Yoga and Healthy Eating: How Yoga Helps You Tune in to the Effects of Your Dietary Choices

by Baxter

Fresh Bread and Fresh Butter
made and photographed by
Rosie Gibson

It is always a bit bittersweet for me come mid-July when I return from my annual yoga retreat at the Feathered Pipe Ranch  in Helena, Montana. It is a magical place for my students, and me, and most of our every-day needs are met by the staff at the Ranch, freeing us up to dive deep into the yoga and community. 

At this year’s retreat, I focused on many of the concepts we talk about here at Yoga For Healthy Aging, including therapeutic sessions on topics ranging from arthritis to digestion. One of the lovely things about going on these sorts of retreats is that all of your meals are prepared for you, and all you have to do is show up for meal times. The Ranch is no different, and they pride themselves of the variety of healthy, mostly organic foods that they prepare for us each year, from Indian to Thai to Mexican, to the “Toledo Lunch” (a throwback to my childhood favorite, grilled cheese sandwiches and tomato soup). In addition, they always have tempting desserts, from fruit cobbler to fresh baked cookies and cakes to something outrageous called Chocolate Decadence! The downside to this, at least from my perspective, is that the food is served buffet style, so there is the daily opportunity to overeat, despite the overall healthy options provided (minus some of the desserts, of course!)

I have to remind myself to be more mindful about my eating when at the Ranch. It is very easy to make a second trip up for some more of my favorite things, even when my first plate of food was more than sufficient to satisfy my hunger. Satiety is different than eating until I feel “stuffed.” which unfortunately happened a few times last week. But because I was also on retreat in my own way, even though I was teaching twice each day, I was able to have the time to meditate consistently first thing in the morning for about 15 minutes. I found that as I sat quietly focused on my breath or simple mantra (see How to Start a Meditation Practice), I became acutely aware of how my body was feeling and responding to the previous day's food choices. I also would recall if I woke in the middle of the night with indigestion, gas, bad dreams, or the urgent need to use the bathroom. This feedback allowed me to more consciously set an intention around my food choices for the rest of the day.

Since I tend to desire more processed sugar than is healthy for me, (is it really healthy for anyone?), I began to modify my breakfasts, the only meal I prepared for myself in the little teacher’s cabin kitchen, leaving out the jam on my toast and adding in a piece of fresh fruit to satisfy that sweet taste desire that I have. And I began to notice that my energy levels were higher for the rest of the morning as the week progressed. Quite motivating! I have to admit that dessert time was still a tough one, but was at least more mindfully dished and consumed than earlier in the week. 

Surprisingly, I realized I was looking forward to being back in my own kitchen where I could more easily design my meals for not just quality, but also quantity.  All these insights about behavior changes and choices arose directly out of the introspective practices of yoga, like simple breath awareness. They were there for me, and they are available for you, too. As we keep reminding you, consistent practice is a key feature of transformational practice. I did my meditation first thing today again, and my continued healthy, well-proportioned meals choices are reflecting it!

I've been thinking a lot about healthy eating and healthy digestion because my two-part online course at Yoga U is coming up soon. To sign up for the course, you can register here. For a free audio interview with me on yoga for healthy digestion, download the interview here.

Tucking and Tilting the Pelvis

by Baxter

We recently received an inquiry about positioning the pelvis in yoga poses that I thought it worth addressing in a general, full-length post. Let’s start with the question:

Dear YFHA Staff,

The phrases "Tuck in and Tuck out" are very commonly used by several of my teachers. I get so confused listening to those words that these days the minute I hear anything close to "Tuck" my meditative yoga practice goes for a ride. What are the teachers referring to when they use those words? Are they alluding to the movement of sacrum? For eg: in Bridge pose and other supine poses, do you draw the sacrum in (I guess the word is Tuck in) or do you draw it out? Can't we just keep the sacrum in neutral position and still get the benefits of the supine poses?

Yes, dear reader, there is a lot of talk about “tucking” the pelvis these days in the yoga world! Although I don’t hear or use the same exact phraseology as you teachers are using, I think I have a sense of what they are going for. I might suggest the terms “tipping” and “tucking” of the pelvis, as a whole, for what is being suggested. In anatomical terms, the action can take place relative to the top of the upper leg bone, the femur bone.

When you “tip” the pelvis, this means you are rolling it forward and down over the head of the femur, in what is referred to in anatomical circles as anteversion or flexion at the hip joint. This happens to some extent in forward bending poses, like Uttanasana (Standing Forward Bend), when we roll the hips forward and down to initiate the forward bend.This movement also encourages the forward rounding of the lumbar vertebrae due to the effect of gravity, known as flexion of the lumbar spine, in the specific situation of Uttanasana. Yet we are also sometimes encouraged to extend the lower spine, as in a backbend, when entering into some forward bends. In other words, as the pelvis is rolling forward over the thighbones, we simultaneously extend the rest of the spine as in a backbend. This can be a useful suggestion in some lower back injury situations, or if you are focusing on strengthening the extensors of the back body. But it could be just as helpful in some cases, to allow the natural flexion of the lower back in Uttanasana accompany the anteversion of the pelvis.

Tipping the Pelvis (Uttanasana)

The other action, which I call “tucking” of the pelvis, is essentially the opposite action, in which the pelvis rolls backwards over the head of the femur bone.  Anatomically, this is called retroversion or extension of the pelvis. It is an essential action, at least to some extent, when we are trying to do some of our back bending poses, like Dhanurasana (Bow pose) or Urdhva Dhanurasana (Upward Bow pose), which require some length and opening at the front of the hip joint to successfully achieve these more advanced backbends. Just like with tipping, the spine may have a natural inclination that accompanies tucking, like some extension of the spine if we are trying to do Upward Bow or Wheel pose. However, if you observe someone standing in Mountain pose, and ask them to exaggerate the tuck, you will notice that the lower spine rounds back, which actually means the vertebrae are tipping forward into flexion. If you then ask the person to tip the pelvis forward, you will see that the lower spine goes into a backbend shape, bowing forward towards the navel. This indicates that the lower spine is going into some extension.

Tucking the Pelvis (Backbend)

Playing with this movement of the pelvis in Mountain pose is a good way to begin to feel these actions and the results at both the hip joint and the lower spine. You might also start to sense if one way feels more typical of how you hold your pelvis relative to you upper leg bones when standing.  If your teacher was suggesting that more tip or tuck would be better for you, see if his or her suggestion actually does what predicted. Be a little skeptical, especially if you are working with a newer teacher. There is a lot of subtlety to this pelvic alignment, and it first it will likely feel a bit strange, even if it ultimately might lead to better posture and lower back alignment. When looking at supine poses, done lying on your back, face up, you will want to do the same experimenting to see what works best for you.

