Thinking about the Wisdom of Yoga

by Nina 

Gaudi Stairway by Brad Gibson

“You have taught the essence of yoga
is equanimity, Krishna;

but since the mind is so restless,

how can that be achieved?


The mind is restless, unsteady,

turbulent, wild, stubborn;

truly, it seems to me
as hard to master as the wind.”

—The Bhagavad Gita

In my post What is Healthy Aging? I added “wisdom” to the list of tools yoga provides for healthy aging. But since then, I’ve been thinking about how reading a bunch of wise words in an ancient (or modern) text is so different than actually living wisely. Haven’t you all watched someone close to you—or even yourself—be drawn irresistibly into self destructive behavior, even as they know exactly how unwise they’re being? As Arjuna says to Krishana above, the mind seems to me, too, “as hard to master as the wind.”

In The Bhagavad Gita, Krishna replies to Arjuna’s question above by saying that constant practice and detachment are what allow you to move toward wisdom.

"You are right, Arjuna: the mind

is restless and hard to master;

but by constant practice and detachment

it can be mastered in the end."

It is the regular practice of mindfulness that allows us to observe our patterns of behavior and ultimately begin to make changes. In his book Yoga and the Quest for the True Self, Stephen Cope describes it this way: 

"Acknowledge the pattern. Study it. Observe it. Respect its power. And, if possible, make an intention to interrupt it just at its very end point. For most of us, that endpoint is the reaction to the reaction. Self-hatred. Negative self-talk. Moralizing. Guilt. Let’s begin by deleting a little of that, and then a little more.

"When we pare away judgment, something remarkable happens. We’re free, for the first time, to observe how the pattern really works."

He says our behavior patterns are samskaras, which are like ruts in a road that deepen through repetition so becomes inevitable that a car will slide into them unawares. But with our newly gained awareness of our patterns, we can use tapas, the energy of restraint, to stop the slide:

"Tapas requires a particular kind of attention—precisely the kind required when driving on a rutted road. We need to be awake. We need to be concentrated in order to avoid the edges of the ruts. And sometimes we need to pull the car wheels—with considerable effort—out of the ridges in the road."

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Friday Q&A: Yoga Tricks for Better Sleep

The Dreaming by Paul Gauguin

Nina: At the end of my post Yoga You Can Do In Bed, I asked for additional suggestions from our readers. Caryn Dickman, a yoga teacher at Piedmont Yoga Studio (see here), wrote in with such good suggestions, I decided, with her permission, to post them here. What I love about her suggestions is that she obviously listened to her body and used her creativity to come up with "yoga tricks" that worked for her.
 
Caryn: I have found a way of doing Child's pose in bed using the pillows that doesn't disturb my partner and allows me to bring the awareness inwards when I can't seem to calm myself through the breath. After 5-10 minutes propped on pillows and still under the covers I find that my mind slows down enough to start benefiting from watching the breath. I eventually crawl back to sleeping positions and then concentrate on watching the inhale and exhale through expanding and contracting the back of the rib cage left to right, etc. I usually fall back to sleep, and a very deep sleep, after doing that.

Another "yoga trick" I do is when I wake up and feel anxiety in my body. I have this need to move some or else sleep will not come. So I stand near the side of the bed in the dark and pay attention to the inhale and exhale. I then very slowly lift my arms towards the sky and then slightly bend my knees as I come forward to a very gentle Uttanasana. I keep bending my knees more so that I come to a gentle squat (very gentle squat) and let my arms dangle towards the ground. When I reach the ground I slowly start to roll into my back body to come on up. I do this a very times. Again, very slowly and gently watching the breath throughout. It tends to get rid of the anxiety in my body and then I can either just go back to sleep or do the Child's pose I mentioned above and I go back to bed.

Nina: I think I'm going to try that under-the-covers Child's pose myself sometime soon. Anyone else have some good yoga tricks up their sleeves?

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What is Healthy Aging?

by Nina

Despite the horrifying vision of “exergames,” Brad’s post on Tuesday ("Successful Aging and the Thinking-Moving-Feeling Triad") got me interested in Dr. Dilip Jeste’s work. After all we’re all blogging away here about “healthy aging” without ever having really defined what it is. And that’s exactly what Dr. Jeste, Estelle and Edgar Levi Chair in Aging and Director of the Sam and Rose Stein Institute for Research on Aging at the University of California, San Diego, is currently trying to do. In an interview on Medscape (here), he said the following: 

“Successful aging has not been consistently defined; that is one reason why this area is ideal for research. There have been some studies funded by the MacArthur Foundation beginning in the mid-1980s going on through the mid-1990s. But the [scientific] literature is limited, and there is no consensus on what is successful aging. Our research goals include developing a definition as well as criteria for successful aging.”

Jeste and his colleagues observed that while the components of successful aging typically include: longevity, life satisfaction, absence of physical disease, freedom from disability, mastery/growth, active engagement with life, high/independent living, and positive adaptation, sometimes only physical functioning and disability are considered. But most importantly, very few scientists include “self rating” in their assessments (that is, to put it bluntly, they don’t bother asking the subjects how they feel about their own experience of aging). So they decided to do a study in which “participants’ subjective ratings of successful aging were contrasted with sets of researcher-defined criteria, and correlates of subjectively rated successful aging were examined.” (See "Correlates of self-rated successful aging among community-dwelling older adults".)

One result of this study was this: “Nearly all the study participants rated themselves as aging successfully, but far fewer met researcher-defined criteria for absence of illness and physical disability.” (Note that only participants with higher levels of cognitive functioning were studied.)

Dr. Jeste concluded, as he said in the Medscape interview, “It is also important to say what is not an essential part of successful aging—absence of either physical diseases or physical disability is not necessarily a part of successful aging. I want to stress that people who have physical illnesses or physical disabilities can be aging successfully.” Instead he lists the components for successful aging as:

• Higher level of cognitive functioning
• Adaptation to changes associated with aging
• Socialization—that is, some kind of social activity and/or social contacts
• Life satisfaction

And in the very same interview, he gives two examples of people he considers to have aged successfully, and they are: Franklin Roosevelt and Frank White, a well-known Los Angeles yoga teacher. Hmmm. It appears we're not on different wavelengths after all. You may want to watch this video of Dr. Dilip, in which he speaks about wisdom and successful aging. Around the 12-minute mark, you can hear him speak about the Bhagavad Gita.

