Arthritis, Exercise and Yoga

by Nina

Hey, I heard this really nice little piece on arthritis and exercise on NPR that I wanted to share with you. Fortunately, NPR has both the audio and a transcript of the piece on their web site (see here). What I liked so much about this particular piece was how simple and clear it was about why it is important to continue to exercise when you have arthritis (even though most people don't) because exercising, while it cannot reverse arthritis, is the only way to prevent the arthritis from getting worse. Here's why:

1. Arthritis breaks down your cartilage, the natural shock absorbers in your joints. As a result, blood doesn't circulate as freely and doesn't deliver adequate nutrition to your cartilage. Exercise massages the joints, improving the blood supply to the joints, providing your cartilage with more nutrition.

2. The stronger the muscles are around the joint, the more protection your body can provide for the joint. Your muscles take up the weight and pressure, instead of the joint itself.

The end of the piece even mentions yoga as a good way to improve the strength of the muscles around your joints! (That's refreshing because most people are under the misconception that yoga is only about stretching.) But yoga is also a good way to massage your joints to get the blood flowing because in a well-rounded practice you move your joints in every direction. Just think of all the directions in which your hip joints move in the various standing poses. And your knee joints are bent or straight, turning out to the side or even turning in slightly (such as in Eagle pose). Your shoulder joints really get a workout, too, as you hold your arms overhead, out to the side, behind your back, or across your body (again, as in Eagle pose).

For strength building, it's easy to think of standing poses (especially those with bent knees) and balancing poses that strengthen the muscles around the knees and hips. But what about your shoulder joints? Downward-Facing Dog and Plank pose spring immediately to mind because you are bearing weight on your arms as they extend forward. But there are also other poses that you can use to strengthen your shoulder joints in which you bear weight on your arms reaching sideways (such as Vashistasana, sometimes called Sideways Plan pose) or behind you (such as the backbend Purvottanasana, sometimes called Upward Plank pose). Here's Esther doing Purvottanasana:

That looks like it does a good job strengthening the hip joints, too! Yeah, it can definitely be a challenge to practice with pain in your joints or to practice modified versions of poses you used to be able to do without props (I know because I have mild arthritis in one of my hip joints), but enjoying more mobility in your daily life and possibly avoiding joint replacement surgery, well, that's a pretty big payoff.

What is Mindfulness?

by Nina

In Baxter’s post yesterday (see here), he described how a student of his, after a day of mindful yoga, was able to achieve a state of detached awareness that helped her deal more effectively with her teenaged son. And in my original post on the relaxation response (see here), I mentioned mindful yoga practice as one of several ways to trigger the relaxation response. So today seemed like a good day to explain what we mean by mindfulness and to say a little about how it helps.

“All of us have the capacity to be mindful. All it involves is cultivating our ability to pay attention in the present moment.” —Jon Kabat-Zinn

Poppy by Joan Webster

You might not realize this, but your thoughts alone can make you stress out. Worries about the future, regrets over the past, and judgments about yourself and others can trigger the stress response because you are essentially telling yourself that you are danger! In fact, in many cases, it is your thoughts about what’s going on that makes you stress out, not the situation itself.

Practicing mindfulness means becoming an impartial witness to your thoughts and experiences as you have them. To do this, step back and tune into the constant judging and reacting to inner and outer experiences that constantly stream through your mind.

“The eye is for seeing; the mind creates doubt; the wisdom faculty is for ascertaining [the nature of things]; the Field-Knower abides as the witness of all these processes.” —Moksha-Dharma

Yogis believe that there is a witness or drashtri (the Field-Knower, the Seer or Pure Awareness) present in all of us. And this witness is the spark of the divine, the single, incomprehensible consciousness that unites all beings, that dwells within.

So how does this witness help with stress levels? Being in mindful state gives you a break from obsessive thoughts about the past or anxiety about the future. And when you are free from stressful thoughts of danger, the relaxation response kicks in.

Pineapple Sage by Joan Gibson

Being mindful also teaches you to recognize the physical and mental symptoms of stress so you can nip them in the bud by using your favorite stress management techniques. And it teaches you about your thought patterns, so you can learn not to react on “auto pilot” (Baxter’s story about Maleena is example of this), which can give you the ability to live more peacefully.

To practice mindful yoga, simply bring your witnessing frame of mind into your yoga practice. Jon Kabat-Zinn expresses how to do this so well that I’m going to quote him:

“We practice yoga with the same attitude we bring to the sitting mediation or the body scan. We do it without striving and without forcing. We practice accepting our body as we find it in the present, from one moment to the next. While stretching or lifting or balancing, we learn to work at our limits, maintaining moment-to-moment awareness. We are patient with ourselves. As we carefully move up to our limits in a stretch, for instance, we practice breathing at that limit, dwelling in the creative space between not challenging the body at all and pushing it to far.”

You can also practice yoga as a moving meditation by focusing on your breath during your practice or on a particular physical sensation, such as spreading your toes evenly on the ground in all your poses. Mindful yoga is one of my favorite ways to de-stress, as I bring into my home practice subtle physical alignment tips I learn from my regular teacher, and then just experiment and feel....

