Medical Conditions Benefited by Yoga

by Nina

Just a quick post today to let you know that Timothy McCall has updated his list of medical conditions that are benefited by yoga (as demonstrated by scientific studies). There are 75 conditions!

1.    Alcoholism and Other Drug Abuse
2.    Anxiety
3.    Asthma
4.    Atrial Fibrillation
5.    Attention Deficit/HyperactivityDisorder (ADD/ADHD)
6.    Autism
7.    Back Pain
8.    Balance Problems
9.    Breast Cancer
10.    Cancer (General)
11.    Carpal Tunnel Syndrome
12.    Chronic Fatigue Syndrome
13.    Chronic Obstructive Pulmonary Disease (COPD) e.g. Emphysema
14.    Congestive Heart Failure
15.    Depression
16.    Diabetes
17.    Drug Withdrawal
18.    Eating Disorders
19.    Epilepsy
20.    Fatigue
21.    Fibromyalgia
22.    Gait (Walking) Problems
23.    Guillain-Barré Syndrome
24.    Heart Disease
25.    Hemorrhoids
26.    High Blood Pressure
27.    HIV/AIDS
28.    Hypothyroidism
29.    Infertility
30.    Inguinal Hernia
31.    Insomnia
32.    Irritable Bowel Syndrome
33.    Kidney Failure
34.    Lymphoma
35.    Mental Developmental Impairment
36.    Menopausal (and Perimenopausal) Symptoms
37.    Menstrual Disorders
38.    Metabolic Syndrome
39.    Migraine and Tension Headaches
40.    Multiple Sclerosis
41.    Muscular Dystrophy
42.    Neck Pain
43.    Neuroses (e.g. Phobias)
44.    Obesity/Overweight
45.    Obsessive Compulsive Disorder (OCD)
46.    Organ Transplant
47.    Osteoporosis
48.    Osteoarthritis (Degenerative Arthritis)
49.    Ovarian Cancer
50.    Pain (Chronic)
51.    Performance Anxiety
52.    Pleural Effusion (Fluid in Lung Lining)
53.    Polycystic Ovarian Syndrome
54.    Post-Heart Attack Rehabilitation
55.    Post-Joint Replacement
56.    Post-Polio Syndrome
57.    Post-Operative Recovery
58.    Post-Stroke Rehabilitation
59.    Post-Traumatic Stress Disorder (PTSD)
60.    Pregnancy (both normal and complicated)
61.    Psoriasis
62.    Restless Leg Syndrome
63.    Rheumatoid Arthritis
64.    Rhinitis (Inflammation of the Nose)
65.    Schizophrenia
66.    Scoliosis (Lateral Curvature of the Spine)
67.    Sexual Function
68.    Sinusitis
69.    Smoking Cessation
70.    Stroke
71.    Total Knee Arthroplasty
72.    Traumatic Brain Injury
73.    Tuberculosis
74.    Urinary Bladder Dysfunction
75.    Urinary Stress Incontinence

Timothy has created a special PDF document that lists these conditions along with the scientific publications that confirm the benefits that yoga provides. And he has generously granted permission for copying and distributing this document. You can find it on his web site: http://drmccall.com/yoga/YAM--75Conditions.pdf.

Starting a Meditation Practice

by Timothy

Berries by Melina Meza

In my last blog post (Is Meditation an Essential Part of Practicing Yoga?), I wrote about why meditation may be the most powerful tool in the yoga toolbox for improving health and well-being. Yet meditation is not part of most yoga classes, which tend to focus almost exclusively on asana. Indeed, many yoga practitioners who have become interested in meditation have looked to Buddhism or elsewhere to learn how to meditate because they weren’t finding it in the yoga world.

But, as I mentioned previously, meditation was traditionally an integral part of yoga practice, and within the yoga tradition there are dozens of different techniques. Contrary to popular belief, in yogic meditation you are usually not trying to make your mind empty, but instead the process begins by learning how to concentrate your focus. To facilitate this, it helps to focus your attention on one thing, perhaps a word or phrase (a mantra), an object like a candle or a picture of a teacher or deity, or simply on your breath itself. With sustained attention, you may slip into a meditative state.

So, strictly speaking, we do not sit down to meditate, but rather we sit to foster the state that may lead to meditation. Since the mind tends to wander—even among experienced meditators—there may not be much (or even any) actual meditation in any particular session of sitting. Still, this movement towards meditation all by itself brings physiological and health benefits. And, of course, with sustained practice, more and more actual meditation can happen. At first, it may just be for a moment now and again, and that’s just fine.

