A Yoga Offer to Health Care Professionals

by Baxter

Before I can let you in on my offer to health care professionals, I need to give you a little background information on how the offer came to be. As many of you know, I spent the first part of my professional life as a family MD, working in a busy primary care office, dispensing prescriptions for all sorts of diseases and acute illnesses, and sending patients off to see the physical therapist or the MD specialists when the situation warranted it.  Nowhere in my training was there any mention of “alternative” or “complementary” therapies that I might offer to my patients. (That situation is slowly changing in this country, thank goodness!) 

When I first started doing yoga in 1994, it was a completely personal thing; it felt really good for my overworked body and my stressed-out mind. I felt more grounded, clear and rested after my practices and that was enough incentive for me to continue to practice. I finally decided my interest was growing beyond the personal and I wanted to learn more so I could teach yoga, too. One of the first workshops I offered was to the medical staff at the hospital my patients would go to if seriously ill. It had a staff over 200 admitting doctors. My theme was the health benefits of yoga, and my hope was to expose my colleagues to those benefits, who by and large had never done yoga and had a very confused idea of what it was. I recall that several of the family docs in my practice attended the evening session, along with several nurses and perhaps one or two other staff docs. It was by no means the turnout I had hoped for, but it was a start.

Clouds Reflected in Jade Green Lily Pond by Nina Zolotow

Since that time, I have been delighted to have several doctors, nurses, nurse practitioners, physical therapists and other health care providers attend classes regularly. And they often express how beneficial the practice is for them, and simultaneously express their frustration with the demands of the works schedule that often makes it hard for them to attend as often as they would like.  Such is the reality of these hardworking people.

So, even though I have had some health care workers in class over the years, I have always had this underlying impression that the vast majority of docs and others in my community have never taken a class, let alone investigated the variety of styles of yoga that they or their patients might explore to assist in improving their health. This is despite decent articles in magazines like Yoga Journal and Yoga International that provide overviews of yoga styles and what a student can expect to encounter in regards to physical demands and such.  

This is why I was delighted to be invited to a yoga blogger’s Round Table on July 23, 2012, sponsored by the National Institute of Health’s NCCAM division, the Complementary and Alternative Medicine branch that sponsors studies on the potential benefits of practices like yoga, meditation and Tai Chi, to mention just a few. And for those unfamiliar with this part of our federal government, they have funded and completed perhaps a dozen studies in the past 12 years or so, looking at the benefit of yoga on a variety of conditions.

The purpose of the Round Table was to engage a group of bloggers who are writing about yoga and health in a dialogue about what they are doing there and to get any input from us out here in the real world.  Super exciting! Leading up the event, we were given access to view a new seventeen-minute video they are releasing tomorrow on some new studies on yoga and health, which also provides some guidelines on yoga’s benefits and situations where caution should be given to patients. I watched it immediately and was delighted in the balanced information they are providing, so do check it out this week when you get a chance (see http://nccam.nih.gov/video/yoga-trailer).  

Later that day, the webinar began with about seven bloggers from around the US online and on a conference call to hear more about what the NCCAM folks are up to and to get our feedback. At one point in the presentation they shared what they called “tips for consumers,” which were all pretty reasonable. As always, they suggested that you discuss your interest in starting yoga for your health with you health care provider. This seems often a kind of perfunctory recommendation that we hear a lot. But it brought up my ongoing concern that there is a disconnect between this recommendation and what your doc may actually know about yoga, so I raised my cyber-hand and suggested that patients might also want to ask their doctor or nurse practitioner what their personal experience has been with yoga before deciding if any advice given by the doc about yoga is sound advice.

I obviously see a gap that exists between what my fellow yoga professionals and I know about the benefits of yoga, and what the medical establishment knows about yoga. I often gripe about this, and nothing changes. As it turns out, a few days later I am away at a yoga festival, and doing a Zen Meditation workshop on the first day, and things get quiet inside (me, of course!). And as often happens a first step suggestion arises in the quiet: get more health care professionals to my yoga classes!  After a bit more reflection, I came up with a plan.  I will now do what I can to make this a reality in my classes with the following offer: for all you health care professionals out there, your first class with me is free. (See bellyoga.info for a schedule of my local classes and my workshops around the country.)

Now, I know that most of our readers are already doing yoga. But you all know health care workers who have never done yoga, could really use it, and would potentially share their new discovery of yoga with their patients.  So I am hoping you will spread the word, on Facebook, Twitter and any other means at your disposal to get the word out. And if you teach, consider making a similar offer to your communities and students as well. I’d love to see 2012 go down as the year that saw a huge exposure of yoga to the medical world in a more real and tangible way, and I am hoping you can help! I know it might be a small step, but sometimes a small step can get things moving in the right direction. And don’t forget to check out the NCCAM web site http://nccam.nih.gov/, as they have a lot of good info for the public regarding the research they have completed. I’ll let you know about two studies featured in their video in the next week or so.

On Vacation

Hadley Cove by Brad Gibson

This is just to let you know that our Editor in Chef (that would be me, Nina) will be on vacation next week, so we won't be posting anything on our blog until August. See you then!

