why I teach Yoga. Yoga as part of Stroke Recovery.. The Lived Experience

in August 2018 I suffered a stroke, caused by a Carotid Artery dissection.  Having a stroke was not what drew me to Yoga in the first place,however it was definitely the catalyst for my decision to become a Yoga teacher.

I have been interested in and practiced some form of Yoga, since I was a teenager. It has been a thread which has woven itself through my life, sometimes re-emerging and sometimes disappearing into the background when jobs, family or moving to different parts of the country took over. In 2014 I started to realise that when times were harder or busier, that was not a time to stop Yoga but a time to increase my practice and find space and time from within, rather than wait for external circumstances to change.This led to a weekly practice, sometimes twice a week until two years ago when, following a freak accident, my Carotid Artery tore and I found myself, age 55, in Durham Stroke Unit.  85% of strokes are caused by a blood clot - the other 15% by a bleed. Parts of the brain are either starved of blood, oxygen and nutrients, or damaged by the bleed. Strokes have been described as an ‘earthquake in the brain’ and so the severity of the damage depends on how extensive it is and which regions it damages.  It can include 

  • Weakness on one side
  • Loss of speech
  • Loss of functional movement
  • A change or loss of Spatial awareness
  • Changes in cognitive functions (thinking, reasoning, judgment, and memory)
  • Psychological issues such as post stroke depression, anxiety, Post Traumatic Stress Disorder, post stroke fatigue


The resulting trauma is individual and unique to each person but it is without a doubt a fracturing of the mind and body - what could be done easily before and without thought, now becomes difficult or even impossible. It is a loss of sense of self, a disconnect between mind and body. Without even realising it at the time, Yoga was my antidote to this - it was not about a cure or ignoring traditional medicine, but using an additional and holistic approach to bring my mind and body back together.

Yoga in Sanskrit means to yoke or reunite - to bring together the whole mind, body and spirit through a regular Yoga practice. Yoga is also ideally placed as an additional rehabilitation practice, because it can be easily adapted to the limitations of each individual, taking into account contraindications such as high blood pressure and physical restrictions. Modifications can be made to the physical postures using props, such as a chair or bolsters and avoiding inversions or neck twists. Even someone in the early stages of recovery can engage in breathwork, meditation and visualisation. Depending on the severity of the stroke it does not have to be seen as  a progressive or deteriorating disease like MS and so improvements can still be made many years after the event.

I have always been a very active person, running, climbing mountains, walking, doing hiit workouts, gym and Yoga - as well as the daily activities around looking after three boys. To find myself in a stroke unit felt incomprehensible and after the initial shock and treatment, I think I went into denial - realisation only dawned on me when I could finally make my own way to the toilet and found that the unit was actually full of really sick people. I had weakness on my left hand side, a leg that did not follow instructions and a strange perception of space-so several cups of coffee went on the floor due to missing the table. I was sent home, after an assessment deemed me to be safe, with a bag of medication and little other advice. Friends called by - all supportive and happy to see me so cheerful and family looked after me, although I didn’t want them to worry. So as the weeks went by I found myself exhausted, anxious and maybe even slightly low, re-living the stroke, the feelings and surroundings at the time, embedded in my brain making it difficult to sleep or to concentrate.The fear about what had happened but also a fear for the future. Even now I can’t see a flickering light without thinking it is happening again and many a supermarket trolley has been left abandoned (the stroke happened in a Sainsburys branch), as my heart pounds and I test my leg and arm to see if they still function. I went back to work too early, believing that if I was at work and not ‘overthinking’, then life would go back to normal. This just led to more anxiety and more exhaustion - days off work and weekends spent on the sofa. Something had to change. My Yoga mat was still out where I had left it and so, without much deep thought or contemplation at the time, I began a daily practice. I assumed when I started writing this project that I would find many trials and research projects to back up my innate feeling about how Yoga has, and is helping me to deal with this incident, maybe it could even be described as a trauma.