The first question then is how do you sit? Despite the pictures you’re likely to see of people meditating, you do not need to sit cross-legged on the floor, though if you can that may be one of the best ways. Kneeling in Virasana (Hero pose), perhaps with a block under your sitting bones, is an excellent alternative. What’s important is that you maintain your normal spinal curves, particularly the inward curve of your lower back (the lumbar curve). This is difficult for most people to do if they try to sit cross-legged on the floor, which is why one or more cushions should be placed under the sitting bones, allowing the healthy forward tipping of the pelvis that facilitates maintaining an easy lumbar curve. When you’ve got the height right, your thighs will angle down slightly toward the floor. If you've propped yourself up high to do this, you may need to put additional support underneath your thighs to remain comfortable. Getting all of this right is an art, and if you’re not sure how to proceed I suggest you seek the help of an experienced yoga teacher.

For many people, it will be much easier and much more effective to sit in a chair for meditation. You’re only going to be able to concentrate and/or meditate if you can remain in a comfortable upright position, and if you’re not comfortable sitting on the floor, it’s best to try a chair. For those sitting in a chair, I recommend scooting to the front of the seat, because if you sit back, most chairs encourage a flattening or rounding of the lumbar spine. If your feet don’t reach the ground comfortably, place blocks, thick books, or folded blankets under them. If your legs, like mine, are long, you may need to place a folded blanket on the chair to raise the seat. But no matter the position you choose, if possible, your head should be directly over your shoulders and pelvis. If you get it right, there should be very little work required to stay upright.

Although it may not be ideal, for those who can't sit comfortably, it is possible to meditate lying down. Some people in the yoga world would take exception to this, but I have found it to be useful in the yoga therapy work I do. One of the principles of teaching yoga is that we try to meet students where there are, and this is where some people are: they cannot sit comfortably. Yes, there is a greater tendency to get sleepy or zone out while supine, but we should not let the perfect be the enemy of the good.

The simple yet powerful practice I often suggest for beginners (and experienced students as well) is a meditation technique known as So Ham (sometimes written So Hum because that’s how it's pronounced). Settle into a seated position that balances ease and an upright spine, and notice the flow of air in your nostrils. Begin to focus on the sound of your breath. The ancient yogis felt they could hear in the inhalation the sound “Soooooooooh” and in the exhalation “hummmmmmmmm.” They didn't make the sound so much as they tuned into the sound that the breath naturally makes, believing it to be a mantra that’s built in. In Sanskrit so ham means “I am that,” which to the yogis signaled their connection to the greater whole. Try to stay focused on that sound, noticing your breath but not trying to control it. If you discover your attention has wavered, simply observe that without judgment, and gently bring your focus back to So Ham.

I'd recommend trying to stay for 3-5 minutes initially, working up gradually to 20 minutes or longer daily. As with all yoga practices, a little bit every day will bring greater benefits than longer sessions done intermittently.

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.

Many Right Ways To Do A Pose and a Few Wrong Ones

by Timothy

Branches and Roots by Brad Gibson

I got involved in a conversation the other day with Nina after class with our teacher Donald Moyer. Another student was wondering about the “correct” way to do forward bends. She’d just read an article in Yoga Journal by a highly respected teacher who said that the only correct way to do forward bends was with a concave lower back, that is, maintaining a normal inward curve of the lumbar spine. Although Donald sometimes prepares for forward bends like Uttanasana by doing the pose with a concave lower back, in the final pose, he suggests we allow a nice, even rounding of the spine, that is, completely reversing the lumbar curve.

Inherent in the student’s question is the notion that there is only one correct way, that everybody in all circumstances, should do any pose. The reality is that it always depends. What are you trying to achieve? What poses have preceded it and what do you plan to do after it in your practice? Are there contraindications you need to consider? Are there quirks in your anatomy or injuries you need to work around?

We could do this analysis for any pose but, since we’re on the topic, let’s stick with forward bends.

There are times when it is definitely not a good idea to fully round the spine. If you have a herniated lumbar disc, for example, rounding is generally contraindicated. When you round forward, the front surfaces of adjacent lumbar vertebrae come together which tends to push the disc material toward the back of the body, near where nerves exit the spine. This rounding the lower back could lead to nerve compression and sciatic pain.

For a similar reason, rounding the back in forward bends is generally not recommended for those with osteoporosis. Compression fractures of the spine happen when the front surface of one vertebra collapses under pressure from a neighbor. But forward bends done with a concave lower back can actually be therapeutic for those with thinning bones, and were part of the routine Dr. Loren Fishman used in his ground-breaking research (still ongoing for those interested in enrolling in the study) that is documenting yoga’s powerful ability to increase bone mineral density.

For those who lack such contraindications, rounding the spine the way Donald teaches may lead to deeper relaxation and more quieting of the nervous system. When looking at students from an Ayurvedic standpoint, long holds of rounded forward bends can be deeply calming to the vata dosha (the imbalance often tied to stress and over-activity). Long holds of such forward bends are part of yin yoga, and can be a wonderful way to open tight hips, for example, to prepare the body to sit comfortably for long periods of time in mediation.

