Creating a Mini Yoga Practice

by Nina

Most of us start doing yoga in a class, and those classes are relatively long, usually ranging from one to two hours. So we often get the idea that practicing at home means doing the equivalent of a full-length class. Finding the time and/or energy to do that can be overwhelming, preventing us from ever getting started.

Practicing with a Friend by Nina Zolotow

But all of us here at Yoga for Healthy Aging believe that even doing a single pose constitutes a yoga practice, and we strongly encourage anyone who wants to get started with a home practice, to go ahead and start small! You’ll probably find that if you’ve bothered to change into your yoga clothes and get out your mat, and you've done your single yoga pose, you’ll feel ready to add on a few more poses. You’re not ready for a full-length practice, but you definitely feel up to a well-rounded “mini” practice that is, say, about 15 or 20 minutes long. But how do you decide what poses, and in which order you should do them for your mini practice?

Of course you could ask your favorite yoga teacher for some suggestions, but, although there is definitely an art to creating a sequence of yoga poses—especially one where you are preparing yourself to take on some challenging pose—you can also start very simply on your own, especially for a short sequence. Here are a few simple guidelines:

1. Ask yourself: what class of poses do I want to today: backbends, twists, forward bends, or inverted poses? Pick one of these general categories to counteract what you’ve been doing lately or what you did yesterday in class, or just because you’re in that kind of mood.

2. Pick an appropriate warm-up pose or two for that category of poses to start the sequence (see Warming Up for information). 

3. Choose a few standing poses or a few Sun Salutations that incorporate elements of the category of poses you’ve chosen. Some ideas:

• For backbends: Sun Salutations, or Warrior 1, 2, and 3, Tree pose, Eagle pose
• For twists: Sun Salutations, or Triangle pose, Extended Side Angle pose, Half Moon pose and the revolved versions of all three
• For forward bends: Downward-Facing Dog, Standing Forward Bend, Wide Angle Standing Forward Bend, Triangle pose, Extended Side Angle pose, Half Moon pose, Pyramid pose (Parsvottanasana)
• For inversions: Downward-Facing Dog, Standing Forward Bend, Wide Angle Standing Forward Bend. 

4. Pick a few of the poses from your category, starting with the easiest first: easy backbends, seated twists, seated forward bends, or Headstand followed by Shoulderstand, Plow pose, Bridge pose, or Legs Up the Wall pose (skip Headstand if you don’t do it).

5. Select a counter pose to balance your practice. After doing backbends, it’s helpful to do a twist, leg stretch or another back releasing pose. After doing forward bends or twists, I recommend doing a gentle back bend to restore the natural curve to your spine. 

6. End with Relaxation pose (Savasana) or another symmetrical restorative pose.

I’ve including standing poses and/or Sun Salutations in all the mini sequences because most of us tend to be sedentary at work, but if you’re on your feet all the time during the day, feel free to skip the standing poses and just add more warm-ups or more poses from your category. Don’t over-think it! Just have fun getting started with your home practice. You’ll be surprised at how rewarding it is. As a matter of fact, Timothy McCall will be writing post for the near future about how much more valuable a home practice is than just going to classes.

Hernias and Yoga

by Baxter

At the Yoga Alliance Leadership Conference this past weekend in Palm Springs, CA, I was presenting a session to and for yoga teachers. (By the way, the gathering was a great example of the positive benefits of “community” that Nina wrote about yesterday in her post What Really Helps Foster Healthy Aging!) It was entitled “Expecting the Unexpected,” and we discussed all the interesting injuries and maladies that yoga students bring to class, and how to work positively with whatever shows up for us. One of the topics I placed on the list of concerns was “inguinal hernia.”  The teachers present wanted more information—just the week before, a student had come to class with a recent discovery of just such a problem and wanted to do some yoga, if it would be safe to do so—so I’m addressing it here on the blog.

Just so happens about 10 years ago, the day after a fabulous week-long yoga retreat I had attended in Mexico, I glanced down while showering and noticed a small bulge in my left groin crease. Having cared for others with such bulges in the past, I knew immediately that I had an inguinal hernia. You might be asking me, what is up with “inguinal”? Isn’t a hernia a hernia? I’ll get to the specifics of this kind of hernia in a moment, but the word “hernia” as in “herniated” refers to one structure bulging or pushing into another space into which is usually does not go. There are hiatal hernias, involving the stomach sack and the diaphragm (another topic we will get to before too long!), umbilical hernias, where abdominal stuff pushes out through the navel area, and herniated discs, where the discs between the spinal bones pushes out into the spinal canal toward the spinal nerves.

In the case of an inguinal hernia, the abdominal contents, such a loop of small intestine, are able to push down through a weakness in the abdominal wall that leads to the inguinal canal. This canal is located just beneath the fold of tissue in the groin area. In men, it leads down towards the scrotal sack, which is why the doctor examines men by placing an exam finger from the scrotum up into the inguinal canal and has the patient cough. An increase in abdominal pressure, such as during a cough, while laughing or lifting, can push some abdominal stuff into the canal, where it is likely to bump against a waiting digit of the doc. In my case, there was a small bulge already visible that would increase in size a bit with any of the above maneuvers. Inguinal hernias are more common in men.  Women can have similar hernias in the groin area, but often have a femoral hernia, just below the groin crease.

Any activity or medical problem that increases pressure on the abdominal wall tissue and muscles may lead to a hernia, including:

• chronic constipation, straining to have bowel movements
• chronic cough
• cystic fibrosis
• enlarged prostate, straining to urinate
• extra weight
• fluid in the abdomen (ascites)
• heavy lifting
• peritoneal dialysis
• poor nutrition
• smoking
• overexertion
• un-descended testicles

When I first discovered the bulge, it was not causing me any symptoms. It might have gone on like that or it could have led to some achy soreness, too. It might have been manageable if I changed habits, avoiding increases in abdominal pressure via less lifting and such. But I knew I wanted to have a normal activity level, if not an increased one involving lots on interesting yoga poses, as well as the ability to have a carefree guffaw whenever I wanted. So I chose to have a surgical repair. The most serious potential problem with an untreated inguinal hernia is if a loop of bowel enters the canal, gets twisted and has its blood supply cut off. If the bowel segment begins to die, it can be a life-threatening emergency. I figured an elective surgery, while my life was not being threatened imminently, was a better way to go. The non-surgical approach is usually to avoid lifting or increased abdominal pressure and to wear a special belt called a truss, that puts external pressure over the groin area.

Most people who develop a hernia are born with the weakness in the area. In some of those people, they never have any overt evidence of the problem, and so may never get a full on hernia. But once it shows up, it is unlikely to spontaneously go away. The bulge can disappear when things are quiet, but it is likely to come back after a coughing jag, some yard work or even a moderate yoga practice. Gravity plays into it too, so if you are standing and engaging the abdominals without any specific modifications, you could aggravate a hernia. Even bearing down to urinate or defecate could worsen the bulge.

So for most healthy yogis who would like to maintain a typical yoga asana practice, I’d suggest you discuss surgical repair of your inguinal hernia with your doctor. And although the procedure is relatively safe, for those who are surgery averse, there was a study in 2006 looking at men with hernias but no pain. Half got surgery, the other half took a wait and see approach. The groups, when compared five years later, had about the same complaints of pain in both groups. This does not apply to other scenarios of inguinal hernia, but you may have other options. 

In my case, my right inguinal canal was actually more open than my left, so I had both sides sealed off with some surgical mesh, designed to prevent unwanted bowel loops from heading down stream. Things have held well for ten years now. If there is some time between diagnosis of inguinal hernia and your scheduled repair, yoga modifications could be of some help in preventing a bulge from getting bigger. Inverted poses, such as elevated legs up the wall, with a bolster under the pelvis and chair shoulder stand, if approached with abdominal softness, could use gravity to your advantage. When you are inverted, the bowel loops will be pulled away from the inguinal canal. 

Another possibility would be to cautiously learn the lower two bandhas: Mula Bandha, the pelvic floor lift, and Uddiyana Bandha, the flying upward lock. Usually engaged during an exhalation, contracting the pelvic floor muscle upward and drawing the lower abdominal muscles inward and upward could act as a protective action when engaging the abdominals is necessary to perform a task or an asana. You would also want to use caution in forward bends, as bringing the belly close to the thighs will almost certainly put downward pressure toward the inguinal canal.