Featured Pose: Eagle Pose Arms (Garudasana)

by Baxter and Nina

This pose from our office yoga series is a wonderful stretch for your middle and upper back and for your neck, which are areas where you may hold a lot of tension. Even thought some of us who are slumped over our computers appear to have wideness in the upper back, you may have noticed there is still quite a bit of tension there. The pose also increases mobility in your shoulders and releases tension from certain parts of your shoulder joint. It moves your shoulder blades on your rib cage into upward rotation, encouraging an important, functional movement for healthy shoulders and arms. It may also build strength in your pectoralis as well as some of the other chest muscles.

Because your hands are typically at elbow height or lower, raising your hands toward eye level helps reverse the effects of gravity (such as, swelling or stiffness of hands and wrists). And if you’ve been hiking all day in the heat with your hands at your sides, the effects of raising your hands to eye level are even more dramatic.

Although it’s a relatively simple pose, that can be done anywhere in almost any attire, it’s a strong, distinct stretch that engages your mind, bringing your attention to the present moment. It’s an excellent pose to do while traveling, and you can do it sitting as well as standing, even in an airplane seat. We’re showing the basic pose today, but you can do variations of this pose by moving your clasped hands either to the left or right of center.

Baxter prescribes this pose for:

•    weak but tight upper backs
•    limited mobility or range of motion in the shoulders
•    rotator cuff injuries (for some people)
•    tight neck muscles
•    upper body strength (in particular, weakness in the chest)
•    numbness in the hands, such as in carpal tunnel syndrome

Instructions: Start by standing in Mountain Pose with your feet hips-width apart. Inhale and bring your arms out in front of you until they are parallel to the floor, with your palms facing one another. Cross your arms over one another, with the right arm on top and your elbow joints stacked on top of each other. Now bend your arms at the elbows to 90 degrees. Bring your left (bottom) hand across your face and bring your fingers onto the palm side of the right (top) hand. Have your thumbs pointing toward your face if possible.

If you can’t clasp your hands, keep your wrists straight up and your palms facing away from each other. If you can’t even cross your arms over your elbows, bend your right elbow and use your left hand to grab onto your right upper arm. Then use your left hand to encourage your right elbow toward the left side of your chest.

Now lift your elbows up until your upper arms are parallel with the floor. Keep your shoulders relaxed away from your ears. If you wish, push your elbows forward an inch or so away from your chest. You will probably feel an increase in sensation between your shoulder blades. Breathe into that space to enhance the feeling of opening your back body. Look straight forward and keep your head and neck even and in line with your spine.

You can also push up with your bottom elbow as you push down with your top elbow and you’ll feel additional muscle groups around the shoulders strengthening and stretching.

For the most benefits, stay in the pose for 90 seconds, if you can. When you’re done, carefully release your arms. Bring your arms to sides and let go of the tension in your arms before moving on to the second side.

Cautions: This is a relatively safe pose. However, if the pose causes pain in any of your joints, try one of the modifications. If that doesn’t work, talk to your teacher for advice. People with a history of shoulder dislocation should be careful with this pose (as with all poses the involve the shoulders).

Wednesday Q&A: Arthritis of the Thumbs

Q: I have arthritis of the thumbs. I'm told that it's fairly common in women "of a certain age." I wear thumb braces if I'm lifting or gripping for an extended time. It seldom affects my practice. But I have noticed that I don't have much hand strength. Do you have any suggestions for hand exercises?

Dear Thumbs,

Thanks for writing in about this. In my years as a Family MD and a medical acupuncturist, I have had the occasional patient with complaints of thumb pain at the joint where the wrist bones meets the thumb palm bone, known as the carpo-metacarpal joint. Sometimes there is swelling at the joint, and even redness to the skin and heat to touch. All these symptoms, as well as limited range of motion, decreased strength and pain with movement point to the probability of arthritis of the thumb. In fact, the thumb is the most common joint affected by arthritis in the hand. This is due in part because the thumb has greater mobility than the other fingers, and tends to be used a lot in daily activities, especially when grasping is involved.

There are multiple factors that can lead to the possible development of arthritis in the thumbs, including a history of injury or trauma, as well as arthritis in other major joints of the body. Additional risk factors for developing arthritis in your thumbs include being female (as you correctly noted), being over 40, having certain hereditary conditions (such as joint laxity or malformed joints), stressful activities for the hands or having rheumatoid arthritis.

As with other kinds of osteoarthritis, the normal covering at the ends of the bones, known as cartilage, ends up wearing down and exposing bone on bone movement, which results in swelling in the joint, and sometimes leads to overgrowth of new abnormal bone, called bone spurs.

As you have discovered, treatment can include special splints that limit range of motion and provide added stability for the joint. This often reduces pain quite a bit. In addition, western docs also prescribe anti-inflammatory medications, occasionally inject corticosteroid medication into the joint, and if the pain is severe enough, may recommend surgery.

According to the Mayo Clinic website, your doc or hand therapist can prescribe range of motion exercises that move your thumb through its full range of motion. This improves the joint’s mobility and may preserve the strength you have, but may not improve your hand strength. Unfortunately, since using the thumb more can cause the joint to become more inflamed, trying to strengthen the thumb can be a Catch-22. Other ways to quiet the pain down in the thumbs include using modified hand tools that limit thumb participation, using ice or heat as indicated by your symptoms, and avoid clenching your hands when you have to carry things. 