For some time now, I’ve been going around saying that yoga provides two out of the three of the requirements for healthy aging: exercise and stress reduction (the third is a healthy diet). As of today, I’m going to add a new one: wisdom.

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Yoga You Can Do In Bed

by Nina

Patterns in a French Garden by Brad Gibson

Did I say “in bed? Yep. It’s normally not a good idea to fall asleep when you are doing yoga (you can overstretch your muscles if you fall asleep in a restorative pose and if you’re practicing conscious relaxation, well, being unconscious pretty much negates the positive effects you’re aiming for). However, there is one exception to this rule of thumb: when you’re lying in bed sleepless due to insomnia.

Whether you have trouble falling asleep initially or can’t fall back to sleep after waking in the middle of the night, instead of working on your To Do list (it’s tempting, I know), try a little yoga. There are a number of yoga practices that just might help you relax enough to finally drift off to sleep and/or improve the quality of your sleep. While practicing any of these techniques, be sure to stay warm and keep the lights off to keep stimulation down to a minimum.

Breath Awareness. This is the simplest yogic breath practice and one of the most basic forms of meditation. Simply bring your awareness to the sensations of your natural inhalations and exhalations. When you notice your mind wandering to your To Do list or elsewhere, gently return your mind to your breath.

Extending Your Exhalation. After observing your natural breath for a few minutes, you can try extending your exhalation (while inhalations are slightly stimulating, exhalations are naturally relaxing). When you reach the end of your exhalation, instead of immediately inhaling, lengthen your inhalation by one or two beats. Keep it relaxed, and if at any point you find the practice irritating, return to your natural breath.

Silently Reciting a Mantra. Just as you would when you are meditating, you can use a silent mantra or any word or phrase in bed to keep your mind from drifting into anxious thoughts. This is helpful for those of you who don’t find focusing on the breath effective (or when you have a cold!). When you notice your mind wandering from your mantra to your To Do list or elsewhere, gently return your mind to your mantra.

Guided Relaxation. Following the instructions for a guided physical relaxation (see here), with or without ear phones, allows you to focus your mind on a soothing voice and your physical sensations, enabling some people to drift off to sleep.

Self-Guided Relaxation. When you are familiar with the basic instructions for deep physical relaxation, it’s simple enough to skip the relaxation track and just gradually relax your body by following your own instructions. Many years ago, my first yoga teacher recommended this as insomnia practice.

Slight Inversion. Take the pillow out from under your head and lie on your back with your knees bent. Lift your pelvis up and place the pillow underneath it. You’re now in a very low version of Supported Bridge pose, a gentle inversion that naturally triggers the relaxation response. Try to stay in the position for five to ten minutes.

Supported Forward Bend. If you sleep alone or aren’t worried about disturbing your partner and you find forward bends soothing, you could try a supported bend in your bed. Sit with your legs straight or in crossed-legs position (whichever is more comfortable and allows a deeper forward bend) and place a stack of pillows on top of your straight legs or in front of your crossed legs. Then lengthen your spine forward and rest your forehead and arms on the pillow and relax. Try to stay at least three minutes. If you can’t get comfortable in the pose, then this one isn’t for you.

If you suffer from insomnia, I sincerely hope you’ll something on this list that will help. Most of these are techniques are ones I’ve found useful myself (I'm a bit too lazy to sit up and try an actual pose, however). Readers, if you have any additional suggestions, please chime in!

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Successful Aging and the Thinking-Moving-Feeling Triad

by Brad

Early this month I attended a symposium sponsored by the Longevity Consortium at the Buck Institute for Research on Aging on “Environmental, Developmental, and Genetic Factors in Aging and Longevity.” There were lots of interesting presentations, especially on the search for genetic determinants for longevity, or what we call genome wide association studies (GWAS). It turns out that almost nothing survives rigorous statistical scrutiny at this level, suggesting that the genetic factors for long life are very complex and highly dependent on a host of environmental factors.

However, there was one talk on a very different subject that was of particular interest. Dr. Dilip Jeste from UCSD gave a lecture on the meaning of successful aging, and why almost no one asks patients directly to assess their views of their own aging experience.  Almost all definitions of successful aging (and again, many prefer the term “healthy aging”, although they are often used interchangeably) are based largely on the absence of age-associated physical disabilities, such as cardiovascular disease, diabetes, neurodegenerative disease, etc. Dr. Jeste made a compelling case that self-assessment of one’s physical and psychological well-being at advanced age is critical for a better determination of what constitutes “successful aging.” Interesting concept, and one that may be more in sync with the yogic idea of the mind-body connection and mindfulness.

Larch Tree in Autumn by Philip Amdal

Intrigued by this, I went on to look at some of Dr. Jeste’s publications on these topics, and came across a very recent editorial published last year in BMJ titled, “Promoting successful aging through integrated care” (see here). I was struck the following statement:

“Another way of dealing with physical and mental health comorbidity may be through use of interventions that simultaneously increase physical activity, cognitive stimulation, and positive affect, thereby affecting all three components of the thinking-moving-feeling triad implicated in poor health related quality of life.”

As I read this I thought this is a pretty good definition of yoga, a “thinking-moving-feeling triad.” Maybe not an especially elegant summation, but pretty succinct. But what followed next took me back a bit:

An example of such an approach is the use of “exergames”—entertaining video exercise games. If such approaches were specifically adapted to the needs of older people, they could conceivably affect obesity, diabetes, heart disease, and depression simultaneously.”

Exergames? Not exactly sure what the meaning of this is (I confess to a horrible vision of a group of seniors playing bingo while clapping their hands to a Lady Gaga video), but if that's the best example they can come up with then something is wrong. Is yoga still met with such suspicion in the medical and academic community that such an obvious and natural connection is not made here? Is it going to take another generation for the current (and aging) yoga practitioners to retire before this can go more mainstream?