Detachment, Discrimination, and Mindful Yoga

by Baxter

At my recent workshop at The Yoga Project in Sellwood (see here), many insightful stories were shared among students over the course of our two days of practice together. One of my favorites came from Maleena on Saturday at the start of class. Maleena was one of the students who had taken both sessions on Friday. The practices we did that day included slower, introspective practices that involved noticing and feeling without jumping to judgment on the insights we perceived. An emphasis on grounded observation was encouraged throughout. Pranayama practices that were cooling, and long Savasanas were also a part of our work that first day.

Maleena mentioned a shift in reactivity that she had noticed upon returning home to her family on Friday evening. Maleena is a mother of three sons, ages 13, 15 and 18, and this night the 18 year old was up to some old patterns of interaction that would normally get Maleena stressed and worried, and could lead to a confrontation. But, to her surprise, she found that she was able to listen, observe and find curious the behavior her son was displaying without her usual emotional reaction.

Clouds Blowing By by Brad Gibson

As we explored this quite welcome discovery, it seemed that the slower, introspective yoga practices had grounded her is such a way that her old pattern had shifted. In yoga philosophy, this skill is known as vairagya, or detached awareness. The Yoga Sutras by Patanjali tells us that the practice of detachment is an important part of what it means to be a yogi:

“Renunciation is the practice of detachment (vairagyam) from desires.” Yoga Sutra 1.15, trans. B.K.S. Iyengar

This “detached awareness” does not imply Maleena did not care deeply about what her son was saying or feeling. But vairagya permits a yogini to have some space with which to apply another essential component of yoga, viveka, or discrimination, in order to chart a beneficial course of action for all involved.

 “The ceaseless flow of discriminative knowledge (viveka) in thought, word and deed destroys ignorance, the source of pain.” Yoga Sutra 2.26, trans. B.K.S. Iyengar

And, of course, the more one mindfully practices, the more readily these new habits, or beneficial samskaras, supercede and eventually replace the older, obsolete reactions. This is one of the many milestone changes that take place as we deepen our practice that let us know we are on the right path. Thanks, Portland yoginis! I’ll see you in March! 

For those of you who are interested in learning more about mindful yoga, Nina will be writing a separate post on the topic this week.

Friday Q&A: Cautions for Inversions

Q: I’ve heard that some people should not do inversions, but you didn’t mention this in your post on Wednesday about inverted poses. Could address this?

A: Oops! My bad, as Buffy would say. It’s true that for certain medical conditions, inverted poses are, as they say, contraindicated. So I’m sorry I did not mention this earlier in my post "Just in Time for the Holidays: Inverted Poses".

First off, the poses you may need to be concerned about only include the full inversions and some of the partial inversions that are held for long periods of time.

If you have high blood pressure that is uncontrolled with medication, you should not do inverted poses, because, as I explained in my post (see here) they temporarily raise your blood pressure. And even if your high blood pressure is controlled with medication, talking with your doctor before doing full inverted poses is probably a good idea. People with heart problems should also consult their doctors.

If you are having eye problems, such as glaucoma or detached retina, inversions should also be avoided. Likewise, if you've recently had oral surgery. And those with neck problems should avoid the inversions that put pressure on their necks.

People with back problems will probably find that at least some of these poses may cause back pain, in which case, you should please come out of the pose and find an alternative (I’ve noticed Supported Bridge pose and Legs up the Wall pose can cause difficulties for people with lower back problems).

There are many yoga teachers who do not recommend inverted poses for women who are menstruating. However, as far as I know, there are no scientific studies to back up their concerns. What I recommend is that each of you do your own research on the subject, talking to your teachers, your gynecologist (I did that), and other female practitioners, and make up your own mind based on their advice.

Finally, if you are pregnant and not already experienced doing inverted poses, this is probably not the best time for you to start.

—Nina

Just in Time for the Holidays: Inverted Poses

by Nina

In my original post about the relaxation response and yoga (see here), I mentioned that inverted yoga poses are one of the many ways you can trigger the relaxation response. Inverted poses are my personal go-to stress busters of choice, and if I could get my hands on Paul Weston (see here), I’d certainly teach him one or more of these amazing poses. So today I’m going to explain what I mean by “inverted poses,” and I’ll also provide some scientific background on them because understanding why these poses work can help you get the most out of them. Okay, here goes:

Any yoga pose where your heart is above your head is considered to be an inversion. Inverted yoga poses include full inversions, such as Headstand and Shoulderstand, where your heart is directly over your head and the rest of your body is also fully inverted. Also included as inverted poses are partial inversions, such as Downward-Facing Dog pose and Standing Forward Bend, where your heart is less directly over your head and your legs are either not fully and not at all inverted.

Standing Forward Bend from Yoga: The Poetry of the Body

The reason these poses trigger the relaxation response turns to be related to the mechanisms that control your heart rate and blood pressure. The nerves that control your heart rate and blood pressure are regulated through pressure sensors called baroreceptors. Your baroreceptors are located in the wall of each internal carotid artery at your carotid sinus (the arteries on each side of your neck that carry blood from your heart to your brain) and in the wall of your aortic arch (just above your heart). These baroreceptors detect any changes in your blood pressure, stretching when blood pressure is high and shrinking when blood pressure is low.

