Vestibular Disorders Michelle D. Williams

“ I would try to grab a door handle and just miss it. Or I’d be walking across a room and would bump into a wall.”

therapy (VRT), which is similar to physical therapy but geared toward movements and exercises for balance. “I had to do squats and walking back and forth in a line.”

Sandra’s life was completely disrupted by her new condition. She had been laid off from work prior to the surgery so her schedule was more open than previously, and her kids were teenagers, so they were pretty self-sufficient. On the one hand, this gave her time to focus on healing and regaining her balance. But many of her day-to-day activities and household duties were impossible.

She couldn’t drive. Her husband had to take over all the errands that Sandra had normally done on her own, or someone else had to give her a ride. She couldn’t go into supermarkets or shopping malls because the lights, colors, and crowds made her dizziness worsen. Restaurants were an unpleasant experience. When you are deaf in one ear, it can be difficult to differentiate between overlapping layers of sound— such as overhead music playing in public places and people talking to you. In these environments, Sandra would often just hear an echoing kind of noise.

“At the time, I thought all these symptoms were temporary, that I was healing,” Sandra says. “I had no idea it would take so long. You just take one day at a time, and you're waiting to get better.”

FALLING IN LOVE AGAIN

Luckily, Sandra had been an Iyengar Yoga student at the Yoga Institute of Broward in Ft. Lauderdale, Florida, studying with Ruth Ann Bradley, for 10 years prior to the surgery. When she came out of the surgery and found out that she now had a vestibular disorder, she knew immediately that yoga would be a part of her recovery and longer-term management of the condition. “Somehow I knew my yoga practice— as well as meditation and help from my personal trainer— were the things that were going to get me through,” Sandra says. “I always knew yoga was beneficial— I saw the benefits every day, but when you have a traumatic event or crisis, that’s when it really comes through. It’s like I fell in love with yoga all over again.”

And she says she knew instinctively which poses were going to help. “It was funny. After the surgery, for some reason, I kept hearing in my mind, ‘Utkatasana, Utkatasana,’ so that’s the first pose I practiced,” Sandra says. “It’s not one of the poses I had practiced regularly and definitely not one of my favorites, but I just had this voice in my head from the first day after surgery telling me that this would help me.”

FINDING BALANCE

At first, Sandra was confined to home because of the dizziness. But about a month after her surgery, Sandra started taking weekly private classes with Ruth Ann. That’s when she began to see tremendous improvement with her balance.

“They say that when the student is ready, the teacher appears, but this can go the other way too,” Ruth Ann says. “A teacher has to be ready to take on what her students appear with.” And Ruth Ann took on the challenge wholeheartedly.

They didn’t do that many poses at first, but they held them longer. For example, she did Ardha Chandrasana using the trestle for much longer than it would normally be done in the middle of the room. The idea was to put her brain in a variety of

positions— not just as it is when standing up or lying down. This

Maintaining balance depends on information received by the brain from three peripheral sources: eyes, muscles and joints, and vestibular organs. All three of these information sources send signals to the brain in the form of nerve impulses from special nerve endings called sensory receptors.

“ If I do a really conscientious

Tadasana, I can improve my symptoms by 50 percent in just a couple minutes.”

brain workout encouraged the left side of her brain to start to compensate for the right.

Many vestibular patients with symptoms of dizziness, lack of balance, and headaches want to lie down flat on their backs and close their eyes. But that avoids the very movements that can kick-start the brain into compensation mode.

Most of the asanas Sandra did early on in her practice with Ruth Ann were supported. She did a supported Sirsasana using the rope wall. She did Ardha Halasana. “We used all the props that were in the studio— the trestle, chairs, everything,” Sandra says. “I learned how props can really help.”

“Restorative poses just make sense after any surgery, and that is where we started,” Ruth Ann says. “I stayed informed as to what her vestibular therapist had her doing and related those movements to asanas. The fact that they had her doing so much movement gave me the go ahead to get her back to her yoga practice.”

Sandra says Iyengar Yoga has been especially good for her because of its pace. “You do a pose. You go into the next pose. You come back. You take your time.”