So my way of thinking is that there is more than one correct way to do forward bends, all depending on the overall situation and what you are trying to accomplish. But that said, there are also certainly wrong ways to do poses. In my mind, any way of doing a pose that unduly increases the risk of injury, or which puts the joints or other bodily tissues in compromised positions is wrong. In forward bends, one common incorrect method is to bend from the waist rather than hinging from the hips. Although not all yoga teachers would agree, I also advise against any knee locking in the poses.

Of course, this just begins to describe all the thinking on forward bends found among different yoga teachers. Some people sit up on folded blankets or other props, which allows them to get more forward tipping of the pelvis, but not everyone needs to do this. Some people hold their toes, some hold a strap looped around the soles of their feet, and some place their hands alongside their legs. Ultimately, good teachers learn to look at students, ask them questions and determine a reasonable approach.

To me the final arbiter of whether a yoga technique is right or wrong is the breath. If you’re able to do the pose and the breath can remain smooth, deep and even, more than likely you're doing it a right way (though probably not the right way).

The Power of Fact Checking: Timothy McCall on Elephant Journal

by Nina

Buddha Waiting for Spring by Michele Macartney-Filgate

Just a quick announcement today to let you know that Timothy has a very interesting post up now on Elephant Journal Does Yoga Kill?

Recently Timothy wrote about yoga and strokes on our blog (see Will Yoga Cause a Stroke? Could It Prevent One?), covering the topic in general and how to practice yoga safely. In his Elephant Journal post, however, Timothy directly takes on New York Times science writer William Broad’s claims about the relationship between yoga and strokes, responding point by point to Broad’s claims and looking more deeply into the research that Broad used to back them up. All I can say is, wow, that fact checking thing is really amazing—wonder why Broad's editors didn’t avail themselves.

My favorite fact is this one:

“To bolster his case, he listed several people whose deaths might have been caused by yoga including this one: “In Los Angeles in 2004, Sita White, 43, a British heiress and a favorite of gossip columnists, collapsed and died in a yoga class. The question is why.”

What Broad neglected to mention is that she wasn’t doing yoga at the time. According to eyewitnesses and media reports, White collapsed and died while students were filing in and putting down their mats.”

I also love Timothy’s conclusion:

“The truth, on the other hand, is often complicated, nuanced, and doesn’t always make a great story. And it is precisely that satya—subtle, interpenetrating, endlessly unfolding—that yogis are after.”

But you should go ahead and check out this article! And let us know what you think.

Will Yoga Cause a Stroke? Could it Prevent One?

by Timothy

There has been concern—and for some even fear—in the yoga community regarding the risk of strokes from doing yoga. How realistic is this?

Much of this fuss was set off by the New York Times writer William Broad, who warned that all the stretching of the neck in various yoga poses like Cobra and Shoulderstand could lead to tearing of the linguini-like vertebral arteries that run along either side of the neck bones, which could then lead to bleeding into the brain. But as I (and others) have written (see Man Bites Down Dog), Broad's analysis was alarming, lacked data to back his extraordinary contentions, and in all likelihood was way off. Still, it may be worth discussing the risk of strokes and what thoughtful yoga practitioners and teachers can do to prevent them.

Arteries of the Neck (from Gray's Anatomy)

Vertebral artery tears and resulting strokes often happen when someone makes an unaccustomed neck movement. The example that is often cited is when an elderly woman drops her head back into the hairdresser’s sink. In such a case, the movement in question is an extension of the neck (the cervical vertebrae), not so different from what happens in backbends like Cobra pose and Upward-Facing Dog. But it’s also at least theoretically possible to tear the artery when you go in the other direction and flatten the neck vertebrae, as in Shoulderstand and especially Plow pose. Even twisting poses could cause problems if you crank the head too far. Outside of yoga, such strokes also have been reported to happen when people simply turn their heads to the side or suffer minor trauma. It is estimated that 1.5 people out of every 100,000 suffer vertebral artery-related strokes every year.

I have observed many yoga students who hyperextend their necks in poses like Cobra and others who flatten their neck in poses like Shoulderstand and Plow. In the case of backbends, many students have the habit of over-arching from the neck. They compress the backs of their necks, and often arch too much from the back of the skull (the occiput), at the atlas-occipital joint. (The atlas is another name for the first cervical vertebra.) This habit is common in those with tight thoracic spines. When the thoracic spine is stubborn, people sometimes overcompensate by overarching the more flexible cervical and/or the lumbar spines. In other words, when one link in the chain is tight, people tend to move more than they should from the links above and below it.

