Friday Q&A: Yoga Solutions for Hypertension

Q: I'm wondering if you could help me ID some yoga resources for my sig other.  He suffered an aortic dissection last Nov while visiting me here from Italy. Barely made it to the ER and surgeon's table on time. Five hour surgery later, he had a new synthetic 4 inch segment replacing his aorta just above the heart and a new lease on life. Six months out he's doing great. He does have a little bit of chance of recurrence, but overall the outlook for his continued recovery is good.

The present goal apparently is to keep his BP down. He's been on medication for it, but our family doctor took him off of it recently as his pressure was quite low before the dissection. He works out lightly at the gym and takes long walks.

He's never done yoga but wants to begin, and I want to help him do that. I'm wondering if you've published (or know anyone good who's published) any videos/sequences of asanas/instructional materials on yoga and BP OR if there's simply a good beginner DVD you might recommend for an older (a young 63 year-old) fit man who's been through what he went through. I've searched around a lot, but am a bit lost in the flood of materials for beginners and finding nothing, on the other hand, other some short articles in YJ, on yoga related to BP.

A: I am so pleased that your partner survived his aortic dissection, which is often, sadly, not the case. And it sounds like for the time being he no longer is showing blood pressure reading of high blood pressure that he had prior to the tear in his aorta. That could change as he gets back to normal activities and eating and such. It is great that he is already doing some weight/strength training and aerobic activity with his gym visits and walks. 

And I can understand your frustration and desire to start off his venture into yoga in a safe way. Please start by checking out the posts we have done here on blood pressure and yoga (see Hypertension and Yoga: An Overview). It is hard to say for sure what kind of beginner practice will be right for him, as he may have other age-related health issues and old injuries to take into account. You can certainly think about having him work with one of the senior teachers in your area individually, initially focusing on stress-reducing practices. There are some general cautions to be mindful of when designing a home practice, like not holding standing poses for very long, skipping and modifying most inversions, other than Downward-Facing Dog and Legs Up the Wall (Viparita Karani) poses, if his blood pressure is elevated at rest. And generally, doing milder forms of most poses including forward bends and twists that also could increase intra-abdominal pressure. Guided meditation, basic breath awareness and yoga nidra would be good to include, with a focus on visualizing a calm and strong heart and vascular system. 

For additional helpful suggestions regarding asana and other yoga practices, there are some written sources that talk about hypertension that you can look over. In Timothy McCall’s book Yoga as Medicine, he devotes a chapter to the subject, featuring experienced yoga teacher Aadil Palkhaivala.  Aadil. He categorizes two kinds of HTN, which he calls “jittery” and “pent-up,” and approaches each a bit differently. Timothy’s book goes on to share three series that Aadil teaches, as well as some specific standing, seated, and reclining poses he recommends. A great warning that Timothy also mentions is avoiding what is known as the “Valsava Maneuver,” in which you hold your breath and bear down, like you would to pass a bowel movement. Doing so can cause a major spike in blood pressure. 

In their book The Woman’s Book of Yoga and Health, Linda Sparrowe and yoga teacher Patricia Walden also devote a chapter to cardiovascular health, and Patricia offers a nice sequence for HTN that is mostly supported restorative poses. This sequence includes one supported Standing Forward Bend and one Downward-Facing Dog (the only two “active poses” in the sequence). 

And finally, Gary Kraftsow’s Yoga for Wellness also has a chapter on cardiovascular system, and he offers an example practice that he did with one of his students that utilizes the Krishnamacharya method of mini-vinyasas. In this case, the opening four poses are either seated or using a chair to modify the depth of the pose, followed by a Cat/Cow variation, dynamic Cobra vinyasa, supine Apanasana (Knees to Chest) sequence, and of course, Savasana.

Although I was not able to find the exact sequence used in the recent study on Yoga for HTN that I referenced in my last post, that would be interesting to review if you can get a copy of the actual study as it likely describes all the poses and practices utilized.

I hope that these ideas will help you to get your sweetie on his way to a safe and effective yoga practice to assist in keeping his blood pressure in a healthy range. 

—Baxter

Yoga Relaxation Techniques: They're Not Interchangeable

by Nina

Patterns in the Sand 2, by Brad Gibson

Okay, I admit it. It’s probably my fault. I’ve been going around saying that you can trigger the Relaxation Response (see The Relaxation Response and Yoga) using any of the following: restorative yoga, inverted poses, Savasana, pranayama, meditation, and yoga nidra, etc. as if all those practices were somehow interchangeable. This has led to questions like the following comment left on a Friday Q&A: Yoga Nidra, Restorative Yoga, Meditation and Savasana:

It is very helpful to read the distinctions between these four practices as I try to practice all of them, but it's hard to find the time. I'd be really interested to get your thoughts on whether it's important to do all four? For example, if you do restorative while listening to a nidra CD, do you also need to meditate? I'm interested to know what the various benefits are of these four practices, or are the benefits all the same?

Let me start by saying that what I said previously—that you can use any of these practices for stress management—still holds true. And it is also true that you can choose whichever techniques you prefer to trigger the Relaxation Response. However, these practices each have different roles to play in a balanced yoga practice.

The role of meditation in a balanced yoga practice is particularly important. That’s why I asked Timothy to write an article on the purpose of meditation (see his absolutely wonderful post Is Meditation an Essential Par of Practicing Yoga?). Basically, although you can use meditation for stress reduction, its role in classical yoga is to quiet the mind to allow union with the divine or “liberation”:

1.2 Yoga is the cessation of movements of consciousness.
1.3 Then the seer dwells in his own true splendor.

— from Yoga Sutras, trans. B.K.S. Iyengar

Meditation is also, as Timothy mentions, a “fabulous tool to study your mind and slowly gain more control over it.”

Pranayama is also an important component of classical yoga, which precedes meditation as one of eight steps on the path to samadhi (union with the divine). It is considered an instrument to “steady the mind” and a gateway to dharana (the first phase of meditation).

“Pranayama removes the veil covering the light of knowledge and heralds the dawn of wisdom.

Its practice destroys illusion, consisting of ignorance, desire and delusion which obscure the intelligence; and allows the inner light of wisdom to shine. As the breeze disperses the clouds that cover the sun, pranayama wafts away the clouds that hide the light of intelligence.” — Sutra 2.52 trans. by B.K.S. Iyengar

On the other hand, the two types of asana I recommended for triggering the Relaxation Response, restorative yoga and supported inversions, are brilliant 20th century inventions, mostly developed by B.K.S. Iyengar, which are designed specifically to maximize physical relaxation and reduce stress. Judith Lasater, one of the most renowned teachers of restorative yoga, writes in the introduction to her book Relax and Renew:

“The antidote to stress is relaxation. To relax is to rest deeply. This rest is different from sleep. Deep states of sleep include periods of dreaming which increase muscular tension, as well as other physiological signs of tension. Relaxation is a state in which there is no movement, no effort, and the brain is quiet.

"Common to all stress reduction techniques is putting the body in a comfortable position with gentle attention directed toward the breath.”

Likewise, yoga nidra is also a 20th century invention (though you may see some claims to the contrary) developed by Swami Satyananda Saraswati. The first sentence of his book Yoga Nidra defines the practice like this:

“Yoga nidra, which is derived from the tantras, is a powerful technique in which you learn to relax consciously.”

In yoga nidra, you lie in Savasana while the voice of a teacher (or a recording) guides you through a physical and mental relaxation process. So, like restorative yoga, yoga nidra is specifically intended as a relaxation technique, and as such does not replace meditation or pranayama in a balanced yoga practice. This would be true of any form of Savasana in which an external voice is providing instructions and/or imagery for you. Unlike other relaxation techniques, yoga nidra includes a sankalpa (an intention) that allows you to influence your subconscious (or so it is claimed). For example, “I will awaken my spiritual potential,” “I will be a positive force for the evolution of others,” or “I will be successful in all that I undertake.” So this may be something you wish to take into consideration when choosing your relaxation practice.