If your baroreceptors detect a fall in your blood pressure, they send signals via your nerves to increase your heart rate, constrict your blood vessels to raise your blood pressure, and switch your nervous system to fight or flight mode. Likewise, if your baroreceptors detect abnormally elevated blood pressure, they send signals to slow your heart rate, relax your blood vessels to lower your blood pressure, and switch your nervous system to relaxation mode.

In an inverted pose, your heart is higher than your head, the opposite of its position when you are upright. With your heart higher than your head, gravity causes more blood to flow in the direction of your head, creating more pressure than usual on your carotid sinus and aortic arch. As the arterial pressure is increased, your baroreceptors are stretched and signals are transmitted to your central nervous system as if your blood pressure was high throughout your body. Feedback signals are then sent back to your body to reduce the arterial pressure, slowing your heart rate, relaxing your blood vessels, and releasing hormones that decrease adrenaline production. This automatically switches your body to relaxation mode.

In addition, inverted or partially inverted poses where your neck is flexed (that is, your chin is pointing toward your chest), as in Shoulderstand, Plow pose, or Bridge pose, puts additional pressure on your carotid sinus (the arteries on each side of your neck that carry blood from your heart to your brain). This added stimulation of your baroreceptors may enhance the calming effects of the inversion.

How simple is that? As long as you are warm, quiet, and comfortable in the inverted pose, all you have to do is let pose work its magic! Naturally, supported versions of the poses (such as Shoulderstand with a chair or Bridge pose on blankets) are more relaxing than straight versions of poses in which you must support yourself, so if you’re practicing inversions for stress reduction, choose the supported versions.

In the coming weeks, I’ll provide details about the various inverted poses, but until then, the following is classic sequence of calming inversions. You can do any or all of these poses, but if you do more than one, I recommend doing them in the order shown below.

1.    Downward-Facing Dog pose, with your head resting on a block or folded blankets (1 to 3 minutes)
2.    Standing Forward Bend, with your head resting on a block or with folded arms and head resting on a chair seat (1 to 3 minutes)
3.    Wide-Legged Standing Forward Bend (Prasarita Padottansansa), with your head resting on the ground, a block, or the seat of a chair (1 to 3 minutes)
4.    Headstand (3 to 10 minutes)
5.    Shoulderstand, with a chair (3 to 10 minutes)
6.    Half Plow pose, with your legs supported by a chair seat (1 to 3 minutes)
7.    Supported Bridge pose, with your shoulders and head resting on the floor, your torso and legs supported by blankets or bolsters (5 to 15 minutes or longer)
8.    Legs up the Wall pose (Viparita Karani) with your pelvis supported with a bolster or blankets (5 to 15 minutes)

I’ve taught this sequence many times, and there are always people in each class who have difficulty with one or more of these poses. So I always teach a non-classic pose as well, Easy Inverted Pose (see here), because this is one pose almost everyone can do. Use this as a substitute for Shoulderstand, Plow pose, Bridge pose, or Legs Up the Wall pose, or just use it on its own.

Caution: Inverted poses may be unsafe for those with certain medical conditions (see here).

Larger Women and Yoga: Getting Creative

Tarot Garden by Baxter Bell

by Baxter

On my last teaching trip to Portland, Oregon, in February 2011, I was asked by studio owner Vilma Zaleskaite of The Yoga Project in Sellwood (see here), if I would be willing to offer a three-hour session to the students  in her Yoga for the Larger Woman class. You can imagine that as a skinny fella from Toledo, Ohio, I might think twice about such a proposition; but once I got grounded, I realized there was a lot I could share about my experience teaching students of all shapes and sizes, male and female, as well as my insights on how yoga could be a positive transformational practice for healthy aging.

Our first go around in February of this year was so well received that the students expressed interest in having an entire weekend experience of yoga. So I returned this past weekend for a 10-hour workshop with this enthusiastic group of practitioners. Topics we covered included healthy joints and improved mobility, and yoga for insomnia, digestion and metabolism, as well as stress and productivity. In addition to what I had to offer, I opened the floor up to discussion so I could also learn from this group of bright, intelligent and compassionate people.

What may seem obvious, but was often overlooked when these students attempted to take regular classes, is that most modern asanas are not that accessible to larger students, at least not the way they are usually taught. A lot of our work together focused on redefining the poses so that instead of cramming their bodies into the pose, the pose could be slipped onto them in a very appropriate way. I tried to encourage them to be creative, to think outside the “exact” structure of any given asana, and come up with ways to personalize the poses, so they will be more inclined to not only participate in class, but start to practice at home. One of the more experienced students echoed an idea we share with you here often: when she practices at home regularly, she feels better on many levels, but when she doesn’t, all bets are off. And it was so exciting to hear so many of the newer students already discovering positive benefits to the practice: improved sleep, mobility and ability to handle everyday stresses, and an improved relationship with their bodies.

Stay tuned for my next installment about how the practice changed the way one of these students dealt with unexpected stress....

Featured Pose: Hunting Dog

by Baxter and Nina

This week’s featured pose is one of Baxter’s favorite poses for lower back pain. Hunting Dog pose, which is a great precursor to strong poses like Warrior 3, is a wonderful way to tone and strengthen your upper body, especially the serratus anterior muscles, as well your pelvic stabilizers and core belly muscles. It’s also a good pose for anyone trying to improve core strength as well as strengthening the lower back.