And I have not even mentioned the movements that can happen between the pelvis and the sacrum, known as nutation and counternutation! Shari and I have written some about that elsewhere, so take a re-read of some of those posts (Friday Q&A: Trikonasana, Janu Sirsasana and the Sacrum and Yoga and the Sacrum if you are not familiar with these terms. Judith Lasater, in her book Yoga Body, has a discussion of what happens in regards to these two actions in forward and back bending poses. There is some controversy about how much nutation and counternutation actually take place in adults in yoga poses, but there is a lot of variability in how much “intra-pelvic” movement (between just the two pelvis bones and the sacrum bone) between individuals from my observations. It is always wise to get the opinion of an experienced teacher who can watch your body move in different poses to see where your fall in this regard.

I would also suggest that you directly ask your teacher to stop and demonstrate the actions of tucking so you can get a clearer idea of what he or she is talking about. Sometimes I find that without that clarity, I am just guessing as to what the teacher wants me to experience. And it would also be reasonable to ask why he or she feels this is important to experience. So, ask the how and the why when these sorts of instructions are creating more confusion than clarity, and rock that pelvis on.

Which Way Should Your Shoulder Blades Go?

by Baxter

Let’s talk about the shoulder blades today. Recently, while evaluating my newest batch of teacher trainees during their teaching intensive, I was surprised to hear the instructions to “move the shoulder blades toward the pelvis” when the arms were in the overhead position, such as in Urdhva Hastasana. I heard it in Warrior 1, in Utkatasana, in Downward-Facing Dog, and virtually anytime my young wards had the arms overhead. And I flinched each time they uttered it, which just about every one of them did for the four classes they taught. Without naming names, I should mention “always move your shoulder blades down your back” is an instruction that I have heard on many occasions from very experienced teachers. These trainees did not hear me utter such words, but I realized that some of their instructors were still using this outdated understanding. This is too simplistic, as it is not what actually needs to happen for healthy movement of the arms overhead and it can actually restrict the mobility of the shoulder joint for most students.

If you look at photos of Mr. Iyengar in the classic “Light on Yoga,” you can see that he is not doing that. His shoulder blades are clearly moving towards his arms, not away from them. (I refer you to the following plates: 12, 23, 42, 91 and 96.) So what is going on here, or more accurately, what is going on with the shoulder blades when the arms go overhead?

When your arms are hanging at your sides, your shoulder blades have several common ways they move: sliding upwards is called elevation, such as when you shrug your shoulders; sliding slightly downwards, called depression, like when you tug the bottom of a shirt downwards; sliding them apart or side ways, called protraction or abduction, like when you give yourself a hug; and squeezing them together called retraction or adduction, like when doing the Cobra with a doorknob.

Shoulder Blade in Neutral (Mountain Pose)

In these four basic movements, the shoulder blades don’t rotate much. Instead, they slide around in the general way they sit on your back upper rib cage. But in addition to those movements, there are two more movements that require a bit more imagination on your part, since we can’t quite see what is going on under the skin and muscles. The first happens when you take your arms overhead, whether forward and up or out the sides and up. It is called upward rotation of the scapula.  There is usually a bit of elevation of the entire shoulder blade from its neutral position, like in Mountain Pose, and a bit of protraction. But more noticeable is the out and up swing of the shoulder blade that allows for the greatest reach of the arms overhead.

Rotating Shoulder Blade

The opposite action is required to get the arms back down to your sides, and is called downward rotation. It is likely that a bit of depression of the shoulder blade and retraction also accompanies this action.

My teacher Donald Moyer refers to the rotational movement of the shoulder blades as “traffic circles.” Depending on which way the arms are moving or how they are positioned on the body, the traffic around the outer edges of the circle will flow in one direction the other. As an example of how you might imagine this, you might start with your awareness at the lower tip of your right shoulder blade. You can likely reach around and feel this with your fingers of your left hand. When your arm goes overhead, the traffic flows up the outer edge, across the top edge from right to left, and down the inner edge back to the lower tip of the shoulder blade. You might have to imagine there is a central pivot point in the shoulder blade, and the traffic causes the shoulder blade to rotate around that point. Then the traffic flows in the opposite direction as the arm comes down to Mountain pose position.

You might be asking yourself if there are times when saying “move the shoulder blades down the back” would be appropriate? And the answer is yes. For instance, with new students who have hunched shoulder blades that are semi-permanently elevated and forward rounded, you might have to ask, show and encourage them to depress the shoulder blades in Mountain pose.  I will keep a slight feeling of downward movement even as the arms approach the 90 degree mark, such as in Warrior 2 pose. In Warrior 2, there is a bit of upward rotation of the blades, but mostly protraction or widening away from the spine. The downward movement is helpful for those with the tendency to hike the shoulders in these lower arm positions.

But so what if you draw your shoulder blades down the back when they are overhead? What’s the big problem? Well, as your arms and shoulder blades swing up, the upper arm bone, the humerus, rolls slightly outwards, so as to have a better contact with the shoulder blade. If you then pull the “shoulder blades towards the pelvis”, the shoulder blades start to downwardly rotate, the arm bone pulls down with it, and the shoulder joint gets narrowed and pinched, meaning that the soft, non-bone structures can get pinched in an unhealthy way. I dislike demonstrating this “wrong” way of doing it for my students, because it quite literally pinches my gleno-humeral joint.

Having a clearer understanding of how the shoulder blades change positions on the rib cage will be very helpful to you as you try some of the shoulder openers we share with you because so many of them work more effectively if you encourage the upward rotation, protraction and elevation of the scapulae I have shared with you here today (see Featured Sequence: Opening Tight Shoulders and future posts about the individual poses). 

Featured Sequence: Opening Tight Shoulders

by Baxter

As a follow-up to my post on Friday last week about tight shoulders (see Friday Q&A: Tight Shoulders), and with the stellar prelude that Nina provided you with yesterday (see Living Proof), I am excited to share with you a sequence of shoulder opening poses. You may notice that some of the poses presented today resemble but are not necessarily formal yoga asanas or poses. In modern yoga practice, teachers and home practitioners have found that there are many “warm-up” poses that are a great way to get the body ready for the more formal yoga poses that might require quite a bit of openness or strength in a particular area of the body.

In this sequence, you will be able to address limits to movement in the shoulder joint in several directions. For those with tight shoulders, we recommend that you do the poses for 60-90 seconds in order to set the stage for more permanent changes in mobility. I am going to let the pictures do most of the talking (thanks again to Erin Collom for her generous help!), and keep my written instructions to a minimum. We will likely revisit many of these poses down the road, and can fill in any gaps in your understanding at that time.