However, surprisingly, despite lots of pilot studies and trials, absolute scientific data is scant. Most end up hinting at the positive effect, but without scientific data to back it up absolutely. Studies published up to 2019, mainly funded by the US Government and the National Stroke Association in Australia, all conclude that further larger scale and more robust trials are required.They concluded that the trials were not large enough, data was incomplete, expectations were possibly too great for a 10 week intervention of a twice weekly class.The classes generally consisted of Asanas but included Pranayama and Meditation too - there appears to be little consistency or discussion on how these classes were structured. In many, the research efforts focussed purely on motor disability, speech and language and cognitive dysfunction, rather than include the psychological damage - anxiety, depression and loss of sense of self. Despite these limitations the findings were still classed as “statistically significant and clinically meaningful”.

Eastern medicine has always had a more holistic approach, whereas Western medicine  typically focuses on the physical body and disease/illness, sometimes forgetting the emotional influences which can slow recovery-stress, worry, negative self talk and depression. However mind/body interventions are steadily gaining recognition in chronic illnesses and are certainly seen as a way to deal with depression and promote resilience which in turn can encourage a physical healing process. Following the studies over the last ten years, the same themes emerged from all the research, but not all were measured quantitative outcomes. Stroke participants self- reported improvements in their quality of life. A feeling of being calm and aware of sensations and connection to their  bodies, which was leading towards a feeling of greater confidence and self-reliance. Extensive emotional changes were reported such as feeling less anxious, less depressed and less reactive, “ feeling more like their old self”. The participants also perceived physical improvements too in strength, range of movement and balance.

On-going research is still happening and Arlene Schmid, an Occupational Therapist, Yoga therapist and a leading researcher working in the area of stroke rehabilitation at Colorado State University, is confident in the belief that Yoga has an integral and valid part in rehabilitation for stroke and other brain traumas. She concludes from her research and observations in clinical interventions that the practice must include Pranayama, Meditation and Mantras - as well as physical Asana. She says, “ while Yoga is 5000 years old,Yoga and Yoga Therapy are relatively new topics of research, but we have seen improvements in cognitive, emotional and physical changes that commonly occur after a stroke”. In the early days, I sometimes only laid on the mat and wondered ‘what next’, but as my confidence grew I began to explore my breath, physical body and mind, in a safe and absorbing way-still unable to express the changes to anyone else. Why was I feeling better - was my new sense of self a natural progression of time passing or could the Yoga be having some effect…?

These thoughts have led me to read more about Neuroplasticity. For many years the mainstream thought was that brain plasticity stopped in childhood.This is not the case, the brain is able to regenerate throughout our life time and can re-establish and make new neural connections. Nerve cells called neurons signal to each other and those lightning fast connections enable everything from our bodily movements to thoughts and emotions.The more we use a pathway the more it becomes established. However the brain can make new connections, as well as making established ones more efficient. If the brain is challenged with new situations, it can reorganize and restructure itself in order to respond to that situation.The more it is exposed to the challenge then the more the new pathway establishes itself. Our brains are constantly shaped by movement and thoughts-often unknowingly. Within a Yoga practice, if we place our focus and attention on our movements, on our body and on our breath, then our brain and nervous system is thought to rewire itself, according to where we place our focus and awareness. Keeping our focus and attention while in a particular posture and with repetition, creates more neural connections as our brain maps out the body's movement. The more we do something and the more awareness we bring to that movement, the better the brain becomes at noticing the subtlety of what we are doing. Repetition is key to activating Neuroplasticity. Stroke patients often have a side that is hemiplegic - paralysis on one side of the body, a weakness, problems with muscle control or muscle stiffness. Repeat practices on this side result in better outcomes due to new or re-establishing neural reconnections. These practices can be done via visualisation too - imagining limbs or fingers moving.Visualisation can be incredibly powerful and now an accepted psychological practice.Visualisation activates the reticular activating system and the brain responds as though whatever is being visualised, is happening.The Reticular Activating System (RAS), filters the information between the conscious and the unconscious mind. It thinks in pictures not words and cannot tell the difference between reality and imagined reality. The brain creates the same neural connections that tell the muscles what to do whether it is real or imagined. It is also worth mentioning that the RAS also responds to negative thought patterns. A positive approach to recovery and the belief that improvement can be made, however slowly, is vital. The neuroscience saying “ neurons that fire together wire together”, reflects the ancient yogic saying, “ As you think, so you become.”