Unlike the modern restorative postures, Savasana is a much older pose. Based on what I’ve read about the original practice, I’m going to go out on a limb here and say that Savasana is a reclining form of meditation. For some traditional yogis, it was a meditation on death, hence the literal translation of the name Savasana is “Corpse pose,” and it was sometimes even practiced alongside actual corpses. To practice Savasana properly, however, you must actually do the work of meditating while you are in the pose (and make sure you don’t fall asleep). If you don’t actually meditate while in Savasana, then, well, you are simply relaxing. But that's okay, too, if that is what you are after.

So there you have it. Which of these practices you decide to adopt really depends on what your goals are as well as your preferences. If you’re just after stress management and better health, it doesn’t really matter which you chose. However, if your goal is the “liberation” that is yoga’s ultimate aim, both pranayama and meditation are essential steps along the path.

Sorry if I caused any confusion!

Ultimate liberation is when the gunas, devoid of any purpose for the purusa, return to their original [latent] state; in other words, when the power of consciousness is situation in its own essential nature. —Yoga Sutra 4.34 trans. Edwin Bryant

Is Meditation an Essential Part of Practicing Yoga?

by Timothy

Patterns in the Sand by Brad Gibson

Do you need to meditate? Can you achieve all or most of the same benefits from just practicing asana, restorative yoga, Savasana, and/or pranayama? Is it worth even trying if you feel like you're no good at it? We get questions like these at the blog from time to time, so I figured I'd tackle them today.

I can't help but notice that people often talk about yoga and meditation as two separate practices. But according to Patanjali, the great codifier of yoga, meditation was an integral part of the practice. By yoga, of course, most people in the U.S. mean asana, which is why people say yoga and meditation. And since most asana classes don't include any meditation, many yoga practitioners have looked outside of yoga, often to Buddhism, if they're interested in learning more. There's nothing wrong with that, but I think people forget that the Buddha was a yogi before he became the Buddha!

Meditation gets a lot of press as an effective tool to de-stress, to calm the mind and the nervous system. That's certainly true, but if that were all meditation had to offer, you could hardly view the practice as vital, since we've got so many tools in yoga that can foster relaxation: asana, breathing practices, chanting and restoratives to name a few.

To many dedicated yogis, however, meditation is the crown jewel of the practice. They recommend asana mostly because it prepares the body for meditation, to sit up straight comfortably for long periods of time. All the high levels of samadhi—absorption as it is sometimes translated—the eighth of the eight limbs of yoga that Patanjali describes in the Yoga Sutras, are said to happen only in meditation. And, more specifically, from its long-term practice over the course of years, even decades.

I have been meditating for a long time, and it has become in many ways the most delicious part of my practice. It didn't start out that way. My mind was very busy when I began, and it was extremely difficult for me to keep my attention from flitting from idea to idea. And it was hard to find comfort sitting in one place, without frequent position adjustments and fidgeting. Many people who try to meditate get discouraged at this point and give up. That, I believe, is a mistake. As with a lot of other areas of yoga, hanging in when things are challenging, even discouraging, can bring rewards. Yoga teaches that it is by strengthening our weaknesses that we become more balanced.

Meditation can be a fabulous tool to study your mind and slowly gain more control over it. (I'm not just talking about the conscious mind, which is mostly what gets dealt with, often quite helpfully, in psychotherapy, but the unconscious mind, which hugely impacts our behavior and happiness.) The first lesson for most of us on the meditation cushion is just how unruly our minds are, and how hard it is to maintain our focus for more than a few seconds. Seeing that reality may be uncomfortable, but it's the first step toward eventually changing it.

And there is real benefit in feeling your mind running all over the place, wanting to get up and move, and continuing to stay seated anyway, trying to bring your attention back to whatever you're focusing on, whether that's your breath, an image, or a mantra. Studies of the Relaxation Response, which were performed on people practicing a demystified form of yogic mantra meditation, have shown that even when practitioners don't feel they are doing it well, they gain the physiological benefits of lower blood pressure, heart rates, etc.

Even after years of practice, some days my mind is still all over the place. But usually, if I stay at it, things eventually settle down. One reason why some experts recommend 20 minutes of meditation daily is that it often takes about that long to settle down. But the more you practice the easier it gets.

You might wonder where you will find the extra time to add a 20-minute practice to your already busy schedule. Well, first off, you don't need to do it for that long. Even a few minutes in the beginning starts to build up the habit. Over time you can slowly increase the time you sit. Interestingly, about a decade ago when I upped my practice to an hour a day, I discovered that I began to need about an hour less sleep each night, as if the meditation were giving me some of sleep's restorative effects. It felt like I was getting to meditate for free, without carving any time out of my day!

In my yoga therapy work, I often recommend meditation, but not always. Sometimes when someone is very anxious or seriously depressed, if they attempt to close their eyes and go inward, they may go into an unpleasant—and potentially counterproductive—state of mind. But if we can use other tools, like breath and asana, to improve the acute situation (along with whatever medication, therapy or other tools they are employing), I will often try to add meditation later. I have come to believe that for the long-term care of anxiety and depression, meditation may be the most powerful tool we have. It gets to places that asana simply can't, as powerful as asana can be.  But unlike a lot of meditators, I don't think you should give up your asana practice once you get into meditating. Because asana also gets to some places that meditation can't, like your hip flexors, for example!

The bottom line is that the different yogic tools appear to work together in a synergistic fashion. Meditating can make you a better asana practitioner, and doing asana can help deepen your meditation. And regular pranayama can help both of them!

In my next post, I'll give more specifics on how to begin a meditation practice. If there are particular themes you'd like to me address, please let us know.

Hypertension (High Blood Pressure) and Yoga: An Overview

by Baxter

On these hallowed blog pages, we have previously addressed several conditions that involve our cardiovascular system (heart and blood vessels), such as arrhythmias, strokes, hypotension and hypertension (also referred to as High Blood Pressure and Hypertension, or HTN). We even have at least six posts that at least mention HTN. However, due to the large percentage of adults who will develop HTN over the course of their lifetimes, I thought it worth revisiting. In 1999-2002, 28.6% of the U.S. population had hypertension. And this number seems to be on the rise. Plus, there is yet another study that demonstrates yoga’s beneficial effect on lowering blood pressure in those with mild to moderate hypertension! (For background information about what blood pressure is, see So, what is blood pressure, anyway?)

Why all the hype about HTN or high blood pressure, anyway?  Well, if you have HTN, you are at an increased risk of developing other more serious health problems, including heart attacks, strokes, rupture of your largest blood vessel (the aorta), chronic kidney disease, congestive heart failure, decreased blood supply to your legs, and problems with your vision. Some people develop HTN secondary to the presence of some other health condition that leads to high blood pressure, such as chronic kidney disease (hey, wasn’t that just mentioned?!), diseases of the adrenal and parathyroid glands (part of our endocrine system), pregnancy, and medications such as birth control pills, diet pills, some cold meds, just to mention a few. 

And some people are at a higher risk of developing HTN, if any of the following factors are present for you: obesity, chronic stress and anxiety, excessive alcohol consumption, excessive salt in diet, family history of HTN, diabetes, smokers, and African American ancestry. Part of the frustration for people who are diagnosed with HTN is that they often don’t have any really noticeable symptoms. I can’t tell you how many times I diagnosed a patient in my family practice with high blood pressure when they came in for a routine annual exam with no real complaints, or were in the office for some unrelated complaint, like a cold or headaches. This is why HTN is often referred to as the “silent killer,” as you may not know you have it until one of its complications like stroke or heart attack strike you.

Complexity in Nature by Brad Gibson

It’s been known now for at least 40 years that yoga practices can help lower blood pressure in people with HTN, starting back in the 60s and 70s with the work of Herbert Benson, MD, a cardiologist who used a particular kind of yogic meditation popular at the time (TM or transcendental meditation) to help lower the blood pressure in his patients who were not responding as expected to the newest medications of that era. Since then, other studies have shown similar results, including the newest study from the University of Pennsylvania, Philadelphia, still in progress, which is following 120 patients with mild to moderate elevations in their blood pressure. Already, with 58 people completing the study so far, there is small but significant decreases in blood pressure readings in the yoga group. This could be of greatest importance to patients who are labeled with “pre-hypertension,” where the blood pressure readings fall between 120/80 and 140/90.  This group of people is at much higher risk of going on to develop full HTN and is at higher risk than the general population of serious situations such as stroke and heart attack. However, if treated with yoga, they could drop their numbers low enough to avoid the need for medications to do the job.  In previous posts, Nina and Shari have talked about kinds of asana practices that have been shown to lower blood pressure, such as forward bends and certain inversions, as well as the effect on the baroreceptors that monitor and influence blood pressure moment by moment.  See Blood Pressure: Talking About Baroreceptors and Yoga and Just in Time for the Holidays: Inverted Poses.