So, without further ado....

1. Arms Overhead with arms angled

Arms Overhead pose (Urdhva Hastasana) is a very common pose in all levels of practice, and is required for both Sun and Moon Salutes, so it is a good one to practice and, if necessary, modify, as shown here. The idea is to bring your arms slowly out to the sides and up and stop when you feel pain, significant stiffness or if the elbows start to bend.  Do all the good stuff you would normally do in Mountain pose, and let it feel like the outer shoulder blades lift faster than the inner shoulder blades toward your arm bones.

2. Bear Hug

This is a modified way to work towards full Eagle pose arms. Try to reach around the sides of your upper arm bones, not over the top of your shoulders. Hold on where ever you can. Lift your elbows to parallel with floor, and push them slightly forward to create a stretch of the muscles located between the shoulder blades. You can invite your breath into that area to experience more stretch. Be sure to repeat the pose on the opposite side.


3. Modified Eagle pose arms

You saw this one last Friday (Friday Q&A: Tight Shoulders).  When you bend your arm at the elbow, the stretch around the shoulder area changes from that of the Bear Hug.  For some, it is much tighter.  Keep the “Eagle arm” humerus bone parallel to the floor, chest broad, and use your other hand to gradually draw your elbow toward the opposite side of your chest. You can also push the Eagle arm elbow forward to increase the back stretch. Be sure to repeat the pose on the opposite side.

 

4. Arms Overhead at the wall

This is a variation of Arms Overhead pose. Facing the wall, stand about six inches from the wall facing with your arms overhead. If you are really tight in the shoulders, your arms may have to be angled as in pose 1. Come up onto the balls of the feet, sliding your hands a bit higher.  Imagine you are gluing your hands as high up the wall as you can. Then, slowly begin to lower your heels to the floor while keeping your hands as high as possible.  Be careful not to let your lower back dramatically arch as you descend your heels, but let it feel like the outer shoulder blades lift faster than the inner shoulder blades toward your arm bones. Keep your neck relaxed.

 

5. Half Arms Overhead at the wall

 This is a great way to open up your side chest and armpit, areas that can limit your arms going overhead. Stand with your body sideways to the wall, with your inside foot about 6 inches from the wall and your outer hip resting against the wall. Take your arm overhead in line with your side body, palm to the wall. Come up onto the balls of the feet, sliding your hand a bit higher.  Imagine you are gluing your hand as high up the wall as you can. Then, slowly begin to lower your heels to the floor while keeping your hand as high as possible.  Monitor the arch of your lower back and keep the side of your neck relaxed.  Repeat on the other side.



6. Arm out to the side and back with wall

This is a great way to lengthen part of the pectoralis major muscle that lies under the breast tissue. It is also a great prep for the next pose. Stand about a foot or foot and a half away from the wall, with the side of your body to the wall.  Reach your arm back about a foot or so behind you, parallel with the floor, palm on the wall with fingers pointing away from you.  Press your hand into the wall, and slowly and carefully turn the chest away from the arm until some stretch arises.  Hold there. Skip this one if you have a history of dislocating your shoulder.  Repeat on the other side.

 


7. Cobra with Doorknob

Tight Shoulder Version

This is another way to address tightness in the front chest that limits your arms moving into extension behind your body. It is a bit more challenging than the last pose, since both arms are doing the action at the same time. Find a door with a good set of doorknobs on both sides of it, and then open the door slightly. Stand Stand a few inches in front of it, then reach back and grab onto the doorknobs.  Keeping a nice lift up your front body, begin to lean forward. Try to keep the sensation happening in your upper chest, not the lower back. You will resemble the figurehead on the front of a 17th century ship.

More Flexible Version

8. Reclined Arms Overhead

This one comes from our teacher Donald Moyer. With a block next to you, and a strap that you have adjusted to a shoulder-width loop, lie down on your back in Savasana, but with strong legs. Place the strap over your arms just beyond your elbow joints towards your hands, then press out against the strap as you pick up the block between your hands and firm your hands against the ends of the block.  You may have to make the loop bigger or smaller to keep your arms straight as you press on the block. Then, take your arms up and over head slowly, heading towards the wall behind you.  If your thumbs don’t touch the floor without bending your elbows, you can put a lift of some sort, such as a folded blanket, under your hands. I put this pose at the end of the sequence as I feel that it requires the most openness and strength of the poses presented here. Nina, however, often does this at the start of a practice and finds it helpful in that position of the sequence.

Parallel or Not: Aligning Your Feet

by Baxter

I received this inquiry from one of our regular readers recently:

One of the things I am noticing is, as much as I try, I can't seem to keep my feet parallel in mountain pose or to begin a flow without constantly looking down and re-aligning them.  I'm wondering if this is something I should give up on (keeping my feet straight) or just let them splay a bit and not sweat the notion of my feet alignment looking like my instructors.  I'm wondering if my body is simply built this way and I'm trying to get the proverbial square peg in a round hole.  I am also wondering if this impacts balancing poses since I try to keep my feet parallel with the edge of the mat and I seem to be fighting stability for foot position.
 
Thoughts welcomed if this makes sense or maybe, just maybe I answered my own question about foot position?

This is a perfect question for this week, as I am thinking a lot about feet this week, as I am teaching my annual Yoga for Healthy Feet workshop here in Oakland on Saturday. And our reader’s observations about his feet are not uncommon. Lots of yoga students, when confronted with the request by their teachers to “parallel” their feet find this quite challenging and sometimes downright impossible. It can feel odd or uncomfortable to stand this way.

There are many reasons for this. A common one that shows up in yoga class are ex-dancers who were taught from a very young age to emphasize a turn out of the entire leg from hip joint to feet, as the classical ballet position of the legs. They develop a “functional” turn out, one that was not present at birth, but develops as a result of a habitual way of moving. We see a similar condition in functional scoliosis, where the thoracic spine becomes bent and twisted as a result of some repeated activity, such as carrying an infant on the same hip all the time, or always swinging a hammer with the same arm.

In addition to functional changes in foot and leg alignment, trauma can result in such troubles, especially an injury like a broken bone that does not set in its original alignment as it heals. And then there are genetic expressions of the skeleton in the lower extremities that you see running through family lines, either with the feet or shins turning out, which we sometimes call duck feet, or turning in, which is referred to as pigeon toed. Genetic patterns in the hip joints, thigh bones, knee joints, shin bones and ankles can also affect the alignment of the feet.