Kaiser Permanente had this link to exercises for thumb arthritis. In looking them over, it seems to me that these might also increase your strength, so you might want to get some personalized instructions from a physical therapist before starting such a program. And although I don’t know about how they might apply, there is a program called Finger Fitness developed by a musician in Cincinnati, Ohio (a town I once called home) named Gregg Irwin that I read about recently in the book Fooling Houdini by Alex Stone. I was interested in checking into it to increase my finger strength for playing all of my musical instruments, but it might be worth investigation on your part as well.

As far as yoga related practices, the yoga tradition has a practice involving the hands called “mudras,” which are used as meditation devices and could have some use in this setting. But you’d want to check around and talk to a teacher in your area who practices mudras in their practice and is comfortable teaching them to you. All the best in your search for improved hand strength!

—Baxter

Delaying Joint Replacement

by Nina

Did any of you read Jane Brody’s latest article on arthritis Relief for Joints Besieged by Arthritis in the New York Times last week? Well, I did. And as someone who had an orthopedist say to me, “You are heading for a joint replacement. It could be months or it could be years, but there is nothing you can do about it,” I was very struck by her discussion of joint replacement, especially the following quote:

 “People with osteoarthritis are relying more and more heavily on surgery,” Dr. David T. Felson, a rheumatologist and epidemiologist at Boston University School of Medicine, told me. “The rate of knee replacement is just skyrocketing, out of proportion to increases in arthritic changes seen on X-rays, and replacement surgery is contributing greatly to the rising costs of Medicare..”

She also quoted Dr. Felson saying that although hip replacement is “dynamite,” knee replacement may be far less helpful. “For 10 to 30 percent of patients, the improvement never comes.” Brody goes on to recommend to people, the same way we at Yoga for Healthy Aging do, that people try to postpone joint replacement if possible and states, ever so clearly and concisely, the reasons why:  

Artificial joints usually last 10 to 15 years. Delaying surgery is helpful because the earlier in life a joint is replaced, the more likely a subsequent replacement will be needed. And both devices and surgical techniques are constantly being improved; by delaying a joint replacement, you may end up with a simpler operation or more durable device.

Snails and a Bee on the Same Flower by Michele Macartney-Filgate

That’s it in a nutshell! So how exactly can you delay surgery if you’re having pain in your joints? Why yoga, of course. Although Brody doesn’t specifically recommend yoga, she does quote Dr. Felson again when talking about the importance of exercise for arthritic joints:

“The severity of pain is directly correlated with the degree of muscle weakness."

Well, that’s pretty clear, isn’t it? In fact, I’ve never seen it put that bluntly before. And the yoga standing poses, because they are weight bearing, are excellent for building strength in your knees and hips. For your knees, the poses where one or both bent knees are particularly beneficial (Warrior 1 and 2, Extended Side Angle pose, Powerful Pose, and so on). Although we have not yet addressed arthritis of the hip (note to self: good idea for future topic), most, if not all, of the standing poses would be beneficial for your hips. For arthritis of the shoulder joint, yoga provides a number of simple poses where you bear weight on your arms, including Downward and Upward-Facing Dog, Upward Plank pose (Purvottansana), and Side Plank pose (Vasithasana), so don’t think that if you can’t do Handstand yet, you can’t work on your arm strength (note to self: another good idea for future topic).  

Sometimes being slow is a good thing. 

P.S. Thank you Michele for this perfect photograph (isn't it amazing everyone?) as well as the rest of the other ones you've shared with us in the past and plan to share in the future. I can't wait for the next batch!

Friday Q&A: On Your Feet All Day

Q: I liked the comments on flexibility (see Flexibility and Aging).  I would love it, since you addressed the couch person or the sitting person, if you could address the person that stands all day. Is on their feet all day.

A: The area that gets tight from standing is your low back. So any type of back-bending is good for counteracting a day spent on your feet. You can do conventional backbends or even bend over the edge of your bed, a table or a counter (the way you back-bend over a yoga horse). Seated forward bends may also help relieve your low back.

Stretching your hips (external rotators) is also helpful, so try the standing twists as well as the seated Marichyasana variations. After you release your hips, you may want to work on your legs. You could try standing lunges with your arms up the wall (a modified Warrior 1 pose). Standing Padangusthasana also works well for this. Any type of calf stretch is also good. Basically, any standing pose will help counteract the static position of standing all day. So how about Triangle pose (Trikonasana), Extended Side Angle pose (Parsvakonasana), and Intense Side Stretch pose (Parsvottanasana)?

—Shari

A: Because your hips and legs get tight from standing, Baxter recommends his dynamic leg stretch and hip opener series (see Dynamic Reclined Hip Stretches). Lying on the floor as your stretch your legs and hips will relax your lower back at the same time as you encourage the blood to flow back toward your torso from your legs and feet (which is helpful if you have any swelling).

My favorite way to stretch my legs and rest my back after spending a lot of time on my feet is to practice the Reclined Leg Stretch series (Supta Padangusthasana) followed by an inverted pose, such as Shoulderstand on a chair or Legs Up the Wall pose (Viparita Karani). The inverted poses use gravity to stretch your legs (how cool is that!) at the same time they return the blood back to your torso, reducing swelling in your feet and ankles.