As to how you might incorporate yoga practices into your efforts to lower your own rising blood pressure, you would likely want to add it to a broader approach to treatment, instead of substituting yoga for medications, for instance. Usually, a combination of aerobic activity, dietary changes, appropriate salt restriction, stopping tobacco use, lowering stress, and achieving an optimal body weight are the first line actions recommended when you are diagnosed with HTN. As we have shown before, yoga can help with many of those goals, such as weight management and stress, as well as improving will power, which could help with establishing all of those changes suggested from your usual dietary and lifestyle habits. But, independent of that, as this newest study again points out, yoga helps lower blood pressure on its own. It can do it via a balanced asana practice, via meditation practices and via breathing techniques. It is, of course, frustrating for those of us familiar with this data, that mainstream medicine has not embraced this cost-effective modality to any significant degree. If it were a pill, I suppose, it would be a no-brainer. 

And for those interested in developing a home practice for hypertension, due to the multiple factors that could influence your unique situation, I highly recommend you work one-on-one with an experienced yoga instructor to create the optimal practice for you. Yoga for high blood pressure? You bet!  

Friday Q&A: Neck Pain and Fear

Q: I read of yoga for back pain, but little about neck pain. I've been in PT for months, with good ideas about posture/extension/alignment, etc. And now I'm in a series of skillful massage targeted to the neck muscles...but such stiffness in spite of it all! Did yoga for years, but not lately (still active!) I'm wary of yoga that my pain might be exacerbated. I'm 52. My work is varied, with some hours at a desk but broken up with people interaction. Thanks for your counsel!

 A: I understand why you might be afraid of doing yoga again but I want to reassure you that starting to practice again will be beneficial for you in so many ways. I currently have a student with a lot of physical challenges and chronic pain from prior surgeries. She has told me so many times that even though her body may not be able to move the way she wants it to, when she wants it to do something, she finds that “yoga is good for my mind. It makes me tune in and just listen to myself.” This individual needs a lot of modifications when she practices, but because she trusts both me and my co-teacher Bonnie, she is willing to try new things, "even when they are scary,” specifically because she knows she can stop WHENEVER she needs or wants to and we respect her decisions. We have a “circle of trust” in our class that is very valuable to both the teachers, the students and our assistants.

The great thing about yoga in my mind is the ability to stop whenever necessary. The practice is an internal dialogue not an external show. Sometimes we need to be reassured we can still do an activity but are afraid because it might hurt. Well, if something or an activity causes an increase in pain, then we have the ability to stop the action. Sometimes although our minds fear something when there really isn't a physical correlation between the fear and the action, we have to teach our mind not to fear the action. It is kind of like relearning to ride a bike when we have fallen off in the past and done some serious damage but now have the desire to get back on the bike. But where to start? With all activities it is helpful to imagine the activity first before attempting it. So, if you had some yoga poses that you used to do that gave you pleasure, start with those. I would set myself up in a position of comfort where I was warm and felt safe, and then I might mentally begin the practice using only my memory. After a while of envisioning the pose, I would try it just a little bit. If I felt scared that I was going to hurt myself, then I would stop and leave it and try again tomorrow.

If this type of mental re-entry into yoga doesn't work for you, then you might re-contact your teacher (if you had one) and ask to talk about your concerns about returning to a class. If you don’t have a teacher anymore, look for someone in your local area who has experience with working with individuals with neck injuries and discuss your concerns about re-entering a class. If that isn’t possible, look for a class either for people recovering from injuries or with a gentle focus, and, again, approach the teacher with your concerns. Going back to a class has to feel safe for you, and in order to feel safe you have to be able to trust the teacher to not make you do more than you are comfortable with. Don’t be afraid to be frank about your needs and to have the ability to keep yourself safe. If you still can't find a teacher who fits this profile, contact the International Association of Yoga Therapists and ask for a teacher in your area or near to you that you can work with. They keep a registry on file for all members.

 And finally when you do begin to practice I would follow the motto of “less is better” because more than that might spiral you back into a flare-up cycle and put you off of yoga for quite a while. Poses that I particularly like when my own neck is feeling fragile are more passive poses like Viparita Karani (Legs Up the Wall pose) or a passive backbend over bolster with neck and head support. Active practice like standing poses with arm motions often make my own neck feel worse, so go easy on those. Learning to twist again without using arms for leverage also is important. I also like Chair Shoulderstand with a bolster under my upper back and no weight on my neck.

You mention only the physical aspect of asana but as you can see on many of the posts on our blog, that is only one small part of the practice of yoga. I might use this opportunity to re-visit some of the other limbs of yoga, especially some pranayama or basic breathing practices. The ability to fully breathe is a gift in learning to manage chronic pain and stiffness because it's like doing a massage from the inside out. I suffer from major neck issues myself, and I find that my neck will often let me know when I am overworked or overly stressed because the littlest things can set off my own pain cycles. There is no quick fix, but there are many pieces to the puzzle in learning how to manage ourselves in life.

—Shari

Energizing Yourself: Overcoming Styana and Alasya

by Nina

I don’t know about you, but Ram’s post yesterday The Dangers of Being Sedentary scared me a bit.

Findings from a recent study showed that individuals who sat for more than 11 hours daily were 40 percent more likely to die within the next three years than those who sat for four hours or less daily—even when people’s physical activity at other times of the day was accounted for. Studies have also indicated that sitting daily for less than 3 hours and watching TV for less than 2 hours extends life expectancy by an estimated 1 to 2 years. Studies reported in the prestigious journals Lancet and the British Medical Journal suggest that a sedentary lifestyle is the cause of one in 10 deaths worldwide. It’s now known that Americans are working less (26 minutes a day less compared to Y2007) and idling off more. Adults in the U.S. spend an average of 55 percent of their day engaged in some kind of sedentary behavior (see Sedentary behaviour and life expectancy in the USA: a cause-deleted life table analysis).

In his post, Ram identified two obstacles that cause us to be sedentary: styana (inefficiency, idleness, procrastination, dullness) and alasya (laziness, sloth). The problem is, how do we overcome these obstacles? I mean, we all basically know that sitting around all day isn’t a good thing, but after hours of doing it—so many of us sit at desks all day or have long commutes—inertia tends to set in. And this can create a lot of resistance to the idea of getting up to practice yoga, even if you know it will be good for you and that you’ll feel better afterward. You think: Oh, I just don’t feel like it today—maybe tomorrow.

"Old man, stiff man, weak man, sick man, they can all take practice but only a lazy man can't take practice." — Sri K. Pattabhi Jois

I know this because even after years of practicing yoga at home on my own, I sometimes notice that tendency in myself. I do have some tricks up my sleeve, however. And I thought today would be a good day to share them, so you’d have some new ideas for fighting both styana and alysya.

My first trick is a mental one: I tell myself that I don’t need to do a full practice, that I can just do one single pose, you know, like Downward-Facing Dog. But I might want to warm up a bit before that one, so, let’s see, maybe a Half Downward-Facing Dog at the wall followed by a full Downward-Facing Dog on my mat. And guess what, by that time, my energy starts flowing and my momentum starts to build, and I end up doing a full-length practice.

My second trick is to pick a pose to start that will energize me, even just a bit. I know that moving with your breath is a good way to fire up your energy. So standing in Mountain pose and raising arms overhead on the inhalation and down by your sides on the exhalation is a good way to energize yourself, maybe even shake off a feeling of depression, and that can lead to some other vinyasas or who knows where.