And keep in mind that, except for disciplines like yoga, martial arts, dance and such, most of us don’t pay a great deal of attention to our feet being aligned parallel, as in yoga. And many non-yogis who don’t concern themselves with such things have wonderful, happy lives. So some of this is kind of arbitrary, and not always essential for a healthy life. But this foot position might be essential in performing well in certain yoga asanas, like Half Moon pose (Arda Chandrasana), where you have to balance on one foot and leg with only one hand on the floor to help you.

There are also inspirational stories of modern yoga practitioners, like that of Muktananda Stiles, who reported being bow legged, and with specific guidance from an experienced yoga teacher (in his case BKS Iyengar), reversed this to symmetric legs and feet.

So, let’s suppose for a moment that being able to stand with your feet parallel does confer some benefit to your posture and your musculoskeletal health. How would you go about assessing and changing what needs to change? You’ll want to do a self-assessment of your lower extremities or have a friend or teacher do one with you, as sometimes others will see something you do not.  Some things to look at: Are your thighs parallel, knees caps straight ahead, but shin bones turning out and the feet go along for the ride?  Also, look at whether both feet turn out or in the same amount, or if it seems to be a one-sided thing. You might have your teacher look at your hip joints as a source of foot turn out, like in our dancer example, or the knee joint, or the shins. Also, do the feet have high or flat arches at play that could also affect your efforts at symmetry?

Once you have some idea of what could be contributing to your particular asymmetry, a clearer path of action may present itself. One way my colleague and friend Richard Rosen has of working on the thighs generally (as they contribute to the effect on the feet) is to use a block between the mid-thighs to activate the adductor muscles of the upper legs, which are often loose and weak for many of us and can contribute to supination of the feet, where we tend to roll onto the outer edge of the foot. Simultaneously, you can place a strap around the outer mid-thighs and cinch it firm, so you can squeeze the block while also pushing out against the strap. This may seem like a paradox, but play with it and see what you discover. 

For those with tight outer hips, which could also contribute to rolling onto the outer edge of the feet, the strap can bring you back to even.  For those with pronation of feet, where you tend to collapse onto the inner foot, the outer press on the strap can get you more toward the outer foot.

The other things to consider are that if you want to get the musculoskeletal system to change, you will have to practice regularly and give it some time to take effect.  As we have mentioned elsewhere, the bones of the body can remodel as they respond to new stresses placed on them, as in osteoporosis. So we can take advantage of that fact here. 

It may also turn out that after careful evaluation you realize or decide that your feet and legs are better off, in the big picture of things, staying as they are.  In that case, you may have to be more creative about how you modify certain poses, such as balancing poses, to take your unique anatomy into account. In either case, you will have an interesting focus for your mind as you explore this common alignment recommendation in your public yoga classes!

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!  

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. 

Yoga and Migraine Headaches

by Baxter

We’ve had a few different requests over the past months to talk about the condition of migraine headaches and how yoga might be helpful in addressing them. So Nina and I are splitting up the topic into two focuses. Tomorrow Nina will share with you some ideas around yoga as a possible preventative strategy for migraine headaches (see Preventing Migraines and Other Headaches, Part 1 and Part 2, and today I will tackle the use of yoga during a migraine attack. And we might even get Brad to weigh in on the topic, as he lectures to the pharmacology students at UCSF on medications used to treat migraines. As we talked about the subject during a recent meal, he shared an opinion about treating acute headache attacks with yoga. “F#*k the yoga,” he joked, “Take the drugs!” As he may go into in more detail here later this week, he feels the modern abortive migraine meds are so effective that it might be foolish to not take them, as migraines can take the sufferer out of circulation for a day or more if a severe headache takes hold (see Brad's Perspective on Migraine Headaches). However, yoga has some effective solutions to offer, too, and there is no reason you can’t combine medication and yoga.

Let’s back up for minute and talk about what a migraine headache is. It is actually important to distinguish this from other forms of headache. In my medical practice, I used to get patients coming in with reported “migraines,” who were actually having more common musculoskeletal headaches that were very strong. They were under the impression that any “bad” headache was a migraine. To clarify the distinction, according to MayoClinic.com:

“A migraine headache can cause intense throbbing or pulsing in one area of the head and is commonly accompanied by nausea, vomiting, and extreme sensitivity to light and sound. Migraine attacks can cause significant pain for hours to days and be so severe that all you can think about is finding a dark, quiet place to lie down.

Some migraines are preceded or accompanied by sensory warning symptoms (aura), such as flashes of light, blind spots or tingling in your arm or leg. Migraines may progress through four stages — prodrome, aura, attack and postdrome — though you may not experience all the stages.”  

Since the physiology of the stages of the headache is quite complex, for now I’d like to suggest that the “acute” attack really starts with the “prodrome,” which can be a period of time a day or two prior to the actual onset of the headache symptoms, and can include any of the following signs or symptoms: constipation or diarrhea, depression, food cravings, hyperactivity, irritability or neck stiffness. As you can see from this list, these symptoms could also be associated with other things going on in your life, but the person with migraines begins to notice patterns that can help them predict the coming of headache over time.  So, if you are migraine sufferer who has identified these prodrome warnings, this could be the time to pull out some yoga tools best suited to this phase of things. I will get to more specific recommendations shortly.

The second stage mentioned is the “aura,” which, interestingly, the majority of migraine sufferers do not get before the headache shows up. But some do, and it can give them another opportunity to intervene, either with their meds or some yoga or both. The aura usually lasts from 10-30 minutes, and can be in the form of some visual phenomena, like flashing lights, or loss of vision, or pins and needle sensations in an extremity, or speech or language problems. There are even some people, like Brad himself, who typically only have the aura and do not go on to experience the full-blown headache.

If things progress to a full blown headache, it is typically a pulsating, throbbing pain on one side of the head, and can be accompanied by nausea, vomiting, fatigue, light, sound, and even smell sensitivity, and can last from 4 to 72 hours.  Once the headache subsides, the postdrome period that follows can often leave you feeling fatigued for a day or two. Migraines occur with differing frequencies for different people, and at least one of my students reports a distinct connection with her migraines and her monthly menstrual cycles.

When considering how to use yoga to attempt to short circuit the start of a full blown migraine or to mitigate the severity of the symptoms if you are already at the aura phase, there will be different approaches. In the one to two day prodrome period, taking some time to do a balanced, yet generally gentle asana practice, could possibly stop things from progressing further. The exact practice might be modified if GI symptoms predominate (doing Legs up the Wall, for example, if diarrhea predominates), or if neck pain is your early clue of a possible impending headache (doing gentle neck stretches, for example). In general, I’d recommend milder versions of all of your more active poses, with more focus on a calming connection to your breath than trying to work hard from a musculoskeletal view. And save time for a few restorative poses and perhaps a guided meditation with a stress-reducing focus.

