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TABLE OF CONTENTS
Welcome
•
About y4c & Disclaimers
Module #1 – the Foundation
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#1 - Introduction & the ABCs
Module #2 – Physical and Emotional State of a Survivor
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#2.1 - Cancer Basics
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#2.2 - The Human Body and Immunity
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#2.3 - Cancer staging & Diagnostic Tools
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#2.4 - Western Cancer Treatments
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#2.5 - Common Side Effects
Module #3 – The Science of Yoga
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#3.1 - Scientific Foundation of the y4c Methodology
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#3.2 - Yoga Benefits
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#3.3 - Warm-up Vinyasa
Module #4 – The y4c Methodology
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#4.1 – Introduction / The y4c Method
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#4.2 – y4c Sequences and Poses
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#4.3 - y4c Tools
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#4.4 - y4c Class Plan
Module #5 – Preparing to Teach
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#5.1 - Advice & Cautions
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#5.2 – Adapting Your Style
Appendix
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Welcome to the yoga4cancer Teacher Training
I am thrilled to welcome you to the yoga4cancer community and the thousand of yoga teachers and
other health care practitioners that have participated in my training over the past 10 years. Together
we can better help cancer survivors & patients to live longer, healthier and happier lives through the
practice of yoga.
My philosophy is that true compassion comes through knowledge & understanding. Only when we
understand the unique challenges – both physical and emotional – of our students can we best provide
guidance and leadership to achieve a healing yoga practice.
The training you are about to undergo will provide you with information, tools, insights about cancer &
its treatment on the human condition. The manual has been provided to reinforce and support your
training, homework assignments and further development. It’s a compilation of expert resources, my
essays, other great articles, practical guides & unique asanas that I have used and improved over the
past 15 years. Some of the enclosed content is purely mine whilst others I have relied on expert 3rd
parties to help provide the scientific data and insight. All sources are well noted for your further use.
My advice is that this training should be just the start of your journey. Research on both cancer and
yoga are still in their infancy. So embrace the curiosity that leads you to this training, as it will be your
ultimate asset. Learn the facts, dispel myths and gain knowledge to be truly compassionate.
Welcome and I look forward to working with you!
Best,
Tari Prinster
Founder of yoga4cancer
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ABOUT y4c
yoga4cancer (y4c) is a specialized yoga methodology that is
tailored to address the specific physical and emotional
needs left by the cancer & its treatments. This unique
approach is not just gentle or restorative yoga but focuses
on how to stimulate the Immune System through movement,
improve flexibility & strength along with reduced anxiety and
boost overall well being.
y4c was developed by Tari Prinster – a cancer survivor and master yoga teacher. Tari has been offer
teacher training, classes and retreats across the US for the past 15 years. Her book, Yoga for Cancer;
A Guide to Managing Side Effects, Boosting Immunity, and Improving Recovery for Cancer Survivors,
launched in November 2014 documents her journey whilst providing the science and practice for
survivors everywhere.
She was featured in the film YogaWoman and regularly presents at Yoga
Journal and other industry conferences.
y4c is helping cancer survivors in the US and other International markets through:
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Classes & Privates
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Teacher Training & Workshops
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Retreats
Today, we help hundreds of survivors; our vision is to help millions. For more information visit y4c.com.
Yoga 4 Cancer is a registered LLC in New York State.
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Medical Disclaimer
The y4c – Teacher Training Manual contains text, graphics, images, and other content (collectively
“Content”), which are for informational purposes only. Content is not intended to be a substitute for
professional medical advice, diagnosis, or treatment. A qualified health care professional should be
consulted for medical advice and answers to personal health questions. This y4c – Teacher Training
Manual does not constitute an attempt to practice medicine.
Ownership and Proprietary Rights
The brands, names, logos, trade names, trademarks, service marks and other distinctive identifications
(collectively “Marks”) in the y4c – Teacher Training Manual, including, without limitation, “Yoga 4
Cancer” and “y4c” are the trademarks and intellectual property of and proprietary to Yoga 4 Cancer,
LLC. You have no right to use any of these Marks or any marks confusingly similar thereto for any
purpose without the express prior written consent of Yoga 4 Cancer, LLC, such consent shall be in the
sole and absolute discretion of Yoga 4 Cancer, LLC. No part of this y4c – Teacher Training Manual
may be reproduced in any form except by prior permission from Yoga 4 Cancer, LLC.