But if you don’t feel like standing up—yeah, I know, sometimes you just don’t—you can get on your hands and knees and do the Cat-Cow pose, inhaling as you come into the Cow position (the sway back position) and exhaling as you come into the Cat pose (the arching position). That leads very nicely into Downward-Facing Dog pose, and then maybe Standing Forward Bend, by which time you might feel ready to stand up on your mat!

My third trick is that when I’m feeling particularly tired or lazy, I tell myself that I can start lying down. Ah, yes, lying down sounds real good.

Often I start with Reclined Leg Stretch and other reclined hip openers, and even just moving my legs around gets me in the mood for a Downward-Facing Dog pose (and helps make that pose easier), which in turn leads....

Another way to energize yourself is to open your chest, and that’s also a good way to counteract all the forward bending you’ve been doing by sitting down for hours. Good news is this is also something you can do lying down. Try a passive backbend over a blanket roll or a bolster for three or more minutes. Then roll over and see what you might feel like doing next. Lately I’ve been starting by doing a reclined shoulder opener that my teacher often has us do in the middle of class: lying on your back, with a strap just above your elbows, bring your arms up and overhead (if they don’t reach the floor, try holding a block between your hands). Three minutes of that, and if I’m not ready for Downward-Facing Dog pose, I might procrastinate a bit with some reclined hip stretches. It’s all good.

And if this strategy doesn’t work? What if you only end up doing just the one or two poses? Well, that’s much better than nothing. It might even start a new habit that will allow you to gradually grow into a longer practice over time—my own home practice started with me practicing just a few poses. And, besides, you can always try again in a couple of hours....

Of course, what I’ve mentioned here are just a few of many possibilities. Readers, how do you shake off your lethargy and start moving? I’d love to hear your recommendations.

The Dangers of Being Sedentary: Styana, Alasya, and Yoga

by Ram

Dance by Marc Chagall

Yoga and Ayurveda are sister sciences, with Ayurveda being the healing side of Yoga, and Yoga serving as the spiritual side of Ayurveda. Through the practices of Ayurveda and Yoga an individual is able to connect to his/her true nature through direct experience, and live a meaningful and purposeful life. This would mean following stable routines, having a balanced and nourishing timely diet (see You Are When You Eat) and adapting the eight fold yogic path (ashtanga yoga). However, there are a number of obstacles that arise on the journey to a meaningful life that can prove to be a challenge. In the Yoga Sutras of Patanjali, verses 1.30-1.32 describe several distractions that serve as obstacles on the journey toward perfect health and enlightenment. 

vyadhi styana samshaya pramada alasya

avirati bhranti-darshana alabdha-bhumikatva
anavasthitatva chitta vikshepa te antarayah

“Nine kinds of distractions that are obstacles naturally encountered on the path are physical illness, tendency of the mind to not work efficiently, doubt or indecision, lack of attention to pursuing the means of samadhi, laziness in mind and body, failure to regulate the desire for worldly objects, incorrect assumptions or thinking, failing to attain stages of the practice, and instability in maintaining a level of practice once attained.”—translation by Swami Jnaneshvara

Sitting for more than three hours, sleeping for extended periods of time, watching long hours of TV or simply idling away the time would qualify as “styana” (inefficiency, idleness, procrastination, dullness) and “alasya” (laziness, sloth), which are now thought to be responsible for decreasing life expectancy in the United States. While technology may have increased our productivity, it has certainly made us lazier. Sitting for long periods, sleeping for more than the required hours and watching TV are the most common activities performed by indolent individuals. That puts these activities up there with smoking as a possible barrier to increasing life expectancy.

Findings from a recent study showed that individuals who sat for more than 11 hours daily were 40 percent more likely to die within the next three years than those who sat for four hours or less daily—even when people’s physical activity at other times of the day was accounted for. Studies have also indicated that sitting daily for less than 3 hours and watching TV for less than 2 hours extends life expectancy by an estimated 1 to 2 years. Studies reported in the prestigious journals Lancet and the British Medical Journal suggest that a sedentary lifestyle is the cause of one in 10 deaths worldwide. It’s now known that Americans are working less (26 minutes a day less compared to Y2007) and idling off more. Adults in the U.S. spend an average of 55 percent of their day engaged in some kind of sedentary behavior (see Sedentary behaviour and life expectancy in the USA: a cause-deleted life table analysis).

Data gathered from 33 countries indicate that sedentary lifestyle accounts for six percent of all cases of coronary heart disease, about 7 percent of type 2 diabetes and 10 percent of breast and colon cancers. The findings also suggested that if only 10 percent of those who are currently inactive started to exercise, 533,000 lives would be saved; if 25 percent began moving, 1.3 million deaths could be averted. Studies have also shown that even children are spending more time sitting at home than playing outdoors. Health experts are unanimous in their opinion that an adult requires at least 30 minutes/day of physical activity to stay fit while children require at least 60 minutes of playtime.

The Dance by Marc Chagall

Thus, there is no doubt that excessive time spent in sedentary behavior is not only having an impact on public health but also has effects on the life span of the individual. Those who maintain a reasonable amount of activity, particularly across the middle and later years, are twice as likely to avoid early death and serious illness. So take my advice, get off the couch and go to the nearest yoga studio for a yoga asana session or seek some enjoyable activity that involves a lot of movement. However, let me also remind our readers that physical activity need not be yoga asanas alone and neither does it have to be strenuous to achieve health benefits. The US Centers for Disease for Control and Prevention (CDC) recommend the following that constitutes physical activity: walking stairs (instead of taking the elevator), gardening, raking leaves, dancing, walking to different stores in the mall while shopping, carrying a grocery basket rather than pushing a cart (when applicable), parking in the farthest parking spot and walking to the office or store.

People of all ages benefit from doing any one or some or all of the above mentioned daily physical activities. Sedentary people need to start with short sessions (about 10 minutes) and gradually build up to the desired level of physical activity. It appears that it is never too late to make some changes and experience these positive outcomes. The antidote for these obstacles and their consequences are awareness, focus and determination (see Thoughts On Dhyana). Cultivating these qualities can prevent us from getting entangled and lost in the mire of delusion that can come from the above-mentioned obstacles (see Achieving Stillness in Turbulent Situations).

Note from Nina: Ram recommends getting off the couch and going to a yoga studio for an asana session, but there is no reason you can’t simply get off the couch and do a little bit of yoga, right next to the couch (or anywhere else in your house). We’ve got lots of mini practices on our blog (look on our index for the three “mini” entries) that you can do, try a practice you find in a yoga book or DVD, or just start out with a Reclined Leg Stretch or a Downward-Facing Dog pose and see what happens next. If you skip just one TV program, you can do a half an hour of yoga without even leaving the house. I started my home yoga practice when I was working full time at a software startup company and co-parenting two young children, so I know you can do this! And, of course, if you’ve been following our office yoga series, you’ll know that we’ve got yoga poses you can do at work, at the airport, or anywhere else you can’t roll out a yoga mat (look on our index for the “office yoga” tag).

Yoga and Heart Health: Tachycardia

by Baxter

We recently received two inquiries regarding a heart condition called tachycardia. In its simplest form, this just means a heart rate that is running faster than normal. For example, the normal range for a resting heart rate is said to fall from 60-100 beats per minute. Sometimes it is considered normal to have a resting rate lower than 60. For example, in long distance runners who are very aerobically fit, a resting rate of 50 or lower could be normal and healthy. Rarely is a heart rate above 100 at rest a normal finding.

N. Watercolor 1 (The Heart Goes from Sugar to Coffee) by Kurt Schwitters 

When we are not resting, but running a sprint as an example, our heart rate will increase so that the heart can adjust to the increased demand for the blood to deliver energy to muscles and take waste products of work away. Once the immediate demands on the heart ease up, the heart rate drifts back to its normal range. In February, I did a post on a particular kind of arrhythmia that happens to involve the heart beating too fast called atrial fibrillation. This happens to be a kind of tachycardia that can lead to serious complications if left unaddressed. Other kinds of fast heart rhythms, especially if they only last for a few seconds or less than a minute, might be felt by the person experiencing them as unusual - a feeling in the chest of a rapid beat, light-headedness, shortness of breath or dizziness, but could resolve uneventfully. I’d tend to be more conservative if this was happening to me, and I’d get in to see my family doc and get an EKG and have the doc listen to my heart to make sure it is not putting me at risk.