Once you are at the aura stage or onward, the possibility of yoga halting a headache is much less likely, and certain kinds of yoga practices actually could aggravate the headache.  Inversions, for instance, are one of the biggest aggravators that my student reported to me, and even lying down flat in Savasana could be too much at times. However, supported poses, where the head is elevated a bit, like Reclined Cobbler’s pose can be quite helpful.

Since many headache sufferers head to a quite dark room anyway, setting up in Reclined Cobbler’s pose, using an eye pillow while in there, could potentially speed up recovery times.

I hope you've found this helpful, and if you have any recommendations from your own experience, please let us know!

Yoga and Hip Dysplasia

by Baxter

I received an email just the other day from a colleague in Colorado who was about to meet with a new private yoga client and was looking for some guidance. The woman coming in had apparently been diagnosed with hip dysplasia around the time of delivering a baby. Even without any more information than that, I could guess that the affected hip is the left one, as statistics for this unique hip condition bear that out. And it is eight times more likely to show up in women than men.

Usually, this is a condition that is diagnosed around the time of birth in babies.  When I was involved in my family practice, I’d go in the morning after a baby was delivered to our practice and one of the routine examination techniques was to check the hips of the newborn for a clunking shift in one or both hips when performing a certain movement of the femur bones. From there, if the test was positive, follow up ultrasound or X-rays was done to confirm the diagnosis. The screening done around birth, however, is not perfect, especially when the hip changes are small and that is why the student in question was not diagnosed until adulthood.

Femur Bone

The term “dysplasia” refers to abnormal development of the place where the femur bone (thigh bone) meets the pelvis bone. It can be either the head of the femur bone or, more commonly, the acetabulum (the rounded, concave receptive part of the pelvic bone) that does not develop normally. This abnormal development leads to an increased chance for the hip joint to mildly or more dramatically shift or even dislocate. This can lead in turn to abnormal walking, limping, shifts in the pelvic alignment and other undesirable changes, including pain. When caught in infancy, there are treatments that can help stabilize or treat the condition to increase the chances of more normal development of the joint as the child ages. Untreated milder forms of hip dysplasia can lead to early development of arthritis in the hip joint. And the opposite hip, if unaffected initially, can start to have it’s own problems as it has to pick up the slack for the misaligned dysplastic joint.

According to one source, all treatment aims to delay the onset of arthritis, but no treatment is fully successful in avoiding it. But despite this seemingly dire prediction, it is worth working via yoga or physical therapy to preserve or improve function of the hip.  I’d always recommend checking in with the student’s orthopedic doctor and/or their physical therapist to get a sense of the degree of change in the joint, and any precautions they recommend. Since subluxation (shifting of the bones out of normal alignment) and dislocation are possibilities, using caution when doing deeper internal and external rotation, and deep forward bending of the joint would be wise. The approach I’d take would be to work on strengthening and stabilizing the hip area via both weight-bearing standing poses (such as Mountain Pose, Triangle pose, Warrior 1 and 2 poses, and Extended Side Angle pose, with appropriate modifications and/or propping) and non-weight-bearing poses (such as Reclined Leg Stretch  and our Dynamic Reclined Hip Stretches).

Dynamic Reclined Hip Stretch Position 2

If there is already some arthritis and pain, I’d treat this situation like any arthritis condition, recommending initially practicing more non-weight-bearing asana variations, including reclining on the floor or using a chair for the standing poses, and progressing to weight-bearing if pain has diminished and strength is improving.  Also, remember that preserving range of motion of the joint is important, so taking the joint through all of it’s movement possibilities, keeping the above cautions in mind, will also help keep the joint healthier over time. I will be curious to see how things progress with my colleague’s work. Maybe we’ll get a report back down the road that I can share with you! 

Thoracic Outlet Syndrome and Yoga

by Baxter

For many of you out there, Thoracic Outlet Syndrome, abbreviated TOS, is one you may not have heard of. Yet, it arises most commonly in people who have been in traumatic accidents, typically in car accidents, or who do repetitive jobs, such as computer work at a non-ergonomic workstation, so that is potentially a lot of people. In addition to the two causes mentioned already, there are other less common causes of Thoracic Outlet Syndrome, like the presence of an extra small rib that can compress nerves and blood vessels near the lower side of the neck.  Regardless of the underlying cause, folks who develop Thoracic Outlet Syndrome often complain of a host of symptoms, which can include, but are not limited to, numbness and pain in the affected side of the neck, that is, in the arm, front chest and neck. There can also be weakness in that arm or hand. Symptoms often come and go, and in some situations can be positional in nature, only arising when the affected side arm is lifted and held overhead for a little while. 

What’s happening under the skin, so to speak, is that any of a number of structures could be getting compressed that should not be. More specifically, the cervical nerves that come out of your spine and come together to form the brachial plexus, (a kind of super highway interchange of different nerves from the cervical spine before heading down into the arm) can be pushed on by muscles and/or bones and lead to the symptoms described above. The same fate can befall the subclavian artery, the large blood vessel from the heart that feeds the arms, as it moves through the area of the side neck, under the collar bone, and out into the upper arm. 

A commonly cited aggravator of this condition is poor posture, which we have mentioned in many other contexts as contributing to other body pain conditions, and for which yoga is such a great antidote. In fact, most people diagnosed with Thoracic Outlet Syndrome will first be referred to physical therapy for postural re-alignment and stretches to open up the area of the neck and upper chest in order to create more space around the brachial plexus and arteries and veins to lessen or eliminate the symptoms associated with the condition. One muscle group that is often implicated in compressing the nerves and blood vessels is the scalenes, specifically the anterior and medial bodies of this three-muscle trio.

Muscles of the Neck

It would be worth your while to review an anatomy book if you are interested in understanding these muscles, which movements they normally create, and how one might stretch them to relieve tension on our delicate nerves and arteries.

Yoga could be a great adjunct to this healing process, since many of our sequences and poses address this area of the body nicely. Even simple warm up exercises like shoulder rolls, where you bring your shoulders forward, then up, then back and down, can start to improve this area immensely. I start class with this kind of attention to the upper chest quite often. Basic attention to Mountain pose and supported reclining backbends would be good starting places as well. And there are a few postures that directly affect the scalenes, such as the head positions in Bharadvajrasana seated twist in which you rotate and then side-bend the neck.