As I wrote in my last blog entry, one of the main reason I started practicing yoga at the age of 50 was that I was looking for a more age-appropriate exercise routine that would provide me with more flexibility, balance and core strength without exposing me to injuries. Sounds to me like yoga would be a much better fit here addressing all three of these goals (“thinking-moving-feeling triad”) in a much more integrated and natural fashion….

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Yoga for Osteoarthritis: Interview with Shar Ser

By Nina

Last Saturday, I took a wonderful workshop at the  Berkeley Yoga Room on Yoga for Bone Health, with Bonnie Maeda and Shari Ser. We covered yoga for osteoporosis, osteoarthritis, and joint replacements. Because I know that many of you are concerned about osteoarthritis (and I have it myself), I asked Shari if I could do another interview with her, this time about yoga for osteoarthritis.

Nina: Why is yoga so beneficial for people with osteoarthritis?

Shari: Yoga is beneficial for people with osteoarthritis because it is something proactive that they can do for themselves to cope this chronic disease. Arthritis is due to imbalances on the ends of bones in the joints with uneven wearing down of the cartilage that covers the bone ends, which allows the bones to move smoothly on one and other. Arthritis is a wear and tear syndrome, an alignment syndrome, or a result of inactivity as well as obesity.

People stop moving with arthritis because it hurts, but when you stop the joint motion you decrease the nutrition to the joint structures. The body tries to repair the area by laying down more bone to protect the area and the result is spurring, which then cause more irritation from the “bones rubbing.”

When the cartilage has deteriorated and there is no movement, the synovial fluid that bathes the inside of all synovial joints decreases, which then decreases nutrition to the joint and the cycle reinforces itself with pain=no movement=more pain with swelling and inflammation=even less movement.

Yoga is so perfect for arthritis because it can stop that cycle by providing infinite variations in joint mobility and ways to maintain the joint alignment to improve joint weight bearing. You need to keep the joint moving in its full range of motion to keep the joint healthy, and yoga allows you to do that.

Nina: Should you do yoga if it hurts?

Shari: Judicious usage of pain meds to allow movement but not to obliterate the feedback mechanisms that pain provides us with is important. Medication that decreases inflammatory response will allow people to move more, but pain medications that mask pain so people overdo activities are dangerous. Pain keeps our expectations and engagement focused. You don't want to be stoned and do something dangerous!! So a healthy respect for pain is important. You can start out with a small movement and then as fluid in the joint increases you can increase the range of motion slowly till you are at your limit. Deep knee flexion (bending) is very difficult with knee arthritis so modifications to the yoga poses are important are important for people with knee arthritis.

Nina: Is there anything that people with osteoarthritis should watch out for?

Shari: You need to study with a teacher who can observe your alignment when you are doing poses to help you correct your imbalances. Co-contraction of muscles is extremely important. I would not do a lot of jumping into poses but stepping into them instead. Playing with joint position is really key because you may need to change things considerable to minimize your pain. Also being gentle with yourself is important because it took years for the arthritis to develop and will take years to manage and prevent it from progressing. It is true that you CAN remodel cartilage but how long it takes is unknown (at least I haven’t seen any studies).

Nina: What are some of your favorite poses for osteoarthritis and why?

Shari: Favorite poses—hmm, this is a hard one because you have to think about what joint you are focusing on. If I am dealing with osteoarthritis in the spine, I would focus on accessible twists and gentle back bends. If it was hips, balance is the key of co-contracting to keep the joint in good congruency and neutral alignment—maybe Ardha Chandrasana (Half Moon pose) would fit. For knees Warrior 2, but not too deep and starting with a chair if it is problematic bear weight in a knee flexed position. Warm-ups are very important to try to get the fluid circulating first, and then adding non weight-bearing isometrics before starting weight bearing activities. Also cool down poses shouldn’t be missed!

Shari Ser has over 25 years of orthopedic experience as a physical therapist and has been teaching yoga for a wide range of medical conditions since 1999. She graduated from The Yoga Room Advanced Studies Program in 1999, and was certified as a “Relax and Renew” teacher by Judith Hanson Lasater. She currently  teaches ongoing beginner level and back safe yoga classes, and co-teaches Yoga for Chronic Health Issues at The Yoga Room in Berkeley, California (see here.)

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Sunday Update: Loren Fishman's Current Osteoporosis Sequence

by Nina

It has been brought to our attention that the osteoporosis sequence designed by Dr. Loren Fishman for the osteoporosis study that we discussed on Friday (see here) is not the sequence he currently recommends. The sequence he currently recommends is described in great detail (with many photographs) on his website under "A Dozen Poses vs. Osteoporosis". This sequence is not only much more accessible (and by that I do mean easier) than the original sequence, but it now excludes forward bends entirely (probably because forward bends are contraindicated for people with osteoporosis rather than due to concern about back strain).

I sincerely apologize for not being up to date on Dr. Fishman's work! However, I do think the exercise Baxter and I went through in evaluating his original sequence was useful because we were able to identify some issues regarding poses that should not be practiced on an everyday basis, which are useful for everyone to consider.

But you may be wondering, is the current sequence safe to practice on an everyday basis? That will have to wait until after Baxter returns to town. (I know you're all dying of suspense, right?) In the meantime, feel free to chime in with your own thoughts.

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Friday Q&A: Is Loren Fishman's Osteoporosis Sequence Safe?

Q: You say that people should not do the same poses all the time. What about programs like Dr. Fishman's osteoporosis study, which has participants doing the same sequence of poses every single day?

A: Thanks for this question. Indeed, if a person does the same sequence day in and day out, you could run the risk of a repetitive strain injury. The fact that Dr. Fishman's sequence is only supposed to take 10 minutes a day to do means that the practitioners are not holding the poses terribly long, which would reduce this risk considerably. However, a review of the poses taught (see here) reveals several poses that I feel could be potentially injurious to the wrists, neck and lower back, these being Upward Bow pose and the deep seated forward bends. I would consider other poses if I were to design such a practice, but Dr. Fishman does mention tailoring the sequence to students individual needs. I would suspect that this had to be done quite a bit.