According to the Mayo Clinic website:

 “if you have tachycardia (tak-ih-KAHR-de-uh), the rate in the upper chambers or lower chambers of the heart, or both, are increased significantly.  Heart rate is controlled by electrical signals sent across heart tissues. Tachycardia occurs when an abnormality in the heart produces rapid electrical signals.  In some cases, tachycardias may cause no symptoms or complications. However, tachycardias can seriously disrupt normal heart function, increase the risk of stroke, or cause sudden cardiac arrest or death.” 

So, even though some tachycardias may be less harmful, it’s that last sentence that should get your attention!

The causes of tachycardia are numerous, but underlying them all is something that disrupts the normal electrical impulses that control the rhythm of the heart's pumping action. There are many factors that can contribute to the development of an abnormally fast heart rate, but a few of the more common ones are:

• High blood pressure
• Smoking
• Fever
• Drinking too much alcohol
• Drinking too many caffeinated beverages
• A side effect of medications
• Abuse of recreational drugs, such as cocaine
• Imbalance of electrolytes, mineral-related substances necessary for conducting electrical impulses
• Overactive thyroid (hyperthyroidism)

The others are usually related to other kinds of heart disease, both inherited and those that develop over time. I list the ones above because we can have more direct influences over these by lifestyle changes and choices, and yoga has been shown to help people who are wanting to make these kinds of changes (see Meditation and Healthy Eating).

In addition, the study that I alluded to in February has just been completed and published (See Effect of Yoga on Arrhythmia Burden, Anxiety, Depression, and Quality of Life in Paroxysmal Atrial Fibrillation). Not only did the study group doing yoga have improvement in their atrial fibrillation, their symptoms improved, heart rate improved, blood pressure improved, depression and anxiety scores got better and reported quality of life scores improved in some areas. A combination of asana, pranayama and meditation were part of the sequence, in the Iyengar tradition, that the participants practiced. No injuries from the yoga were reported, and they did ask and check with the students on this question. And the researchers noted that yoga’s multi-system benefits (that previous research has shown)  are probably at play here as well, especially the ability of yoga to quiet the fight-or-flight response of the nervous system.

Keep in mind, too, that if yoga is done in overly-stimulating ways, for example, moving through a rapid series of poses that gets the heart rate up high and fast, or holding poses for longer timings (5-10 minutes - especially if they are physically demanding), this could trigger a tachycardia episode in someone who is susceptible. Therefore, choosing the right practice for students with tachycardia symptoms would be very important. Even certain kinds of breath work that is stimulating to the sympathetic nervous system (fight-or-flight response), such as longer inhalations compared to the exhalation length, with holding after the inhalation, should be avoided. The opposite approach, with a longer exhalation and a gentle hold after the exhalation, has been shown to help slow the heart rate and lower blood pressure in most students.

So once again, a balanced yoga practice, with asana, relaxing breath work and conscious relaxation and/or meditation is the way to go if you have a tendency to develop abnormally fast heart rhythms.

Yoga for Healthy Aging Retreat

by Nina

Napa Valley Wine Grapes by Nina Zolotow

Last week Baxter and I talked about having our first Yoga for Healthy Aging retreat. We were thinking of having it at a retreat center in the California Wine Country, either in the Napa or Sonoma valleys. That way, people would not only get the full wine country experience (wine is good for aging, right?) but we would be close enough to the Buck Institute for Research on Aging that people like Dr. Ram Rao and Dr. Brad Gibson could easily drop in to give talks. And, of course, there would be lots of yoga (and good food).

Our first retreat would probably be three days long, over a long weekend (Friday through Sunday) and in the year 2014. We’re still in the brainstorming stage, though these things need to be planned quite a long time in advantage. But we thought it would be a good idea to put it out there: would any of you be interested in attending this type of retreat? And, if so, what kind of things would you like to see us teach.

Let us know in the comments section of this post or email Nina via the Contact Us tab at the top of the blog.

Friday Q&A: Yoga Teacher/Stroke Survivor

Q: I am a yoga instructor and a stroke survivor as well. I know, I know, a yoga instructor AND a stroke survivor. Fancy that! I have a compromised left shoulder and it's getting much worse. Have had it for 6 years. This is the problem: my right side of my body is also compromised but in a different way. It's just less. Little shoulders and most of all hands. It's just less. Imagine what my yoga classes are like, little demonstration. My questions. How long would a person be totally on foot before I would have to do little thing alone? How long would I teach yoga class? When is too much complications you say above is more serious? Anything else you can think of. Also, the article Yoga and Shoulder Joint Replacements was truly wonderful.

A: I am not exactly sure I understand your question but my initial response is you should teach as long as you have students who will come. But maybe your question is more about mobility and how long will you be able to walk "on your feet" and if you can't walk, can you still teach? Again, as long as you have eyes and a heart and can use your language to convey intention, then you can teach, as long as you have the endurance. With all chronic disabilities, and especially strokes, fatigue is a big factor. Sometimes the struggle to do all the little things of life are overwhelming and then there is no more energy left for other things. If your situation is such that fatigue is a factor, can you have an assistant that you train to do the physical adjustments for your  students and perhaps the physical demonstration? Your expertise is why people come. I personally don't feel that a teacher has to demonstrate. My teacher, Donald Moyer, doesn't demonstrate much, and if he needs something modeled he chooses a student that he can use to convey the concept he is teaching for that class.

I think chronic illness makes you more adaptable because you can't do things the old way, and have to create new ways. So it might be an interesting teaching tool for you to teach your students what your body feels like to teach compassion. Acceptance is a big deal with acute illness as well as with chronic illness. Learning to accept changing body images as not “limitations” but variations is a powerful lesson.

Also, the complications referred to in the post Yoga and Shoulder Joint Replacements were for the post-operative period. In a shoulder joint replacement, they are reattaching tendons and repositioning muscles to do other jobs.This is why I said that trying to work too vigorously too quickly following the post-operative protocol can lead to serious complications in the success of the surgery. But you are alluding to pain from a stroke, as well as increasing dysfunction on the other side. This is very common because when one arm can't do, the other arm does more and overuse develops. Being referred for a total shoulder replacement is not common as there aren't a lot of docs who do them and do them well. Dysfunction from a stroke with loss of motion is not the same thing. I recommend that if you have access to health care, you see a physical therapist or occupational therapist who specializes in the upper extremity (this includes the shoulder, elbow and hand) to get a holistic view of your  movement and movement patterns. From there you can be more specific in your questions of your physical mobility and continuation of teaching yoga.

I hope this helps. Please let me know what happens!

—Shari

Brad's Perspective on Migraine Headaches

by Brad

The first time I had a migraine “aura,” I was working at my computer and wondering why there was this small area of flashing light in the center of the screen. I was using a new large screen Apple display and I was concerned that it might be malfunctioning. It didn't take too long, however, before I realized something was wrong with me: my vision was screwed up. Stroke? Migraine? Something else? I decided to quickly conduct an experiment: I walked down to the bathroom, shut the door and turned off all the lights and with my eyes open or closed, I saw the same thing, a growing crescent and jagged shaped object that was oscillating in my filed of vision. As I walked back to my office, I suspected this was a migraine aura, something that I had heard about (in words) but never experienced.

As fate would have it, I ran into a neurologist colleague in the hallway and explained what was going on. He immediately replied, “Do you get headaches?’ I said, “Of course, everyone gets headaches.” “Not so,” he explained. “Only about 50% of people get headaches.” And he motioned towards his office where he pulled out a neurology textbook, and turned to a page with a sketch that looked remarkably like the aura that I was in the midst of experiencing: a 30 minute timeline with a multicolor oscillating crescent shaped object, now twice its original size and now moving to my left field of vision. This was exactly what I was experiencing, and I could now predict that I must be about halfway through this phase, with about 15 minutes to go….  So I walked outside a bit to get some fresh air, but then retreated inside as the light was now too bright (“photophobia”).