Baxter prescribes this pose for:

• lower back pain
• balance issues
• fatigue (when standing poses are too tiring)
• improving right/left coordination
• building arm strength

General Instructions: Start by placing a folded blanket on the floor. Then come into a hands-and-knees position, with your knees on the blanket and your hands on the floor or yoga mat. Keep a neutral curve in your lower back and strong arms.

Next, slowly take your right leg back behind you into a lunge position, with your toes turned under and the ball of your foot on floor. Try to keep your pelvis area and lower back in the starting neutral position at all times—no tip, tuck or turn. 

If you are feeling stable, lift your right leg up until it is about parallel with the floor, but no higher. Again, no change to pelvic alignment!

Finally, consider reaching your arm forward parallel to the floor.

Hold the position for at least 6 breaths, and up to 16 breaths. When you release, shake out your left hand and wrist.  Repeat on the second side.

Cautions: If you are having lower back pain, keep the toes of your straight leg on the ground rather than lifting your leg. If you have wrist pain, bend your elbows and rest your forearms on blocks, rather than putting weight on your hands.

Any Activity is Better than None

by Nina

A recent article in the New York Times "Aging Well Through Exercise"  (see here) cited several studies on exercise and aging that confirm, once again, that through exercise you can preserve your muscle mass and your strength, and thereby avoid declining from vitality to frailty as you age. Here's a brief quote from the article:

“We think these are very encouraging results,” said Dr. Vonda Wright, an orthopedic surgeon and founder of the Performance and Research Initiative for Masters Athletes at the University of Pittsburgh Medical Center, who oversaw the study. “They suggest strongly that people don’t have to lose muscle mass and function as they grow older. The changes that we’ve assumed were due to aging and therefore were unstoppable seem actually to be caused by inactivity. And that can be changed.”

Yeah, well, we've pretty much all heard that by now. So what really struck me about the article, was the fact that all those scientists still haven't figured out what kinds of exercise are best for healthy aging, how much you need to do, or how intense the exercise needs to be. They're still researching questions such as: Is endurance exercise necessary for muscle sparing? Or weight training? 

In the end, the article concluded rather lamely: “What we can say with certainty is that any activity is better than none,” Dr. Wright says, “and more is probably better than less."

From Yoga: The Poetry of the Body by Yee with Zolotow

I pondered this for a couple of days, wondering how it applied to all us yoga practitioners. And I realized that the good news for us is that if any activity is better than none, we get to do whatever we want! So if you're thinking of starting a home yoga practice, go ahead and just do whichever poses make you happy. Or whichever poses intrigue you. Or whichever poses calm you down. Or whichever poses you want to learn to love. Or all the poses with animal names (I once did a practice like that with some children).

Hey Doc, What I Can I do About this Ringing in My Ears?

by Baxter

In the 20 odd years I have been working with patients, this question comes up a lot! And the challenging part for me as a healer is that western medical treatments don’t have much to offer the problem of Tinnitus, or ringing in the ears. Often related to exposure to loud noise over time (whether from work setting, environment or loud music), and therefore more common as we age, Tinnitus can range from a mild annoyance to a truly disruptive condition. I was hopeful for a while that acupuncture might provide some relief for my patients, but that modality has had minimal impact for those I have tried it with.  So you can imagine my delight when a friend of mine, who just happens to be a research psychologist at UCSF, mentioned in passing a study she had just completed, applying Mindful Meditation (MM), a system developed by Jon Kabat-Zinn, PhD, to Tinnitus. 

Although our resident scientist will immediately point out that the number of participants (only eight) makes predicting benefits to all suffers of Tinnitus a bit premature, I am still pleased to see that there was significant improvement for those in the study. If you don’t know about MM, it involves sitting meditation practices, breath awareness techniques and gentle movement practices--wow, that sounds like some other system I have heard of…yoga! And not surprisingly, since it is based on yoga asana and Buddhist meditation techniques. To read all about the study by Jennifer Gans and Robert Sweetow, click here. And to learn more about Jon Kabat-Zinn’s work, check out one of my favorite of his books, Full Catastrophe Living, while listening to your favorite music at a reasonable volume.

You're Too Late

by Nina

“From contentment, the highest happiness is attained.” Yoga Sutra II.42 (Edwin Bryant)

“This sattvic happiness does not depend on external objects, which are vulnerable and fleeting, but is inherent in the mind when it is tranquil and content.” Edwin Bryant

Too Late by Brad Gibson

We started out with an agenda. The plan was to go to the Japanese Garden in the Seattle Arboretum to see the Japanese maples in their brilliant fall glory. But we we arrived, the garden was closed until February. We peeked in through gate—what we could see through the bars looked gorgeous. The arboretum itself was open and we could see from the road that mixed in with the evergreens there were still trees in brilliant scarlet, orange, and yellow, so I asked the gardener just outside the gate of the Japanese Garden where we should go to see the best fall color. But he just waved his hand dismissively and said, “You’re too late. It’s over.” I said, “Not to us. And what I can see of the Japanese Garden through the fence still looks beautiful.” He shrugged and said, “You should have been here last week.”