When instructing backbends, I encourage students to try to keep the back of the neck long. Rather than looking up in a pose like Cobra, I encourage those with the habit of neck hyperextension to keep their gaze forward, which tends to keep them from tipping the head back too much. It’s also useful to think of originating the movement in your neck from the middle of the thoracic spine and the lower cervical vertebrae (where the neck attaches to the back).

Poses like Shoulderstand and Plow pose tend to flatten the neck. This is especially problematic if the student tries to move the chin towards the chest (an unfortunate instruction that some yoga teachers use). Instead, I encourage students in these poses to lift the front of the chest toward the chin, and actually slightly move the chin away from the chest. If you try this, you may notice that it lessens the feeling of pressure at the back of the neck.

In the traditional hatha yoga Shoulderstand, known as Viparita Karani (not to be confused with the restorative pose that uses the same name), the legs are in a jack-knife position. In other words, the pelvis is behind the spine and the feet are forward of the spine. This pose can be done safely without any props, especially if you follow the instructions of moving the chin slightly away from the chest. This is the version of Shoulderstand I’ll do if I wind up somewhere with no props.

Rare is the yoga practitioner who is flexible enough to do the modern, more-directly vertical version of the Shoulderstand—in which the legs are stacked directly over the hips and shoulders—without blankets or other props to raise the shoulders off the ground. To keep suppleness in your neck, the number of blankets required varies. For example, I use four folded blankets under my shoulders. Try to place your shoulders near the edge of the folded blankets so you graze the skin over C7, the lowest cervical vertebra, while you work to lift C7 away from the ground. Your breath should be soft, slow and even throughout the pose, and if at any point you can’t breath smoothly, or otherwise feel uncomfortable come down.

Plow pose is even more challenging to the neck, and I recommend the same blanket set-up. If you notice any discomfort at the back of the neck, however, I recommend either skipping the pose entirely or placing your feet higher, for example, on the seat of a chair.

In twists, try not to lead with your head. In other words, the turn should come from the vertebrae all along your spine, with no twist whatsoever from the atlas-occipital joint. One instruction I give if students feel any tension in the neck is to turn the head ever so slightly (say 1 millimeter) in the opposite direction of the twist. What this accomplishes is to stop people from trying to twist the skull on C1, a motion those joints are not meant to do. Even more conservative, is to not let the chin turn any more than the chest, in other words the nose and chest point in the same direction.

Beyond lessening the theoretical risk of a vertebral artery stroke, all the above advice will also tend to help avert yoga’s contributing to such musculoskeletal problems of the neck as arthritis and overstretching of spinal ligaments. Indeed, averting these problems is actually my primary reason for recommending doing the poses as I suggest. Broad generated tremendous publicity for his book by trumpeting the risk of vertebral artery strokes, and made the absurd, entirely unscientific calculation that yoga causes 300 strokes and 15 deaths per year in the U.S. My guess is that it’s more like in a one in a zillion scenario. 

Ironically, skillfully practicing the very poses that Broad recommends avoiding might actually lower the risk of the vertebral artery strokes. When you gradually stretch the arteries and surrounding tissues as could be expected with a regular yoga practice, the vessels would likely become more pliable, and resistant to tearing with sudden movement or trauma.

And the bigger picture is that vertebral artery strokes are a tiny percentage of all strokes, estimated to strike 269 people per 100,000 every year. Yoga’s documented ability to lower blood pressure, cholesterol and stress hormones, reduce inflammation, thin the blood, etc., in all likelihood greatly lowers the incidence of all types of strokes—as well as heart attacks and a host of other conditions. Just be sure to be mindful of contraindications. So, for example, if you have poorly controlled high blood pressure, you probably want to avoid inversions like Headstand entirely. The risk of having a stroke as a result is probably small, but it’s better to err on the side of caution.

Man Bites Downward-Facing Dog: Dr. Timothy McCall Takes On William Broad of The New York Times

by Nina

Could yoga make you fat (especially if you're a woman)? Does it cause hundreds of strokes per year? Sex you up so much you'll engage in unethical behavior? Did the entire discipline start out as a sex cult? If you read The New York Times you might think so. As much as I've often disagreed with him, up until now I've been diplomatic in my responses to William Broad's writings about yoga in Times and in his book The Science of Yoga. But after his recent article in which he asserted that "yoga is remarkably dangerous — for men," I felt it was time to speak up. —Dr. Timothy McCall

In his new paper “Man Bites Downward-Facing Dog,” Yoga for Healthy Aging blogger and Medical Editor for Yoga Journal Magazine, Dr. Timothy McCall responds to William Broad’s ongoing sensationalistic claims about yoga. In his post on our blog Is Yoga Really Dangerous for Men?, Timothy addressed Broad’s most recent claim that yoga is “remarkably dangerous” for men. In this new paper, he goes further and responds to other over the top claims that Broad has made previously, such as that yoga can make you fat or that the entire discipline started out as a sex cult. He also makes it clear that he is not denying that yoga injuries are a problem; and he acknowledges that he is not in disagreement with all of William Broad's assertions.