Because the tightness in your torso, shoulders, and neck is the similar to that created by sitting all day, the two poses Shari recommended for counteracting sitting will also be very helpful for standing (see Flexibility and Aging).

—Nina

Yoga Journal Conference Topic Contest Winners!

As we announced recently, Baxter’s going to be teaching at the San Francisco Yoga Journal Conference, January 17 - 21, 2013. For the first time, Baxter will be presenting an all-day workshop on Yoga for Healthy Aging. He’ll also be teaching a two-hour class on Yoga for Arthritis. As many of you know, he was asked to teach one more class and had trouble deciding on the topic. So, because he is so inspired by you, our readers, we had a contest to see what our readers recommended. Now, the results of the contest are in:

This could be yours....

Best suggestion: Joanne for "Posture." Since Joanne asked us to give her prize to someone else, we're giving it to Luscious because Luscious suggested something very similar to "Posture."

Random winner: Heather Patton (who made her suggestion on Facebook). We chose her by numbering the entries and then using a random number generator.

To claim your books, Luscious and Heather, please use the Contact Us tab at the top of the page to send your mailing address to Nina, and remind us which of the two books you'd like.

In the end, Baxter decided to go with another topic for his Yoga Journal Conference weekend class: Yoga for Healthy Eating (not telling where he got that idea). But we both really like Yoga for Healthy Posture, too, and expect there will be future courses and workshops on that topic as well. For the rest of you, thanks so much for all your excellent suggestions, and we plan to use your ideas on our blog.

I, Nina, will be assisting Baxter at the conference, and we both look forward to meeting some of you in person.

or maybe you want this!

Cultivating Healthy Posture with a Simple Restorative Pose

by Timothy

Poor posture is a common problem that people of any age can have but it is one that tends to worsen over time. Particularly common is the rounding of the upper back into a C-shaped curve, aka Slumpasana. People often hold their heads several inches forward of the body’s plumb line, which can lead to neck and upper back discomfort, among other problems. I’m just back from teaching workshops on therapeutic yoga at Kripalu and the Himalayan Institute and several of the people I worked with—some despite years of yoga practice—still had this postural habit. So I thought today I’d share with you a simple technique that in a number of cases has proved helpful for improving posture.

You might not think poor posture would be a factor is serious health problems, and we certainly weren’t taught much about it in medical school. But if you read medical textbooks and search out relevant studies, you will see that poor posture can contribute such problems as carpal tunnel syndrome, osteoporotic fractures, and even heart disease and depression. From a yogic perspective, this combination of slumping posture and the less-than-ideal breathing that accompanies it is also believed to contribute to anxiety, insomnia, digestive difficulties, etc.

When your back rounds, your lower ribs compress the top of the abdomen so it’s not possible to fully move your diaphragm, the major muscle of breathing, and take a full breath. As a result, people take shallow breaths, primarily bringing air into the upper parts of the lungs. Such a breathing pattern is not as efficient in bringing oxygen into the body, and more importantly for many health concerns, is agitating to the nervous system. I won’t go into the physiology here, but suffice it to say that I have repeatedly seen that improving your posture in a way that allows you to take slower, deeper breaths can lead to an improvement in overall health and well-being.

When you’ve had a long-term habit of slouching, however, it may not just be as simple as remembering to sit up straight or to pull you shoulders back when standing. Long-term slouching leads to shortening of muscles in the front of the upper body, as well as of the fascia, the connective tissue that surrounds and interpenetrates the muscles, and which can limit movement. It’s said that longer holds of poses are necessary to help lengthen the fascia, and while people differ on what the ideal holding time is, I believe staying in a pose for a few minutes may be ideal. That’s hard to do in most regular asana, particularly the backbends, which open up the back. The pose described below is a supported backbend, which like a regular backbend helps correct the postural problem, but because it’s restorative, it’s easy to stay long enough to have the desired effect on the fascia.

To do the pose, you’ll need one blanket and something to place under your head. Take a standard folded yoga blanket and unfold it once, so that you’ve got a long rectangle. Roll the blanket from the longer edge into a thin cylinder. Place the cylinder sideways on your mat a couple of feet from the head of the mat, sit in front of the blanket, and lie back so that rounded edge comes to your mid-thoracic spine.

Thoracic Spine, the portion of your spine to which your ribs attach—
between your cervical spine (neck) and lumbar spine

You can play with the placement, maybe a little higher or lower to get the region of your upper back that seems the most stubborn. Most people, particularly those who tend to slouch, need a pillow or folded blanket under the back of their heads, so that the chin can be more or less at the level of the forehead or slightly lower.

Once you’ve got your props in place, come to a supine Mountain pose with your back on the blanket roll, your head on the head support, and the tops of your shoulders on floor between the head support and the blanket roll. Now, take your arms out to your sides in a T-position, externally rotating your upper arms so your palms face the ceiling, which will help counteract the tendency of most slouchers to internally rotate them. Engage your leg muscles and lightly flex your feet. After  you’ve established your alignment, let go of all effort and lie back into this restorative backbend and let the blanket do all the work. Your only job is to remain mindful, trying to breathe slowly and deeply for the next several minutes. Titrate the time you stay to your comfort levels and schedule. For most people, I’d recommend starting with a minute or so then working up to 5-15 minutes a day. The longer you hold it (as long as you remain comfortable), and the more regularly you do it, the better the results!

