I just got back from teaching a triple Bikram class and had two students with separate instances of Tetany Syndrome in tonight.
Fortunately, these two new students experienced the symptoms fairly mildly and managed to continue to the end of class. Unfortunately, this is something that occurs regularly in the hot room and is worth being informed about as a teacher or practitioner.
It really concerns me that there are now a lot of yoga teachers of other styles currently realising and teaching the benefits of a Bikram class, but either they have had no training in the heat whatsoever, or their training is minimal. They might not have any idea of how to deal with certain heat related issues, or simply how people behave when they are not used to being in the hot room.
Tetany is caused by dehydration and/or hyperventilation and is exacerbated by low levels of carbon dioxide in the blood.
If your student is already thirsty and reaching for the water before Eagle then they may be already dehydrated!
Bikram yoga or heat exhaustion are often listed as the causes of Tetany Syndrome. One 90 minute Bikram class is not going to cause dehydration, but it will highlight a perpetually dehydrated person soon enough! I have practiced Bikram Yoga for 15 years and experienced many things in the heat, but never once Tetany. It’s clear that it is not Bikram yoga causing Tetany, but more often how people react—breath!—in a Bikram yoga class. Mouth breathing lowers the CO2 levels in the blood, which then combines with a lack of calcium resulting in Tetany Syndrome.
”Low levels of carbon dioxide, most commonly caused by hyperventilation (over-breathing), can cause tetany by altering the albumin binding of calcium such that the ionised (physiologically influencing) fraction of calcium is reduced. So, if someone over breathes it is possible that they can reduce the amount of calcium available causing their feet and hands to spasm.
If the spasms have been brought on through hyperventilation, the casualty must be reassured and encouraged to slow their breathing rate down in order to correct the carbon dioxide imbalance that has built up through over-breathing.”
Prevention is better than cure! So notice who is ‘mouth breathing’ or chugging their water too quickly. Remind them to take small sips only and to breathe normally and slowly through the nose with the mouth closed.
These are likely to be newer students; usually very muscular men who have been taught to breathe through the mouth for running or other forms of exercise, or very slim young girls who maybe haven’t eaten much in the last 24 hours. These are the two most common body types I have noticed that are most susceptible to Tetany.
The Five Step Plan:
1) Be aware.
You might notice your student looking down at their hands with a confused face and maybe even opening or closing their fist as if they can’t feel their hand. One of the first things someone suffering with Tetany experiences, besides a little dizziness or nausea, is a tingling or numbing of the hands and fingers. This may also include the feet and even the tongue as all of the nerve cells have become stimulated. They may also experience cramping or ‘curling in’ of the limbs which can be scary for them—and very unnerving for whoever is teaching them and the rest of class!
2) Be confident! If you are confident, your student will also be confident!
Ask them what’s going on with their hands if they are clenching them. If they say they ‘feel funny’ or similar, then make ’em laugh to relax and reassure them and those around them, address your student by name and tell them that although the condition can feel odd it will pass and is not dangerous.
I always remind students that breathing through the nose burns more calories than breathing through the mouth—that normally closes the mouth up pretty quick!
3) Ask them when they last ate.
Give them an electrolyte sachet or a coconut water if it’s been more than a couple of hours.
This is usually enough for most students to relax enough to breathe through their nose—they have a ‘cure’! The ingredients in most electrolyte sachets will increase calcium, magnesium and hydration levels and sometimes just the distraction of putting a sachet in the bottle of water is enough to allow them to relax a little into breathing normally through the nose. Rarely, you might have a student whose hands are cramping so severely you will need to put their electrolytes in their water for them —help ’em out, smile sweetly and remind them it’ll pass and that we all have bad hair days in the hot room!
4) Allow your student to kneel down and encourage them to watch.
This may prove challenging as the two body types most prone to Tetany in the hot room tend to be Type ‘A’ over-achievers—typically who will be naturally reluctant to take a break. Check on them regularly, give ’em a thumbs up and encourage them to have another go at joining in with the rest of the class when they feel okay again.
If you feel like you have reiterated the point about ‘breathing through your nose’ one too many times then give ’em a wink next time they try to catch your eye and just tap the tip your nose with your index finger to remind them to nose-breathe as you carry on teaching the rest of the class.
5) If all of the above has not nipped Tetany in the bud…
Get your student to breath into a paper bag (most Bikram/Hot Yoga Studios are organized enough to tuck a folded paper bag in the ‘supplies’ box on your teaching podium.) This is a very last resort and can be tricky to use effectively as you have to cover the nose and mouth in the bag.
They may naturally want to leave the room, but encourage everyone to stay and finish class if they are not too freaked out (leaving the room for the last 10 minutes won’t actually improve the condition anyway as there is likely less CO2 outside the room than inside.) Your student will feel super proud of themselves when 90 minutes is over and they did it! Chances are, this will never happen to them again and they will have learnt to look after themselves before and during yoga practice for the next class.
“Nose is for breathing—mouth is for eating.” ~ B.K.S. Iyengar
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