  

On our late fall walk along the Azalea Path, we not only saw beautiful fall leaves, but also mushrooms and berries and moss and even a few late flowers. Look!

Moss and Berries by Brad Gibson

Thursday Q&A: Head Rolls

Q: I note that you don’t recommend 360 head rolls, but there seems to be great variation in this among yoga instructors (as well as other types of instructors). Could you please explain the issues with particular reference to us older folks?


I don’t do neck rolls that move the head back into extension, especially if I have older students in class, as there is a risk of causing pain in the neck from several sources, including the facet joints, nerves and vertebral artery.

I prefer to introduce gentle neck extension against gravity via poses like Locust and Cobra, where there seems to be less chance of trouble arising in this area. I also teach to variations of neck releasing movements to my students. One, called Owl Turns, involves looking to the right or left as far as you can go with a bit of stretch. The second one, called Curious Dog Tips, involves tipping the head to right or left as far as you can go with a bit of stretch, ear to shoulder on that side.


--Baxter

Friday Q&A: Feet and Comments

Q: I have a lot of trouble with Tree pose, which I know I need to do to help my balance. I find that I have problems with my feet feeling wobbly and insecure, not the rest of me, my feet, like I can’t get them flat and in solid contact with the floor. I usually wear custom orthotics because of my knees/arches, so I wondered about this being a factor in my feet feeling so weird (I love being barefoot but find it is harder on my knees). So I tried Tree pose with my shoes on, and found I could do it much, much better. Just felt so much more solidly rooted. However, I don’t really want to do yoga with my shoes on for part of it. I think many of us have trouble with our feet, and I am wondering if there is anything I can do to just help my sorry feet when doing Tree pose. I do try to do “yoga toes” first, making sure my toes are spread out, etc. I suspect others may also have feet problems, of various sorts.

A: If you wear orthotics in my mind it might be good to explore in yoga wearing them in some type of non-skid sock so your toes can still feel the floor when you are practicing your balancing poses. It sounds like you have very high arches so to contact the floor without your orthotics will be difficult. I might suggest that you explore doing the balancing poses (such as Tree pose) with your orthotics and non-skid socks, then take them off and try in your bare feet directly afterwards. Sometimes this can work to build muscle memory to teach your feet what to do. I wouldn’t push your feet to hurt your knees though. Be patient and kind to yourself when you try this. — Shari Ser

A: Interestingly, I had a woman in my workshop on Saturday in Petaluma who also wears orthotics, and is now using a special pair that she wears when not in shoes in her yoga classes. She can get away with not using them at times, and in fact did the workshop with out them.

As a balance exercise, instead of Tree pose, we did the Tadasana (Mountain pose) to Urdhva Hastasana (Upward Arms) dynamic series, where you lift the heels of both feet off the floor as you swing your arms up, and then lower your heels down as you exhale your arms down. The idea is to keep the ball of your foot even on the floor as you lift and lower your heels, as folks with stiff, high arches or flat, collapsed arches tend to roll in or out. This can also strengthen the foot muscle that associated with a healthy arch. In addition, I find that keeping the ball of the foot grounded and lifting the toes off the ground can encourage strengthening of the medial and lateral arches of the foot, so I recommended students with flat feet to do this in their standing poses. —Baxter Bell

Q: Can you tell me how to leave a comment on a blog post? (I can’t quite figure it out.)

Don’t feel bad—it’s not particularly obvious. Here are the basic steps:

1. Find the post you want to comment on.

2. Scroll down to the end of the post and look for the signature on the post. To the right you’ll see the word “comments” preceded by the current number of comments on the post. That phrase is a link.

3. Click on the comments link. A new window will open showing the current comments (if there are any) and a space for you to write your own comment.

4. Type your comment in the “Leave your comment” box.

5. Type the word verification letters you see displayed in the “word verification” box. (This helps prevent spam from appearing in the comments.)

6. Choose an identity. You can use a Google identity (if you have one), you can enter your name, or you can choose to be anonymous.

7. Click the Preview button if you wish to see how your comment will look before you submit it (in case you want to edit it).

8. Click the Publish button to submit your comment to the blog.

The comment will not appear immediately on the blog. Email will be sent to the moderator (that would be me, Nina), who will then approve the comment. (I have chosen to moderate the comments in order to screen them. So far, I’m happy to say, I have not needed to censor anything.)

After the comment is approved by the moderator, it will appear on the blog. If you want to see if there are any responses to your comment, check back by viewing the comments at a later time. (It’s possible to have an entire back and forth conversation in the comments.)

Now you know! I look forward to reading your comments, everyone. —Nina

 

Featured Sequence: Dynamic Reclined Hip Stretches

by Baxter

Last week I introduced some thoughts on low back pain and yoga (see here). As I mentioned, the majority of episodes of lower back pain are related to short-term issues of muscle strain or spasm, or other soft tissue and joint situations that usually resolve in six weeks or so. However, it is possible that a regular yoga practice or a special sequence directed at the lower back area can speed up that process and get you back on track a bit sooner. I have frequently observed that for students who come to class for the first time, acute low back strain often requires only a few sessions in my Back Care Yoga class before the student is well enough to return to or advance to a regular yoga class. In this setting, the variety of poses that may be helpful is a bit larger than with more serious lower back injuries or conditions. For example, you can be a bit more comfortable with some twisting and forward bending poses, which often have to be modified in the other situation.