Need a Vacation from Your Vacation?

by Baxter

It happened again today. I was asking one of my students about the vacation he recently returned from. And he said, “Oh, man, I am so tired…I didn’t get much sleep ‘cause I was up late and having so much fun.  But now I’m exhausted!” This was only about the third person so far this summer who has shared a similar experience after their “vacation.” It made me wonder if the crazy pace of our western work life is infecting our vacation planning.  There are adventure vacations of all sorts, and often we might head off to see lots of family, eating, celebrating, and generally overdoing it and not getting any exercise or good sleep along the way.

Just the opposite thing happened this past week while I leading a “yoga vacation” we now commonly refer to as a “yoga retreat.” I’ve been leading this one now for about eight years every summer at the Feathered Pipe Ranch outside of Helena, Montana (see featheredpipe.com). People come from all over the states and even overseas to experience the natural beauty of the Montana Rockies, while immersing themselves in healing yoga practices. And of course, all your basic needs are met, such as daily meals, leaving attendees to truly take care of themselves in the process. Now, two of my students this week commented on how much they were sleeping; the good news was that they had the freedom to do that, and throw in a few naps as well!  And by the end of our six days together, they appeared rested, relaxed mentally and physically, and happy. This appeared to be generally true of all of the participants.

Feathered Pipe Ranch

Going on retreat, unlike some of what we now refer to as vacation, can often serve other purposes as well. The retreats I lead include several yoga practice sessions each day, but also free time to rest, hike, journal, meditate or visit with others. One of the reasons Feathered Pipe Ranch was founded was to provide a safe, beautiful place for people to reconnect to themselves, to others and to the bigger picture of the direction of their lives. They also wanted to have a place for the Leaders of Tomorrow to have a place to start their journey. When I first visited in 1999 as I was considering the shift from full-time family doc to who knew what, it was the Ranch that grounded me in the knowing that at least starting a journey to becoming a yoga teacher and medical acupuncturist was going to be okay.

For me thirteen years ago, the retreat setting helped me refocus my life’s work, and I witnessed another student on just such as search last week. In this case, it was the transition from a busy and successful work life towards the possibility of “retirement.” He, too, seemed to have greater clarity about the path ahead at the end of our time together. It made me recall the yogic phases of life. According to the yoga tradition, there are four distinct phases of life we each ideally pass through: brahmacarya, the celibate student (age 5-25), garhasthya, the householder (age 25-50), vanaprastha, the hermit or forest dweller (age 50-75), and the samnyasa, the renunciate, monk or swami (age 75-?).  Even though we don’t follow such a structure in the west, at least not commonly, I have encountered students over the years essentially grappling with the essence of each of these stages. And the retreat setting, again and again, provides just the right milieu to refine their experience and direction.

Yoga also has four aims of life, known as the purusathas, which are not in chronological order but can play into all of the above stages. These include: dharma, meaning virtue, such as being a good person; artha, referring to our means, such as the work we do to earn money;  kama, referring to desire, such the desire to marry and have children;  and moksa, meaning liberation, which could mean experiencing the inner light within. Again, the retreat setting, free of our usual distractions, can be the perfect place to investigate our personal aims in life.

So the next time you get home from your vacation wishing you had a vacation from your vacation, consider making your next vacation a retreat. This is another way yoga supports healthy aging. (Information on stages and aims of yoga found in Nicolai Bachman’s The Yoga Sutras.)

Got Mindfulness?

by Nina

Yesterday I read an Op-Ed piece by Mark Bittman in the NY Times Got Milk? You Don't Need It and I was very surprised to read the following:

“This in a country where as many as 50 million people are lactose intolerant, including 90 percent of all Asian-Americans and 75 percent of all African-Americans, Mexican-Americans and Jews.

Seventy five percent of all Jews are lactose intolerant? Wow! I’m Jewish and I never even heard this before! When I was a kid, I hated drinking milk. But my mother was so convinced that it was imperative for my health that I was not allowed to leave the table until I forced down my entire (totally yucky) serving. When I was old enough to stop drinking milk as a beverage, I did, although I continued to eat dairy products in their many tempting forms (cheese, butter, ice cream, yoghurt, in lattes and on cereal, etc.). Meanwhile, I always had a rather delicate digestive system, but I tended to blame it on other things (soy, garlic, etc.) Then several years ago my digestive problems got worse, and I finally consulted my doctor about it. She suggested that perhaps it was just the aging process and added there was little I could do about that (to her credit, she did ask me if I was lactose intolerant, but I said that I wasn’t).  Hope I’m not boring you with all this, but there’s a point, I promise.

Anyway, I had noticed that when I spent a week or two eating a vegan diet (because my two kids took turns being vegan during different periods) I felt great. But I still wasn’t connecting the dots. It wasn’t until a few years ago when my husband and I decided to experiment by giving up diary products entirely for other reasons (the environment, global warming, a new theory of inflammation, consideration of dairy cows) that I noticed, hey, my digestive problems are gone! And all the plant foods I thought I couldn’t digest well now made me happy and healthy. Because I felt so much better, it became easy for me to pass up the tempting treats I used to indulge in, even to give them up for life (though with the occasional splurge—hey, my daughter is a pastry chef).