Once your hernia is repaired, a return to your yoga practice should be guided by your level of soreness and pain, which will hopefully recede as you advance your poses gradually. Core strengthening utilizing the bandhas, should help support overall healing and could have a preventive benefit to minimize the risk of a recurrent hernia. I was able to gradually resume my full asana practice gradually of a two-month period, and I no longer even experience the soreness I felt right after the operation.

If you decide to go the non-surgical route, there was a recent study conducted in India looking at asana for treatment of inguinal hernia. They found it effective in some ways.  The following are the poses they used. I do not suggest you do these without consulting an experienced yoga teacher to make sure your technique does not aggravate your condition!  Here we go:

“Vajrasana, Ustrasana, Paschimottanasana, Pawanmuktasana, Utthanpadasana, Matsyasana and Sarvangasana were selected based on its effects to compress inguinal canal, strengthen the abdominal muscles and to reduce the intra-abdominal pressure, because weakness or flabbiness of abdominal muscles and elevated intra-abdominal pressure may be the causes for the hernia in non-congenital subjects included in this study.” 

To learn more, see the International Journal of Yoga. It seems that like a lot of health issues, the approach to treating this common condition is gradually changing. So do some research, talk to friends, talk to your doctor, and come up with a plan that works best for you. 

What Really Helps Foster Healthy Aging?

by Nina

Leaves Starting to Turn by Brad Gibson

As some of you may have noticed, the Sunday New York Times Magazine had an major article on aging with the rather overly dramatic title The Island Where People Forget to Die  about the island of Greek island Ikaria. A study at the University of Athens concluded that:

“people on Ikaria were, in fact, reaching the age of 90 at two and a half times the rate Americans do. (Ikarian men in particular are nearly four times as likely as their American counterparts to reach 90, often in better health.) But more than that, they were also living about 8 to 10 years longer before succumbing to cancers and cardiovascular disease, and they suffered less depression and about a quarter the rate of dementia. Almost half of Americans 85 and older show signs of Alzheimer’s. (The Alzheimer’s Association estimates that dementia cost Americans some $200 billion in 2012.) On Ikaria, however, people have been managing to stay sharp to the end.”

As usual with studies of long-lived communities, it was impossible to identify a single factor that was responsible for the long and healthy lives of the individuals within it. As the New York Times article says:

"If you pay careful attention to the way Ikarians have lived their lives, it appears that a dozen subtly powerful, mutually enhancing and pervasive factors are at work. It’s easy to get enough rest if no one else wakes up early and the village goes dead during afternoon naptime. It helps that the cheapest, most accessible foods are also the most healthful — and that your ancestors have spent centuries developing ways to make them taste good. It’s hard to get through the day in Ikaria without walking up 20 hills. You’re not likely to ever feel the existential pain of not belonging or even the simple stress of arriving late. Your community makes sure you’ll always have something to eat, but peer pressure will get you to contribute something too. You’re going to grow a garden, because that’s what your parents did, and that’s what your neighbors are doing. You’re less likely to be a victim of crime because everyone at once is a busybody and feels as if he’s being watched. At day’s end, you’ll share a cup of the seasonal herbal tea with your neighbor because that’s what he’s serving. Several glasses of wine may follow the tea, but you’ll drink them in the company of good friends. On Sunday, you’ll attend church, and you’ll fast before Orthodox feast days. Even if you’re antisocial, you’ll never be entirely alone. Your neighbors will cajole you out of your house for the village festival to eat your portion of goat meat."

In fact, if you leave out the rather sensationalist aspects of the story (the man who was cured of cancer just by returning to the island, a tale which may or may not be true), the main conclusion of the author had to do with community.

"The big aha for me, having studied populations of the long-lived for nearly a decade, is how the factors that encourage longevity reinforce one another over the long term. For people to adopt a healthful lifestyle, I have become convinced, they need to live in an ecosystem, so to speak, that makes it possible. As soon as you take culture, belonging, purpose or religion out of the picture, the foundation for long healthy lives collapses. The power of such an environment lies in the mutually reinforcing relationships among lots of small nudges and default choices. There’s no silver bullet to keep death and the diseases of old age at bay. If there’s anything close to a secret, it’s silver buckshot."

So, what, if anything, does this have to do with yoga? Well, did you know that all of us here at Yoga for Healthy Aging, even those of us who teach, take regular yoga classes? And we certainly do not attend these classes because we don’t know enough to practice on our own home. I think I can speak for all of us when I say that we do it for two other main reasons. The first reason is for the wisdom we continue to receive from our teachers, which helps keep our home practice inspired. But the second reason has more to do with the other people in the class than with the teacher: we want to stay connected to the yoga community. Being part of the yoga community is like belonging to a small “ecosystem” within our larger culture. Practicing with other people helps us stay steadfast in the healthy choices we have made, whether that is a having regular asana or meditation practice or even making career, family or other life decisions that we believe will be better for us.

So, thank you, thank you, thank you to all my fellow students in my regular class (you know who you are!). And, dear readers, I hope you, too, find the same sense of community in your yoga class. And if you don’t feel supported and encouraged in your current class, I urge you to get out there and look for one where you do.

Friday Q&A: Low Blood Pressure (Hypotension)

Q: I've a question that I'm hoping you can address. I have low blood pressure and lately am finding that I am becoming VERY lightheaded moving from inversions, even simple ones like forward bend, to standing poses. I've spoken to my doctor about it and she has recommended the standard "eat move salt" approach, which I'm already doing. But I am wondering if there is any yogic therapy or advise for this issue?

A: You are not alone! I have students tell me they suffer from low blood pressure on a regular basis. Maybe “suffer” is not the right word, as some of these students don’t actually have any symptoms related to their lower than normal blood pressure, so they often just mention it in passing. But others will complain, as you are experiencing, of dizziness or lightheadedness with changing positions, especially when going from the ground to standing or inverted to upright positions.

To bring everyone up to speed, hypotension is usually defined as a blood pressure that is low enough to produce symptoms, which is usually below the numbers 100/70 when you get your blood pressure checked. Keep in mind that people in excellent aerobic condition, such as regular runners, will often have a resting blood pressure at or below this level. Of course, the blood pressure being a dynamic number that usually increases with increased demand on your body, like during a run, will rise to levels above the resting normal range without any untoward effects.

When someone has low blood pressure, as you do, and is having symptoms, it is wise to do a few things to rule out more worrisome causes, like check blood sugar to rule out diabetes, or check thyroid hormone levels to rule out an under-active thyroid gland. Other conditions to rule out are anemia, dehydration, or heart failure. To evaluate your heart itself if there is any suspicion of it being the source of your symptoms, you may be asked to get an ECG or heart tracing, an echocardiogram which uses sound waves to take moving pictures of the heart and valves, or even a cardiac stress test to see how your heart responds to increase demand via walking or running. And one final test, called a tilt-table test, can measure moment-by-moment changes in blood pressure as you are tilted up or down.This is ordered if your doctor suspects faulty brain signals (neurally mediated hypotension) as the cause of hypotension.

When symptoms are mild, the usual treatment is actually lifestyle/diet modifications, in the form of increasing salt in your diet, increasing water intake, wearing support stockings (which shunt blood from legs back to the heart, potentially increasing your blood pressure readings). If all else fails, there are several medications used to increase your blood pressure in order to see if your symptoms will resolve. According to the Mayo Clinic web site, there are several medications that are prescribed to raise the blood pressure:

“For example, the drug fludrocortisone is often used to treat this form of low blood pressure. This drug helps boost your blood volume, which raises blood pressure. Doctors often use the drug midodrine (Orvaten, Proamatine) to raise standing blood pressure levels in people with chronic orthostatic hypotension (which means hypotension that occurs due to change of position). It works by restricting the ability of your blood vessels to expand, which raises blood pressure.” 

As always, there are likely side effects to consider when deciding to try a medication for the symptoms.