This week I would like to give you a very brief sequence of poses to try when addressing low back pain. This is a great little sequence that Raven, my wife, cam up with a few years back. 

My intention is to add to this sequence over the next few weeks. I have found that it is better to start with shorter practices and advance as you are ready.

The Reclined Hip Stretches sequence allows you to gently release tension around your hip joint and hamstrings, which may help relieve lower back pain. This sequence is a good general warm-up you can do at the beginning of any asana practice. It takes your hip joint through most of its range of motion, so it could be helpful for conditions from mild joint stiffness to arthritis. It is also a great way to begin stretching your hamstrings, and because your arms move up and overhead at the start of the sequence, it can help loosen up tight shoulder joints. 

Caution: If you have significant lower back problems, make sure to take your knee across your mid-line slowly and keep it on the easy side for a while. Allow your lower back and pelvis to stay flat on the floor.

1. Start by lying on your back, with your legs straight. You can set yourself up near a wall, so your feet can press into the wall. 

2. Inhale and raise your arms overhead and back toward the floor.

3. Then exhale and bend your right knee to your chest, bringing your hands to meet the knee. 

4. Inhale, and gently guide your right knee toward the right using your right hand.

5. Exhale, and guide your knee back to center, then, changing to your left hand, guide your knee 6-12 inches over to the left.

6. Inhale, and guide your knee back to center. Then exhale, and holding onto the back of your leg, straighten your leg toward the ceiling as much as you can. 

7. Inhale, bend your knee, release your foot to the floor, and straighten your leg along the ground.

Repeat the entire sequence on your left side. After that, if you wish, you can repeat the sequence on both sides a few more times.

 

Balance and Strength

Today we’re pleased to present a second interview with Shari Ser, a practicing physical therapist and yoga teacher. This time we asked her about strength and balance, as a follow-up to our original conversation about balance in general (see here). 

Nina: Why is strength an important factor in our ability to balance?

Shari: Balance and strength need to go hand in hand like cookies and milk! Muscle strength has to be present in sufficient amounts for us to resist gravity and move our bodies through space, allowing us to sit, to stand, and to walk efficiently. When we are weak, we can’t move efficiently and smoothly, and our effort is often more than the effects we can produce. Strength also has to be reproduce-able and renewable. But muscle strength is very concrete, and it is something that can be improved. Just the act of standing up from a chair 10 times will build your strength. Learning to use your legs instead of your arms to stand from a chair builds strength.

Repetition of effort with your current range of motion builds strength. From coming up from a chair with no arms, you can progress to Powerful pose (Utkatasana) to build back strength as well as arm and leg strength (see here). Using a wall to pike forward over bent knees to come down into Powerful pose is easier than fighting gravity to come up into the pose. But how you use gravity will work differently on your strength. Powerful Pose trains muscles differently depending on how you do it.

For good balance, your muscles have to be both strong enough and coordinated enough to fire on demand, not with a lag time till “everything is set up just right.” So isolated strength training doesn’t translate to improvement in balance. Smoothly transitioning between positions with repetitions will build strength better. Think sun salutations, with countless modifications.

Nina: Are there particular muscles we need to keep strong?

Shari: In order for us to maintain our balance, all our postural muscles need to be kept strong. But gastroc-soleus (one of the calf muscles) is a really big deal in balance, as are hamstring and quadriceps (the backs and fronts of our thighs), quadratus lumborum (a lower back muscle), and the hip abductors, and hip adductors (the inner and outer thighs). And we need the strong back extensors to keep us upright (which is especially important if there is a pendulous abdomen pulling us forward). 

Nina: Can you list some of the key yoga poses for building strength, and explain why you've chosen those particular poses?

Shari: I have touched on Powerful pose already and mentioned Tree pose in a previous post (see here). Warrior 1 and Warrior 2 (see here) are also favorites because any standing pose that puts you into an isometric hold position with a bent knee is going to build strength in the legs. And any pose where a limb is raised up is going to build strength in that limb, and both Warrior poses have raised arms. Warrior 1 is also a backbend, which helps strengthen back extensors.

Nina: This is one of the many reasons why yoga is so wonderful. A well-rounded yoga practice, with an assortment of standing poses, backbends, and twists, helps strengthen the postural muscles you need to maintain good balance as you age. Add to this moving smoothly between poses in some form of sun salutation or moving with your breath between two poses (viniyoga style), and you’re all set!

Shari Ser has over 25 years of orthopedic experience as a physical therapist and has been teaching yoga for a wide range of medical conditions since 1999. She graduated from The Yoga Room Advanced Studies Program in 1999, and was certified as a “Relax and Renew” teacher by Judith Hanson Lasater. She currently  teaches ongoing beginner level and back safe yoga classes, and co-teaches Yoga for Chronic Health Issues at The Yoga Room in Berkeley, California. For information see here.

