoga practice again. Since then, I have adapted the practice for other people too and the key to adaptation is to get acceptance of the residual limb (stump).

ACCEPTANCE

I would be careful not to set too many expectations, especially for people who have phantom limb sensations lasting longer than 8 months after an amputation. In that case, it is likely to takes longer to deal with acceptance because the neural pathways are more established.

KINDNESS

A lot of issues start because people are in denial about their amputation and don’t ‘make friends’ with their amputated limb. Rubbing it and looking at it are quite important. Often it is the sight of a newly amputated limb that puts people off. I understand why, it is weird, but it is important to accept your body’s new configuration by both looking at it and feeling it.

breathe first, mindfulness and compassion follows

So… having made friends with what is left of my right leg this is the process that I used. It worked for me very quickly and continues to work in the very rare cases when I have some phantom sensations. They usually occur when my prosthesis presses on my leg in an unfamiliar way when it is tired and sore.

First I regulated my breathing so there could be a bit of focus. No need to get too picky about precise technique but extended exhalation and conscious inhalation matter. A 1:1.5 ratio is sufficient. The focus in the instance is the residual limb. Notice the change in sensation between inhalation and exhalation. People often use the language of breathing into their residual limb which is fine as long as it isn’t taken literally.

The next step is mindfulness, to look at the limb and see what it really looks like, visually locating the change of sensation between inhalation and exhalation. In my case the obvious thing to see is that there wasn’t a foot regardless of what I might have been feeling. However, the residual limb does have feelings that are consistent with what it is really like. Focusing on those feelings is the point of this step.

While focusing attention on sensations in the residual limb I felt it with my fingers until the place where the phantom sensation was actually coming from was located. It might be sensitive or the phantom sensation simply changed when a certain spot is pressed. While I was looking at the spot on my leg and pressing it gently so I focused on the feeling in that precise location I simply told myself, 'The feeling is here, there is no foot.'

I did so with compassion and a degree of humor and I have found that matters to other people as well. The end result is to have a response rather like ‘Oh, the feeling is here, silly'. It definitely doesn’t help to get serious and morose about it. While people do have to go through a grieving process regarding their old limb, this process requires acceptance. I found that doing this practice every time I felt a phantom sensation stopped them very quickly. After two weeks I had no serious phantom limb sensations. This is important if one wants to be able to do what nurtures the soul.

from pain, fear and denial management

This is interesting for people, especially care and yoga professionals, because there aren't many opportunities to hear about the early stages of limb loss. This is useful both for understanding as well as some insight into the adaptation of techniques for mental focus that I used to reprogram the associated neural pathways.'

'The response begins with this saying from Krishnamacharya 'Teach what is inside you, not as it applies to you, to yourself, but as it applies to the other'.

An example of applying that from my experience is managing pain. Pain is worse the more afraid you are. Naturally, Pranayama helps greatly and if you can suppress the activity of your sympathetic nervous system sufficiently even extreme pain becomes just an unpleasant sensation. Now I am across Pranayama but a person I am helping at the moment, almost certainly isn't.

It is usually not possible to get someone to the point where they can manage pain by a direct approach, i.e., 'Do this and you'll feel better'. Pain is complex. So working on reducing fear — which can approach blind panic — is an important beginning. That requires an understanding of what triggers the fear for a person as well as finding out what engages them, to decrease the intense focus on themselves. Often the care for their children, grandchildren, dog, whatever can start the process.

Once there is a purpose that a person really cares about it is possible to teach them some breathing techniques to reduce the experience of pain. They will need support because it may hurt more at first as their existing way of coping switches off and the new method begins. They may be going from denial to management and that is an important step to help them through. Gently bringing the practice back to its purpose e.g., to be able to support their grandchildren as they grow up, helps people stay in track and get past difficult bits.