Short of going through more testing, which might be a good idea in order to cover all your bases, is there anything that yoga might have to offer?  Well, one other recommendation the folks at Mayo Clinic offered may give you a way of coming out of forward folds that could impact your dizziness. In addition to moving slowly when going from supine or prone to standing, here’s what they suggest:

“if you begin to get symptoms while standing, cross your thighs in a scissors fashion and squeeze, or put one foot on a ledge or chair and lean as far forward as possible. These maneuvers encourage blood to flow from your legs to your heart.” 

The first suggestion sounds a lot like the leg position we use in Eagle pose (Garudasana).  You might try coming out of Standing Forward Bend (Uttanasana) with your legs crossed and squeezing as suggested and see if the dizziness lessens. The second suggestion sounds like Standing Leg Stretch (Padangustasana) done with a foot on a lift, such as we do onto a chair or top rung of a chair.  This later suggestion might be more applicable if your dizziness comes on when standing, as opposed to while changing positions. 

In addition to these ideas, you could carefully work with kumbhaka, or a hold at the top of the inhale, along with lengthening the inhale compared to the exhale. Start easy, with a one or two second hold. Try a 2:1 ratio timing for the inhale/exhale. This has a mild stimulating effect on heart rate and possibly blood pressure. You may want to practice these techniques separate from your asana practice, perhaps before starting. It might be possible to employ them during asana practice as well, although this is done less often, except in certain traditions, such as viniyoga or the yoga of Krishnamacharya.  So you could consider working with a teacher from those lineages. I hope this information is helpful.  I’d love to hear back if something improves, and all the best in resolving this situation!

—Baxter

Featured Pose: Downward-Facing Dog Variations

by Baxter and Nina

Downward-Facing Dog pose is one of the most effective and versatile upper body strengthening poses we know. Unfortunately, because the full pose requires you to bear weight on your hands with your wrists bent, many people find this pose inaccessible due to hand or wrist problems, such as carpal tunnel syndrome.

But you just know we’ve got solutions for that, don’t you? Well, of course we do. And, yes, today we’re going to introduce four variations of Downward-Facing Dog pose for people with hand or wrist problems. In the coming weeks, we’ll be covering these poses in detail, but for now we’re just going to show them all together, starting with the easiest first and ending with the most challenging, so you can see what your options are. The first two versions are also suitable for people who find full Downward-Facing Dog pose too challenging due to stiffness or weakness or just too exhausting.

So without further ado, here we go!

1. Downward-Facing Dog with knees on the floor (Puppy pose).

Because your knees are on the floor in this pose, you bear very little weight on your hands in this pose. And because your shoulders are lower to the ground, the position of your wrist stays closer to neutral. However, keeping your arms and shoulder active in this position helps build upper body strength. This pose is a wonderful variation for people who are too weak to do a full Downward-Facing Dog pose. 

2. Downward-Facing Dog with Chair.

Placing your hands on the seat of the chair takes some of the weight off your hands (though not as much as Puppy pose) and keeps your wrists in a more neutral position. Benefits not provided by Puppy pose include leg stretching and strengthening, as well as increased upper body strengthening. Depending on your hand and wrists issues, you can choose between two hand positions: hands flat on the chair seat and hands holding the chair edges (see close-up photos). Because this version is easier than a full Downward-Facing Dog pose, it is suitable for someone who is still building up a enough strength to do the full pose.

3. Downward-Facing Dog with Headstand Arms (Dolphin Pose 1).

This version takes most of the weight off your hands and wrists and keeps your wrists in a more neutral position, while providing the full upper body strengthening for your upper arms, shoulders, back and chest provided by Downward-Facing Dog pose. Most people find having the forearms in a triangle position (headstand position) easier on the shoulders than keeping the forearms parallel. However, the hand position of the next variation may be better for your hands and wrists. Depending on your flexibility, this pose may be as challenging or even more challenging than full Downward-Facing Dog. So take it easy with this one, starting off by holding it for short periods of time and working up to longer holds.

4. Downward-Facing Dog with Parallel Forearms (Dolphin Pose 2).

Like Downward-Facing Dog with Headstand arms, this version takes most of the weight off your hands and wrists while keeping your hands and wrists in a neutral position, while at the same time providing full upper body strengthening for your upper arms, shoulders, chest and back. Use the block between your hands to keep your hands and forearms in a parallel position, about shoulder-width apart. Because this version requires a lot of flexibility in the shoulders, many people—like me, Nina!—find this version more challenging than full Downward-Facing Dog pose (though an excellent preparation for several inverted poses). So take it easy with this one, starting off by holding it for short periods of time and working up to longer holds. 

Do let us know how these variations work for you (or your students)!

Sitting is Bad for You

by Nina

Yesterday’s New York Times article “Get Up. Get Out. Don’t Sit.” reported that two different scientific studies have added to a growing consensus that “the more time someone spends sitting, especially in front of the television, the shorter and less robust his or her life may be.”

Sitting by Nina Zolotow

The studies, including one published in the October issue of The British Journal of Sports Medicine the other published on Monday in the journal Diabetologia, looked at TV watching habits as a way of learning more about the effects of sedentary behavior on health. The conclusions? Sitting actually reduces your life expectancy. An adult who spends an average of six hours a day watching TV over the course of a lifetime can expect to live 4.8 years fewer than a person who does not watch TV.

“Every single hour of television watched after the age of 25 reduces the viewer’s life expectancy by 21.8 minutes.”

Unfortunately, for us yoga practitioners, the results are true even for people who exercise regularly. The article quotes one of the authors of the study in the British Journal of Sports Medicine, Dr. Verrman, saying, “a person who does a lot of exercise but watches six hours of TV every night might have a similar mortality risk as someone who does not exercise and watches no TV.”

Furthermore, it’s not just TV watching itself that causes the problems. In modern society, many of us—including me!— have jobs that require sitting in front of the computer all day. Dr. Emma Wilmot, a research fellow at the University of Leicester in England, says that while we might try to convince ourselves that 30 minutes of exercise a day will protect us, we “are still at risk if we sit all day.”

The author of the article goes on to speculate way this may be true, quoting David W. Dunstan, a professor at the Baker IDI Heart and Diabetes Institute in Australia, senior author of the Australian study, and a pioneer in the study of sedentary behavior, “The most striking feature of prolonged sitting is the absence of skeletal muscle contractions, particularly in the very large muscles of the lower limbs.” The thinking is that when your leg muscles don’t contract, they require less fuel, and the surplus, in the form of blood sugar, accumulates in the bloodstream, contributing to diabetes risk and other health problems.

The article recommends reducing the hours you spend sitting, starting eliminating one hour of sitting a day. And you just know that I’m going to recommend some yoga! Obviously, if you have not already done so, incorporating standing poses (those really cause your leg muscles to contract!) into your daily practice is vital. But what about outside the yoga room? How about taking a short break and doing some office yoga? Our office yoga series includes some seated poses, but we also have a number of poses you can do in your office attire that require getting up and out of your chair!

Try one or more of our Standing Shoulder Stretches. Or how about our Standing Leg Stretches? Even Half Dog pose at the Wall, which you can do almost anywhere (try putting your hands flat on the desk, if you don’t have a free wall space) and in any attire, requires getting out of your chair and moving those legs!

Arthritis of the Hip Joint

In past posts, we have shared with you poses that can open tight hips, as well as discussed hips in a few specialized settings, but we have not addressed perhaps the most common aging concern for hips: the development of arthritis in the hip joint. The hip joint is a synovial joint, meaning the pelvic bone and the femur, or upper leg bone, connect with one another via a closed system. A sock-like sleeve of connective tissue holds the two bones relatively close together via what is called the joint capsule. The inner lining of this structure is lined with a specialized tissue called the synovial membrane, which secretes a special liquid, not unlike a lubricant such as oil in you car engine, to allow the bones to move over each other more smoothly. In addition, the ends of the bones are coated in a layer of cartilage—also a kind of connective tissue—that acts as a tough barrier over the bone for shock absorption, and is smooth and slick, so the bones again can glide over each other more smoothly. Finally, the inner surface of the acetabulum, the hollowed out part of the pelvic bone that the head of the femur bone fits into, has an additional cushion of cartilage lining it called the labrum. This provides a better fit for the two bones and a lot more shock absorbing potential.