Recall that the number of patients that started the study was much larger than those that completed the study. (117 vs 11). Interestingly, there is no discussion as to what caused so many to drop out  and why they were unable to do a 10 minute practice everyday. One factor could have been boredom, which is why I often suggest that students alternate practices from day to day to help maintain better focus and follow through. And it is possible that some found the sequence too advanced, despite the individual adjustments offered. The bottom line, in real life, when you can vary your practice, I highly recommend you do so.

—Baxter

A: With Baxter's blessing I'm going to tell you why I wouldn't want to do this sequence on a daily basis. I'll start by telling you that the three yoga injuries I've sustained have all been repetitive strain injuries. I was a pretty enthusiastic practitioner for a number of years, and did a lot of standing poses and sun salutations. And the injuries I had were: sacroiliac joint injury (common among dancers and yoga practitioners, but not the general public), tennis elbow (possibly from sun salutations), and housemaid's knee (from kneeling too much on the bare floor).

Now let's look at the sequence:

1. Triangle Pose (Trikonasana)
2. Downward-Facing Dog Pose (Adho Mukha Svanasana)
3. Upward-Facing Dog Pose (Urdva Mukha Svanasana)
4. Bridge Pose (Setu Bandhasana)
5. Upward Bow Pose/Rainbow Pose (Urdva Dhanurasana), without or with a chair
6. One-Legged Forward Bend (Janu Sirsasana)
7. Two-Legged Forward Bend (Paschimottansana)
8. Boat Pose (Navasana)
9. Reclined Leg Stretch (Supta Padangusthasana)
10. Marichyasana 1 twist
11. Lord of Fishes twist (Matsyendrasana)
12. Reclined Twist (Jathara Parivarthasana)

After I got over the shock of trying to imagine doing all those poses in 10 minutes, without any warm-ups, I examined the poses in detail. First, two of the poses in the sequence are known for causing sacroiliac joint injuries, Triangle pose (Trikonasana) and One-Legged Forward Bend (Janu Sirsasana), with One-Legged Forward Bend a particularly guilty party. For me, personally, I've concluded it's just not good to do either of those poses every single day. Then, as Baxter mentioned, there is a very deep backbend in the sequence, Upward Bow, and doing this every day could put a lot of strain on the wrists and elbows, but of just as much concern to me is that it is followed immediately by a deep forward bend, taking the lower back into such extreme movements with no rest between. In particular, the Two-Legged Forward Bend is known for causing lower back strain. The combination of the deep backbend followed by the deep forward bend could cause a lot of back strain (personally, I would have moved the forward bends to the end of the sequence). The sequence ends with three twists, asymmetrical poses that are also hard on the sacroiliac joint, with no symmetrical counter pose to finish the sequence. (On the bright side, no danger of housemaid's knee here.)

I understand some of the thinking behind this sequence, which tries to engage all the different muscles of the body to strengthen as many bones as possible, within a short sequence, and uses the twists to "release" the back after the strain of the backbends and forward bends. However, if I were to design an osteoporosis practice, for safety's sake, I would develop five or more different sequences that the practitioner could alternate between on different days, rather than trying to cram everything into one single practice. There are so many wonderful poses in the yoga tradition, why would you limit yourself to just 12?

—Nina

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Featured Sequence: Wrist Flossing for Wrist Care

by Nina

In Baxter's post on wrist care (see "Wistful Wrists: How to Keep Your Wrists Safe"), he recommended a wrist "flossing" sequence developed by Tom Alden that was featured in Timothy McCall's book Yoga As Medicine. This is a wonderful sequence you can do if you over-worked your wrists doing yoga, have wrist problems, such as carpal tunnel syndrome, or just want to give your hands and wrists a break during a marathon typing session. There are three different "flossing" movements:

1. Palms Down. Start by interlacing your fingers and turning your palms to face the ground. Move your elbows out the sides, so both arms are parallel to the floor. Gently pull your wrists apart, so you feel a slight traction, then raise your right arm and lower your left, bringing your right wrist into a forward bend and your left wrist into a backbend. Allow your right arm to do all the work, while your left arm is passive.

Repeat the movement on the other side by using your left arm to do all the work while your right arm is passive. Go back and forth any number of times.

2. Palms Facing You.  Start by interlacing your fingers and turning your palms in to face the ground. Move your elbows out the sides, so both arms are parallel to the floor. Now turn your palms inward, to face you. Gently pull your wrists apart, so you feel a slight traction, then move your right arm outward and your left inward, bringing your right wrist into a forward bend and your left wrist into a backbend. Allow your right arm to do all the work, while your left arm is passive.

Repeat the movement on the other side by using your left arm to do all the work while your right arm is passive. Go back and forth any number of times.

3. Palms Facing Away. Start by interlacing your fingers and turning your palms to face the ground. Move your elbows out the sides, so both arms are parallel to the floor. Now turn your palms outward, so they face away from you. Gently pull your wrists apart, so you feel a slight traction, then move your right arm inward and your left outward, bringing your right wrist into a forward bend and your left wrist into a backbend. Allow your right arm to do all the work, while your left arm is passive.

Repeat the movement on the other side by using your left arm to do all the work while your right arm is passive. Go back and forth any number of times.

See http://www.tomalden.com/ for information about Tom Alden. For information about Timothy McCall and his book Yoga As Medicine, see http://www.drmccall.com/.

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What is an Advanced Yoga Practice?

by Nina

Year-Old Snow and New Snow by Philip Amdal

A number of years ago, I encouraged a close friend of mine, M, to join me in taking Rodney Yee’s advanced class. Even though she had a muscular, athletic, and stiff body that made doing super bendy poses difficult, if not impossible, I knew that she understood how to take care of herself in class, that she would adapt the poses for her particular body type and keep herself safe, so I wasn’t worried about the class being too hard for her. She was interested, however, she expressed some concerns about not being “advanced” enough for the class. I decided to discuss the matter with our teacher himself, feeling fairly sure of what he was going to say. But what he told me when I asked him if she was “advanced” not only took me by surprise but has stuck with me all these years, transforming my thinking about the asana practice in general. What he said was this:

“Of course she’s advanced enough. M does yoga more mindfully than any student I’ve ever seen.”