What was surprising in retrospect was that I didn't get a migraine headache, which would be expected to follow in greater than 95% of cases immediately after the aura phase. I was apparently one of the (lucky) few percent who get an aura (visual disturbances, photophobia, etc.) but without the headache, or what is referred to as a “silent migraine.”  That was some 10 years ago.  And my last aura was just last Sunday during an afternoon walk with Nina, although by the time I got home, the aura was over, I retreated to my bedroom, closed the curtains and lied down for an hour. I needed to shut down….

Phases of Migraine Headaches by Brad Gibson

Since my first aura, I’ve taught a lecture on migraines to pharmacology students at UCSF for over 10 years. I’ve also talked with a lot of friends and students about their own experiences. And I have my own (somewhat atypical) experiences to draw from as well. This is what I’ve learned:

1. When you experiencing an aura, you pretty much can’t do anything for about 30-60 minutes until it’s over, so it’s best to sit down and just wait it out. You really can’t do anything else – no reading, no computer work, no physical activity.  Even walking might be too much. If you’re fortunate enough to have access to pain medications (NSAIDs, triptans, etc.), this is the time to take them.
2. Although I’ve been spared the worst aspects of the throbbing headache phase, at this point the body (and mind) just wants to shut down. No lights. No sound.  No movement. If you have taken pain medications during the aura phase (if you had an aura, but not all people do), you’ll be hoping they’ll kick in soon.  Lying on a bed in dark and quiet room is a good option if you can do it.
3. Besides the throbbing headache, some people also get nausea, vomiting and other side effects of the migraine headache. Beside pain meds, one can also consider anti-emetics and sedatives for these additional symptoms.
4. After the headache, most people are exhausted and depressed, although (some lucky few?) experience a type of euphoria. This could last a few hours to a couple of days.

So, what can yoga do to help any of this?  One possibility is during the trigger phase, when a largely unknown set of environmental and/or physiological states may “cause” the migraine to be set off in the first place. Certain foods are triggers for some people (wine, nuts, milk products, beans etc.). For others, stress can be a major player (see Preventing Migraines (and Other Headaches), Part 1). Personally, I don’t think it’s a coincidence that the majority of my migraine auras have been experienced mid-day, typically after sitting a computer for several hours. Bad posture, eyestrain, and neck and back issues associated with sitting and staring at a computer screen are for me the most likely culprits. While there are a number of drugs that are known to be partially effective at preventing migraine attacks and/or their severity, such as certain beta-blockers (propranol, timolol) and calcium channel blockers (verapamil), anti-seizure meds (valproate), this is still relatively unexplored and poorly understood territory. I think it’s worth considering how yoga might be helpful in mitigating some posture and body alignment issues (see Preventing Migraines (and Other Headaches), Part 2) as well as reducing daily levels of emotional stress that might contribute to migraine triggers (see Preventing Migraines (and Other Headaches)). Keep in mind that Nina’s suggestions in these posts are for preventing headaches from being triggered, not for practices to do during any phase of an active migraine.

A second phase where yoga could be beneficial would be the pain or headache phase of migraines, as well as the long postdrome that some migraine sufferers endure that can last up to a day or more. Most people don’t resort to the best and more expensive meds for this phase (e.g., the triptan class of prescription serotonin agonists such as sumatriptan) and rather use over-the-counter NSAIDS (aspirin, ibuprofen) or if the headache not too painful, just wait it out. While most yoga asanas at this point are not an option (remember, no one want to do much physical activity as this can worsen symptoms), Savasana, breath awareness, and other meditative or restorative poses would seem to me to be helpful and appropriate, as long as there are no inversions. Anyhow, I would check out Baxter’s suggestions on this in his post Yoga and Migraine Headaches.

Fast Exercise vs. Slow Yoga

by Nina 

Image "Borrowed" from The New York Times

The exercises should be performed in rapid succession, allowing 30 seconds for each, while, throughout, the intensity hovers at about an 8 on a discomfort scale of 1 to 10, Mr. Jordan says. Those seven minutes should be, in a word, unpleasant. The upside is, after seven minutes, you’re done. —New York Times

Did anyone else happen to see the recent New York Times seven-minute exercise routine? Well, I did. And my first response was irritation. Something seemed so wrong to me about the routine. At first, I thought it was the seven minutes part. That seemed to me a crazy amount of time for doing twelve exercises, and I thought it would be healthier and more effective to divide up the routine into, say, three or four different routines, and cycle between them on different days. That way, you could spend more time on each exercise and not do the same thing every day (which could lead to boredom or even injury).

But even after I had my private little rant about the subject, every time I saw that picture I continued to feel irritated; it was like a grain of sand in the soft belly of an oyster (not that this rant is going to turn out to be pearl, mind you). But it wasn’t until a few days later that I realized what was really bothering me: it was the phrase “seven minutes of steady discomfort.”

“In 12 exercises deploying only body weight, a chair and a wall, it fulfills the latest mandates for high-intensity effort, which essentially combines a long run and a visit to the weight room into about seven minutes of steady discomfort — all of it based on science.” — Gretchen Reynolds

It seems to me if exercise is something so unpleasant that you do just to get it over with, you’re never going to be able to incorporate it into your life on a regular basis, something people in our exercise-averse culture desperately need to do. I mean, why would you want to add seven unpleasant minutes to your life every day? I can’t help but feel that half an hour of enjoyable exercise has got to be better for you than seven minutes of “steady discomfort.” It’s kind of like the difference between fast food and slow food. For me, yoga asana practice is truly an enjoyable, sensual experience, where I'm present in my body and appreciating what it can do and how it feels. Why would I ever want to trade that for fast, efficient, and unpleasant? (Actually the phrase “all of it based on science” irritated me a bit, too. I’ve had food concocted by nutrition scientists and food made by with love by friends and family members, and, of course, no contest there.)

Granted, sometimes it’s a bit hard for me to get started with my yoga practice—there’s a certain mental inertia that makes me reluctant to switch to that activity—but once I begin, I almost always enjoy myself. Of course, there are moments of unpleasantness (the mild painfulness of a stretch, the frustration of falling out of a balance pose, the feeling of mild fatigue after holding a strenuous pose for an extended period of time), but these are interspersed with moments of pleasure and even joyfulness. (I’m thinking now of a fellow student in my weekly class, who, when we do her favorite pose, now always says to me with a twinkle in her eye, “Oh, boy!”) Then, there’s the huge bonus that a mindful asana practice confers in addition to strength, flexibility, balance, and agility: stress reduction.

Maybe I’m preaching to the choir here, but for our physical and emotional health (not to mention healthy aging), we each need to find a form of exercise that is a life-affirming experience rather than a form of torture that we must submit to. And it’s worth the extra time, even just, say, 20 minutes rather than 7, to make that kind of practice a part of your life. Of course, I love yoga, so I’m always here singing its praises. But if you hate every minute of the yoga you’re currently practicing, try some different styles. And if you hate all the styles, maybe it’s not for you. Walk, run, cycle, swim, work out in a gym, dance, play golf, tennis, basketball or soccer, ski—get out there and live!

Is Yin Yoga Right for You?

by Baxter

We recently received two questions regarding a style of yoga known as Yin Yoga, in which one assumes certain yoga poses, often done sitting or down on the floor, and passively holds the poses for 3-5 minutes.  An example of a pose done in the Yin way would be Sukasana (Seated Crossed Legs) with a forward fold, done passively for the allotted time. As a disclaimer, I have limited personal experience with Yin Yoga, but have done several two hours sessions over the years.

According to articles that can be found online at Yoga Journal Magazine, as well as the websites of two well-known teachers of Yin Yoga, Sarah Powers and Paul Grilley, Yin Yoga is more than just doing yoga asana a particular way. There is a focus on not just affecting the physical structure of the muscles, bones and connective tissue, but reportedly also influencing the energetics of the body via stimulation of certain Chinese meridians associated with the acupuncture/pressure systems. And there is an emphasis by some teachers also on working with the discomfort that arises in holding the poses longer, as a form of meditation. The concern both of our readers brought up had to do with how safe it might be to stretch the joint stabilizers known as the ligaments via this approach to yoga asana. One of the readers self-identified as being very flexible already, in her 50s, and noted that after a recent Yin workshop (which she found wonderful on many levels), she was left with joint pain for days after the practice and possibly some chronic pain. She specifically wondered if Yin style of practice is safe for students who are hypermobile and don’t really need more flexibility in their joints.

