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April 27, 2015
Namaskar, Dear Ones
The following is a conversation regarding safe Hatha or Vinyasa Yoga practice for those of us who have blood clots. Any doctor, or anyone who has blood clots, please feel free to add any information, or present an opposing opinion. It is important that we share our findings, even if we do not agree.
Question: I do have a question for you, and it's kind of a biggie. Here is the background: In early September I developed a subclavian-axillary blood clot. I felt a tiny "ping" during warrior 1 during a class, perhaps from too-vigorous shoulderblade wrapping, and I had been painting ceilings for three days prior. I woke up with a swollen arm. Subsequent tests revealed some minor genetic inclination toward clotting. I have been on anticoagulants (coumadin) since then and will be for six months.
A recent ultrasound revealed the auxiliary clot was gone, the sub-clavian clot was well on its way, and I had good flow throughout the region. The clot stabilizes after a couple of weeks and there is almost zero danger of a pulmonary embolism. They also did the ultrasound with my arm lifted overhead and determined there was no compression of the vein. Prior to that, I had been told to avoid any arms-overhead movements or arms-straight-back (requiring a LOT of modification to my practice) just in case it compressed the sub-clavian vein.
With this discovery, the doctor (who is somewhat familiar with yoga - none of my family M.D.s have been) gave me the OK to return to my usual yoga practice. I asked whether there was any reason I should not invert (Google searches had turned up some suggestion of this, and I knew as a teacher that certain related circulation issues were prohibitive of inversions) and he said he didn't know of any, as I was inverted every time I bent over to pick something up. The resources I've found that list clots as a contraindication never seem to say why.
I see a hematologist in another city next week to determine what, if any, long-term treatment I need. I have some minor swelling in the arm still, but I think returning to vinyasa practice has made that better and not worse. All of my doctors have recommended exercise, including for the arm, to help heal. Still, I'm very concerned about this happening again. None of my fellow yoga teachers have been able to provide any information on clots/propensity to clot and any specific yoga postures. Any information you have would be incredibly helpful. I have added prior postures back in one by one since the doc's OK, including headstand, forearm stand, and urdhva dhanurasana. The only one I haven't attempted is handstand.
Also, since I developed this clot, it seems other people who have had similar problems have been coming out of the woodwork (though it's always in the legs - the location of mine is very rare, and even more so because it was spontaneous and not related to an underlying disease like cancer or to insertion of a catheter). I hope to be able to advise students in the future who may have had a similar problem.
I understand that you can't give specific medical advice - I would like to present information to the specialist next week from a qualified yoga perspective so he can evaluate it for my specific case and advise me. I appreciate any insight you may have.
Answer: Thank God they found it, and have you on Coumadin. I'm surprised that no web sites have gone into this one, but let's look at body mechanics, and in this case a comparison to plumbing.
If you had a clogged pipe in your house and turned the house upside down for a while, the clog would find its way to the highest pipe in your house. Therefore, gravity would send a blood clot toward your brain if you hold inversions long enough.
Worst possible scenario is a stroke. Even though you are taking a good anti-coagulant, it's not worth the risk. Sorry to say, I would advise against inversions until a Dr. gives you the o.k. Take it easy and be patient.
Last Response: A doctor has already given me the OK, but I'm just being extra cautious. Wise not to take chances, as you said.
What remains of the clot is very stable - it essentially becomes part of the wall of the vein and then breaks down slowly. I have no doubt years of yoga helped save my life. The clot was completely occlusive behind the clavicle, but I had such fantastic collateral blood flow that even the swelling was minimal. Years of pranayama, etc., no doubt!
April 27, 2015
Blood Clot Contraindications for Yoga Poses
While yoga is known for improving circulation, lowering the heart rate, thinning the blood, and decreasing blood pressure, there are times that yoga is not advisable. Blood clots can be very serious; in severe cases, they can lead to fatalities. Patients with chronic or recurrent blood clots should be aware of the caution they should take when practicing yoga, and they should only do so after consulting a licensed physician who is familiar with yoga and its therapeutic benefits. Patients with blood clots that are being medically managed can practice yoga, but there are limits to what they can or should do.
Yoga can decrease the incidence of blood clots when practiced safely. The improved circulation prevents pooling of blood in the vessels, and the hormones released by the regular practice of yoga produce more healthy red blood cells and less platelets and other clotting factors. As a result of these improvements, the blood is thinner and it travels through healthier, more elastic vessels. In this way, yoga can therapeutically treat mild blood clots, because the blood is less capable of forming large or permanent clots. This leads to an eventual decrease or complete stopping of the health problems associated with clots.
The risk associated with blood clots can be exacerbated by certain yoga poses, and these poses should be avoided at all costs by patients with previous or current blood clot problems. Poses that involve inversion should be avoided, particularly if they would be held for any length of time, because the clot could travel with gravity and move to the heart or brain faster. Poses that involve bending the neck or spine, or extending the peripheral muscles too far, should also be avoided to prevent problems associated with blood clots.
It is not, however, only specific poses that can cause problems for students with blood clotting concerns. Hyperextension of the muscles can lead to torn blood vessels, which can lead to clots forming that may not be noticed until the situation is dire. These consequences may include a stroke or heart attack, which can be fatal and very rarely will there be signs leading up to the attack. Yoga can be dangerous for patients with blood clots if they do not consult a physician regarding their routine. Prevention of blood clot formation is ideal, and yoga can help to prevent them with the possibility of medical assistance, as well.
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