And here I’d been thinking that being advanced meant being capable of doing difficult poses, like 10 minute headstands or extreme backbends, at some level or another! But doing yoga “mindfully”—now, here was goal we could pursue for our lifetimes and no matter our level of physical capacity was, we would always have the the ability to go deeper and deeper into the practice.

I’m thinking about this today because I’m helping a new friend of mine adapt her practice to allow her to heal from an ongoing injury. It’s taken her a long time to even be ready to temporarily give up certain poses and ways of practicing, because she felt such regrets about excluding poses from her practice that she used to be able to do with such great enjoyment. 

But as Baxter mentioned in his post on Wristful Wrists: How to Keep Your Wrists Safe, sometimes rest is the best way to heal from an injury. So being willing to adopt mindfulness as a goal in the practice rather than achievement is a necessary element in being able to heal from an injury.

People who are aging may find themselves in a similar position, not necessarily due to injury but simply due to the physical changes that come along with aging. To be honest, I used to have what I sometimes call a “semi-fancy” yoga practice. But in the last few years, I developed arthritis in my right hip that makes it impossible to do seated poses that involve a lot of external rotation. Lotus and half lotus are now impossible for me, and seated forward bends and twists that require certain leg positions are painful and difficult. And I now need props in many of the standing poses now. Still there is no question I consider my practice more advanced these days than it was in the years when I regularly took the East Bay’s most “advanced” yoga class.

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Wistful Wrists: How to Keep Your Wrists Safe

by Baxter

Following last week's hoopla around the New York Times article "How Yoga Can Wreck Your Body" and my interview on San Francisco public radio’s KQED last Thursday (see Can Yoga Be Bad For You?), Nina and I realized that it might be helpful to look at the most commonly injured areas of the body (from yoga or otherwise—more often otherwise!), and see if we could recommend a few helpful ways of avoiding injury or working with trouble when it arises.

I already mentioned Loren Fishman’s survey of 2009, in which he identified the areas of the body most likely to get injured. Wrists ranked number one among yogis surveyed. The main risk factor for modern yogis is the fact that contemporary hatha yoga, the practice of postures, relies heavily on poses that bring lots of pressure and force onto the wrists. The list of these poses includes such favorites as Cat/Cow, Plank Pose, Downward-Facing Dog, Upward-Facing Dog, Push-up Pose (Chaturanga), most of the arm balances (which we should rename accurately hand and wrist balances), and even the bottom hand in the asymmetric standing poses like Triangle pose.

There are very few manual labor jobs anymore that require us to have our hands on the ground supporting our weight. In fact, from an evolutionary point of view, we have evolved to our upright posture so having our hands on the ground is no longer necessary for our survival, except for that precious few months before we begin to walk as pre-toddlers. And modern society places our value as workers squarely on having a functional brain and adept hands to plug into our computers and produce! So the rest of our body is superfluous to the economy. Forgive my tendency to be hyperbolic, but we are stuck between and rock and a hard place. Yoga is wonderful way to reconnect with our whole self, and yet we must simultaneously be cautious with the delicate wrist area. And in fact one could argue that yoga asana is helpful in conditions such as osteoporosis in actually requiring us to bear weight on the wrists, a common area affected by thinning of the bones.

A Rock and Beyond by Philip Amdal

What’s a yogi to do? Well, from the start, gradually introduce weight to the hands and wrists if you are new to yoga. This came up again and again in last week’s discussion: beginners should start at the beginning with a competent guide (aka teacher) and gradually advance and integrate the yoga asanas. Secondly, consider the wrists you bring into your practice, taking into account any preexisting conditions that could put you at greater risk of injury while doing yoga, such as a history of carpel tunnel syndrome, other repetitive stress injury to the area, family history of arthritis, and so on.

You might want to invest in slightly thicker yoga mat to give your hands and wrists a bit more padding. When placing your hands on your mat, make sure to have equal pressure on the first knuckle area of your hand (what I call the ball of the hand) and the heel of your hand (which is closer to the wrist joint). It can be helpful to create a slight lift under the heel of your hand using either the front of your yoga mat rolled under tightly, or by placing a wedge under the front of your mat so it slopes toward the front of mat. There are also specialized gloves that have a small built in wedge in the palm of the glove that can be helpful, as well as a prop called the Gripitz. (For the latter, I find it is helpful to go over the use of the Gripitz with students to keep it helping and not aggravating their wrists.)

And there is nothing better than rest for an angry wrist, so if you have one, consider designing a non-hand weight bearing practice with your teacher that you can do as your wrists settle down. It should not be difficult to create a satisfying practice with the myriad poses that do not require much support directly from your wrists and hands. 

Another factor to consider as that many of the poses mentioned earlier require your wrists and hands to do a movement called extension (the wrist is bending back toward the arm), and there is a risk of hyperextension if you are not paying attention. Conversely, the opposite action of extension, flexion of the wrist (with the wrist bending forward away from the arm), is sorely missing in the asana practice. Practicing flexion of your wrists is a helpful counter-pose for wrist health. So if you are having wrist problems, you might start practicing the “wrist flossing” exercises described in the book Yoga as Medicine by Dr. Timothy McCall, featuring the wrists of moi. My students and I have found them helpful over the years in balancing our wistful wrists!

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Does Yoga Wreck Your Body? A Scientist's Perspective

by Brad

There’s been a lot of buzz after the Sunday Times article on yoga and injuries, "How Yoga Can Wreck Your Body." My own take on this is that this is pretty shoddy journalism. The writer should have looked no further than the New York Times own Science Times format for Q&A.  Maybe a question like “Does yoga cause more injuries than similar exercise regimens?” would have been more appropriate? I suspect the answer would have been “no.”

In any case what’s the control here? No exercise at all, running, or lifting weights at the gym? All of these have both intended and unintended consequences on your physical well-being and injury status, especially as you get older. When I was a graduate student at MIT, I remember one of my professors invoking his own law to explain missteps in some scientific papers: “if you think you know the answer beforehand, you will undoubtedly find it.”  He used this to explain why some scientists misinterpreted their results by either overly fitting data to some preconceived notion, or ignoring or explaining away other types of information that was inconsistent. Makes for a good story, but this is not good science. Not good reporting, either.