I wish this was an easy question to answer. I might start by saying that there is probably a style of yoga best suited for each of our unique body types, and conversely, there are some styles of yoga less beneficial for you. Secondly, I would recommend, as Paul Grilley does in one of his balanced articles on Yin style of practice, that you need to proceed slowly and with lots of attention, sometimes to subtle body signals, as you try out a new style of practice like Yin Yoga, if you have never done it before. With Yang styles of practice, which is just to say more active asana styles where you are more likely to be engaging muscle groups on both sides of joint that is moving, you will experience what is called your “active range of motion” of your joints, meaning that which you can create by contracting the muscles around the joint alone. However, this is not the “full” range of motion for most joints.

In anatomy circles, there is another term to describe this second stage of joint movement, “passive range of motion,” which usually involves gravity or some other part of the body taking you past the active range of motion place. An example would be lying on your back and using your muscles alone to bring your knees into your chest, like an upside down Child’s pose. This would be the active range of motion of your hip and knee joints in flexion (bending forward). Now, if you take your arms around your shins and pull with your arms (your “outside” force), your legs fold in deeper, thus taking you to your passive range of motion. The idea here is that this may be good for your overall flexibility and joint health, as some compression of the joints seems to be good for the cartilage of the joints as we discussed in our posts on osteoporosis and arthritis. When you flip over and do regular Child’s pose, you now have the full weight of the body pressing down on your hip and knee joints and this might get you even more deeply into the full range of motion of the joint. The question is how much is safe and where do things get potentially troublesome. The answer to that, again, is not easy.

Most sources I can find suggest that keeping your connective tissues—like the fascial containers around all of your muscles—mobile is a good idea. They also suggest that ligaments, the usually smaller bands of connective tissue that keep two bones in a joint close together are not designed to actually stretch much at all without the risk of injury, tearing and chronic looseness. Two things to watch out for if you try out Yin type classes: do I have persistent pain for more than a day or so after class?  And do my joints feel too loose, wobbly or unstable after such practices? If neither situation arises, this style of practice may be fine for you. If either does arise, maybe this practice is not for you. A combination of a Yin type practice with an active Yang style practice may work well for some. And if props take away some of the physical intensity of sensation when you are in Yin poses, this could possibly be a safer way for some to try the longer passive holds of Yin style without causing joint pain or overstretching of ligament. So do experiment a bit and see what you can discover to find the style that works best for you. 

Mission Statement

by Nina

Above the Fog by Brad Gibson

Recently I received a question from a reader asking two questions; the first question was yoga related. The second, which was not yoga related, asked which supplements we recommended for a certain condition. After letting our reader know we would be happy to address the first question (and in fact, an answer to her question will be coming this very week), I wrote:

But regarding the second question, we don't address nutrition and supplements on the blog. None of us are trained in that area, and recommending supplements is a very tricky issue for a number of reasons. So, from the beginning, we established a general policy against writing about anything except yoga and the science of aging. So we're going to have to decline to address that one. I hope you understand!

The reader graciously—we love our readers!—wrote back saying that she did understand. But as we have a number of new readers since we published our original mission statement (see In the Kitchen), I thought I’d take a moment to let you all know a little bit more about our mission. Of course, we’re blessed here at Yoga for Healthy Aging to have an extraordinary staff, including two MDs (Dr. Baxter Bell and Dr. Timothy McCall), two scientists who study aging (Dr. Bradford Gibson and Dr. Rammohan Rao) and a practicing physical therapist (Shari Ser, P.T.). Naturally with so much available expertise, you might assume that we’d be able and willing to address subjects other than yoga that know quite a bit about, especially if they are related to the aging. But even we were first discussing the blog, we understood that for differing reasons, some subjects needed to be off limits. So without further ado....

What we will take on: 

1. Yoga asana, meditation, pranayama, and other practices, especially as they relate to healthy aging.
2. Yoga philosophy and yoga history.
3. The science of aging and various theories of aging.
4. Scientific studies regarding yoga.
5. Medical conditions in general and how you can use yoga to address them.

What we won't take on:

1. Diet
2. Supplements.
3. Medical advice. (Yes, we have doctors here, but as with any doctor, our doctors cannot dispense medical advice without examining you in person. Besides, this is a yoga blog!)

Even after declaring those three topics off limits, we can assure you, we've still got an enormous wealth of useful and inspiring information to share with you. Plus, we've added three new regular contributors (Timothy, Ram, and Shari) since we first started the blog, who have even more ideas and new points of view. During the very first discussion Baxter, Brad and I had about the idea of the blog (we were in the kitchen, preparing a meal together), Baxter was initially concerned that we might not have enough material, but Brad said, "No way. We'll never run out of topics!"  

Friday Q&A: Swollen Knees (and Meniscus Tears)

After Shari’s recent post about her swollen knee (see Yoga and Pain Management), a reader left this question for her in the comments section. We like to answer these questions on Fridays, just in case there are other readers out there who might be interested in the discussion. For all you new readers, feel free to ask questions about yoga as comments on any post, even  older posts. or to email me via the Contact Us tab at the top of the page. We're keeping track of all questions and will answer them all eventually! —Nina

Q: Re: your swollen knee - can I use these poses for someone with a meniscus tear? I have been avoiding balasana, but am wondering whether cat/cow is okay as the weight is split between 4 points of the hands and knees. Would be grateful for any other useful pointers.

A: With a meniscal tear, there will range of motion loss, especially in flexion (bending the knee). Extension (straightening) can also sometimes have a slight loss of range of motion. That said, any pose that doesn't cause swelling afterward is okay. Pain may or may not be the limiting factor but swelling definitely is. As to specific poses like Balasana (Child’s pose), if you have pain, use a prop, like a block or a bolster, to limit the knee flexion. Cat-Cow pose is certainly a weight-bearing pose through the patella (kneecap), but that may or may not be a factor. You’ll have to try it and see what happens. Using padding under the knees would be helpful. Definitely avoid knee movements that involve rotation, as it will cause pain and swelling.

—Shari

Preventing Migraines (and Other Headaches), Part 2

by Nina

Yesterday I wrote about preventing migraines and other headaches through stress reduction (see Preventing Migraines (and Other Headaches), Part 1). Another way you may be able to prevent and/or reduce your headaches, is to practice yoga poses that release muscle tension in your back, shoulders, neck, and head. As Timothy says in the headache chapter of Yoga As Medicine:

“Yoga teaches that releasing the tight muscles improves blood flow to them, and can help relax the mind a well.”

But as Timothy also reminds us in all his writings about yoga therapy, everyone is different and yoga therapy, whether for migraines or any other condition, needs to be individualized. So with that in mind, I’m just going to toss out a lot of ideas for poses you can try to work with your back, shoulders, neck and head; you’ll have to figure out which works best for your body and your yoga experience level. In fact, I have so much to say on this topic, I’m going to—gasp!—use subtitles on this post.

Working with Your Neck

There are two basic ways to release tension in your neck: stretching your neck and relaxing your neck. To stretch your neck, you can do gentle neck stretches, either while standing or sitting. Baxter recommends not doing full head rolls. Instead, he recommends Owl Turns, which involves looking to the right or left as far as you can go with a bit of stretch, and Curious Dog Tips, which involves tipping your head ear to the shoulder to the right or left, as far as you can go with a bit of stretch, ear to shoulder on that side. Another way to stretch your neck (along with your back and chest) is to do seated twisting poses, such as Bharadvajasana, Marichyasana, and Arda Matseyendrasana. As you move into the twist, make sure to turn from your spine first, and then, moving mindfully, let your head follow your spine (so you don’t over-twist your neck).

To relax your neck, try seated forward bends with your head resting on a support. Before bending forward, place a bolster or folded blankets on your straight leg (or a chair over your straight leg if your hamstrings are tight), and rest your head on the support as you come into the pose. Prop yourself high enough so you can stay in the pose for three minutes or so. You can even do the pose seated in a chair, in front of your desk. You can also use gravity to release your neck in a Standing Forward Bend (Uttanasana) or Wide-Legged Standing Forward Bend (Prasarita Padottansana). Instead of having your hands on the floor in this pose, try clasping your elbows so you can just hang. To make the pose more relaxing, try practicing with your buttocks against a wall and your feet about six inches from the wall.