Now that you have some idea of what makes up the hip joint, we can talk a bit about arthritis of the hip. As with arthritis anywhere in the body, there are two broad types. The wear and tear type of arthritis, which could be a result of repeated movements over a long time, or complicated by some old trauma, infection or injury to the joint, is called osteoarthritis (OA). In this, the most common form of arthritis, the cartilage covering on the ends of the bones is worn away gradually, exposing sensitive raw bone, which, when rubbing against another raw bone, leads to inflammation inside that closed synovial joint described above. This results in swelling, stiffness, tightness, decreased movement and pain.

The other main type of arthritis, rheumatoid arthritis (RA), in an auto-immune disease, meaning your body mistakes itself (in this case, the joint lining) as a foreign invader and mounts an immune response to fight it off. This response is an inflammatory one, resulting in damage to the ends of the bones, sometimes even at a young age. It is quite a bit less common than osteoarthritis, but still seen enough to be aware of it. 

It almost goes without saying that this condition can be painful. What other symptoms would you look for? Because of the damage to the cartilage, people with arthritis may feel as though their hip is stiff and their motion is limited. Sometimes people feel a catching or clicking within the hip. The pain usually gets worse when the hip joint is strained by walking long distances, standing for a long time or climbing stairs. The pain is usually felt in the groin, but also may be felt on the side of the hip, the buttock and sometimes into the knee.

Here in the US, we start to diagnose the condition via the history and physical exam, with the aid of X-rays, which often reveal diminished space between the bones. If surgery is being considered, an MRI of the joint will also likely be ordered. Treatment offered by your family MD or arthritis specialist could include medications for pain and inflammation, recommendations to change activities to reduce the stress on the joint, a plan for weight loss which also reduces joint stress, assistive devices like a cane if needed, and surgery to clean out the joint or to replace the joint. 

At the start of any treatment regimen, conservative recommendations are made, which include rest and avoiding any repetitive activity that may have strained the joint or muscle, as well as working with a physical therapist who can help increase your range of motion or strengthen muscles to increase stability on the joint. Here is where yoga can fit into your healing regimen. But first, you want to take a good look at what you are already doing in your yoga practice to see if any of the poses or vinyasa practices you do now could be contributing to your pain and dysfunction. Do you get pain while doing certain poses, like the front leg hip joint in a Lunge pose? Do you have a flare of pain in the hip after class or the next morning? Yes to any of these questions requires you consider suspending the offending practice, at least temporarily.

On the other hand, it is not uncommon for a student to start yoga because they have heard it could help their condition. In this setting, you will want to begin at the beginning, with a gentle practice as your entry into yoga. A one-on-one session would also be a good way to start. If you are having chronic, persistent pain, start out by lying on the floor and moving through our Dynamic Reclined Hip Stretches, in which you take the joint through many of the movements it is capable of. Add to this Snow Angel Legs, where you are lying supine (on your back) and you spread your legs wide on the floor, without rolling your thighs in or out, and then bring them back to center. Follow this with by Dynamic Locust pose, which is done on your belly, lifting one leg up off the floor without bending your knee. Lift up on your inhale and lower down on your exhale. These three explorations will give you a better sense of the range of motion of your hips, right and left, as well as movements that cause immediate pain. This is very useful information as you explore other poses in different positions. 

It is considered important in arthritis care to keep the joint as mobile as you can and keep the supporting muscles as strong as they can be in order to keep you functional and prolong the time before surgery has to be considered (surgery is not inevitable, by the way).  Since you can do many yoga poses without bearing direct weight on the joint, either prone or supine poses, seated poses and inversions, yoga provides lots of opportunity to work on range of motion and some strengthening of the joint. The pose Reclined Leg Stretch (Supta Padangusthasana) and its variations are good example of both goals being met.  Each time you lift your leg straight up to begin the pose, you are strengthening the quad muscles and the psoas, for instance. And even the standing poses can be done in a fairly weight free manner if your do them with your pelvis supported on a chair. Poses like Lunge, Warrior 1 and 2, and Extended Side Angle, all have chair variations that could be helpful when full weight on the joint needs to be avoided. And as always, breath work and meditation can be helpful with pain management, as well as yoga nidra.  I understand that yoga is even being taught in swimming pool settings, where weightlessness is beneficial for arthritic hip joints.  Sounds potentially helpful, but I’d skip the inversions class!

When your symptoms are milder, movement practices like Sun and Moon Salutations done slowly, mindfully and with the idea of soft foot landings might be safely added to your home practice. If your yoga practice can diminish your pain, improve your mobility and delay any invasive treatments, you’ll be getting your moneys worth! And the mental equanimity that is a result of a balanced yoga practice can hopefully guide any difficult decisions you may need to make about your hip toward the best outcome.   

Healthy Treats: An Indulgent Yoga Practice

by Nina

Last week I wrote about taking on a yoga challenge (see Taking on a Yoga Challenge). As I said in that post, working on a difficult pose can help you start a home yoga practice or inspire a practice that’s starting to feel a bit stale. But, as fate would have it, the very next day after I wrote that post, taking on a yoga challenge felt like the last thing I wanted to do in my home practice. I was feeling on the anxious side, so I thought that doing poses that made me feel any stress—even in tiny amounts—was probably not such a good idea. Instead, I decided to indulge in a practice just of poses that made me feel good. Some days you need that!

I know from experience, that for me forward bends are soothing and quieting. So I decided to create a sequence that ended with seated forward bends. Usually in my forward bend practice, I warm up for the seated forward bends by doing a sequence of standing poses that stretch my hamstrings, some of which, like Standing Hand to Foot pose (Utthita Hasta Padangusthanana), really challenge my balance. But on that day, I decided to eliminate the stressful poses from my sequence, and just do the standing poses that felt easy and comforting (in my case, Triangle Pose and Pyramid pose). The result? A nice relaxing sequence that felt nurturing in just the right way, for that particular day.

Treat for the Eyes by Brad Gibson

Of course, I had to laugh at myself that the very day after I was recommending to people that they take on a yoga challenge, I was doing the very opposite. But then I realized, of course, sometimes indulging in poses that you love can do the same thing that taking on a yoga challenge does: help you start a home practice or inspire a practice that’s starting to feel a bit stale.

So how would you plan an indulgent yoga sequence? Start by thinking about which poses sound good to you today. These could be a certain class of poses (like my choice of forward bends) or they could just be any poses that sound particularly appealing, like whichever poses are your “favorites.” You could then, of course, make a list of the poses that sound appealing and sequence them according to the traditional Iyengar style of sequencing (see Iyengar-Style Sequencing, Part 1). But you know what? You could also do them in just about any order you feel like. Of course, we are usually taught to warm up for the more challenging poses and cool down afterwards, so you could think about that as you are planning your sequence (see Iyengar-Style Sequencing, Part 2). Your intuition will probably tell you not to start with the most challenging pose in the list, but on the other hand, maybe that’s exactly what you feel like doing. Experiment! On the other hand, you could also start, instead of ending, with a restorative pose. Maybe you need a good rest in Relaxation pose, Legs Up the Wall, or Reclined Cobbler’s pose before you move onto more active poses. Try it!

Go ahead. Sometimes indulging yourself in your practice is exactly the right thing to do.

Friday Quote of the Day

Through the Leaves by Brad Gibson

"If you are taking yoga classes but not practicing at home, you may be missing the best—and potentially most therapeutic—part of yoga. Your personal practice is where the deepest work happens, when you go inward and go at your own pace." — Dr. Timothy McCall from Yoga As Medicine

Featured Pose: Warrior 3 (Full)

by Baxter and Nina

Warrior 3 is the third pose in our upper body strengthening series because this pose provides unique upper body strengthening with no weight bearing on your hands. Last week, we featured the wall version of this pose (see Warrior 3 (Wall Version)), which makes it accessible to almost everyone. This week, we’re featuring the full pose. In the full pose, your back body muscles work more than when you’re at the wall, so the spinal extenders in your back and neck are strengthened even more.

As we said last week, Warrior 3 is unique in that in this pose you keep your torso and one leg parallel with the floor. In this position, gravity challenges you to keep yourself upright instead of folding over your front leg. All the musculature on the back of your body has to work actively to keep you in this position, including your hamstrings and buttocks along with all the spinal muscles up to the base of your neck. This week, we’re introducing three different arm variations for the pose, moving from the easiest to balance in to the most difficult. Each arm position strengthens different upper body muscles.