Fair Use Notice
This Manual contains copyrighted material the use of which has not always been specifically authorized
by the copyrighted owner. This material is made available for educational purposes. It is believed that
this constitutes a 'fair use' of any such copyrighted material as provided for in Title 17 U.S.C. section
107 of the US Copyright Law. This material is distributed without charge or profit.
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MODULE #1 – The Foundation
Introduction and the ABCs
The y4c methodology was developed over the past two decades through personal experience, medical
and scientific fact finding, applied professional experience and ultimately results. When Tari was
diagnosed with breast cancer, she found yoga extremely helpful during her treatment and recovery
process. Her personal experience of the benefits of yoga for cancer ignited a passion to learn more and
uncover the science behind both yoga and cancer. Ultimately, Tari became a Vinyasa yoga instructor
and developed a teaching approach tailored specifically to cancer survivors—one that can be adapted
to suit different types of cancer and stages of treatment and recovery. The methodology she developed
is shared in this training.
The following ideas are key to the yoga4cancer approach:
Awareness
True compassion grows out of understanding and knowledge. Understanding begins with awareness of
our own preconceptions about cancer and yoga, and a willingness to continually investigate and
challenge those notions, seeking out facts.
For example, people may have the following ideas about cancer and yoga:
•
Cancer is one disease. FALSE. There are hundreds of categories of cancer, and within each
category there may be several types, all requiring different treatments and involving different
side effects.
•
Cancer is a death sentence. FALSE. Many people do not die from cancer, and the numbers
who survive are continually growing. This means more people will need yoga and other
solutions to help with recovery and maintaining a strong Immune System into the future.
•
Cancer is the hard part. FALSE. Treatments such as surgeries, chemotherapy, and radiation
are often more debilitating.
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•
Yoga for cancer is all about relaxation. FALSE. Active exercises have benefits for survivors,
including supporting the Immune System, strengthening bones, and providing a sense of
empowerment. The y4c method includes both active and restorative poses.
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Yoga won’t hurt you. FALSE. There are many styles of yoga and movements that can be
harmful to cancer survivors. A responsible teacher must know how to modify to provide a safe
class.
Awareness also applies to the teacher’s own fears about cancer and death. Whether you are a survivor
or not, this training will encourage you to face your fears, since facing them is an important step toward
deepening your understanding of what cancer survivors may experience.
“When I heard three little words—invasive ductal carcinoma—that mean you have
cancer, it took my breath away. An uninvited guest, cancer came into my life and
refocused me. The diagnosis was only the beginning of my breathless moments. The
parade of treatment options, decisions, side effects, medication, expenses, insurance
forms, phone calls, and empty hours of waiting for test results—all left me floating on a
sea of uncertainty and fear. No matter what kind or stage, cancer or other lifethreatening traumas steal the breath, cloud the mind, and weaken the body.”
— Tari Prinster
We must also be aware, and acknowledge, that the science of yoga and cancer is still in its infancy.
More research is coming out, but further studies are needed and much remains unknown. So
awareness also means remaining aware of the limits of our understanding—both in terms of the
science, and in terms of the inner experience of a particular survivor—and the possibility of
misunderstanding.
“Do not imagine that you already understand
and impose your imperfect understanding
on those that come to you for help.”
— B.K.S. Iyengar
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Benefits
Awareness leads to a better understanding of the benefits of yoga for cancer survivors. In the y4c
approach, we strive to be informed about the physical benefits of certain types of poses and
movements, as well as the emotional benefits yoga can offer in helping to reduce the stress, fear, and
anxiety that may accompany a cancer diagnosis and treatments.
During this training we will explore and discuss specific benefits, so you will be prepared to teach
classes that can help students regain strength and mobility after surgery, support a healthy Immune
System, protect and strengthen bones that may be weakened from treatments, and reduce stress.
Additionally, the y4c approach places an emphasis on educating students about the benefits so they
will have a sense of how they can participate in their own healing process. This is an important means
of empowering survivors and giving them hope.