Above the Fog Again by Brad Gibson

You see, last week’s interview with Dayna Macy Yoga for Healthy Eating about mindfulness and healthy eating really made me think, especially the following: 

"Most people don't just sit in Lotus, they work to open their hips and one day, maybe, they get there. It's the same with food. You are discovering who you are in your relationship with eating. You don't just wake up one day and say, "ah ha! This is the perfect way to eat! Now I will do this perfectly from now on!" Knowledge is earned and learned, one day at a time. The truth must resonate and live in your body to become real change."

I just realized this morning that I had been practicing exactly what she described, and that mindfulness about my eating led me to healthier eating habits for my particular body, even though I never heard that fact about Jews being lactose intolerant. My long-time yoga practice no doubt helped me tune into how my body was reacting to different foods, and that ultimately brought me to a decision about my diet that is not only going to have the short-term benefit of making me feel better on a daily basis but will also help my health in the long run.

Have any of you used mindfulness about your eating to move yourself toward a healthier diet? We’d love to hear from you.

Friday Q&A: Purvottansana (Upward Plank pose) Variations

Q: In yesterday’s post Flexibility and Aging, Shari recommended Purvottanasana as an essential pose for maintaining flexible. But this is a challenging pose for a large number of people. Are there any good alternatives?

A: I’m so glad you asked this question! I, myself, was wondering whether I should mention some more accessible variations of Purvottanasana (Upward Plank pose). Then one of our readers, Joanne, left a comment on the post describing how she teaches the pose to her older students using a chair. Before I get to her comment, I’d like to start by describing some of the variations I know, starting with a modified version of the pose you can do on the floor.

Instead of going into the pose with straight legs, start with your knees bent and the soles of your feet the ground. Then, as you press up into the pose, keep your knees bent so your body forms a kind of table shape (this version is sometimes called Table pose). I found an odd little video of it for you (try not to turn your head to face the camera when you do the pose, though):

Another version of this pose that you can do almost anywhere, in any clothing, is the door or kitchen sink version. In the door version, you open the door that has doorknobs on both sides, and stand with your back about six inches in front of thin edge of the door. Reach back with both hands and take hold of the doorknobs behind you. Then, moving from your upper chest rather than your lower back, allow yourself to lean forward away from door, so you come into a Purvottanasana shape, hanging from the door knobs.

In the kitchen sink version, you stand with your back about six inches from the kitchen sink. Then reach back with both hands to grasp the front lip of the sink. As in the door version, moving from your upper chest rather than your lower back, allow yourself to lean forward away from door, so you come into a Purvottanasana shape, hanging from the door knobs.

Last but not least is the chair version that Joanne (thank you, Joanne!) wrote to us about, which makes the pose accessible to folks who are unable to practice on the floor. I’ll let Joanne tell you about the pose in her own words because the results she achieved with her students are so inspiring:

“My chair yoga students do a variation of Purvottanasana that is easier for older students. Sit near the front edge of the chair seat. Place your hands behind you, grasping the side edges of the seat near the back. First just feel a stretch in the upper back, lifting the sternum and arching the upper back. Then move the feet out in front, hip distance apart and pointing forward. Lift the pelvis off the chair. Hold as long as comfortable.

When we first did this, the students were collapsing back on the chair seat after just a few seconds. Now they can hold this position for 30 seconds and longer. One woman who is 87 can hold it for a long time! One woman who is very overweight struggled for over a year to lift her pelvis off the chair. For weeks she pushed with her arms, getting stronger every time. Finally she lifted up and was she ever proud of herself. Now she can hold this position for a long time.”

With all these options, there will surely be a variation that everyone can do. Combining this pose with some version of Downward-Facing Dog pose (if you can’t do the full pose, put your hands on a chair seat, a table top, or on the wall) allows you to stretch both your front body and back body while you strengthen your arms.

—Nina

Flexibility and Aging

by Shari and Nina

Shari and I have talked in the past about how essential it is to maintain strength as we age (see Strength and Aging), but I’ve learned from her that it’s equally essential to maintain our flexibility. I thought today I’d talk with her about this important topic. —Nina

Nina: Why is it important to work on flexibility as we age?

Shari: This question kind of has a long answer because we need to define flexibility and how it might change as we age. The first thing is that as we age we tend to only do things we like to. There isn’t anyone telling us to “stand up straight” or go for a walk or do something other than lay on the couch! I am sort of exaggerating but the truth is that we tend to have habitual postures, and if we don’t reverse these postures often during the day we end up looking like what we do all day. If you sit in a soft sofa or recliner chair all day long when you finally decide you WANT to stand erect, you might not be able to because certain muscle groups have shortened from habitual posture! Also, the adage “use it or lose it” really is true in regards to flexibility. So if you want to continue to be mobile and independent as you age, maintaining flexibility is as important as maintaining strength.

So what should the couch potato do to counteract their sitting posture? Stretch those hips, upper and mid and low back! Move those arms and legs! See yoga does affect our flexibility. But why? When we perform asana, whether it is active or more passive like supported restorative poses, our muscles are often lengthened. We know this intuitively because when we stretch TOO much, we pull back and come out of a pose (at least that is the safe and healthy way to practice asana). But we can also intelligently approach stretching in asana by understanding some fundamental spinal cord reflexes all of us have, at least those of us who are ambulatory with four limbs moving in space.