Mugsy, the Yoga Dog by Nina Zolotow

Timothy's article is on his web site, in  PDF format rather than on a web page. So if you want to read it, you’ll need to download it and view it with Adobe Acrobat. To get your copy of the paper, you can either use the link in the previous paragraph or go to Timothy's web site www.drmccall.com. I highly recommend that you go ahead and download the paper. Then feel free to pass it on to your friends. We really want to get the word out!

Is Yoga Really Dangerous for Men? Dr. Timothy McCall's Response to William Broad

by Timothy

Science reporter William Broad, who a year ago woke the proverbial sleeping (downward facing) dog of the yoga world with his NY Times Magazine article How Yoga Can Wreck Your Body, is back at it. This time he's claiming—based on a review of injury statistics—that men are at much greater risk of serious injury from yoga (see Wounded Warrior Pose). The claim may or may not be true, but I don’t think you can really tell from the data he presents. I plan on writing more about this topic in my next email newsletter, but wanted to respond to Nina's query for the blog today.

Man in Unwounded Warrior 3 Pose by Nina Zolotow

As Broad makes clear in his book, The Science of Yoga (from which the first Times yoga article was excerpted), the subject of his inquiry is the physical practice of yoga as found in most classes. He’s not talking about meditation, chanting, selfless service or spiritual development. Even so, styles of asana practice, different teachers and classes vary enormously. It’s my feeling that Broad's failure to account for these differences could entirely explain his findings.

Back when I was taking a lot of classes of different styles (which I'm not doing anymore, so if things have changed I’d love to get feedback from readers), I found that in the more meditative and restorative classes, I was often one of the only males in the room. But in some of the more vigorous and acrobatic classes, the gender split was closer to even. Thus, men having a higher incidence of yoga injuries could simply be a reflection of their favoring the kinds of classes where injuries seem more common, and not actually reflect any greater vulnerability to injury.

It is also my experience (and that of most yoga teachers I’ve spoken with) that people who are more flexible are generally at greater risk of injury, particularly for injuries like hamstring muscle tears, and overstretching of the ligaments. It varies from person to person obviously, but on average men are much stiffer than women, and seemingly less prone to these types of injuries.

Many yoga injuries—again based on my experience, since we lack data—happen when people are trying too hard to achieve a particular result. Your foot won’t go into Lotus pose, for example, so you pull a little harder to get it into position, and in the process tear ligaments in your knee. But before that happens, the body almost always gives warning signs, such as pain or strained breathing. If you decide to ignore them and power your way through, problems may result. Both men and women can do this, but if I had to guess I’d say men are more likely to, so in this way may be at higher risk.

William Broad loves to create controversy. Beyond claiming that yoga can wreck your body, he has also written that yoga can make you fat, and that the entire practice started out as a sex cult (neither of which is true). Statistically speaking, if Broad’s analysis is correct (and given the methodological problems in how he did his analysis—see Is Yoga Really Dangerous for Men? Dr. Ram Rao Weighs In—I don't think we can know), men may indeed be at higher risk of injuries when practicing asana, but this may miss a larger truth. My guess is that if a man practices less demanding forms of yoga, or any style of yoga in a less aggressive and more mindful way, that his risk probably isn’t any greater than that of a woman, and may even be less. Uh oh, there’s a potential future headline for Mr. Broad: Women at Greater Risk of Yoga Injuries! You heard it here first….

Wondering What to Practice at Home? Consider a Private Lesson

by Timothy

Door by Brad Gibson

In a recent post Home Practice: The Best Way to Improve Your Health and Well-Being, I wrote about the value of a regular home practice. Practicing at home is particularly important for people with a medical condition who can’t do (or at least probably shouldn’t be doing) most public classes. But medical condition or not, the question remains, which yoga practices should you be doing at home?

One of the best ways to find the answer is to get a private yoga lesson. As it turns out, yoga goes about prescribing home practice in a very different manner than doctors prescribe medications or other treatments. In western medicine, we always try to diagnose the condition first, and then give drugs or other treatments to address that problem. If we can’t diagnose the condition, then all we can do is give treatments to relieve the symptoms.

In yoga therapy, the western medical diagnosis certainly can influence the treatment, but it’s only one of the many factors we consider. Two women, for example, may have the same diagnosis of Stage 1 breast cancer, and would likely get very similar recommendations from their doctors about how to treat it. But the appropriate yoga approach (used as a complement to medical therapy) might vary a lot depending on how fit they are, how much yoga they’ve done (and what styles), how much time they have to dedicate to their practice, how spiritually oriented they are, and so on.