In Variation 1, with the arms back alongside the torso (a kind of Downward Flying Super Hero pose), the muscles you use to take your arms into extension (behind your back, as in Camel pose) are activated. These include the back part of your deltoids, your triceps muscles, and your lattissimus dorsi, as well as the muscles between your shoulder blades that help bring your shoulder blades close together. This variation provides a rare opportunity to strengthen muscles that don’t get much of a workout in your daily life, and it is also the easiest version to balance in.

In Variation 2, with your arms out to the sides (it’s a plane!), your balance is challenged more than in Version 1, therefore your back body muscles get a more intense work out. With your arms out the your sides, you continue to use the backs of your deltoids, but you also activate the muscles between your shoulder blades even more (middle trapezius, rhomboids, etc.).

In Variation 3, the most challenging version to balance in, the fronts of your deltoid muscles, some of your rotator cuff muscles, and your shoulder blade stablizers are strengthened as keep you keep your arms overhead. Because your arms and upper body are resisting the downward pull of gravity, the trapezius, anterior and posterior deltoid, and serratus anterior muscles that are strengthened in the wall version get a more intense workout in the version away from the wall.

Of course, as a bonus, all three versions of Warrior 3 are also excellent for improving balance and for general strengthening of your standing leg and for strengthening the back leg muscles of your raised leg, including your hamstring muscles, which can become overstretched from certain other yoga poses.

Instructions:

Variation 1: Start by moving Warrior 1 pose on your right side (with your right foot forward). From there, bring your hands to your hips. Now tip your torso forward about 45 degrees over your hip joint and come onto the ball of your back foot. On an exhalation, straighten your right leg as you gently propel yourself forward to balance over it with your torso and back leg parallel with the floor. Try to keep both hips even with the floor. Once you have your balance established, bring your arms along side your body with the palms facing each other.

The position of the head of your head should be slightly turned up to face forward (as shown in the photo). This is easiest head position for balance. However, if this is too hard on your neck, try keeping your head aligned with the rest of the spine, with the crown facing forward. Stay in the pose for a couple of breaths, and work your way up to 30 seconds to a minute in the pose.

To come out of the pose, bend your right knee slightly, and bring your raised foot down to floor. Then swing your arms up into Warrior 1 pose, and release from there. Repeat on the left side.

Variation 2: For Variation 2, come into it the same way as version 1, with your hands on your hips. When you have your balance established, bring your arms out the sides, with your palms facing down.

Stay in the pose for a couple of breaths, and work your way up to 30 seconds to a minute in the pose. To come out of the pose, bend your right knee slightly, and bring your raised foot down to floor. Then swing your arms up into Warrior 1 pose, and release from there. Repeat on the left side.

Variation 3: For Variation 3, come into the same way as Variation 1 except you should leave your arms in Warrior 1 position as you come into full Warrior 3. However, if balance is a big issue, you can start with hands on the hips and then bring your arms forward when your balance is established.

Stay in the pose for a couple of breaths, and work your way up to 30 seconds to a minute in the pose. To come out of the pose, bend your right knee slightly, and bring your raised foot down to floor. Then swing your arms up into Warrior 1 pose, and release from there. Repeat on the left side.

Cautions: If you have low back pain, you may have to drop your lifted leg a bit lower or bend your back knee to reduce the weight stress this pose puts on your lower back (even a micro bend to the back leg can be helpful). If you have arthritis of the neck, you may want to avoid lifting your head to face forward. As always, use common sense. It if hurts to do the pose, come out and ask your teacher for some feedback about what you’ve been doing. If balancing is a big problem and you’re just getting frustrated, return the wall version we featured last week (see Warrior 3 (Wall Version)).

If you’re having a lot of trouble and want to work your way gradually into the pose, you can do the pose at an angle instead of parallel. For more tips, see Nina’s post on Taking on a Yoga Challenge.

Abuse of Power in the Yoga World

by Nina

Yoga is not about culling out spirits or surrendering one’s individual will power to a teacher who assumes the role of a yoga-sorcerer. No teacher in the world has a right to demand authority over others. The goal of yoga is Kaivalya, independency and not wrong devotion. —R. Sriram

There is another scandal in the yoga world due to a famous yoga teacher abusing his position as a teacher and authority figure. This time the teacher is Kausthub Desikachar, son of TKV Desikachar and grandson of T. Krishnamacharya, one of the most important yoga teachers of the 20th century. Kausthub is accused of systematically intimidating female students into believing that they are unwell and need his help, and then sexually harassing them.

By now it is not news that yoga teachers, like many other authority figures, can succumb to the temptation to abuse their power. But I think it’s worth reading about this case because of the way it is being handled, at least by one person. R. Sriram, a student of Sri T.K.V. Desikachar for almost 30 years who also studied with T. Krishnamacharya himself, has released a letter to his yoga community in which he unreservedly condemns Kausthub’s behavior, refers to the women who spoke out as “brave” and encourages other affected people to speak out. He forthrightly says:

The details lead us to the conclusion that Kausthub is developing psychopathically, needs perhaps professional help on a long term basis and should be stopped from further activity in the yoga world. It is awful to say this, since I have seen Kausthub’s astuteness in teaching theory. But his continuation poses a threat not only to women but also to the right awareness for the teachings of the two masters.

R. Sriram also advises people to boycott the Krishnamacharya Healing & Yoga Foundation. Although the details are disturbing, I encourage you to read the entire letter here.

Reflections by Brad Gibson

Of course, this does not diminish the tremendous contributions made to modern yoga by T. Krishnamacharya and T.K.V. Desikachar. In fact. Baxter, who agreed me with me about the importance of posting a link to this letter, asked me to reiterate this, and to mention how honored he was to get to work with T.K.V Desikachar both in the U.S. in India. But it does remind us that as students it is our responsibility to use discernment when choosing a yoga teacher. As yoga sutra II.26 says:

“The means to liberation is uninterrupted discriminative discernment.” —trans. Edwin F. Bryant

And never follow anyone blindly. As R. Sriram points out, “The goal of yoga is Kaivalya, independency and not wrong devotion.”

What Your Yoga Teacher Really Wants to Know

by Baxter

You may recall one or more of us suggesting that one way to keep yourself safe as you are learning yoga, or dealing with an illness or injury, is to advocate for yourself when you are in class. But what exactly do we mean when we ask you to do this? Another way of thinking about this is that you should take responsibility for your own well-being when you head into any public class by telling your teacher before the class about any problems you may be experiencing.

Before I address what you should be sharing with your instructor, I want to tell you why you should do so. First off, any teacher worth their salt (which used to be very valuable a century or so ago!) or who is operating with genuine compassion and concern for his or her student actually wants to know what is going on with you.  Especially if you are dealing with illness or injury! And don’t think your experienced teacher is fooled for a moment when you are asked if you have any injuries or health conditions they should know about and you reply “Not really.” My next question is always, “So what is that I should not really know about?” This question is usually received with a smile, and sometimes I even become privy to what is going on with my student. Yes, we really want to know! Hopefully this argument alone will be enough for those of you feeling reluctant about sharing, for whatever reason, to go ahead and spill the beans.

Beans, Beans, and More Beans (from Wikimedia)

But what if you’re unsure about whether or not the problem you have is one that your teacher should know about? Now it just so happens that in preparing for a workshop I am giving to teachers next weekend, I came up with a list of conditions that we really want to know about, before, not after class!  Telling me you are twelve weeks pregnant at the end of class doesn’t serve either one of us (or the three of us, in this case!).
 
Some other urgent or significant things to report are the following:

• can’t stand and balance well on two feet
• can’t get up and down from the floor without assistance
• dizziness
• advanced pregnancy or history of miscarriage in previous pregnancy and no yoga experience.
• acute recovery from stroke or heart attack
• communicable diseases

With such symptoms or conditions, you might be advised that a one-on-one setting would be safer and more appropriate at this time. 