My own experience with yoga suggests a different perspective on this question. I started yoga when I turned 50 because I thought that it would be more age-appropriate and not lead to as many injuries. In my case (Caution! N=1), I never injured myself in nine years of practice.  One reason was I had a good teacher (Baxter Bell), who did not push his students too far, and who also paid attention to preexisting injuries to tailor their practice. He was also well-trained and knew about anatomy and physiology. Not all yoga teachers have the appropriate training, so this is one of the most important first decisions in your practice:  choose a good teacher.  Finally, I did not push myself beyond what I thought was appropriate (if it hurts, back off a bit—you're not trying to prove anything to the teacher or other students).

A Crow by Philip Amdal

While I did not injure myself in yoga these last nine years, I can’t say the same about other activities. I have suffered from tennis elbow injury (overzealous gardening and foosball), heel pain (bad shoes as a kid leading to something called Haglund’s deformity), and lower back pain (digging all day with a shovel a year ago to clear a section of the yard).  What’s interesting is how yoga has helped to alleviate and moderate these injuries. Downward Dog and other similar poses have helped stretch my Achilles heel and tendon, considerably reducing my foot pain. I use a strap around my arms now for various positions, and this has seemed to both strengthen and better align my arms and elbows. And, lastly, I have noticed that my lower back feels better after a yoga practice than before—as long as I don’t overdo things.  So, at least in my case, I can honestly say that yoga has helped alleviate injuries, not caused them. Maybe someone should write a follow up article, “How Yoga can Help You Recover from Injuries?” Not as sensational, but....

And speaking of shoddy journalism, Dr. Timothy McCall tells us that although he was quoted in the article, he was not actually interviewed by the author and that the quote from him was taken out of context, from an old article. To read his rebuttal and his advice about practicing headstand, see his website http://www.drmccall.com/ and read the article "How to Not Wreck Your Body Doing Yoga or, How I Really Feel about Headstand" on the home page.

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Friday Q&A: Propping for Shoulderstand

Q: For years I've read & been told at the Piedmont Studio (great teachers as you know) that I should use a blanket while doing Shoulderstand. Yet, when I'm home on a carpet surface w/mat I'm very comfortable doing the Shoulderstand with no blanket/s. When I use one or two blankets, it's actually uncomfortable on my neck. Yet, I respect what I've been told and am concerned that suddenly one day an injury will pop up just because I was too lazy to get up & get the blankets! I use them at the studio because I know I'm expected to, but at home much more comfortable w/out.

A: Thanks for your question regarding the correct propping of shoulderstand. Shoulderstand may need to be approached differently for different people, due to many factors. These can include age, level of practitioner, history of injury to the neck or other health issues that could require caution, such as newly diagnosed high blood pressure. But to cut the crux of your question, to support the shoulders with blankets or not, let's talk for a moment about the normal range of motion of the cervical spine, specifically in flexion or taking the chin to the chest. If you were to observe a friend or family member from the side as they actively brought the chin toward the chest, you would see that the neck bends about 45 to 50 degrees forward. This is a far cry from the almost 90 degree angle that occurs when we invert in Shoulderstand. This is called active range of motion, that is, how far you can move the joints using just the muscle contraction.

When you come into Shoulderstand, gravity adds an additional amount of movement, resulting in what is know as passive range of motion. But just because you have the potential to bend the neck further does not make it a good idea! Why not? Well, first off, it is not designed by nature to bear your full body weight. And because of that, the neck is at risk for sudden or gradual injury if we are not careful. And that could be anything from a temporary muscle stain to a more serious disc rupture or, even more rarely, a stroke (a few have been reported!). By using one, or my preference, at least 2 firm blankets, you stay closer to the active range of motion of the neck and decrease the chances of injury. So, although the carpeted floor seems to feel pretty good for your head, neck and shoulder today, it ultimately is a risky way to experience this advanced posture. I hope this helps to motivate you to grab those blankets, even at home!

—Baxter

A: I think it's important for you to figure out why you are uncomfortable using blankets because the aim of using props is to make you comfortable (as well as safe). Is it possible your shoulders are positioned incorrectly on the blankets? When you are up in the Shoulderstand, the tops of your shoulders should be near the edge of the blanket, while your neck is completely free of the blanket, sloping down to the floor. In order to make this happen, before you go up, you need to start with your shoulders about two inches from the edge of the blanket (feel with your hands to check your position), because as you go up, your shoulders tend to shift a couple of inches toward the edge of the blanket (and will go off the edge if you start out too close to it). Or maybe you are starting with your shoulders too far from the edge, so some of your neck is flattened on the blanket after you get up. Again, you can try to feel with your hands after you're up (or ask someone to look at you). It's kind of a Goldilocks thing; you've got to get your shoulders positioned on the blanket "just right."

If your shoulder position on the blanket is not the problem, I recommend that you approach your favorite teacher and tell him or her that you want them to look at you in Shoulderstand and recommend better propping for your body type. Maybe a lift under your elbows, a strap around your upper arms, a little something to help you keep the cervical curve in your neck, and so on. With the right propping, your Shoulderstand should feel better, not worse. Good luck!

As to your reluctance to use props at home, I feel you! I used to say that my least favorite yoga pose was "blanket folding." It all seemed so complicated and time consuming. But since it's important for safety as well as comfort, stick with it and eventually it becomes quick and easy, almost automatic, like learning to drive a car. Years of practice later, I can now brag that I am excellent blanket folder.

—Nina

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Baxter Bell on KQED's Forum: Can Yoga Be Bad for You?

Today Baxter participated in one-hour panel discussion hosted by Scott Shafer on public radio station KQED's Forum program. Other members of the panel were:

• Glenn Black, yoga teacher featured in the New York Times Magazine article
• Jason Crandell, yoga teacher and contributing editor of Yoga Journal
• Kaitlin Quistgaard, editor in chief of Yoga Journal
• Moshe Lewis, physical medicine and rehabilitation physician at California Pacific Medical Center, St. Luke's Campus

If you want to stream or download the audio, go to the KQED web site http://www.kqed.org/a/forum/R201201121000.