Meditation is one of the eight limbs of Yoga and an essential component of a Yoga practice.

Studies on Meditation using MRI scans, have shown how, not only are there changes in the way the brain functions, but also changes in the physical structure of the brain. It has been proved that regular meditation increases the grey matter in the brain - the area that is responsible for emotional regulation and attention. In a study in 2013, 20 mins of meditation was added to a stroke rehabilitation programme.The meditation group showed greater improvements in low mood/depression, less fatigue and improved balance, compared with the non-meditating participants.

Mantras can also be used with Meditation as well as embedded in an Asana practice - including using a positive intention or a Sankalpa. Following a stroke there is often a focus on what a patient can no longer do. I remember calling my left side my ‘bad side’, my “bad leg”, “ the side that doesn’t work”- a disconnect from half my body, focusing on the negative. Using positive visualisation ,Mantras and Sankalpas can help heal this disconnect and bring a strength back to mind and body - using intention or  Mantras such as “ I am strong”, “I am whole,” “ I am stable,” “ I am healthy.” The yogic and scientific  idea is that positive thought will embed in the mind and body and become part of the healing process. Instead of focusing on things that hold you back, focus on things that can improve. Instead of imagining doomed scenarios “ this side will never be the same again”, try with positive thought and action and positive mental energy towards improvement - however small.

Positive thoughts are good but changes in the brain happen in two ways, top down and bottom up. Top down is the executive part of the brain (the prefrontal cortex), using rational thought. If we are saying to ourselves, ”I am balanced”, but not making any attempt to practice balance, the body and brain will not believe it. The body must feel it too - with breath, with movement with visualisation - this is bottom up. Bottom up comes from the brain stem, experiencing things differently via the body, the embodiment of sensations. Yoga enables this to take place.

The breath is the gateway to the autonomic nervous system-long slow breaths and mindful movement send signals to our body that all is well.This activates our Parasympathetic Nervous System (PNS), with the Vagus nerve playing a major role. The Sympathetic Nervous System (SNS), activates in response to fear or threats, or even normal activities, such as music/drama performances, or job interviews which need a healthy amount of adrenaline. A healthy SNS responds to our body’s need for action - an increased heart rate and release of cortisol and stress hormones. Both systems are valid and needed but sometimes we can be too much in one or the other. Hyperarousal - panic, anxiety and agitation or hypoarousal - low mood, depression, burnt out. After my stroke, I found myself too often in flight or fight, my SNS activated in a state of hyperarousal - heart pounding, very close to panic, high blood pressure, feeling sweaty and full of fear, often waking in the night - my body constantly perceiving an ongoing threat.This was often followed by exhaustion when I felt low and exhausted and could not move off the sofa.Yoga has been an antidote to this, enabling me to recognise sensations in my body and thoughts in my mind, which in turn has allowed me to respond in an appropriate and balanced way and move mind and body to a place of wellness and wellbeing.

There is no space to allow time to discuss the variety of yoga Asana available for stroke rehabilitation, but I do want to mention Contralateral and Cross Lateral or Cross Crawl movements. Cross Crawl means that opposite sides of the body work together to coordinate movement. Humans are contralateral beings, walking, running. We thrive on Cross Crawl movement because it accesses and develops the Hippocampus which is the part of the brain that affects memory and concentration, as well as being the part of the brain which processes information about stress and depression. Cross Crawl creates neurological impulses to pass freely between the right and left hemisphere via the Corpus Callosum. Cross Crawl helps to integrate the Vestibular System (balance) and Spatial Awareness - Proprioception. It creates optimal brain functioning for eye hand coordination as well as memories - all vital in stroke recovery when we need to stimulate brain and nervous system development and integration.