And here is a list of common areas of injury and other situations that we also really want you to tell us about:

• plantar fasciitis
• acute ankle sprains
• acute knee strain and beyond
• acute hip pain
• hamstring strains or tears
• sacroiliac joint issues
• lower back pain
• inguinal hernia
• acute shoulder strains
• acute neck pain
• recent motor vehicle accident
• carpal tunnel syndrome and other wrist and hand pain
• broken bones, splits, or braces
• missing or limited functioning limbs
• severe scoliosis
• post surgery (even small wounds, such as skin tears, can be problematic)

(This list is not done is not in order of importance, as they are all important to share with your instructor.)

There are also some conditions that affect stamina that we would like for you to let us know about:

• hypertension
• stroke
• fatigue due to illness
• headache, nausea, dizziness
• respiratory illness such as asthma and emphysema
• fibromyalgia
• diabetes (type 1, and type 2 if newly diagnosed or poorly controlled)

Finally, some conditions might be more appropriately addressed in a gentle class or even a restorative yoga class, so if we know what is happening with you, we can guide you to resources you might have a hard time finding on your own, such as specialty classes or an especially talented instructor for what is going on with you. A few conditions that might fall into this category would be:

• chronic fatigue syndrome
• active multiple sclerosis
• post chemotherapy
• severe rheumatoid arthritis
• Lyme disease

Now that I’ve—hopefully—convinced you of the importance of informing your teacher of any problems you may be experiencing and let you know the kinds of conditions we want to know about, how should you approach him or her? If you want to talk to your teacher in person, it is probably a good idea for you come a few minutes early to class to have adequate time to give your teacher a good synopsis of what is going on. Or, you can use email prior to coming to the class. I often have had students send me an email to check in with me about the appropriateness of my class for their level of experience or their present condition. This is a good way in our modern era to get the information you need to feel more comfortable attending class as well as to keep your teacher informed. But really, in any and all of these cases, it takes you stepping up and sharing what is happening with you, so your teacher has the best chance of providing an appropriate and beneficial experience for you in class.

Taking on a Yoga Challenge

by Nina

A highlight of my week last week (at least from a yoga asana perspective) was getting up into handstand by myself again in my class. Although I was able to do handstand for a number of years, I lost the ability to do it due after some shoulder injuries (two frozen shoulders to be specific—who knew you could get that nasty condition more than once!). So I’ve had to go through the process three times of learning/re-learning to do this pose. The way I did it was by practicing the pose home. But how can you practice a pose that you can’t do? Well, I just made up my mind to try getting up into handstand several times a week. Just casually. Just one try. And if that didn’t work, no big deal. After I after finally got up once, still keep practicing. If I failed after that first success, again, no big deal. Just keep practicing. Just keep practicing. Just keep practicing. That’s basically the way I not only learned to do handstand, but also a number of other challenging poses. This process always reminds me of the main message of the Bhagavad Gita.

You have right to your actions,

but never to your actions’ fruits

Ac for the action’s sake.

And do not be attached to inaction.

Self-possessed, resolute, act

without any thoughts of results,

open to success or failure.

Taking an approach like this is one of the many ways your asana practice can teach you about yoga philosophy in action. And this approach to a difficult asana is one you can use for any challenging task that you take on.

But I decided to bring up this topic because this week Baxter and I will be featuring Warrior 3 pose, which is a very challenging balance pose (in fact, this is another one of the challenging poses that I practiced at home on a regular basis so I could become better at it). Do you think you can’t do Warrior 3? And do you want to learn?

1. Start with the wall version (see Warrior 3 (Wall Version)) with hands flat on the wall. We had a comment from one our readers saying her students found the wall version too challenging. But if it’s too hard to lift one of your legs up parallel to floor, you can try lifting it up a tiny bit or even just coming onto the toes of one of your feet so more weight is on one leg. That’s still the pose!
2. Keep practicing the wall version until it’s relatively easy and you can maintain comfortably at least 30 seconds. (If you are not lifting your leg all the way or up or even off the floor, keep practicing until you finally do.)
3. Now try practicing with your hands on the wall to fingertips. Work with this version until you can maintain comfortably for at least 30 seconds.
4. Now try the pose away from the wall for just a brief moment, keeping your torso and leg at angle (not coming full parallel). Yay, you did it! Work with this version until you can maintain comfortably for at least 30 seconds.
5. Experiment with the full pose as we will show it later this week. Start with the easiest version first (arms back), the middle version next (arms out to the sides) and work up to the hardest version last (the full pose). Work through each version the same way, starting with a brief hold and than working up to a longer hold.
6. Once you learn the pose, keep practicing it on a regular basis!

Although this post has been about Warrior 3, I hope this inspires you to start practicing any pose you find challenging. Practicing a challenging pose at home is a great way to start a home practice or to keep your home practice from getting stale. And even though the instructions today were specifically for Warrior 3, it should be pretty easy for you to extrapolate from them to come up with your own path for practicing whatever pose you decide to take on.

Friday Q&A: Restless Leg Syndrome and Yoga

Q: How about a post on yoga for restless leg syndrome?

A: Restless leg syndrome is a disorder that causes an urge or need to move your legs to stop unpleasant sensations. The sensations occur in your lower legs between your knee and ankle, and the feeling makes you uncomfortable unless you move your legs. These sensations are described as creeping, crawling, aching, pulling, searing, tingling, bubbling, or crawling. They usually occur at night when you lie down, or during the day when you sit for long periods of time, and may last for one hour or longer. They may also occur in your upper legs, feet, or arms. You will feel an irresistible urge to walk or move your legs, which almost always relieves the discomfort.

Most patients have rhythmic leg movements during sleep hours, called periodic limb movement disorder. All of these symptoms can disturb sleep, and this lack of sleep can lead to daytime sleepiness, anxiety or depression, and confusion or slowed thought processes. The symptoms can also make it difficult to sit during air or car travel, or through classes or meetings.

Restless leg syndrome occurs most often in middle-aged and older adults, and seems to be exacerbated by stress. Patients with chronic kidney disease, diabetes, iron deficiency, Parkinson’s disease, peripheral neuropathy, pregnancy, use of certain medications such as caffeine, calcium channel blockers, lithium, or neuroleptics, and withdrawal from sedatives have a higher incidence as well.

There is no specific test for restless leg syndrome and no known cure. Treatment is aimed at reducing stress and helping the muscles relax through gentle stretching. Ding, ding, ding! Obviously, given the fact that western recommendation includes gentle stretching exercises, not to mention stress reduction, yoga is an excellent alternative for someone with this condition to try.

We recommend that you gently stretch all the basic muscle groups in your legs. All the basic standing poses are helpful if you do them in a gentle way, moving dynamically or just staying in the poses for short periods of time. And, of course, one of the most effective leg stretches is the Reclined Leg Stretch series (Supta Padangusthasana series). Baxter’s Dynamic Reclined Hip Stretches would also be great the legs and hips. To stretch your calves, try practicing Warrior 1 with your forearms on the wall to give your back leg a good stretch.

To reduce stress while releasing leg tension, we recommend Legs Up the Wall pose (Viparita Karani) and Easy Inverted pose  (Relaxation pose with your legs on a chair, with or without a folded blanket under your sacrum). To promote better sleep, try a guided meditation or yoga nidra before bed (see Audio Tracks at the top of the page). When you set yourself up for yoga nidra practice, set your intention that when you notice restlessness arising, you will just watch the feeling rise and fall without having to move your legs.

—Baxter and Nina

Featured Pose: Warrior 3 (Wall Version)

by Baxter and Nina

Warrior 3 is the third pose in our upper body strengthening series because this pose provides unique upper body strengthening with little or no weight bearing on your hands. Before providing instructions on how to do the full pose (coming soon), which can be quite challenging, we’re providing an alternative using the wall that is accessible to almost everyone.

Warrior 3 is unique in that in this pose you keep your torso, arms, and one leg parallel with the floor. In this position, gravity challenges you to keep yourself upright instead of folding over your front leg. All the musculature on the back of your body has to work actively to keep you in this position, including your hamstrings and buttocks along with all the spinal muscles up to the base of your neck. You are also building strength the arm muscles required to keep your arms overhead (the position known as flexion), including trapezius, anterior and posterior deltoid, serratus anterior.

To enhance the strength building aspect of the pose when you are using your hands on the wall, use the lightest touch possible on the wall so your arms still have to work to hold themselves up. Touching the wall with just your fingertips is the most effective, but you can still gain strength building with your palms lightly on the wall if you prefer full contact with the wall for support, balance, or even just a sense of security.