Conveying benefits to students in a way that is clear and accessible is a skill. It must be done with
sensitivity. Keep in mind that cancer patients are often overwhelmed with technical information from
doctors and specialists—procedures, statistics, facts, medical jargon, and anatomical explanations are
all part of the cancer journey.
The C Word
We use the word ‘cancer’ in y4c classes. Rather than tiptoeing around the issue, the aim is to provide a
safe space where cancer can be openly acknowledged. Thus, one goal of the training is to increase
your comfort level with using the word cancer, so you can use it confidently. Of course, there’s no need
to use it repeatedly or focus on cancer throughout class, but don’t avoid it—your students can’t.
Other C words are also important to the y4c approach:
Curiosity and Care. Be curious about your students, get information about their specific situation and
needs (surgeries, treatments, injuries, etc.), and modify accordingly so the class will be safe for them.
Know what to avoid and why.
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Community. A big draw of the classes is the sense of togetherness or family they can offer, beyond
the walls of a hospital or support group. How can you help foster a feeling of community in your
classes?
Compassion. It’s likely compassion brought you to this training. But remember it should be backed by
an effort to understand. What a cancer survivor wants may be different from what you think. Most
cancer survivors don’t want to be coddled or treated as weak, but are eager to feel, look, and act
normal again.
Control. A feeling of loss of control is common among many cancer survivors. The yoga practice can
help students regain a feeling of control.
“The retreat promised three days of pampering and yoga, but as we introduced
ourselves to the group there was more of a commonality that we were there to connect
with other women battling this disease and to give and receive strength from the bond
that had unfortunately united all of us. In the capable hands of the instructors [. . .] we
breathed, stretched, moved and breathed some more. There was no coddling and
pitying of our situations, just adaptations to our unique abilities. We were encouraged
and sometimes pushed to learn what we were capable of or what we were not.”
— Student Testimonial
“I’ve learned that people will forget what you said,
people will forget what you did,
but people will never forget how you made them feel.”
— Maya Angelou
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MODULE #2 – The Physical and Emotional State of a
Cancer Survivor
#2.1 - Cancer Basics
As discussed, true compassion comes from knowledge. Therefore, without specific understanding of
the physical and emotional challenges of a cancer patient or survivor, a yoga teacher is challenged to
develop the most effective, comforting yoga practice to aid a cancer patient or survivor. Caring for
another being is so important, but understanding is rooted in scientific and medical facts. Without this
grounding, well-intentioned compassion can be harmful or ineffective. So our starting point is expert
information on the basics of cancer, its treatments and side effects so true compassion is achievable.
We have relied on experts and reputable national institutions like the National Cancer Institute and
American Cancer Society. We – nor I – pretend to be a doctor or a medical expert. So we have
compiled the relevant information from these sources. However, please know that new research and
better ideas emerge every day. It is hard to keep up! So, the concepts on these pages are not all the
information that you should know or could know to develop the required skills to work with survivors.
This is your starting point. Please research and feed your curiosity through facts and information. Also,
our understanding of cancer—just as it is the case with yoga—is still in its infancy. Facts, research and
guidance continue to evolve! So must our understanding and knowledge.
Often breast cancer becomes the focus in y4c trainings and in yoga classes, in general, because of its
high incidence (about 29% of all new cases are breast cancer). Plus it’s one of the best researched as
well as one of the most physically debilitating types of cancer. But it’s not the only cancer that can be
addressed by yoga. Most of the science, principles and asanas reviewed in the training are relevant
and necessary for all types of cancer survivors. This methodology and my teachings is valid to all
cancer – regardless of type, stage, gender, location etc.
At the same time, hundreds of other cancers exist and each person’s cancer experience varies
enormously from the treatments, physical and emotional challenges. And often the cancer distracts
from other health issues that need to be understood, mitigated or focused on for any practice. Cancer
doesn’t stop diabetes, heart issues! So part of this process is to provide you the basics but arm you
with the confidence for you to engage your students about their specific cancer and treatment side
effects. They can provide you with the blueprint you need to build the best practice for them. To help
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you, we have developed am ‘Intake’ process later in the training to help you gain the necessary
information of any new student.