There are three main spinal cord reflexes: the stretch reflex, the autogenic inhibition, and the reciprocal inhibition.

The stretch reflex is a specialized reflex that regulates the length of your muscles. Whenever you elongate a muscle beyond a certain preset length or unconsciously stretch it too fast, this reflex makes the muscle automatically contract so you can’t lengthen it any further. The stretch reflex is governed by a long thin receptor in the muscles called a muscle spindle. The spindle’s role is to let our feedback systems know about muscle length and the rate of muscle lengthening. When a muscle is rapidly stretched, the spindle (via a loop of nerves) triggers a reflex contraction of the muscle that is undergoing the stretch and this muscle contraction limits the stretching of the muscle.

Within the muscle tendon (which attaches muscle fibers to bone) are structures called Golgi tendon organs (GTO). The GTO’s are stretch sensors, which provide the central nervous system with information on muscle tension. When a muscle is either contracted or lengthened (stretched), this information is processed by the central nervous system. The central nervous system then tells the muscle to release and be inhibited from contracting or to relax and lengthen. This autogenic inhibition protects the muscle from tearing.

The muscle spindle is also responsible for a phenomenon known as reciprocal inhibition. In this case when a muscle contracts, the opposite muscle will relax to allow the movement to occur without resistance. An example here is when you straighten your leg, the quadriceps muscles cause the knee to straighten, but for this to occur the hamstrings on the back of the leg/knee must relax or release at the same time.

We can perform static stretches where our body’s joints are positioned in their outer limits of available range and hold these positions for a certain time, this activity becomes a continuous passive stretch. This type of stretching is typically safe because we don’t go further than we are able. In this type of stretch the connective tissue and the non-contractile tissue is lengthened because of its unique structure. Muscle tissue is called viscoelastic because it CAN lengthen and then return to it’s “resting length.” This is basically what we are doing in asana. AND if we hold a pose for more than 6 -20 seconds, we can stimulate the autogenic inhibitory reflex to trigger a relaxation in the muscle.

If you are interested in a scientific approach to stretching, get Ray Long’s anatomy and asana books for clear through pictures and direct relationship to asana practice. He has six books and you can find them on Amazon. Also, see Fernando Pages Ruiz’s article What science can teach us about flexbility in Yoga Journal March April 2000 issue.

Nina: Which are the most important areas to target for maintaining flexibility as we age?

Shari: How about the entire body? Honestly, I can’t think of any area that should be neglected if we consciously stretch. Of course, we all think about our legs (hamstrings) and hips (hip flexors), but what about keeping mobile ankles and feet and hands? Think about all the arthritic changes that happen in our hands and feet as we age. Also, our spines absolutely need to be maintained to perform full range of motion for flexion, extension, side-bending and rotation. Our activities of daily living aren’t enough and we need to MOVE out of our habitual postures.

Nina: It’s true that most people think about their legs being stiff and maybe their hips, but not so much about their spines, shoulders, feet, ankles, and hands. So what are you favorite poses for maintaining flexibility?

Shari: My favorite poses for maintaining flexibility would be Downward-Facing Dog pose and Purvottanasana (Upward Plank pose). I think of these two poses going together, with the back body being stretch in Downward Dog and the front body in Purvottanasana. Shoulder flexion is nicely addressed in Dog pose and shoulder extension in Purvottanasana. 

And, of course, backbends are important for stretching the muscles that get tight from typical seated positions. Passive backbends are good because they don’t take as much muscular effort as Upward Bow pose (Dhanurasana). In an ideal world we should practice our flexibility poses daily. We could do both Downward Dog pose and Purvottanasana for 30 seconds. Then, if we were on a roll, we could add Triangle pose (Trikonasana), and Extended Side Angle pose (Parsvokonasana). Simple and effective!

Nina: What a great mini practice! Both Downward-Facing Dog pose and Purvottansana are also excellent for building upper body strength. Most people practice Downward-Facing Dog pose on a regular basis, but I think Purvottansana is often overlooked and under-appreciated. Thanks for reminding us about what a valuable pose it is.

Yoga for Healthy Eating: An Interview with Dayna Macy

by Nina

Although we haven’t addressed the issue so far on this blog, we’re all aware that maintaining healthy eating habits and a healthy weight as we age is vital for healthy aging. As Dr. Timothy McCall says in Yoga As Medicine: 

“This is a matter of serious concern because there is little doubt that being overweight can have major health consequences, including type 2 diabetes, sleep apnea, high blood pressure, heart disease, and some forms of cancer. Extra body weight makes back problems more likely, increase the strain on the joints, and can contribute to or worsen injuries to ankles, knees, hips and other vulnerable areas of the body.”

And Brad says that being overweight may contribute to a shorter health span (the years of your life during which you are relatively healthy) as well as a shorter life span. So recently Baxter and I decided that we wanted to learn more about how yoga can help with healthy eating. As a first step, I decided to interview Dayna Macy, who is a long-time yoga practitioner and the author of Ravenous, which describes how her yoga practice helped her lose weight and develop healthier eating habits for life.

Nina: Can you tell us a little about your weight issues and how yoga has helped you with maintaining healthier eating habits?