Conversely, since folks with Thoracic Outlet Syndrome often get symptoms when their arms are held overhead, some caution must be used when doing yoga poses with the arms ups, like Warrior I pose, for instance, especially if you intend to hold the pose for a while. I would not be surprised that a few people out there may have become aware of their positional symptoms after starting yoga due to the demands of the poses on the arms. (Yoga would not “cause” Thoracic Outlet Syndrome, but could alert you to its presence in such positions as Mountain pose with arms overhead, Urdhva Hastasana.) If such postures do bring on pain or numbness, it might be more prudent to experiment with dynamic versions of such poses, moving the arms up and down with the breath to see if the dynamic action precipitates symptoms. If not, you could continue to practice this way or even add in short holds as long as no symptoms arise. 

By moving and liberating held tension in this area, ultimately you may be able to relieve the compression that is underlying the Thoracic Outlet Syndrome. In fact, most patients with this diagnosis find some improvement with modalities like physical therapy and, I suspect, yoga as well, and very few have to resort to surgical intervention to find relief. 

Voting With Your Feet: Avoiding Abusive Teachers

by Baxter

Another View of Clear Water by Nina Zolotow

After Nina posted yesterday about abusive yoga teachers (see When to Fire Your Yoga Teacher), we received a follow-up message from another reader who had a similar experience of being humiliated when she attended the workshop of a visiting teacher to her community. In her case, she voted with her feet and did not attend a follow-up visit by the same teacher this year, but instead chose to study with a local teacher, and loved her experience. 

In discussing the humiliating teacher’s behavior with her regular teacher, the student was told, “That’s how they do it in India.” Well, this may indeed be true, but does it make this kind of behavior acceptable? In my own experience of studying with many teachers over the past 19 years at workshops and conferences and retreats, I have come across my fair share of angry, condescending, overtly or subtly demeaning behavior by teachers from at least two different traditions. In fact, I  studied with a well-regarded teacher a few times before a more subtle way of demeaning students on a fairly regular basis made me decide to give up the class despite some "good" asana instructions I was learning.  I could not justify continuing to support that kind of treatment of me or my fellow students.

 I also heard stories about a teacher I came to respect about how he had been a bear to study with when he was younger and how he had mellowed out as he aged. I felt blessed to have missed his “abusive” period since I learned so much and witnessed compassionate behavior from him regularly. I did carry a background concern about whether the other side might re-surface at some point; fortunately, I never had to encounter that situation from this particular teacher.

I do feel that teachers who study in a “lineage” that permits or even subtly approves of this bullying, degrading treatment of students tend to be more likely to participate in such behavior and maybe are even drawn to it. I don’t want to get into some deep exploration of trauma and its long-term effects, as it is a complex topic and I am not an expert in it. But, as Nina pointed out yesterday, you can vote with your feet, and I myself have done so more than once over the years. And that old observation that a happy customer tells one person about their experience, but a dissatisfied one will tell ten certainly has played out for me. I am asked all the time for referrals to other teachers or recommendations for teachers to study with at conferences. If a student happens to ask about a teacher I have had a bad experience with, I will recommend someone else instead.  I do not always go into the why of it, but do on occasion share my specific experience if I know that my personal experience was also confirmed by other yoga friends of mine. The good news is that we have more and more choices all around the country—and even internationally—when it comes to yoga instructors. So, don’t settle for anything less than a good instructor who is also respectful and kind.  

We Didn’t Mean to Scare You, Part 2: We Really Want to Inspire You!

by Baxter

Another View from 1/2 Mile Marker by Brad Gibson

Nina asked me to share my own thoughts on her post from last week, We Didn't Mean to Scare You, and I wanted to begin by saying how much I appreciated her common sense response to this writer’s dilemma. As many of you know by now, our purpose here at YFHA is to provide you with information and tools to assist you in practicing and teaching yoga as you age in healthy and beneficial ways.

Now I'd like to address one particular issue that our questioner raised:

"My own thought about practice is, if I'm not feeling something, why bother? I know most of my students feel the same way."

Indeed, much of what we experience internally as we practice yoga is some sort of increase in sensation, whether it is a feeling of stretch or compression in muscles or near joints, or strong muscle contraction when we are using a muscle group to keep us in our pose. On the level of physical-mental connection, we get this feedback from the body and we know that something is happening. The vast majority of the time, if taught or practiced skillfully, this is probably a beneficial thing that leads to some very positive, “delicious” changes, as our writer points out.

One of the skills that we develop as we practice more consistently is the discrimination to know when the level of feeling is better or worse for us. It is true in yoga and in everyday life. We learn at a young age how hot is too hot, and such.  If we acknowledge this experimental way that we all learn, then even when we go a bit too far in practice and have a brief “injury” or setback, it really shouldn’t be discouraging, because in some way this happens for us to find our limits and edges and provides us with wisdom for our future practice. We actually have learned something valuable about the yoga practice and ourselves. And, just to play devil’s advocate, don’t forget styles of yoga asana and meditation where there is not much going on, very little feedback or “feeling” happening, yet much benefit for the your entire being. This could be the case for restorative yoga or Yoga Nidra. These practices are equally an experience of yoga and the ultimate aim of yoga as a physically demanding style of practice.  

And as a teacher of yoga concerned about the general safety of the classes you teach, periodically re-assess the population you are teaching to, their average age and the fitness level of your students.  As your community ages, you may decide to learn new styles of practice and teaching that will better serve the needs of your student base that might be considered “gentle,” “restorative” or even “therapeutic.”  Nothing wrong with that, and you will become a more skilled teacher, able to work with many different kinds of students.  Our education as teachers should really never stop. And instead of letting the expanding knowledge about yoga scare us, let’s get inspired to learn and integrate this new information into our work in such a way to build our confidence, both as practitioners of the art and teachers of the path.

When to Transition to a Gentler Yoga Practice

by Baxter

Meadow, Forest, Fog, Sky by Brad Gibson

The question of when to transition to a gentler way of practice is one of those million dollar questions, right? When (and how) should we start changing our yoga practice? In fact, we recently received this very question from a reader:

“Thank you for this wonderful blog. I am 60 years old and new to yoga. I come from 10 years of doing weight lifting. I also would like to know when to transition to a gentler way of practice? It seems that after a strenuous yoga class it takes a couple of days for my muscles to stop from being sore. But I don't want to lose my strength. Any thoughts on this would be appreciated!”

Yesterday’s post (see Range of Motion: Yoga's Got It Covered) is a timely one, as it speaks to the benefits of maintaining a certain amount of yoga asana practice over time to help maintain good range of motion at the joints so we can do things we want and need to do in life. But there is relatively little guidance from the various yoga schools that have made their way to the US or have actually evolved into new systems of practice in the US on how the intensity of a yoga practice should modify and change as students age.