Good yoga teachers always consider the broader context. When I evaluate a student, after interviewing them, I often start out by looking at them structurally. How is their posture? Are their shoulders rounded? Is the head forward of the spine? Are they stiff or flexible? Are there certain joints that are giving them problems, and, if so, how well are the bones on either side of those joints aligned?

After structure, I tend to move onto the nervous system (and breath, since the two are intimately linked). Are they suffering from excessive stress? Agitated? Sleeping poorly? Can’t get out of bed? What’s the balance of the sympathetic nervous system (fight or flight) vs. the parasympathetic (rest and digest)? Is their breathing smooth and deep or is it shallow and choppy? Is it primarily in the upper chest or does the abdomen move out and in with each breath?

In a similar manner, I evaluate each student’s balance as seen through the lens of Ayurveda, India's indigenous holistic medical system, as well as their psychological functioning and such spiritual matters as their level of joy, compassion and fulfillment. In my Yoga as Medicine workshops, we divide our student assessments into five categories, using the acronym SNAPS: Structural, Nervous system, Ayurveda, Psychological, and Spiritual. Each student winds up with a different constellation of findings, which we then try to address with the yoga routines we recommend.

Although I developed the SNAPS protocol to use on people seeking yoga therapy, the same process can help determine a good routine for someone who is simply interested in using their yoga as preventive maintenance, to build strength and flexibility, or to work off some of life’s inevitable stressors.

Say a student looking for a home practice has a slumping posture, a restless mind, shallow upper chest breathing, and an increase in the Ayurvedic dosha of vata or air (see my post on vata, Autumn, Healthy Aging and the Ayurvedic Dosha Vata). If I considered only structure and breathing in developing her routine, I might think that focusing on backbends would be helpful. But too many backbends, or more intense ones, like full Wheel pose (Urdhva Dhanurasana), could increase her mental agitation and push her vata further out of whack.

Perhaps I would end up settling on some gentle, restorative backbends done over folded blankets to open her shoulders and chest, while simultaneously allowing her to rest physically and mentally. I might also recommend daily alternate nostril breathing to balance her nervous system, and quiet her mind to the point that seated meditation would be more effective. Often, we reach the final recommendations based on trial and error, for example, putting the student in a potentially helpful pose and seeing what it looks like and how it feels. Maybe we change the blankets a bit and look again or try a different pose entirely.

What I am describing is what a good yoga teacher or therapist would do in a private lesson. Not everyone can afford a private lesson (price varies based on the experience of the teacher, the length of the session and the geographical area), though some teachers have a sliding scale, or take on a few cases as karma yoga for those in need. But once you get home, yoga is free, of course, so a lesson could end being cheaper than a series of classes. (If you don’t know a suitable yoga teacher or therapist in your area, check out the database of the International Association of Yoga Therapists at iayt.org.)

Although science has yet to test the idea, it is my belief that a well-designed practice tailored just for you will likely be better than a standardized protocol used in a study or a sequence printed in a magazine. All those approaches, good as they may be, are determined without ever laying eyes on the student—and that’s simply not the best yoga has to offer.

To me, it’s a testament to the power of yoga that so many people are helped by these one-size-fits-all yoga fixes. However, to most of us working in the field, there is little doubt that a tailored approach can be safer, more efficient, and much more effective. As a scientist, I’m all for testing these notions, but yoga research hasn't progressed to the point where such studies are being done (or funded). In the meantime, my advice is, whenever possible, to tailor your practice now, and ask questions later.

Even if you don’t have a medical condition, working one on one with a teacher can help you create the home practice that suits your particular body, needs, and goals. And if such a tailored approach moves you more efficiently in the direction you’d like to go than an off-the-shelf routine, you’ll likely notice the benefits and be more motivated to stick with it. And that, of course, is the key to success in yoga.

Home Practice: The Best Way to Improve Your Health and Well-Being

by Timothy

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

This quotation from my book got posted on Facebook the other day and generated quite a bit of interest. But not everyone, particularly those who only take classes, agrees with the statement. A woman came up to me at a yoga conference earlier this year to say she’d heard me make a similar comment at a workshop I taught in Los Angeles a few years ago, and it made her really angry. It’s easy to understand that reaction when your experience in class has been so positive, and even healing.

But now scientific research seems to back up the notion that a regular home practice really is the key to health and well-being, perhaps particularly so as we get older. A study recently published in the journal Evidence-Based Complementary and Alternative Medicine by researchers at the University of Maryland and the National Institutes of Health found that, among more than 1000 practitioners of Iyengar yoga, the frequency of home practice predicted positive health more than how long you’ve been practicing or how many classes you attend per week. According to the article “Frequency of yoga practice predicts health: results of a national survey of yoga practitioners,”:

“Frequency of home practice favorably predicted (p < .001): mindfulness, subjective well-being, BMI, fruit and vegetable consumption, vegetarian status, sleep, and fatigue.”

