What Yoga Teachers Need to Know About Teaching Cancer Survivors

• Yoga

Yoga for cancer patients—what better way to manage anxiety, gain strength, increase flexibility, and create feelings of well-being. A growing body of research points to the potential of yoga for supporting cancer patients, both during and after treatment.

But it’s important for teachers to realize that teaching yoga to cancer patients and survivors is different than teaching yoga in a typical class. Here’s why.

Specialized Training Is Required

B. K. S. Iyengar said it best: “Do not imagine that you already understand and impose your imperfect understanding on those who come to you for help.” Most yoga teachers, whatever their style or practice, are trained to teach a general population. While 200-hour trainings typically include anatomy modules, there’s not enough time to cover specific physiological topics, such as cell development, or psychological challenges, like the acute anxiety induced by a diagnosis of a life-threatening disease. It’s not possible to cover the specific needs or risks of the survivor in a standard yoga training.

A specialized teacher training about cancer, like my Yoga4 Cancer (y4c) methodology, helps teachers identify and work with the lifelong side effects triggered by cancer and its treatments. Yoga teachers need the essential facts about both cancer and yoga because understanding, not just compassion, is essential. Compassion might, for example, lead a teacher to provide only gentle or restorative poses for a cancer survivor. But yoga is not just a relaxation technique; movement is necessary to stimulate the cardiovascular and lymphatic systems that assist in recovery and in creating long-term stability. Recent research suggests that the physical exercise provided by yoga improves immune function, reduces inflammation, and enhances the efficacy of chemotherapy and radiation. Still, there are limits, especially right after surgery, or if a survivor is physically challenged. Only training and supervised experience can inform a yoga teacher about safe, effective methods of adapting yoga for this population.

Safety Comes First

Healing begins with feeling safe. Safety for a cancer survivor, whether physical or psychological, can be different than for a typical student. The effects of some cancer treatments go beyond hair loss and fatigue to create serious long-term fragilities requiring special attention. For example, Forward Bend, a yoga staple, can be dangerous to cancer survivors, because bone loss created by chemotherapy is a common long-term side effect; doing a Forward Bend quickly without warming up can fracture or rupture spinal vertebrae. Yoga teachers who work with cancer patients need to anticipate such risks.

Emotional safety is important as well. Survivors bring their fears to class, such as the fear of developing lymphedema (fluid retention and swelling caused by a compromised lymphatic system), which may be as strong as the fear of cancer. Students need to hear that the teacher understands their fears and will know how to provide modifications of poses or sequences they teach. A student touched by cancer might be struggling to understand the new limitations of their body and will be looking for reassurance and informed advice.

Risk Factors When Teaching Survivors

When teaching workshops or giving y4c trainings, I am often asked about yoga’s benefits. Rarely am I asked about its risks. But, like cancer, yoga is not “one size fits all.” Each survivor’s specific cancer, treatments, side effects, and body are different, and yoga teachers must adapt to their needs. The difference in teaching yoga to cancer survivors is that the risks are higher and a teacher should know what they are.

My short list of risk factors includes:

• Fragile bones that increase the risk of fracture
• Abdominal obstructions and sensitivities
• Weak or missing muscles
• Peripheral neuropathy affecting balance
• A compromised immune system, increasing the risk of infection.

Becoming an Authentic Teacher

When offering a class for cancer survivors, a teacher is saying, “I am responsible. I know what yoga is best for you and I will protect you from possible discomfort and injury, and calm your doubts or fears with knowledge and facts.” Survivors expect teachers to understand three general topics: first, the effects of cancer treatments on the body; second, the poses that have the most benefits; and third, the poses that can be harmful.

Survivors will come with questions:

• Will Downward-Facing Dog cause lymphedema?
• Would hot yoga be good for flushing chemotherapy toxins from my body?
• When is it safe to start doing yoga after starting treatments?
• If I have implants, could they rupture doing yoga?
• Is it okay to practice yoga with axillary nerve damage?
• Forward bends cause me pain. Am I doing something wrong?

Be prepared with answers to questions, anticipated and unanticipated, about both yoga and cancer. Authenticity starts with having answers to such questions without hesitation—and also having the honesty to say, “I’m not sure, but I know how to get the right answer.”

It’s also important that a yoga teacher for cancer survivors takes the time to reflect on and process their personal fear of cancer and dying. It’s easy to feel overwhelmed by the suffering of others. Inexperienced teachers may treat students with hesitation, due to a lack of confidence or their own fears about cancer and dying. In my personal experience as a survivor, a yoga teacher who was overly compassionate only made me feel more like an invalid, rather than on my way to health and recovery. I found hope and well-being in being treated as “normal,” without coddling or denial.

I hear the same from my students. They get treated as patients by their doctor, nurses, family, and friends. Having to reconnect with that feeling is not why survivors come to yoga class. Learn the facts about cancer and appreciate that true compassion flows from knowledge and facts, not just feelings. 

Cancer Is the Real Teacher

Some survivors will not make it, and a yoga teacher must be prepared to face that reality. I believe that living with fear makes me a warrior. It is the first lesson cancer teaches a survivor: having to be prepared for the uncertainty of a whole new life. For someone with a life-threatening diagnosis, practicing Savasana, the final resting pose, is no longer an abstraction. It is part of daily life.

I believe this is the biggest difference in teaching yoga to cancer survivors. A life-threatening illness can help us all learn how to live fearlessly. If faced directly, cancer is everyone’s teacher.

© Kripalu Center for Yoga & Health. All rights reserved. To request permission to reprint, please e-mail editor@kripalu.org.