Dayna: I've overeaten for most of my life. It wasn't until I hit 35 that my habits really started to catch up with me. I put on a lot of weight and that made my yoga practice, and my life, difficult. Extra weight made it difficult to do any kind of flowing asana. And it made standing poses and inversions more difficult as well, because it was hard to hold a pose for any length of time. My extra weight also made it harder to simply move through my day. Hiking, cleaning, walking the dog, the stuff of daily life is made more difficult when you have excess weight. When I reached my mid-forties, I realized that if I didn't really start to get a grip on my issues, I was looking at a less than optimal midlife and old age. 

I think it's always wise to start where you are, and yoga is a fundamental part of my life. I've been practicing for twenty years. Who and what you are shows up on the mat, and I knew that the practice itself could help me see myself more clearly. It helps you "be here now" and that is essential when wrestling with issues of habit and addiction.

Nina: Are there any particular yoga poses or practices that you found especially helpful for healthier eating and that you would recommend to other people? 

Dayna: I have learned to pay deep attention to my feet and how my feet are grounded on the mat. It is essential to learn to literally ground your body when you are working with old samskaras and habits that you want to unwind. I also found slow and attentive sun salutations very useful. It builds tapas and heat, and for people who are carrying extra weight, it is important to slowly burn your inner fire.

Nina: Now that your book has been published, have you heard anything from other people who have also been able to change their eating habits? If so, what about your story do you think has inspired them the most? 

Dayna: What I learned most is that just like yoga is a practice, so is learning to eat in a way that serves your body. Most people don't just sit in Lotus, they work to open their hips and one day, maybe, they get there. It's the same with food. You are discovering who you are in your relationship with eating. You don't just wake up one day and say, "ah ha! This is the perfect way to eat! Now I will do this perfectly from now on!" Knowledge is earned and learned, one day at a time. The truth must resonate and live in your body to become real change.

This sense of slow change is helpful for people. It gives them breathing room to experiment and learn. We hear a lot in yoga about how there is no perfect pose. I would say you could also say that about eating, weight and our bodies. In the course of my journey, I lost about 25 pounds. I'm still a curvy girl. And frankly, even at my thinnest, I was still a curvy girl. What I've learned is that I am so grateful for my body. Today, at 51, I'm healthy, active, and my body works. It's a miracle. I spend less and less time wishing I were something other, and more time grateful for what I am. This is the gift of yoga. 

Photo by Victoria Yee

 Dayna Macy is the communications director and managing editor of international editions for Yoga Journal. Her book, Ravenous: A Food Lover's Journey from Obsession to Freedom, was recently published by Hay House. See www.daynamacy.com for more information about Dayna and her book.

Recovering from Ankle Injuries

by Baxter

Part 3 today of my series on ankles! This post is for those people with more serious injuries than ankle sprains or with post-surgical repair. Although many of recommendations for acute ankle sprain may apply (see Ankle Sprains), your ankle may have some movement restriction in any of the directions we have covered under Getting to Know Your Ankles (plantar flexion, dorsiflexion, supination, and pronation).  And because of this, you may be advised by your surgeon to avoid overstretching your ankle to help preserve the stability that surgical correction has provided. Therefore, you may need to modify poses that require more plantar flexion or dorsiflexion than your ankle safely permits, as well as any other combination of movements.

My favorite way of accommodating these variables is by using a yoga wedge. Many studios have at least a few of these around for you to use in class, but you may want to get one for yourself to use for your home practice.

Typical Yoga Wedge

Let’s look at an example of how you might use the wedge. Say you have limited ability to point your right foot; in other words, you have limited plantar flexion. Poses like Triangle pose (Trikonasana) and Pyramid pose (Parsvottanasana) would be challenging for your front leg when it is your right one. Without support, the ball of your foot might be up in the air, unable to touch the ground. By placing the wedge pointing toward you under the ball of your right foot, you can now ground down though both your heel and the ball of your foot.

For limited plantar flexion, wedge goes under  front foot.

The opposite case would be limited dorsiflexion of the foot. Say you have limited dorsiflexion of your right foot. In this scenario, poses like Downward-Facing Dog pose or the back foot in Warrior 1, Warrior 2, Triangle pose, Extended Side Angle pose and Pyramid pose,would all challenge your ability to safely press your back heel onto the floor.  By positioning the wedge toward your heel and slipping it part way under your back foot, you may very well be able to ground both the ball and heel of your right foot.

For limited dorsiflexion, wedge goes under back foot.

Another challenge for our first example, limited Plantar flexion, is poses that require your shins to be on the ground and your feet to point backward, such as Hero’s pose, Child’s pose, Vajrasana and several other seated variations. In this situation, you want to create a support for the front of your ankle joint to diminish the pressure on the front of your ankle joint. Sometimes the wedge can be positioned to do the job, but I prefer to create a small roll with a yoga blanket and place that under the front of the ankle joints. As you drop into Child’s pose, for example, you should monitor your ankle for pain or any other suspicious sounds or symptoms. If you have the proper sized support, all should be quiet and happy on the affected side. By the way, place the support under both ankles so you don’t end up listing to one side.

As always, cultivate patience with your body to both gently guide it back to a healthier place and honor its limitations.