Being diagnosed with cancer sets a survivor on the fast track for a doctorate from ‘Cancer University’,
and so too yoga for cancer teachers. So many questions; “what is a cancer’, “what causes cancer”,
“what asanas should a cancer patient / survivor do or not do’ and many more. The answer to these
questions gives us information about the critical question of prevention and avoiding recurrence or new
cancers.
So “where do we start?” Let’s start with thinking about cancer like a scientist would. We start by
thinking about it as a puzzle, asking questions. We ask how a particular cancer behaves. Okay, it is life
threatening, but how does it act? How does it evolve in the body and how does it respond to our
treatments to eliminate it or manage its growth?
We can only answer these questions by examining the behavior of a cancer cell and versus a noncancer cell. Understanding what normal healthy cell behavior is holds the key. What is normal cell
behavior?
Call it mystery or miracle— life starts when one egg cell (ovum) and one sperm cell bind together and
start doing their job. They began to divide and grow, each cell born of another, the growth controlled by
genetic code. Two cells grew to four, then 16, 32, 64 and so on until the body has an estimated 75-100
trillion cells! Dancing all together, each cell is programmed by its genes on what to do, how to divide,
and how to become an eye or a toe—eventually, this mass of dividing, differentiating cells becomes a
complete human body composed of interlocking biological.
Every human cell behaves like this: NOTE: Consider doing a Visual for this
•
It is born from a similar cell
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It performs a specific job in the body
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It maintain and nurtures itself
•
It reproduces itself a limited number of times
•
Then it dies a normal death.
It is these last stages where a healthy cell versus a cancer cells act differently. A cancer cell of the
breast, lung, bones or blood refuses to die and the body cannot identify and / or kill this unruly cell. So
like the ‘healthy cells’ it begins to multiply but is unchecked by the body and can either grow large (e.g.
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a tumor) or spread throughout the body (eg. metastatic cancer). Regardless, this unchecked cells
growth will impact the normal cell and system behavior causing what we understand as ‘cancer’.
Since Richard Nixon declared the War on Cancer in 1971, billions of dollars have been poured into
research looking for a ‘cure’, which remains elusive 40+ years later. Only until recent research has so
dramatically pointed to the inherent root of cancer is DNA have we taking into account that every
individual person has pre-cancer cells. I agree with Thomas Bosch, an evolutionary biologist at Kiel
University who published, The Primordial Roots of Cancer | Acumen | OZY , who says, “Knowing your
enemy from its origins is the best way to fight it and win many battles.” That is our goal in this Module,
to know enough about what cancer so we can make proper judgments about how to use a yoga
practice to win that ‘War on Cancer’. http://www.ozy.com/acumen/what-if-cancer-simply-can-t-becured/33199
Webster Dictionary definition: cancer [kan-ser] –noun, genitive Cancri [kang-kree]
1. any evil condition or thing that spreads destructively; blight.
2. Astronomy. the Crab, a zodiacal constellation between Gemini and Leo.
3. Astrology. the fourth sign of the zodiac: the cardinal water sign.
4. a malignant tumor of potentially unlimited growth that expands locally by invasion and
systemically by metastasis
The American Cancer Society gives us the following descriptions and analysis, which can be accessed
on their website: http://www.cancer.org/cancer/cancerbasics/what-is-cancer
“What is cancer?
Cancer is the general name for a group of more than 100 diseases. Although there are many kinds of
cancer, all cancers start because abnormal cells grow out of control. Untreated cancers can cause
serious illness and death.
Normal cells in the body
The body is made up of trillions of living cells. Normal body cells grow, divide, and die in an orderly
fashion. During the early years of a person’s life, normal cells divide faster to allow the person to grow.
After the person becomes an adult, most cells divide only to replace worn-out or dying cells or to repair
injuries.
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How cancer starts
Cancer starts when cells in a part of the body start to grow out of control. Cancer cell growth is different
from normal cell growth. Instead of dying, cancer cells continue to grow and form new, abnormal cells.