However, as I mentioned previously, in the yoga tradition of Krishnamacharya, they teach that there are different stages of life, from student to householder to senior to hermit, more or less. At each stage of life there are different responsibilities and goals to address, and yoga practice would be modified at each stage to help accomplish those goals. Also, in that tradition, not only does the level of strenuous practice typically go from lots when you are a child, gradually diminishing as you age, but students often work with an individual teacher who can act as a more objective guide to assist them in figuring out just such questions that arise, especially as practitioners get into their 60s and 70s.

I am not aware of any other specific guidelines from other yoga traditions or styles that specifically address what our reader has noticed following a strenuous yoga asana class. I think it is reasonable to expect a bit of soreness the day after a class that is somewhat challenging to your body on both a strengthening and stretching level. But if your symptoms of soreness last more than 24 hours, I’d be looking for a class that is a bit less challenging and more tolerable for you body.

Not finding much in the yoga world about this, I came across this great website from the Centers for Disease Control (CDC) that addresses western recommendations on both aerobic activity levels and muscle strengthening activities for older adults (see How much physical activity do older adults need?).

What you will smile at if you make it all the way down to the bottom of the page is that yoga is listed last as an acceptable strengthening activity. So how much yoga are they suggesting? Well, they recommend “muscle strengthening activities” at least twice a week that work all the major muscle groups of the body. However, they don’t state how long these sessions should be. A typical average yoga class in the gym or studio is 1 hour to 1.5 hours long. So you’d be meeting these criteria if you went to 2 classes a week. As an alternative, you could do a home practice two or more days a week for 20-30 minutes, and if you designed a sequence of poses that works all the major muscle groups of the body, which CDC defines as legs, hips, back, abdomen, chest, shoulders, and arms, you might also meet their recommendations. I’d use the soreness levels as a way of deciding how strenuous your work should be, and I think it is a good idea, if you do get sore for 24 hours after you practice, to space your sessions out to at least every other day—just a common sense recommendation.

Having said all that, there is a more organic way in which many of us allow our practices to change and evolve over time that has been true for Nina and me, and Nina will share those ideas with you tomorrow. In the meantime, if any of our readers have come across other recommendations on this topic from their yoga traditions, please write to us and let us know what you have learned. We’ll pass it on the rest of our readers!

To Peel or Not to Peel: Working with Bridge Pose

by Baxter

I received this question a while back from one of our readers and thought today was the perfect day to address it:

“I often hear teachers instruct to come out of Bridge 'one vertebra at a time.' What are your thoughts on this? Is this healthier for the spine? Or is it in fact better to maintain the lower lumbar curve?”

It turns out that most of my first teachers would encourage just such an action when instruction for Bridge pose (Setu Bandha) with bent knees. In those days, I was practicing a style of yoga in which we would hold the poses for several minutes once in the shape of the pose. My instructors would often say to come up into Bridge one vertebrae at a time, as if your spine were taped to the floor and you were slowly peeling the tape off the floor. And they would suggest a similar action upon exiting the pose only in reverse: lower down slowly, one vertebra at a time, as if you were pressing the “tape” of the spine back onto the floor.

Bridge Pose (from "Yoga: The Poetry of the Body")

This way of entering or exiting Bridge pose is one of two basic ways I still think are valid and reasonable ways to work in the pose. The second way that I instruct entering and exiting is as follows: From Constructive Rest position (supine, knees bent and heels about 4 inches from your hips), establish the normal, slightly arched shape of your lumbar spine. Lift your hips straight up as you push down into your feet, like an elevator going up a few floors, maintaining the neutral arch of the lower back. To come down, lower your hips straight down, like an elevator returning to the lobby floor.

The obvious question would be what are the advantages to the two different ways of getting in and out of the pose? The Peel Method, as I call it, is particularly well suited to the generally stiff student who does not have any lower back problems, specifically, but not exclusively, lumbar disc issues. For the healthy, stiff student, this way of moving in and out of Bridge pose creates more movement in certain directions between the individual bones of the lower spine, a bit more flexion (forward bending) than extension. So you can create better movement in a stiff part of the body using the Peel Method. And it is a fine way to work with healthy students who have normal flexibility as well.

However, in my specialty Back Care class, where lots of students have bulging or inflamed discs or structures in the lower back, there may be some instability and/or too much mobility that can result in increased pain. In addition, flexion (such as in a forward folding, rounded spine) which as I mentioned above, happens with the Peel Method, could potentially worsen disc problems and even run-of-the-mill general lower back pain. So the Elevator Method provides more stability to the lower spine, as well as encouraging a more neutral or natural curve in the lumber spine. I find that almost all of my Back Care students can not only do this variation without pain, but also seem to benefit from the overall strengthening of the back body muscles that come form this particular back bend.

There will always be some students who are exceptions to the above recommendations, and so each individual has to try the methods out for themselves and see which feels better for their body and seems to have the overall desired effects from regular practice. And, as with all asana, there are certainly other creative ways to get in and out of Bridge, so playing around to find a new way of working in the pose can add some fun to your home practice as well. I personally like to mix up the way I enter and exit poses a bit, so that I don’t get stuck in a rut of doing things the same way each time. This way of varying things keeps my attention more clearly focused on the task at hand, so I am more present with my regular asana practice. And this cultivation of moment-by-moment awareness in my yoga practice has great benefit for my everyday activities as well. In this way, I can move beyond the mere performance of yoga poses and reap the deeper benefits that yoga has to offer. So, play around with Bridge pose this week and see what you discover for yourself.

Holding It All Together, Part 1: Ligaments

by Baxter

As I was prepping for my upcoming workshop this Saturday on Yoga and the Musculoskeletal System out in Brentwood, CA (see Brentwood Yoga Center Workshops for registration information), I decided to look back at my old blog posts to see what I had written regarding tendons and ligaments, two of the main structures we’ll be talking about this weekend. And much to my surprise, I found that I had not yet addressed these basic and vital topics. So today I thought I’d begin a discussion on ligaments, anticipating that I’ll come back to tendons again in the future.

Let’s begin by looking at some basic definitions for these two structures. Both ligaments and tendons are composed of something anatomists call “connective tissue,” which is a collection of tissue types that often serve the function of keeping our different body structures together, and include such diverse tissues as the above tendons and ligaments, as well as fascia, intervertebral discs, cartilage in the ears and nose, cartilage coating the ends of bones and others. Connective tissues, depending on what their function in the body is, will either be more or less elastic by virtue of the proportions of the components that make up connective tissue: collagen and/or elastin fibers, which float in a semi-fluid gel called ground substance. According to Mel Robin, in his book A Physiological Handbook for Teachers of Yogasana, connective tissue works as a mechanical support or binder for other tissues, allows for food and waste from cells to move in and out, acts as a lubricant and is the body’s glue. 

