To yoga or not to yoga...

One of my LPA goals is to learn more about yoga and how to incorporate it with advice for my patients. I have since been taking up yoga, and experiencing different styles of yoga in an effort to see what they offer, and whether they are appropriate for particular patients.

My first ever yoga experience I went to a Vinyasa Flow yoga session, lasting 90 minutes at my gym. This style of yoga is definitely not for beginners, or for those who experience any sort of pain. Very fast moving, and difficult regarding controlling your breathing (which is a big thing in yoga) and moving whilst controlling your breathing. The positions themselves were at times complex.

A few weeks later I tried out Iyengar yoga, which was much more simpler, slower, and easy to get into. Although some of the positions might be difficult, as long as the teacher is aware of your injuries beforehand, you can always adapt.

I managed to arrange a meeting with a yoga instructor, just to get a little more insight on yoga, its principles and if its something I should be encouraging my patients to do.

One form of yoga was developed by a man called Patanjali, who came up with the '8 limbs of yoga'. The aim was to master each limb reaching eventually enlightenment 'Samadhi'. One of the limbs needed to be mastered involved improving on ones flexibility in order to achieve a seated position (Lotus position) which you are meant to remain in, in order to mediate.

The Western world has taken this element of yoga and used it as a tool to sell and focused on the healthy aspect regarding improving ones flexibility.

Generally people practise Hatha Yoga (Hatha is divided into Ha, meaning Sun, and Tha meaning Moon). Subsections of Hatha yoga are Vinyasa (fast pace and relatively high intensity yoga), Bikram (yoga in a room at high temperatures), Iyengar (slow, relaxing, stretching) and Ashtanga (high demand on the body, very active).

With the research I have done, discussing with a yoga instructor and participating myself in different types of yoga I have concluded the following:

> Yoga is good as long as its the correct yoga (Iyengar)
> When giving yoga as advice ensure the patient knows what they're getting themselves into! My experience seemed very spiritual and that threw me a little
> Yoga is advisable for those who need to improve general flexibility
> Yoga is not advisable for those who are flexible already! Hypermobile patients do not need to further improve their range of movement!
> Yoga takes time and as such the patient needs to commit to it and give it a chance.

Applying Functional technique in clinic

One of my goals is to apply the techniques I've learnt in my electives onto patients and seeing if they are effective both to myself and my patient. So far so good! Both times when applying functional technique I felt a positive tissue response and the patient has also reported feeling a positive change. Will have to reassess next week and see how long it holds

Apparently I am good at what I do...

With the permission of a fellow 2nd year BSO Student...

[18:57:45] Emily Stern: just an ego boost for you..random as it is, but i have been hearing ur name being banded around the place a lot lately with students singing ur praise
[18:57:49] Emily Stern: good work!
[18:58:21] Tamir Grant: who have you been talking to?
[18:58:24] Tamir Grant: thats nice!
[18:58:39] Emily Stern: nah, ur name literally just keeps popping up...i think the technical term is...'arghhhhh, he's shit hot... ppl who've seen u, shadowed u

Always nice knowing people have good things to say about you behind your back!

Additionally I was given some good feedback by another student - see scrap of paper attached below!

One Monday morning we carried out an exercises where we all would write something positive about our fellow clinic team mates as we were drawing close to CCA's, this is what was said about me collectively:

New patient clinic

Yesterday morning I experienced new patient clinic (NPC). This involves taking a new patient and having one of your peers observe and make notes about how you were with the patient from general case history taking to treatment and professionalism.


Overall I was happy with my comments and in general agreed with what I needed to work on. I learnt about how to differentiate between a facet, disc and sacro-iliac joint.

This carried on nicely into my obstetrics elective where I further learnt how to differentiate between the three. Looking forward to applying my new knowledge on the next patient that presents with a lower back pain. Wonder how long I'll have to wait for that patient :oP

Leg Length Discrepancies...

Everyone has a leg length discrepancy (LLD) of some sort, whether it be 1 mm or 1 cm. An interesting way to check which leg is shorter was shown to us in our Obstetrics and Osteopathy technique class on Thursday. I later used this in clinic on Friday afternoon and it made life a little easier!

Firstly you have to obtain consent to lower the patients underwear so you can see the gluteal cleft. The cleft will point to the left or the right (unless it points straight up which means your patient does not have a LLD, but like I mentioned earlier, apparently we all have some sort of LLD!). The side which the cleft points to is the shorter leg, therefore if the cleft points to the right, the right leg is shorter. This can further be confirmed by asking the patient to bend their left knee, whilst keeping their heel on the ground, thereby leveling out the pelvis. If the were to bend their right knee you would see the pelvis dip significantly.

The diagram does not show much in way of which leg is shorter, but I thought it would be amusing to have a cleft on show to liven up this blog!

The difficulty that is the ungrateful patient

Let me set the scene. Clinic on a Wednesday PM shift, full list and unlike other days every one of my patients decided to show up, thankfully on time. My last patient is one that does not seem to feel better before, during or after treatment but nevertheless will come back to endure another 40 minutes of treatment which the patient describes as 'pokey' amongst other adjectives. Needless to say I was not looking forward to this patient at the end of the day.

I also had two first year students observing me so I had to not only be on my best behaviour but also so some level of professionalism.

The patient presented with bilateral thoracic outlet syndrome symptoms and seemed to fluctuate between having good days and bad days.

As a student osteopath I feel I need constructive criticism in order to further improve myself as a practitioner, so I can be the best osteopath I can be. But when a patient generally has nothing positive to give you, you start to question yourself and your abilities.

I don't think I am the finished product of a well rounded BSO student, as I have another 8 months to go before I finally qualify. But I definitely think I am better than what this patient perceives me to be! And the full list must mean I am doing something right with my patients (unless you look at it in a negative perspective that they keep coming back because they never get better...).

Having said all of that the patient actually felt better and thanked me for the treatment! Was a great way to end a very long afternoon. And the first years seemed to be impressed too so it was a win-win situation.

My first taste of the electives

Chose Functional technique and Osteopathy and Obstetrics which I am partaking in for this Autumn term and already they have had an effect on my technique when treating patients. We learnt to percuss (tapping?!) the vertebrae to detect a difference in tissue response, and found myself doing that the very next time I was in clinic. Obstetrics also left its mark, opening my mind to the many ways to treat patients rather than just on their back, front or sidelying. Using the 8 finger soft tissue technique too which my patients seem to respond well to. Looking forward to seeing what else will be taught!

East Street Clinic 23/09/11

Good half day in ESC. Saw two interesting patients, one was a 1500m runner who unfortunately was attacked and has since been experiencing pain in her left knee and left shoulder. The other is a semi professional footballer who pulled his hamstring. Working with people like this has further pushed me to realise how much I would love to work with sports personel and athletes.