Cancer cells can also invade (grow into) other tissues, something that normal cells cannot do. Growing
out of control and invading other tissues are what makes a cell a cancer cell.
Cells become cancer cells because of DNA (deoxyribonucleic acid) damage. DNA is in every cell and it
directs all the cell’s actions. In a normal cell, when DNA gets damaged the cell either repairs the
damage or the cell dies. In cancer cells, the damaged DNA is not repaired, and the cell doesn’t die like
it should. Instead, the cell goes on making new cells that the body doesn’t need. These new cells all
have the same abnormal DNA as the first cell does.
People can inherit abnormal DNA, but most DNA damage is caused by mistakes that happen while the
normal cell is reproducing or by something in the environment. Sometimes the cause of the DNA
damage may be something obvious like cigarette smoking or sun exposure. But it’s rare to know
exactly what caused any one person’s cancer.
In most cases, the cancer cells form a tumor. Some cancers, like leukemia, rarely form tumors. Instead,
these cancer cells involve the blood and blood-forming organs and circulate through other tissues
where they grow.
How cancer spreads
Cancer cells often travel to
other parts of the body
where they begin to grow
and form new tumors. This
happens when the cancer
cells get into the body’s
bloodstream or lymph
vessels. Over time, the
tumors replace normal
tissue. The process of
cancer spreading is
called metastasis.
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How cancers differ
No matter where a cancer may spread, it’s always named for the place where it started. For example,
breast cancer that has spread to the liver is called metastatic breast cancer, not liver cancer. Likewise,
prostate cancer that has spread to the bone is called metastatic prostate cancer, not bone cancer.
Different types of cancer can behave very differently. For instance, lung cancer and skin cancer are
very different diseases. They grow at different rates and respond to different treatments. This is why
people with cancer need treatment that is aimed at their kind of cancer.
Tumors that are not cancer
Not all tumors are cancer. Tumors that aren’t cancer are called benign. Benign tumors can cause
problems – they can grow very large and press on healthy organs and tissues. But they cannot grow
into (invade) other tissues. Because they can’t invade, they also can’t spread to other parts of the body
(metastasize). These tumors are almost never life threatening.
How common is cancer?
According to the American Cancer Society, half of all men and one-third of all women in the US will
develop cancer during their lifetimes.
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Today, millions of people are living with cancer or have had cancer. The risk of developing many types
of cancer can be reduced by changes in a person’s lifestyle, for example, by staying away from tobacco,
limiting time in the sun, being physically active, and healthy eating.
There are also screening tests that can be done for some types of cancers so they can be found as
early as possible – while they are small and before they have spread. In general, the earlier a cancer is
found and treated, the better the chances are for living for many years.”
I hope you find this basic information from the American Cancer Society useful. Now, let’s go to
another source for the causes of cancer, which are so varied from genetics to environmental to
behavioral. And often causation is multi-variant and not one thing can be found to ‘cause’ cancer. In
recent years, causation has become more understood but there is still a long way to go.
Cancer is not one disease and seldom is there one cause. Hundreds of different types exist, and both
symptoms and severity vary with each individual. And as a yoga teacher, you will see many types
through your practice and teaching. Here are 2013 estimates of new incidence and deaths for the
United States.
“What causes cancer?
Source: What Causes Cancer? From News Medical Net written by Dr Ananya Mandal, MD
(http://www.news-medical.net/health/What-Causes-Cancer.aspx)
Cancers are a broad group of diseases and accordingly have a wide range of causes. Each cancer is
different according to its biology and pathophysiology. All animals and even plants are susceptible to
cancers.
The body is made up of trillions of living cells. These cells grow, divide, and die in an orderly fashion.
This process is tightly regulated and is controlled by the DNA machinery within the cell. In a baby or a
child normal cells divide rapidly to allow for growth. After the person becomes an adult, most cells
divide only to replace worn-out or dying cells or to repair injuries.
When cells of the body at a particular site start to grow out of control, they may become cancerous.
Cancer cell growth is different from normal cell growth. Instead of dying, cancer cells continue to grow
and form new, abnormal cells. In addition, these cells can also invade other tissues. This is a property
that normal cells do not possess.