Yoga for Insomnia, Part 1

by Nina

Paul Weston and his new therapist from "In Treatment"

There I was on Saturday night, doing that thing where you talk out loud to a fictional character on your TV screen. But, really, Paul Weston in Season 3 of “In Treatment” was asking his new therapist for another Ambien prescription. And when he told her that he’d been taking Ambien every night for over a year, I just lost it. I said, “That’s addiction, not a solution! You need to help him wean himself off the pills!” But his therapist wouldn’t listen to me. And then Paul told her that even with the pills he didn’t sleep through the night, but always woke from a nightmare after several hours, and then had trouble going back to sleep, often taking another Ambien to get himself through the second part of the night. He was worried that he might have Parkinson’s Disease. But even though I begged her to offer him an alternative, in the end his therapist wrote him another prescription and said he could come back and talk to her if he wished, so besides the pills all she had to offer him was long-term talk therapy.

Then on Sunday morning I was doing it again because I read an article in the NY Times “Sleep Medication: Mother’s New Little Helper” (see here) about mothers who can’t sleep because they are too stressed out about all the little things they had to do, and instead spend hours in the middle of the night fretting over their “To Do” lists. Both the author of the article and the women themselves seemed to think the only options these women had were sleeping pills or lack of sleep. “Conscious relaxation!” I shouted to the author and the women in the article, but to no avail. It is just part of being a mom these days, they claimed. Some of them even talked about how useful it was to have time to themselves in the middle of the night, when they could get even more work done.

It’s a good thing I can rant in this post today! I do think sleeping pills can be useful on a short-term basis to get you through a short, difficult spell, but they are not a long-term solution because they do not solve the underlying problems (and you do, in fact, become addicted after just two weeks). If you read my first post on chronic stress (see here) you will know that what’s keeping both Paul and the women in the NY Times article from sleeping well is chronic stress. And a different solution to their insomnia could be practicing yoga stress management techniques. So what would I prescribe for Paul Weston?

During the afternoon or evening, Paul should practice calming yoga poses, such as restorative poses, supported forward bends or supported inversions (such as Legs Up the Wall Pose). Seated meditation is another good option for this time of day. If Paul can do Savavana or yoga nidra without falling asleep, these practices would also be effective, but taking a nap won’t be effective. The idea is for him to switch his nervous system from chronic stress to the relaxation response, providing him with time in a state of conscious relaxation. (See here for info on the difference between conscious relaxation and sleep.)

Then when Paul is in bed trying to fall asleep, I’d recommend either yogic breath awareness (or extending the exhalation) or a self-guided Savasana (such as progressive physical relaxation of different body parts) so that when he falls asleep he will be more relaxed (and will hopefully sleep deeper and longer). Even though he has important things to worry about, the key is to keep his mind on neutral subjects when he is going to sleep (he can always do his worrying the next day!).

Finally, if Paul wakes in the middle of the night, rather than getting up and turning on the light to read a book, work on the computer, or watch TV (these activities are mildly stimulating), I’d recommend that Paul stay in bed in the dark, and again do a yogic breath practice or a self-guided Savasana. There is a good chance this will help him get back to sleep again. Granted, worrying is very tempting; in the middle of the night it feels like important work. But like any other practice, moving the mind away from worry to a more neutral subject gets easier and easier with experience.

“Paul,” I’d say, “I’ve been there, too. And these are all practices that have helped me learn to sleep better, even during stressful times.”

Friday Q&A: Yoga and Menopause

A Beautiful Branch by Brad Gibson

Q: Now that I am making the transition into menopause, I would love a post or several on how yoga can make things less problematic.

A: In my mind there are two different ways to approach the “problems” of menopause, one about which our staff here at Yoga for Healthy Aging knows quite a bit and the other not so much.

By this I mean that even though I myself have gone through menopause, I don’t consider myself qualified to, say, create a sequence for hot flashes, which is just one out of a long list of typical symptoms. And Baxter doesn’t consider himself qualified to do so either, mostly due to his gender. So for that type of advice, we will be seeking a guest contributor. Until then, I highly recommend the menopause sequences in the book The Woman's Book of Yoga and Health by Linda Sparrowe and Patricia Walden, which devotes an entire section to this topic (though we don’t necessarily endorse the accompanying recommendations for herbs and supplements).

However, what we do know quite a lot about here is how to approach a situation like menopause with equanimity, both through stress reduction practices and a yogic attitude (based on yoga philosophy). By this I mean something like: Did I have hot flashes during perimenopause and menopause? Yes I did/do. Do I consider it a problem? No, not really. I mean, it isn’t exactly fun, but I’ve just accepted it. And that helps a lot. More even than Patricia’s wonderful sequences (which I did practice, especially the fatigue sequence). And while Baxter and Brad don’t have to cultivate equanimity toward menopause, that equanimity thing sure comes in handy for aging in general. I began exploring this topic in my post "Acceptance, Engagement, and The Bhagavad Gita" (see here), but I’ll write another post on acceptance in the near future, maybe even next week.

There are a couple of symptoms of menopause that I do feel qualified to write about and those are depression and insomnia. That’s because for many years now I’ve made this area of yoga (emotional wellbeing) my focus. And I will be addressing both depression and insomnia on the blog in the future, though probably in a general context rather than just in relation to menopause.