 Although I am not a scientist, I hope my essay still holds some evidence based theories to back up my thoughts. It is, however, largely written from a felt sense of what this time, post stroke, has been for me. It is an essay about how Yoga has enriched my recovery and led me on a pathway towards a deeper practice and the inevitable step of becoming a Yoga teacher. Everyday I think how lucky I am because  the effect of my ‘earthquake’ could have been so much worse - as it is for thousands of others.

The more I study and practice Yoga, the more I realise what potential it has to enable me and others to live in the present and find a calmer and more purposeful, as well as practical way to approach the difficulties life sometimes sends our way. BKS Iyenger in his book “Light on the Yoga Sutras of Patanjali” says,  “Yoga is an Art, a Science and a philosophy. It touches man at every level, physical, mental and spiritual”. 

To conclude, I can find no words better than my favourite poet and writer John O'Donohue, who talks about thresholds in life - moving from one to another and trusting your own internal senses to know how to negotiate the transition. A new way of being, to move or end one part of life, but to step into and start another. 

To Bless the space between Us  John O’Donahue-Irish Poet, Author and Philosopher and Priest 1956-2008

“To acknowledge and cross a new threshold is always a challenge. It demands courage and also a sense of trust in whatever is emerging. This becomes essential when a threshold opens suddenly in front of you, one for which you had no preparation. This could be illness, suffering or loss. Because we are so engaged with the world, we usually forget how fragile life can be and how vulnerable we always are. It takes only a couple of seconds for a life to change irreversibly. Suddenly you stand on completely strange ground and a new course of life has to be embraced”.

Yoga is now my way of finding my own guiding light, my internal sense of self so that I can trust in the possibilities that each threshold has to offer, even though each threshold can contain a complexity of emotions - fear, sadness, excitement, confusion as well as hope. By Yoga I mean not only postures, breath and meditation but also ethics which are rooted in an ancient historical practice, but can be adapted for the modern world.This has resulted in so much more than, “will Yoga help my left leg move again?”


Calm Soul Yoga

bibliography and references

  • Jill Bolt Taylor Ph.D.- My Stroke of Insight.A Brain Scientist's personal Journey.   
  • Matt Moore- Neuroplasticity.                                                                     
  • Deborah Adele-Yamas & Niyamas                                                                 
  • Arlene A Schmid & Marieke van Puymbroeck-Yoga Therapy for Stroke    
  • Iyengar BKS-Light on the Yoga Sutras of Patanjali
  • Centerhealthyminds.org
  • Marion Buckwalter-Ted Talks
  • Kristine Weber-Subtle Yoga. The Neurobiology of Yoga
  • Henry Hoffman-Benefits of Yoga for Stroke Recovery-Blog
  • John O'Donohue-To Bless the space between Us


  • Effects of mental practice on affected limb use and function in chronic stroke | SJ Page, P Levine, AC Leonard | Archives of physical medicine and rehabilitation 86 (3), 399-402 2015
  • Poststroke Balance Improves With Yoga: A Pilot Study 2012 | Arlene A. Schmid, Marieke Van Puymbroeck, Peter A. Altenburger, Nancy L. Schalk, Tracy A. Dierks, Kristine K. Miller, Teresa M. Damush, Dawn M. Bravata and Linda S. Williams
  • Buddha's Brain: Neuroplasticity and Meditation | Richard J. Davidson, Director and Antoine Lutz, Associate Scientist 2010
  • Yoga and Mindfulness as Therapeutic Interventions for Stroke Rehabilitation: A Systematic Review 2013  Asimina Lazaridou, Phaethon Philbrook, and Aria A. Tzika 
  • Yoga for stroke rehabilitation 2017 | Maggie Lawrence, Francisco T Celestino Junior, Hemilianna HS Matozinho, Lindsay Govan, Jo Booth, and Jane Beecher
  • A yoga-based exercise program for people with chronic poststroke hemiparesis | Julie V Bastille 1, Kathleen M Gill-Body 2008