In other words, those who practiced at home the most reported better health and well-being, greater awareness of themselves and others, improved sleep, less fatigue, and healthier body weight. They were even more likely to eat their vegetables!

Bed in a Mirror by Nina Zolotow

The study bore out something else I’ve been teaching for years: when you combine the various tools in the yoga toolbox including asana, breathing practices, meditation and even study of yoga philosophy you tend to get even better results. As the authors put it, “an intense practice involving all aspects of yoga practice may be more beneficial to health than a less intense practice that includes only one or two aspects of yoga practice, such as just practicing the physical poses or breath work.”

There also appeared to be additional benefits for combining different types of asana practices, such as standing poses, vigorous practices like Sun Salutations, restorative poses including Savasana, and inversions like Shoulderstand. Different practices appeared to be particularly beneficial for specific conditions. Vigorous asana and inversions seemed to help the most with insomnia and body weight, whereas, according to the authors, “because breath work and meditation appear to influence mindfulness and well-being, they may be particularly useful in treating conditions such as depression and anxiety.”

One finding that may be of particular interest to readers of this blog has to do with fatigue. Overall, older practitioners had less fatigue than younger practitioners, but both groups improved when they did yoga. But it appears to take less practice for older practitioners to experience improvements in energy.

As for the woman who was mad at me for saying that a home practice was more important than going to classes, she went on to say that, almost despite herself, she did try doing her yoga at home. Now she does it regularly and believes it’s the most important part of her practice. She thanked me profusely, though of course most of all she can thank herself!

Stress, Your Health, and Yoga

by Timothy

As I travel around the globe teaching workshops on yoga therapy—the use of yogic tools from postures to meditation to help people heal—I am struck by what an enormous problem stress-related illness is.  Everywhere I go, from ultra-modern cities like Stockholm where I've spent the last week, to less developed nations, people young and old are suffering the health consequences of their increasingly busy schedules and sometimes even busier minds.

Surprisingly, in this time of widespread tension, unrest and economic insecurity, most doctors still seem not to fully appreciate the deadly consequences of out-of-control stress or how much something like yoga can help. In medical school we were taught about the connection of stress to such health problems as duodenal ulcers, migraine headaches and irritable bowel syndrome. But scientific evidence is increasing indicating that stress can be a factor in life-threatening conditions from heart attacks to depression to hip fractures. Ironically, doctors may be among the most at-risk members of our society, due to their endemic stress and lack of understanding of simple non-drug tools like yoga that can fight it.

When scientists talk about the stress-response system, they are referring to a complex web of events that ramp the body up to deal with an acute crisis. The sympathetic nervous system—the so-called “fight or flight” system—kicks in, which among other things increases blood flow to the large muscles that help you defend yourself or run away from a physical threat. Stress hormones like adrenaline and cortisol are also released. In response, blood pressure and heart rate go up and breathing quickens. Blood sugar and other energy stores are mobilized to fuel whatever challenge you are about to face. In case you are injured, your blood begins to clot more easily. In crisis mode, the body shunts energy away from restorative functions like digestion and reproduction, mediated by the parasympathetic nervous system, which you can think of as the “rest and digest” system.

Arctic Landscape by Michele Macartney-Filgate

This built-in stress-response system is well-adapted to acute crises but can lead to all kinds of problems if it doesn’t gets switched off after the acute crisis passes. Blood clots increase the risk of a heart attack or a stroke, as does the high blood pressure and elevated blood lipids that stress contributes to. Elevated levels of cortisol are associated with everything from major depression to osteoporosis to overeating and weight gain (and the many problems that result from that). And while the immune system initially gets stronger during an acutely stressful event, it starts functioning less well if the stress goes on too long, raising the risk of serious infections and, as at least some evidence suggests, autoimmune diseases.

The problem is that the ancient human stress-response system isn’t so well adapted to mostly non-physical modern world stressors like work deadlines, traffic jams, and even abstract ideas about whether you are happy or fulfilled. If you repeatedly mull these problems over, the chemical and physical changes that were designed to deal with an acute threat to physical health—and which are then supposed to shut off when the threat is removed—remain activated. Such mental tape loops can thus turn abstract worries into concrete threats to health and even to life itself.

Yoga is arguably the best overall system of stress reduction ever invented. More and more evidence suggests the practice can help treat and prevent a wide range of health problems (for details see my web site). Beyond the harmful effects on the body, feeling stressed is a drag. It can make you feel anxious, preoccupied, full of dread.

Yoga can—sometimes within minutes—quiet down an overactive stress-response system. One of the great insights of the ancient yoga masters is that when you move and breathe with awareness, it calms your nervous system and slows down the tape loops in your mind. When your inner monologue slows, most people experience a sense of peace, relaxation and a feeling of being centered.