Instructions: Start by facing a wall, standing about one foot away. Place your hands on the wall shoulder-distance apart, either with palms or your fingertips on the wall. Depending on your hamstring and hip flexibility, your hands should be somewhere between shoulder height and elbow height. Next, bend your knees and push your hips back away from the wall, and, keeping your buttocks over your heels, slowly walk back until your arms and torso form one long line approximately parallel to the floor.

You are now in Half Downward-Facing Dog pose (see Featured Pose: Half Dog Pose at the Wall for photos and detailed instructions of moving into this pose). From here, push your fingertips or palms firmly into the wall as you press your sitting bones away from the wall. Then shift your left foot to the right, at the mid point between your feet, while allowing your hips to shift a little to the left so you are balancing on the left foot. Then swing your right leg up and back, in line with your arms and torso.

Be careful to avoid letting your chest sink toward the floor, because hanging from your shoulder joints puts a lot of strain on them. Instead of feeling a stretch in the shoulders, you want a feeling of even strength around your shoulder joints. So think about lifting your chest up into your shoulder blades, as opposed to dropping your chest down toward the floor and aim for a feeling of completely parallel line (if you are flexible) or an even slope (if your hamstrings are tight).

One you’re in the pose, try lightening the press of your hands on the wall so you can feel the work of your back body’s musculature keeping you in position. With your raised foot slightly pointed, lengthen through your hell away from the wall. Start by staying in the pose for six breaths or so and gradually over time work your way up to 1.5 to 2 minutes.

To come out of the pose, release your right leg down to the floor, bend your knees, and walk in toward the wall. Repeat on left other side.

Cautions: This pose requires a lot of back strength, so if you have lower back issues, you may need to modify the pose by placing your hands higher on the wall or by keeping your lifted leg slightly bent. If you have a hamstring strain, if you feel any strain in the standing leg, bend it slightly so you don’t aggravate your injury.

Osteoporosis, Balance and Yoga

by Brad

A couple weeks ago, I attended a very interesting seminar on “Bone Marrow Adiposity:  An Age-Associated Phenotype; What's between bone and fat?  New insights into age-related osteoporosis” by Dr. Clifford Rosen, MD.  Dr. Rosen is the Director of the Center for Clinical and Translational Research at the Maine Medical Center Research Institute in Scarborough.  His talk was fairly technical and had to do with the regulation of fat in bone and how it increases slowly with age, as well as being affected by other environmental and genetic factors. His data showed that as fat accumulates in bone with age, it appeared to be related to a decrease in bone density, and therefore could be a driver of osteoporosis in both men and woman. He also stated that the clinical manifestation of osteoporosis is bone breakage, and therefore as your bone density decreases, it is the fall and inevitable bone fracture that typically turns people into patients. Avoiding a fall in the first place is possibly the best and for some the only way to avoid the adverse effects of this age-related decline in bone density.

After his seminar, I had a chance to talk with him after his research and asked him whether yoga might help by decreasing the risk of falling. He immediately said yes, and added that the yoga and tai chi were the two things that he knew that had been shown to have the greatest benefits in reducing this falling and bone fractures (see, for example, the Mayo Clinic web site's Exercising with osteoporosis: Stay active the safe way by choosing the right form of exercise and the New York Times article Ancient Moves for Orthopedic Problems). He implied that this was primarily through an increase in balance as opposed to strength. Indeed, while there is plenty of evidence that strength training is important, an increase in balance and flexibility can make all the difference between a stumble or misstep and a full-fledged fall.

As I sit on my flight to Seattle, I am reminded of how much variation exists in flexibility and balance among adults. Squeezing out of an aisle seat to make your way to the restroom or retrieving a suitcase from the overhead bin can easily become an awkward and precarious—and at times dangerous—act. And it is often not the oldest passengers, but the middle-aged and muscle-bound adults who induce serious cringing from neighboring passengers. Imagine how much more agile they would be if they all practiced yoga!

And for those of us who already do yoga, this is yet another compelling argument that working on balance is critical as we age. So if you haven't done so already, check out Shari's post last week about how to create a yoga practice to improve your balance (see Planning a Practice for Improving Balance).

Yoga and Arthritis of the Hands

by Baxter

Every time I get a call from a student or patient about arthritis of the hands, it brings to mind an image of my beloved Grandma Lopresto, at her towering height of 4’11”, who lived to be 93 with the clearest mind you can imagine. She had arthritis in her hands. Yet I never recall her complaining about it. In fact, I never heard her complain about her body at all, even though she also suffered from post-herpetic neuralgia, a chronic painful condition that is an aftermath of getting shingles. 

But back to Grandma’s hands—when you looked at her hands, she had obvious swelling around the knuckles of almost every finger on both hands. And although I would see her working the fingers by rubbing and bending them, it did not seem to slow her down, as she lived on her own for 29 years after her husband died when she was 64. I can recall her even doing some simple sewing projects to replace a button and such.

Ah, if this were the case for others with arthritis of the hands! For many, there is chronic pain that is disruptive to daily activities, sometimes requiring pain medication, anti-inflammatories, injections and more invasive measures to deal with it. Grandma certainly had classic osteoarthritis of the fingers, which affects the last joint of the finger, the DIP joint, and involves small nodular swelling around the joint known as Heberden’s nodes, and the closer knuckle, the PIP joint, with Bouchard's nodes. The most common site affected by arthritis in the hands, however, is the thumb. It is usually a form of osteoarthritis, the common wear and tear arthritis that affects millions of Americans annually. It affects the joint between the carpal (wrist bones) bones and the metacarpal of the thumb (which resides in the palm of the hand). On its worst days, basal joint arthritis (its other name) can cause pain, swelling, stiffness, weakness or immobility. In addition to what I have mentioned already, treatment by your family doc or rheumatologist can also include self-care recommendations and splints. These splints can help decrease pain, re-align the bones, and permit the joint to rest. Obviously, if you have to wear a splint, you’ll need to modify your hand use in yoga.

One thing to keep in mind is that osteoarthritis often results from trauma or injury to the thumb at some point in the past, and that over time the protective coating of cartilage on the ends of the bones wears away, exposing sensitive bone to bone.  One way to address this via yoga or visualization is to lengthen the thumbs or fingers, depending on which joints are affected, from palm to fingertips, specifically focusing on the affected joint. The encouragement you get from your teacher to spread and lengthen the fingers in poses like Downward-Facing Dog pose is pretty good advice. Although, as you might imagine, you may need to avoid putting full body weight onto your hands if you are experiencing a full-blown joint flare.  In such situations, non-weight bearing asana would be more appropriate, of which there are many.  Ones in which the arms are overhead, such as Warrior 1 and Tree pose, can be particularly helpful to enlist the aid of gravity in pulling swelling away from the hands and back toward the heart. 

Often the pain and stiffness of osteoarthritis in the hands is most noticeable in the morning when you first get up. Warming your joints in the shower and gentle movements of your hands and fingers for 15 to 20 minutes can result in less stiffness and decrease in pain.  If you have not seen a physical therapist for specific range of motion exercises, consider asking to do so. In the meantime, you can use your yoga sessions to put your hands and thumbs through their paces, maximizing the range of motions in the most pain free way you can. 

Other patterns of finger arthritis include the less common condition of rheumatoid arthritis, which affects the hands at the wrist joint and at the joint between the palm bone and the finger bone, the metacarpal-phalageal joint.  Often, more than one joint is involved. Rheumatoid arthritis is an autoimmune illness, and it can cause much worse and more persistent symptoms than osteoarthritis so even gentler approach may be needed.

If you are at risk for developing arthritis in the hands, via age (over 40), sex (female), family history of osteoarthritis or rheumatoid arthritis, or history of trauma to your hands, a balanced yoga practice, with a careful, stepwise approach to yoga poses that involve bearing weight on the hands (such Cat/Cow pose, Downward-Facing Dog pose, Upward-Facing Dog pose, and all arm balances), may be helpful in maintaining a good range of motion in your hand joints over time. Adding a variety of hasta mudras, or hand seals, could exercise and strengthen your fingers in a non-weight bearing fashion.