So what then are the structures that ligaments glue together and what are the unique features of ligaments? Ligaments are specialized connective tissue that binds bones to bones. They keep the bones of your joints in close proximity so they don’t dislocate (which sometimes still can happen, in the shoulder joints, for example), and they allow for a certain amount of passive movement in some directions and restrict movement in others.  In fact, restraining movement is one of the main functions of ligaments. They happen to be high in collagen fibers and low in elastin fibers, which makes ligaments strong, but not very flexible. According to David Coulter in his book Anatomy of Hatha Yoga ligaments are:

“...made up of tough, ropey, densely packed inelastic connective tissue fibers, with only a few cells interspersed between large packets of fibers.”

Knee Joint (with ligaments)

Usually, the amount of stretch that can take place in a ligament is very minor, only around 4%, but there are exceptions, such as ligaments in the cervical spine region, which have been found to stretch up to 200%! In contrast, those around the knee joint have very little elastin, so are much more rigid to provide more stability to the joint. This can have relevance for our yoga practice. As an example, deep flexion (forward bending) of the neck as in Shoulderstand will not permanently overstretch the neck ligaments. But deep flexion (bending) of the knee as in Supta Virasana has to be approached cautiously and mindfully so as to not overstretch the supporting ligaments of the knee. If the ligaments are overstretched, they will not return to their original length and will be permanently loose and ineffective in stabilizing the knee. In general, you want to focus on stretching the muscle and not the ligaments in your yoga practice.

Another reason to avoid overstretching or, even worse, tearing a ligament, is that ligaments have a poor blood supply. Due to this poor supply, getting repair cells into an injured ligament and taking away the waste and injured material is more difficult, and healing is therefore slow. Also, ligaments have very few cells—which are the things that have to be stimulated in an injury to produce more fibers and fluid—and this contributes to slow healing as well. 

Those out there who have injured the ligaments at the side of the knee joint, the collateral ligaments, via sports like soccer or football, can attest to the long healing times I am referring to here. When we sprain a ligament, not only do we experience some pain and swelling, but the area also seems looser and more prone to re-injury. A ligament sprain that almost everyone has experienced at one time or another like this is the outer ankle.

It seems that one of the safest ways to stretch your tight muscles, and avoid stretching your supportive yet rigid ligaments, is via moderate intensity, slow, held stretches. Warmer muscles and ligaments seem to do this more healthily then cold ones, so I like to move slowly and mindfully in and out of a position a few times to warm up the tissues, and then follow that up with a more sustained hold. And the good news regarding safe stretching is that our nervous system warns us as we approach the kind of overstretch that could tear our ligaments (and tendons) through pain (which can have a whole range of variety and intensity), trembling or weakness. This is yet another reason to pay close attention to the sensations that arise as you perform your asanas. Also important is the location of the sensations, as those arising in the mid-length of the muscles is much more acceptable than sensations occurring right over joints. You might hang in there a bit longer in the first instance and come out of a stretch promptly in the latter!  

Next time, I’ll discuss tendons, which share some similarities with ligaments, but have some unique functions as well.

Yoga and Heart Health: Atrial Fibrillation

by Baxter

A yoga workshop to Cincinnati brought me face to face with my first “medical emergency” in the yoga classroom. On the first night of a two-day workshop, one of the students began to complain of a rapid heartbeat and some shortness of breath. I took her off to the side while my co-teacher continued to work with the rest of the group, and discovered, after a few more questions, that she had a condition know as atrial fibrillation. Turns out she had been feeling well lately and had decided to cut back on the medication used to keep her heart rate in a safer range. Fortunately, in this instance, I was able to get the life squad there quickly and shuttle her off to the ER for appropriate care, and the rest of the workshop continued without a hitch. Now a dozen years later, an ongoing study at the University of Kansas seems to suggest that yoga may be helpful in treating this particular heart condition!

So what is atrial fibrillation? According to the National Institutes of Health:

“Atrial fibrillation (A-tre-al fi-bri-LA-shun), or AF, is the most common type of arrhythmia (ah-RITH-me-ah). An arrhythmia is a problem with the rate or rhythm of the heartbeat. During an arrhythmia, the heart can beat too fast, too slow, or with an irregular rhythm. AF occurs if rapid, disorganized electrical signals (emphasis mine) cause the heart's two upper chambers—called the atria (AY-tree-uh)—to fibrillate. The term "fibrillate" means to contract very fast and irregularly.”

Sometimes, people who develop this condition notice the rapid, irregular beating of the heart, but sometimes it can go unnoticed for a while. And two very serious conditions can result from untreated atrial fibrillation: strokes (which occur suddenly) and heart failure (which develops more gradually). The underlying problem has to do with the heart’s electrical system not functioning correctly. And because the normal spread of the electrical impulses is both too fast and uncoordinated, the heart becomes both less efficient at sending blood out to the lungs and the body, and blood tends to pool or hang out in the heart chambers longer than it is supposed to. This pooling can lead to blood clots forming in the chambers of the heart, which could then be launched into the arteries that lead to the brain, and—whammo!—a stroke occurs. For more information about AF, check out What is Atrial Fibrillation? from the National Institutes of Health.

Back to 12 years ago, when I was confronted with someone who was having acute symptoms of her rapid heart rate, I needed to get her to a facility that could quickly get her heart rate in a safer range and make sure she was not at risk of a stroke. And I did not have information then on how yoga might impact the course of her problem. Now, research being conducted in Kansas is suggesting that yoga may be a part of the future treatment of AF. At the University of Kansas Hospital, an ongoing study is looking at the effect of regular yoga practice on irregular heartbeat. The yoga world has long known about the connection between yoga meditation and breath techniques and the ability to influence the heart rate. This connection between the mind and the heart is at the center of the theory on how yoga may help with AF. Via yoga’s ability to influence and change the autonomic nervous system, patients may be able to have more control over their heart rate than those who do not do yoga. It is also known that stressful situations and emotional moments can trigger the AF person’s heart to beat more rapidly. So the researchers are monitoring the study participants for how many episodes of recurrent AF happen while on the yoga regimen. They report that the initial results look promising.

AF is one of those medical conditions where a combination of modern western treatment, which includes medications that help control the rate and rhythm of the heart and procedures to help if meds don’t, and lifestyle modifications, like yoga as well as diet and other exercise, will optimize the health of the person with AF. The study is not yet completed, but we will try to keep an eye open for the final report and give you an update when that happens. In the meantime, see Yoga My Heart  for more about the University of Kansas Hospital study.