Working with Your Shoulders

To release your shoulders, which helps release tension at the base of your neck, you can try any number of targeted shoulder stretches. See Standing Shoulder Stretches for a good, short sequence that stretches your shoulders within their full range of motion. In general, most of the standing poses also help release tension from your shoulders, because your arms are either overhead, out to sides, or behind your back. So all varied standing pose practices will help both strengthen and relax your shoulders.

Working with Your Back

To release tension from your back, you can practice the seated twisting poses I mentioned above for releasing your neck, or any reclined twist that you prefer. You can also try passive backbends or restorative backbends, such as lying over a bolster with your arms either out to the side or overhead. Just make sure to keep your head supported so that your neck and head is in line with your spine or only in a mild backbend (and not fully extended, that is, in a full backbend position). And, finally, you can try an easy forward bend, such as a Child's pose (Balasana) with your knees together or a Supported Restorative Child's pose, or a Standing Forward Bend (Uttanasana) with your knees bent to release back tension from the extensor muscles of spine.

Working with Your Head

Timothy mentions that poor posture, especially head forward syndrome, is a possible trigger for headaches. So working in Mountain pose, learn to keep your neck aligned with your spine and your spine aligned with your neck. You can also do passive backbends, holding for at least three minutes, to open your chest and active backbends to strengthen your back. These and the shoulder stretches mentioned above will compensate for all the forward bending of your upper body that you do at your desk, car, gardening, etc., and help improve the position of your neck and head relative to your spine.

As far as relaxing your head goes, wow, I have to say, I’ve never thought about how to relax my head before! The main thing that comes to my mind—which is actually very relaxing—is to lie in Savasana with enough support under your head so your neck is in a neutral position and your chin is pointing toward your chest. Then, using the power of your mind, consciously move from one part of your head to another (including, one by one, your sense organs) and intentionally relaxing that area. Be sure to include your forehead—lots of tension there—your scalp and the crown of your head.

About Backbends and Headaches

And, finally, a little warning about backbends: Extreme extension of the neck (the bending you do when you take your head back behind your shoulders) can actually trigger headaches! So if you are doing a backbend where you can control the back-bending in your neck, such as Cobra, Upward Facing Dog, Bow pose, try to work with your head in a more neutral position instead of automatically thrusting it back. If the backbend is one where you can’t really keep your head in a more neutral position (such as Urdva Dhanurasana, called Wheel or Upward Bow), try eliminating the pose from your practice to see if that helps your headaches.

Preventing Migraines (and Other Headaches), Part 1

by Nina

Supported Child's Pose

A dear friend of mine, with whom I’ve stayed on many vacations and have traveled with, suffers from terrible migraines; the kind where all you can do is curl up on the fetal position for 24 hours in a dark room. So even though I don’t have migraines myself, I’ve witnessed first hand how awful they can be. Baxter had some good suggestions yesterday (see Yoga for Migraine Headaches) for how to use yoga to get through a migraine headache. But wouldn’t it be nice if you didn’t have to get a migraine in the first place?

Unfortunately, since there are many different triggers for migraines, including different types of food,  it is impossible for us to give you any guaranteed solutions. However, we do have some recommendations for yoga practices you can try. Suffering from a migraine is such a miserable experience and these yoga practices will benefit you in many other ways, so it really seems worth giving them a shot. And everything we’re going to suggest here applies to ordinary tension headaches as well as to migraines, so listen up, everyone!

In his book Yoga As Medicine, Timothy McCall identifies two possible triggers for migraines and other headaches that we can address with yoga: stress and muscle tension in the head, neck and back areas. Today I’m going to talk stress and tomorrow I’ll post something about muscle tension (see Preventing Migraines and Other Headaches, Part 2).

Okay, now to address stress. In his book, Timothy says, “Since stress is a major factor in both tension headaches and in migraines, yoga can certainly play a role in prevention.” And he goes on to say that “There is scientific evidence that relaxation techniques and biofeedback can be effective for both tension and migraine headaches, lessening the duration as well as the frequency of attacks.” That sounds pretty promising to me!

I’ve been ranting about the subject of chronic stress and the importance of stress management since we started the blog (see Chronic Stress: An Introduction  and The Relaxation Response and Yoga), but as a reminder, I’ll simply reiterate that yoga provides a huge selection of possibilities for stress management and you can pick and choose from amongst them according to your experience level, temperament, schedule, and/or personal preference. All of the following yoga techniques reduce your stress levels by switching your nervous system from stress mode (Flight or Fight) to relaxation mode (Rest and Digest). This type of relaxation is something you cannot achieve with a nap or even a full-night’s sleep (see Conscious Relaxation vs. Sleep).

•    Meditation. See How to Meditate for information on how to meditate.

•    Breath practices (pranayama). See Your Key to Your Nervous System for information your nervous system and your breath. For stress reduction and headache prevention, be sure to avoid stimulating and/or overly complex breath practices and focus on simple, calming practices.

•    Restorative poses with a focus for the mind (such as your breath or the relaxation of your muscles).

•    Inverted poses. Studies by Dr. Roger Cole proved that inverted and semi-inverted poses, where your heart is higher than your head, trigger the relaxation response through the mechanisms that control your blood pressure. This is why supported inversions, such Legs Up the Wall pose and Easy Inverted Pose (legs on a chair), are so effective for stress management (See Just in Time for the Holidays: Inverted Poses).

•    Corpse pose (Savasana) with a focus for your mind (such as your breath, the relaxation of your muscles, or peaceful imagery). See Savasana for information.

•    Yoga nidra (yogic sleep), a long, structured form of Savasana. See What is Yoga Nidra? for information about yoga nidra and the Audio Tracks tab at the top of the page for a mini version of yoga nidra that you can stream or download.
 
If you find it difficult to settle in and relax because you’re too restless or anxious when you lie down, first try any active asana practice to burn off steam (although you might want to be careful with backbends—I’ll address that tomorrow) and then move on to relaxation practices.

If you are interested in practicing a combination of inverted and restorative poses, you might like to check the headache sequence in Yoga As Medicine, which includes the following poses:

1. Legs Up the Wall pose
2. Supported Reclined Cobbler’s pose
3. Chair Shoulderstand
4. Half Plow Pose (with chair)
5. One-Legged Forward Bend with head support
6. Full Seated Forward Bend with head support
7. Breath Awareness

Note that this sequence was designed for an experienced practitioner, and if you aren’t familiar yet with or can’t get comfortable in Chair Shoulderstand and Half Plow pose, you may want to skip over those two poses. An easier alternative to those two poses would be to do a Supported Straight Leg Bridge pose (must photograph that for our blog one of these days!). The teacher who designed this sequence also recommended his student use a head wrap (a large bandage that is wrapped around the head to relax the eyes) while practicing, so that may be something you could experiment with. Start wrapping the bandage clockwise at your forehead, go down to your eyes, and then come back up again. Tuck the loose end to secure the bandage.

If the sequence from Yoga As Medicine is too long or complicated for you, any simple restorative sequence could be very effective. Try our Mini Restorative Sequence, which includes three classic restorative poses that almost everyone can enjoy.

So how often should you do these stress reduction practices? I think that if you are chronically stressed out and suffering from debilitating headaches, you should practice six or seven days a week for at least 15 minutes (keep in mind that could be 15 minutes of meditation or 15 minutes in Legs Up the Wall pose). I realize that sounds like a lot. It will take some work—if you can call relaxing “work”—to bring your overall stress levels down. Keep in mind that the payoffs could be huge, as stress management can result in many additional health benefits besides reduced headaches, such as lower blood pressure and a stronger immune system, as well as quality of life benefits, such as increased equanimity and maybe even happiness. And if any of you take up this headache reduction challenge, I’d love to hear back from you about the results.

Check back tomorrow for tips about how to use yoga poses to release neck, shoulder and back tension that can trigger headaches.