And for those who have already developed arthritis, less weight-bearing asana is likely the way to go. There are also a number of props coming out that could assist in more pain-free exploration of the asana in which your hands are on the floor.  Specialized gloves with a rubber cushion for the heel of the hand, as well as wedges, rounded blocks, and weird circular cushions called Yoga Jellies are all possible aids to permit careful inclusion of weight-bearing asana in your practice.  And surely, as you must know by now if you are a frequent reader, enlist the help of an experienced teacher who has worked with others who have arthritis!

Benevolence of Spirit

In a Japanese Garden by Brad Gibson

“The practice of yogasana for the sake of health, to keep fit, or to maintain flexibility is the external practice of yoga. While this is a legitimate place to begin, it is not the end… Even in simple asanas, one is experiencing the three levels of quest: the external quest, which brings firmness of the body; the internal quest, which brings steadiness of intelligence; and the innermost quest, which brings benevolence of spirit.” —BKS Iyengar

Planning a Practice for Improving Balance

by Shari

We've had a question about how to practice when you want to work on balance. We're going to take our time addressing this issue because there are several factors involved in balance. When you plan a daily balance practice, it is important to include all six basic balance components:

1.  Strength: Strengthening your legs is critical. Leg muscles that need to be strong for good balance include the quadriceps, hamstrings, adductors, gluteal, and ankle muscles. (Please see Baxter’s recent posts on feet and ankles). In addition, the back muscles specifically the back extensors, are also important.
2. Proprioception: The ability to sense where we are in space is critical for balance. Practicing with an emphasis on proprioception can help maintain or even increase this ability.
3. Central Nervous System Reactivity: The ability to coordinate movements of your eyes is essential to seeing objects in your environment clearly while you are in motion, and other central nervous system reactions help you maintain balance.
4. Postural Control: Standing well is the critical component for maintaining balance.
5. Gait: Varying how fast and slow you walk, as well as the sizes and directions of step, can help you stay more nimble and avoid falling.
6. Vestibular System: The vestibular system is the sensory system that contributes to movement and sense of balance. Together with the cochlea, a part of the auditory system, it constitutes the labyrinth of the inner ear in most mammals, situated in the vestibulum in the inner ear.

You can target your specific “challenge” areas by varying how you incorporate these components in your practice.

Strength

We need dynamic as well as static strength to prevent falling. Simple ways to strengthen your legs can be standing up and down from a standard height chair without using your arms to assist you. How slowly or quickly you do this can add to the variability for the muscles. Holding the position at various points in going down and coming up is also good. Working until your legs feel fatigue is the key to strengthening these muscles. But please remember these types of quadriceps exercises load the knees significantly and they could potentially aggravate an arthritic knee. So be careful.

Another way to build leg strength is a stair-stepping routine of stepping up and down one step with one leg and then changing and doing it on the other leg. You can also side step up and down with one leg as well as back stepping up and down with one leg. Try not to use the handrails unless you absolutely need to. Varying the speed of the step is good, too.

So now to translate this to yoga poses: think Warrior 2, Warrior 1, Extended Side Angle pose (Parvakonasana) and Powerful pose (Utkatasana). Move into and out of these poses first as a flow, pivoting your feet to keep changing directions. Then move into and out of these poses more quickly. Having a friend call out the poses so you can’t anticipate them can be fun—putting together your own sequence to delight your practice buddies! Then working to hold the poses with a timer to build strength. Start with a doable time, for example, ten seconds, and then increase it slowly. Thirty seconds is actually an eternity to hold a pose that is difficult for you. Varying how low you go into a pose is also valuable. Stepping into poses but not taking the actual pose also will challenge your reactions especially if someone else is also calling it out to you.

For back strength (this also includes gluteal muscles), try Locust pose (Salabasana) with arms and legs, as well as an all-fours position with opposite arm and leg lefts (Baxter calls this Hunting Dog pose—see Hunting Dog Pose for complete information on how to do this pose).

For ankles, try lunges with an emphasis on the back foot, toe rises and rocks with no hands (with both legs or one at a time). 
 
Proprioception

Closing your eyes while you practice can help with proprioception. For example, do toe rises and heel rocks but now close your eyes.

You can also work on an unstable surface, such as a foam mat (thick), an inflated air bed, your own bed or a couch (be creative and safe when choosing the unstable surface). Try standing in Tadasana (Mountain pose) with your feet hips-width apart and then with feet together on an unstable surface (first with your eyes open and then closed). After Tadasana, try heel-toe rocks on your unstable surface, first with your eyes open and then closed if possible. If you feel really adventuresome, try some standing poses on this surface, such as Warrior 2, Triangle pose, and Downward-Facing Dog or Hunting Dog pose as shown above. If this is doable, try closing your eyes and doing these poses on an unstable surface. Please make sure that you don’t fall off of whatever you are on because that would really be counterproductive.
 
Central Nervous System

Now let’s add the central nervous system challenge. Standing on an unstable surface, use your eyes to track a moving object. If you are doing this with a friend, he or she can hold a bright object in their hands while you use your eyes to follow their movement in front of you. Do not move your head or body, just use your eyes to track the object’s movement.

Now you can do a dynamic resistive exercise together. Stand facing each other palm to palm with your hands at shoulder height. One person is the leader and the other is the follower. The leader slowly starts to push into the follower’s hands and the follower matches their push into them with an equal push toward them. The leader keeps slowly increasing the force and the follower continues to match it. Then, without warning, the leader with quickly releases the force and move away from the follower. The follower is trying not to fall when the force has been removed. The leader is close enough to steady the follower so they don’t really fall. Change roles and repeat.

Another partner idea is to stand front to front again, but this time one person is holding a light object just out of their partner’s reach. The reacher is trying to lean to grab the object but the partner continues to slowly move the object just out of reach. The reacher cannot move his or her feet but can shift weight or turn without moving his or her feet. High reaching as well as below waist level reaching is good. There will be a point of reach when the reacher will lose his or her balance—that is the whole idea and the person holding the object should be able to assist their partner so no actual fall occurs. Change roles and repeat.

Postural Control

When working on postural control the key is to learn axial (skeletal) elongation as well as peripheral (arm and leg) elongation. The practice of Tadasana (Mountain pose) is difficult because of its simplicity. But learning your own postural habits is something that does affect balance and the ability to right yourself when a fall occurs.

You can address this component with a friend. Get a stick, such as a dowel, that is approximately six feet long and have your friend stand in Tadasana. Place the stick along his or her back body and see how many points of contact there are. Does the back of the head touch the stick? The upper back? The lower back? The buttocks? Do the backs of the knees touch the stick? Then look in an anatomy book to see what ideal posture is. Once you understand what your own issues are, then if you work with a yoga teacher, he or she can help you start to work on those areas that may need some attention.

Another component to address is the ability to safely lift an object off of the floor without falling forward onto your face when doing so. You can try this first with a friend and a light object like a newspaper. Each of you can do the task, which may be easier for some to do than others. Talk with each other to see if you can identify what makes it easy for some of you and more challenging for the others. With this information then you can decide if your personal issues are strength deficits, mobility or flexibility challenges, or other balance issues.

Now back to yoga poses that combine strength proprioception, and posture. Think Tree pose (Vrksasana), Mountain pose (Tadasana), Half Moon pose (Ardha Chandrasana), and Powerful pose (Utkatasana) with eyes open and closed, and with a stable and unstable surface. I am also particularly fond of the all-fours routine (Hunting Dog pose) on an unstable surface with eyes open and closed. Really you could pick one standing pose a week and work it through these variables of changing the surface you practice on, and whether you have your eyes open or closed. Moving into and out of the posture slowly or with variability in the degree of depth of the posture. The choices are endless actually.
 
Gait and Vestibular System

Try varying the speed of your walking—very fast or slow, big steps or small steps, quick changes in directions. You can also try stepping over items and around items, with quick changes again in direction after stepping over objects. Vary the objects you step over; some can be high and some can be low. You could do this with a group of friend, and have one person calling out what to do and the others following the directions. You could add music (like musical chairs) but when the music stops a pose might be called out for you to do.

And then there is what I call the “Queen Elizabeth walk” Walk at a stately pace while waving with alternating hands and turning your head to look at your adoring subject. The idea here is to make your practice fun!