To read Baxter's blog post on this topic, see Getting Clearer and Yoga and the Risk of Injury.

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Getting Clearer on Yoga and the Risk of Injury

by Baxter

If you have not had a chance to read Nina’s Monday post (see here) about the New York Times article “How Yoga Can Wreck Your Body,” please do, because she articulates some very important points to consider as you digest all this hype coming from William Broad, a New York Times writer. In addition, you’ll find my take on this issue on Yoga Journal’s blog, where I am an occasional guest blogger (see here).

Before getting into recommendations for modifying specific poses to reduce the risk of injury, I’d like to step back today, and look at what we know about key areas of the body that are at risk of injury from an unbalanced asana practice. What do I mean by an unbalanced practice? In my view an unbalanced practice is one where you are doing one or more of the following:

• Practicing at an incorrect level of difficulty for your present level of expertise 
• Doing the same poses over and over, increasing your risk of repetitive stress injuries
• Attending classes with an inexperienced teacher unfamiliar with guiding students who have special vulnerabilities or who is aggressive with adjustments
• Attending a class or pursuing a home practice that has an overly competitive quality to it

Well, you get my drift. One of the few studies that has tried to get a handle on this topic of yoga-related injuries was published in 2009 in the International Journal of Yoga Therapy by Loren Fishman, MD, et al (see here). He and his colleagues surveyed 33,000 yoga practitioners from around the world, got back 1336 responses, and compiled the results. In descending order, the areas of the body most affected were as follows, with the number of times reported in parenthesis beside it: neck or cervical spine (674), shoulder, including rotator cuff (661), low back, including sacrum, SI joint, sciatica (644), knee (597), wrist (414), back or spine, any area (392), hamstring (332), hip (112), leg, including ankle and foot (64), and groin (52). There were other areas also mentioned, but at much lower frequency, including elbows, headaches and nausea.

A Clear Day on Mount Tamalpais by Brad Gibson

What does this mean for you and me?  Should we be overwhelmed and fearful? Probably not. Remember, only four percent of the surveys sent out were returned, so we still have a relatively small sample of folks here. What we can say is that, just as Nina pointed out Monday, any physical endeavor has some inherent risk of injury to it. However, if we keep returning to the essential quality of mindfulness and honesty in our practice, we can go a long way in minimizing the risks of injury. I can honestly admit that I have injured myself on several occasions, once from inattention in class, once from being in over my head in an advanced class I was not ready for, and once when my ego decided I should do an advanced pose that my hamstring had other ideas about. But I have also had several injuries, yoga related and not, that improved and healed through mindful and attentive practice of yoga asana.

In my next post, I’ll look at Fishman’s number one area of injury, the wrists, with some ideas and recommendations on how to approach poses that are more risky for us ordinary humans! Until then, keep on practicing.

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Featured Sequence: Low Back Care

by Baxter

Several weeks ago, I introduced some thoughts on low back pain and yoga (see here). As I mentioned, the majority of episodes of lower back pain are related to short-term issues of muscle strain or spasm, or other soft tissue and joint situations that usually resolve in six weeks or so. However, it is possible that a regular yoga practice or a special sequence directed at the lower back area can speed up that process and get you back on track a bit sooner. I have frequently observed that for students who come to class for the first time, acute low back strain often requires only a few sessions in my Back Care Yoga class before the student is well enough to return to or advance to a regular yoga class. In this setting, the variety of poses that may be helpful is a bit larger than with more serious lower back injuries or conditions. For example, you can be a bit more comfortable with some twisting and forward bending poses, which often have to be modified in the other situation.

This week I would like to give you a very brief sequence of poses to consider when addressing low back pain. (The poses in the sequence are all poses that we have already featured individually on the blog.) My intention is to add to this basic sequence over time. However, I have found that it is better to start with shorter practices and advance things as you are ready. Some of the poses in this sequence can be done dynamically, with you moving in and out of the pose with your breath, while others are done more statically, with you holding the pose for 30-60 seconds in most cases.

1. Reclined Hip Stretch Sequence (Dynamic). See here for a complete description of pose. 

2. Reclined Leg Stretch Sequence (Static). See here for a complete description of the pose.

3. Hunting Dog Pose (Static). See here for a complete description of the pose.

4. Half Dog at the Wall (Static). See here for a complete description of the pose.

5. Locust pose (Dynamic). See here for a complete description of the pose.

6. Knee to Chest pose (Dynamic). See here for a complete description of the pose.

7. Corpse Pose (Savasana) with Blanket Roll Behind your Knees (Static).

Notice how you feel after the practice and how you feel the next day. We’ll eventually add more poses to our back care routine, but these are a good start for you.

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Not All Yoga Poses Are Created Equal

by Nina

If you haven’t read it already, you might want to check out the article “How Yoga Can Wreck Your Body” in the Sunday New York Times Magazine (see here). So were Baxter and I—we’ve both read it—shocked and surprised to read that yoga can cause serious injuries? Well, not exactly. As teachers and long-time practitioners, we’ve both seen our share of injuries and had them ourselves, too. And for some time, I’ve been talking about wanting to write an article or post called “Not All Yoga Poses Are Created Equal” that would differentiate between relatively safe poses that can be done frequently by most people and other poses that should probably be done less often due to their tendency to provoke injury. (Think about it: you’re probably not going to hurt yourself doing Savasana unless you’re practicing near a bookshelf during an earthquake or something, however, poses that combine external rotation of the leg with a forward bend, such as One-Legged Seated Forward Bend aka Janu Sirsasana and maybe even Triangle and Extended Side Angle poses, if done too frequently really do have the potential to cause some pretty yucky injuries).

Forward bend with external rotation of bent leg

To be honest, there are a couple of myths in the yoga world that are currently in the process of being exposed. The first is that the poses have evolved over thousands of years and are therefore “perfect.” In fact, if you read books like Yoga Body: The Origins of Modern Posture Practice by Mark Singleton or The Yoga Tradition of the Mysore Palace by N.E. Sjoman, you’ll learn that most of the poses we do in modern-day classes were developed during the early twentieth century. Of course the modern yogis who developed the poses (including Krishnamacharya and B.K.S. Iyengar) were geniuses, but they were also, like us, only human.