At first, this only happens when you are doing yoga and perhaps for a short time afterwards. But if you maintain a steady practice, more and more you become aware of and can tap into the tranquility you find in yoga throughout the rest of your day. Over time, you can actually make your nervous system less reactive to minor stressors, and less likely to get knocked off balance by life's inevitable ups and downs. You learn that you can be in a difficult situation, but nonetheless keep the breath slow and deep, and the mind both relaxed and attentive.

This sense of inner calm can make you feel more grateful for what you have, appreciate the beauty around you (which you otherwise might not have noticed) and help you realize that some of the stuff you're getting bent out of shape about may, ultimately, not be very important. And that may be one of the best stress reducers of all.

Cultivating Healthy Posture with a Simple Restorative Pose

by Timothy

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

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

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

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

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

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

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

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

Dr. Timothy McCall Joins Yoga for Healthy Aging!

by Timothy

I am happy to be joining my friends Nina, Baxter, and Brad on the Yoga for Healthy Aging blog! They’ve been doing fantastic work, and it’s great to become part of it. Since many of you may not know me or know me well, they’ve asked me to write a brief introduction with some information about my background and what I’m interested in.

Like Baxter I’m an M.D. who practices and teaches yoga. The focus of my teaching and my writing is yoga therapy, that is, using various yogic tools, including postures (asana), breathing practices, meditation, chanting, visualization and even philosophical ideas to help prevent and treat a variety of health conditions. I was trained in conventional internal medicine and practiced for about a dozen years in the Boston area before devoting myself full time to writing and researching the scientific basis of yoga and yoga therapy, starting in the year 2000.

Chives in Flower by Michele Macartney-Filgate

Boston, or more precisely Cambridge, was also where I started to practice yoga in 1995. I met someone at a party who mentioned she liked a local yoga studio, and I ended up checking it out. Although I didn’t know who she was at the time, it was my great fortune that the teacher who ran that studio was Patricia Walden. Even better, Patricia starts a new beginner’s class once every decade or so and my timing was perfect! Seven years later I’d finished a two-year teacher training with her, and began to assist her in that class. Also around that time, she and I began teaching workshops together on Yoga for Depression.

It was at one of those workshops Patricia and I did at a Yoga Journal conference in Estes Park, Colorado, where I first met Nina Zolotow. Nina went on to help me in numerous ways as I was in the final stages of writing my book Yoga as Medicine, including orchestrating the photo shoot (not an easy job)! Another year at that same Yoga Journal conference I met Dr. Baxter Bell. Bax and I became friends when I moved to the SF Bay area in 2006, and he ended up being one of the yoga models for Yoga as Medicine.

Yoga is, in my opinion, an ideal tool for those looking maintain or even improve their health and well-being as they get older. Yoga is a close to one-stop shopping as you can find. The practice can make you stronger, more flexible and better balanced—both mentally and physically. It can boost your mood, improve your immune function, improve cardiovascular fitness, and help you sleep better. It can teach you how to relax and concentrate in ways far deeper than what most people mean when they use those words.

If you have a serious illness, yoga can be a wonderful complement to conventional medical care, one that can render its treatments more effective and that is less likely to cause debilitating side effects. To cite just a single example of that, studies are now finding that those who do yoga while undergoing chemotherapy and other cancer treatments have less fatigue and better mood than cancer patients who don’t do yoga.

Pink and Green DO Go Together by Michele

In additional to yoga, in recent years, I’ve also been studying Ayurveda, the traditional medical system of ancient India, and I’ll undoubtedly be bringing an Ayurvedic perspective to some of my upcoming blog posts. Ayurveda is a natural complement to yoga, and I believe that even a basic understanding of it can help you better personalize your own yoga routine or practices you recommend to others.

The foundation of Ayurveda is in using simple dietary and lifestyle habits to keep yourself in balance. It’s natural, incredibly safe, and like yoga, surprisingly effective for a wide range of healthy conditions. And like yoga therapy it’s strong medicine but slow medicine. I’ve personally been following some of its dietary and lifestyle advice, and doing twice-weekly oil massages for half a dozen years, and feel it’s made a tremendous difference in my both my yoga practice and in my overall health and well-being.

Ayurveda is all about living in alignment with nature’s cycles: daily, seasonal, and time of life. Yoga for healthy aging is in part about adapting your yoga practice to meet your changing needs as you get older. Thus, a practice that may have suited you well at age 25 or 35 may no longer be appropriate at 55 or 65. Indeed many yoga injuries happen as a result of people doing practices or classes that no longer are—and sometimes never were—ideal for their bodies. That doesn’t mean that your practice can’t be strong and vital as you get older, only that you need to be wise about what you do and how you do it. And that is something I’m looking forward to writing about in the months ahead!