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Cancer cells originate from normal cells when their DNA (deoxyribonucleic acid) or blue prints within
the cell nucleus is damaged. DNA is in every cell and it directs the entire cell’s actions, growth, death,
protein synthesis etc. when DNA is damaged in a normal cell the cell either repairs the damage or the
cell dies.
Normally, the body safeguards against cancer via numerous methods, such as: apoptosis or a process
by which abnormal cells die on their own accord, helper molecules (some DNA polymerases), possibly
senescence or aging, etc.
In cancer cells, the damaged DNA is not repaired, and the cell does not die. Instead it gives rise to
more such abnormal cells with abnormal DNA. These new cells all have the same defective DNA of the
original cancer cell.
DNA damage may be inherited from parents or may be a spontaneous problem that occurs during the
lifetime of a person. This is called a mutation. DNA damage may also be triggered by exposure to
certain environmental toxins such as those present in cigarette smoke. There are, however, multiple
factors that may cause cancer and it is difficult to pin point an exact cause.
Mutations may be:
•
Those in the error-correcting machinery of a cell. This may cause accumulation of errors rapidly
in the cell and its progeny.
•
Those in signaling (endocrine) machinery of the cell. This leads transmission of the error signals
to nearby healthy cells as well.
•
Those that allow the cells to migrate and disrupt more healthy cells away from the primary site
of origin.
•
Those that make the cell immortal so that the abnormal cell refuses to die.
Risk factors for cancer
According to World Health Organization (WHO), common risk factors for cancer include:
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Tobacco use
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Alcohol use
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Overweight and obesity
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Dietary factors, including insufficient fruit and vegetable intake
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Physical inactivity
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Chronic infections from helicobacter pylori, hepatitis B virus (HBV), hepatitis C virus (HCV) and
some types of human papilloma virus (HPV)
•
Environmental and occupational risks including ionizing and non-ionizing radiation
Cancer-causing agents
Agents that may cause cancer include:
•
Chemical carcinogens
Several chemicals and environmental toxins are responsible for changes in normal cellular DNA.
Substances that cause DNA mutations are known as mutagens, and mutagens that cause cancers
are known as carcinogens.
Particular substances have been linked to specific types of cancer. Tobacco smoking is associated
with many forms of cancer, and causes 90% of lung cancer. Similarly, prolonged exposure to
asbestos fibers is associated with mesothelioma.
Tobacco is also related to other cancers such as lung, larynx, head, neck, stomach, bladder, kidney,
oesophagus and pancreas as it contains other known carcinogens, including nitrosamines and
polycyclic aromatic hydrocarbons.
•
Ionizing radiations
Radiations due to radon gas and prolonged exposure to ultraviolet radiation from the sun can lead
to melanoma and other skin malignancies. Radiation therapy given for one type of cancer may also
cause another type of cancer. For example, those who receive chest radiation therapy for
lymphomas may later develop breast cancer.
•
Viral and bacterial infections
Some cancers can be caused by infections with pathogens. Notable among these include liver
cancers due to Hepatitis B and C infections; cervical cancer due to infections with Human Papilloma
virus (HPV); Epstein Barr virus causing Burkitt’s lymphoma and gastric or stomach cancer due to
Helicobacter pylori infection.
•
Genetic or inherited cancers
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Common examples are inherited breast cancer and ovarian cancer genes includingBRCA1 and 2.
Li-Fraumeni syndrome includes defects in the p53 gene that leads to bone cancers, breast cancers,
soft tissue sarcomas, brain cancers etc. Those with Down’s syndrome are known to develop
malignancies such as leukemia and testicular cancer.
•
Hormonal changes
Notable among these are changes in the female hormone levels estrogen. Excess estrogen
promotes uterine cancer.
•
Immune system dysfunction
Impaired immunity including HIV infection leads to several cancers including Kaposi's sarcoma,
non-Hodgkin's lymphoma, and HPV-associated malignancies such as anal cancer and cervical
cancer.”
As just explained, getting cancer is a mix of both controlled and uncontrolled factors. And pinning down
the particular cause is very challenging. But some of the above facts gives us a hint at a powerful tool
to prevent and manage cancer… the human body itself. We will explore that in the following section.
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