The second myth is that if you do a pose “properly” with the “correct alignment” it is always perfectly safe. And, conversely, that if you injure yourself, you must be doing something “wrong.” As you can see in the NY Times article, scientific research is backing up what many of us have already understood intuitively: that while there while there are certain robust individuals who seem to be able to do extreme forms of yoga without serious problems, that’s not really possible for the rest of us. For example, the Ashtanga Primary series is notoriously hard on the knee joints and Sun Salutations that include Chaturganga Dandasana (Pushup pose) are equally hard on vulnerable shoulder joints.

But does all that mean we should stop doing yoga?

Just yesterday a good friend of mine showed me her hand, which was still swollen and black and blue after a fall she took when she was walking her dog. And when I was in the software industry, a significant number of people I worked with seriously injured their wrists sitting at their desks, typing. My point is obvious; almost any physical activity you take up has the potential to cause injury. And we all need to continue being active. So for our practice of yoga, as in our other activities, it’s really of matter of combining knowledge with common sense. I’ve asked Baxter to work on a post where he specifically lists the poses that you should approach with caution, but in the meantime, here are some common sense guidelines:

• Don’t do a pose that hurts
• Don’t do the same poses or the same types of poses over and over (repetitive stress injuries are not limited to typists, cashiers, and factory workers)
• Come out of a pose early if you need to
• Use props as needed to help prevent overstretching or strain
• Find a yoga teacher who has had a long, thorough training and experience teaching people of your same age and condition
• Tell your teacher about any injuries you may have or any relevant health conditions

You may have noticed that for every pose we feature on our blog (and these are generally very safe and accessible poses), we provide a list of cautions. These are based our current best knowledge, but if you have any concerns of your own that we haven’t mentioned, follow your common sense and listen to your body.

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Friday Q&A: Yoga After Retina Repair

Q: I'm interested in discussion regarding yoga and retina issues.  Cautions and options for yoga after retina repair and doctor permission to return to class.

A: Thanks for your question regarding practicing safely with eye related concerns, specifically cautions and options for yoga after retina repair and doctor permission to return to class. This is not an uncommon concern among some of my students. In fact it came up again this past month, when a student had to undergo laser treatment to the retina for a partial tear to the back surface of the eye. His doc recommended avoiding inverting for a full two weeks. And I suspect given individual circumstances, you can expect even longer periods of rest from inverting before safely re-introducing poses like down dog to your practice. I suggested to my student that he could modify many of his poses and still practice safely at home and in class. For instance, I suggest half forward fold instead of full forward bend, half dog at the wall versus full down dog. It might also be good to avoid holding poses for a long time, as there could be a corresponding rise in blood pressure that could negatively influence the pressure in the eyes. A focus on restorative poses, calming pranayama (breath practices) and yoga nidra (guided relaxation) would likely support healing.

—Baxter

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When Less is More

by Nina

In Baxter’s post about meditation on Tuesday (see here), he recommended that students who want to start a meditation practice should start out small, with short sessions only a few times a week. This reminded me of a quote from The Wisdom of Yoga by Stephen Cope that not only made me laugh, but also made me really think about how to approach making changes in your life.

As Swami Kripalu often pointed out, Eight-Limbed Yoga begins not necessarily with the admonition to tell the truth, to be generous, chaste and so forth, but rather to be a little less greedy, a little less untruthful, a little less unchaste.

With regard to non-lying, Swami Kripalu said: “Our condition is such that we need not worry about practicing truth in speech, but merely need to delete a little untruth from the mass of untruth we usually speak. Therefore, to practice truth, we should decrease our practice of untruth.

Mushroom Closeup by Brad Gibson

Hey, is that a tiny blade of green grass in this photo?

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Featured Pose: Reclined Leg Stretch Sequence

by Baxter and Nina

The Reclined Leg Stretch sequence (Supta Padangusthasana) opens your hips and stretches the backs of your legs. It’s a perfect starting pose for just about any practice, as we usually like to start low (on the ground, that is!) and work up to standing poses. But it also works as a great standalone mini practice, providing relief for lower back pain or release of leg muscle tension due to sitting, traveling, or walking. And if you tend to store stress in your body, it’s also a great anti-stress pose after any stressful event or simply at the end of your work day.

The three variations of the pose take you first through forward folding at your hip joint, then, with your top leg out to the side, abduction of the femur, and finally, with your leg across the midline of your body, into a twist, adduction of the femur and rotation of the lower vertebrae of the spine, so you get overall opening of your hips and some twisting, too.

Baxter prescribes this pose for:

• any musculoskeletal conditions that result in tightness in the hamstrings, hips and lower back
• chronic back pain
• general knee conditioning
• stress relief

Instructions: Start by making a loop with the strap and have it ready off to your right side.

Now recline on your back, bend your right knee into your chest, place the loop over the arch of your right foot and straighten your leg toward the sky. Adjust the size of the loop so your arms can be comfortably straight. Press from both your hips to your heels. Stay in this version one for 14-16 breaths.

For the next variation, keep your bottom leg engaged and take the loop into your right hand and extend your left arm out to the side. Now slowly take your right leg out to the right side of the room until your foot is about 12 inches off the floor. If this feels painful or like too much effort is required to hold your leg in position, place a block or folded blanket under your right thigh for support. Stay for 14-16 breaths and on a exhale return to your leg to vertical.

Finally, take the loop into your left hand and extend your right arm out to the side. Then take your right leg across the midline of your body and over to your left side about 6-12 inches, keeping your lower back and pelvis on the floor.

Stay for 14-16 breaths, then release out of the pose, returning to a symmetrical position, either with legs straight or both knees bent, feet resting on the floor. Take a few moments to feel your body, and then repeat the series on your left side.

Cautions: Don’t pull your top leg aggressively toward your chest (although you can encourage it in that direction) as this could result in a strain to the origin of your hamstrings at your sitting bone, as well as aggravating a lower back condition if your lower back ends up flattening too firmly into the floor.

If you have weak wrists and fingers, you may need to modify the strap by making a loop and hooking your fingers over the loop to hold onto the strap—this makes it much gentler and easier for fingers and wrists.

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