Finally, if you can tell us more about what you consider to be “problematic” about menopause, either because you are going through it now or because you are concerned about going through it later, please let us know. That way, when we plan our future posts, we can give your topics a priority. And anyone else should chime in with their questions and concerns!

--Nina

Featured Pose: Powerful Pose (Utkatasana)

by Baxter and Nina

In his post “Come On, Stand Up, Get Outta that Chair!” (see here), Baxter recommended that Powerful pose (Utkatasana) was one of the most helpful poses for maintaining the ability to move with ease from sitting to standing. And in Shari Ser's workshop on yoga and balance that Nina attended, Shari recommended Powerful pose for balance because it strengthens the thighs and the muscles around the knees (see an interview with Shari here). In addition to improving balance and building leg strength, Powerful pose also opens the upper back and shoulders, as well as strengthening the arms. And the variations described below make this pose accessible to almost anyone.

Powerful Pose (Utkatasana)

Baxter prescribes Powerful pose for:

• improving knee strength and patella tracking
• recovering from illness that resulted in fatigue and weakness (helps you reclaims leg strength)
• preparing for intense physical activity, such as skiing and hiking
• improving balance when you can’t balance on one foot or building leg strength to maintain balance
• improving shoulder mobility

General Instructions:Stand with your feet parallel to each other and hips-distance apart, with your hands on your hips. Keeping your thighs parallel, slowly bend your knees directly forward until your knees are either in line with your toes or just past them. Make sure that your heels do not come off the floor. Tip your hips slightly forward so your torso leans forward over your legs but keep your back elongated (in the same alignment as in Mountain pose).

Now inhale and raise your arms forward and up. If your shoulders are tight, keep your arms parallel to the floor. If your shoulders are more flexible, keep your arms in line with your ears, as shown in the drawing above. To come out of the pose, release your arms, then straighten your legs.

Recommended Timing:30 seconds (6 to 8 breaths) for beginners, working up to 1 minute (12 to 16 breaths).

Some Helpful Variations:

1. To strengthen the muscles of your inner thighs and around your knees (muscles that are weak in many people), use a block between your knees. Use the narrow side of the block (and step your feet a bit closer if necessary)

2. If the full pose is too difficult for you but you wish to practice in the middle of the room, you can bend your knees only slightly, keep your back vertical, and place your hands on your knees.

3. If you have balance issues or are weak, you can work at the wall. Start with your buttocks on the wall but your feet about six inches away from it.

4. If you want focus on strengthening for your thighs and knees, work at a wall as above, but allow yourself to drop lower in the pose. Intense!

If you’d like to see a video that shows how to do this pose, here is a link:
 

For The Young and The Old: Back Care

by Baxter

Back in the day, say 20 years ago or so, when I was a Family doc back in Cincinnati, every day someone came into my office with the problem of low back pain. And if it was your average run-of-the-mill, muscular strain-style back pain, regardless of what I had to offer, things usually got back to normal in about six weeks. However, for the smaller percentage of patients whose pain did not resolve in that time frame, difficulty often lingered for much longer, and there were a myriad of possible underlying causes to account for the situation.

My tools at the time included medications, referrals to physical therapists, and finally consultations with specialists like orthopedic or neurological surgeons. The latter two groups were often interested in offering surgery as a solution, since that was their main “tool” of healing. However, the results rarely matched the billing, and often these same patients would return following a procedure with little or no change in their baseline symptoms.

To say the least, I found myself very frustrated with the repeating scenario I was a part of. What I had to offer did not seem to be very effective; the patients were also frustrated, anxious and worried about what the future held for them. At that time, in my community, hatha yoga was not mainstream, and certainly was not looked upon as a possible therapeutic option for addressing chronic pain of any sort.  Fortunately, the winds of change started blowing at just the right time!

From Yoga: The Poetry of the Body by Rodney Yee with Nina Zolotow

As I began to explore yoga personally and eventually transitioned into teaching and using it therapeutically with my students, it became very clear again and again how helpful yoga practice is in addressing not only the root anatomical, kinesiological issues in back pain, but also in providing prompt benefits for the mental and emotional issues that arise due to chronic pain: anxiety, depression, frustration and disappointment. I suspect that we will return to talk about back pain a lot over the coming weeks, months and years, so today’s post is really an opportunity for me to give you some background thoughts on low back pain and chronic pain in general, with an eye to expanding and addressing more specific issues as we travel along together. Update: See here for further information (and a sequence of poses).

In the meantime, I recommend you read Brad's post from last week (see here). He makes some very important observations regarding the research that has been done to date on this issue, and again reminds us all that ultimately we need to do our own personal study of yoga on our health, sometimes with the caring and expert guidance of our yoga teachers and sometimes on our own.


There are a more and more good books available to all of you out there to get you started on applying hatha yoga techniques to healing your back pain. Now classics are Mary Pullig Schatz, MD’s 1992 Back Care Basics, which is grounded in the Iyengar tradition, and TKV Desikachar’s The Heart of Yoga, which is not specifically a back yoga book but introduces a different and equally powerful method of working with yoga and your body. And if you find yourself in the San Francisco Bay Area, please join me any Monday night at Piedmont Yoga Studio (see here) for my ongoing series of Back Care Yoga. Until the next time, happy backs to you!