One challenge for Sandra was that she couldn’t look up while in certain poses or she would lose her balance. This was especially a problem in Trikonasana and Utthita Parsvakonasana. So Ruth Ann had her look down instead of up, which helped.

“Usually when you’re in Trikonasana, you’re either looking straight ahead or up at the ceiling. I couldn’t do that without losing my balance,” Sandra says. “But when I looked down, I could hold the pose.”

Because Ruth Ann knew Sandra’s issues, Sandra was able to attend classes alongside her private lessons. “My approach changed depending on what kind of day Sandra was having,” Ruth Ann says. “I noticed that if she had had an overstimulating day before her private session, she would be dealing with more dizziness and balance issues. In that case, we would start with restorative, quieting poses or sitting poses. If she came in rested and feeling good, we did more standing poses, inversions, and eventually backbends and twists.” like it was at first. With her ongoing private lessons, classes three times a week, and home practice, she is now managing her disorder with no medical therapies at all.

“Ruth Ann was a blessing,” Sandra says. “That’s what I’m most thankful for.”

POSES THAT WORK

Ruth Ann advises teachers who have students with vestibular disorders to start with the basics. “Lots of people starting as beginning yoga students have balance issues that have nothing to do with any disorders.”

It makes sense that the first pose Sandra turns to when she feels dizziness or a headache coming on is Tadasana. “If I do a really conscientious Tadasana, I can improve my symptoms by 50 percent in just a couple minutes,” she says. “Sometimes everything is blurred and turning around, but when I do Tadasana, I’m immediately grounded. Then I can think, ‘OK what’s next?’”

For Sandra, the most important asanas have been those that take her out of vertical and supine positions. These poses challenge her brain to find balance. Backbends are especially helpful. “If you have balance issues and try to do certain backbends, it can be difficult to understand where you are going as you arch back.”

Sandra does backbends most days. She also has a stable of poses she turns to when specific symptoms arise. When she’s dizzy, Sandra says Viparita Karani works magic. Salamba Sarvangasana is also very good, but she prefers Viparita Karani because she can do it quickly and easily. If you have no balance, it can be challenging to set up all the props and get into a more challenging pose.

One of Sandra’s favorite poses is Uttanasana. She does it every day because it really helps with her balance. “I’m sure there is a scientific reason for it. That forward bend with my head down feels important.”

She says she used to do Uttanasana at a wall when she was first diagnosed, but now she usually does it in the middle of the room. “It’s similar to Sirsasana in some way,” Sandra says. “Going upside down— inversions and forward bends— are very good for me.”

She also loves restoratives, especially when her symptoms flare-up. Ardha Chandrasana has been a very important pose for Sandra. And, she says, Prasarita Padottanasa really helps— another standing forward bend.

“I don’t have to fix my gaze in Prasarita Padottanasa. I could do it with my eyes closed,” Sandra says. “The poses where I have to keep my eyes open and fixed in a certain direction are more

challenging because my vestibular system relies on my eyes. And it’s a relief to not have to engage the eyes for balance.”

Now, four years after her surgery and subsequent diagnosis of vestibulopathy, Sandra feels dizzy symptoms and migraines less and less. She’s gone from having symptoms constantly to every other day to only when triggered by overstimulation. Busy days, trips to the mall, crowded places—all can provoke dizziness.

But Sandra has developed the skills and awareness to keep her symptoms in check. In addition to her asana practice, she meditates daily and practices pranayama.

“Breath is very very important,” Sandra says. “I love pranayama. During critical moments, it just comes to me— Ujjayi breath somehow just comes. And Viloma helps me center.”

“Iyengar Yoga to this day helps me stand on my feet.”

Michelle D. Williams is the editor of Yoga Samachar. She has been practicing Iyengar Yoga for 23 years and studies at Jewel Yoga in Portland, OR.

Agrawal Y, Carey JP, Della Santina CC, Schubert MC, Minor LB. Disorders of balance and vestibular function in US adults. Arch Intern Med. 2009;169(10): 938-944.

Sandra Roberts in supported Sirsasana at the rope wall.