Friday Q&A: Questions

Q: You have questions and answers on your blog almost every Friday. My question is about the questions: where do the questions that you answer on your blog come from?

A: The questions come from you, our readers! We answer questions that we receive in person, via email (you can find our email address by clicking on the Contact Us tab at the top of the page) or through comments left on individual blog posts (click on the How to Comment tab at the top of the page to learn how to leave comments). Some of our reader's questions get answered on a Friday Q&A post, but others trigger full-length posts on the particular topic.

Okay, fine, I admit it, not all the questions come from our readers. I made up the question for today because it's time for another round of questions and/or concerns, and I thought that some of our newer readers might not realize they can ask us any questions they like.

So speak up, everyone! Do you have any specific questions you'd like us to answer? Or, do you have any requests for general topics for us to address? We love hearing from you.

—Nina

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Yoga Journal Conference and a Giveaway!

Good news, everyone! Baxter’s going to be teaching at the San Francisco Yoga Journal Conference, January 17 - 21, 2013. We hope to see some of you there. For the first time, Baxter will be presenting an all-day workshop on Yoga for Healthy Aging. And he’ll also be teaching a two-hour class on Yoga for Arthritis. Obviously, he was inspired by his writing for this blog, and by the feedback he gets from you, our readers.

Speaking of which, he’s been asked to do one more class at the conference and hasn’t yet picked the topic. What would you like him to teach? Yes, we want to hear your ideas!

This could be yours....

To encourage you to make some good suggestions, we decided to hold our first-ever giveaway. The prize will be a yoga book by Nina and Rodney Yee, either Yoga: The Poetry of the Body or Moving Toward Balance, your choice.

To enter the contest, leave a comment on this post suggesting a topic for Baxter to teach at the conference and tell us which of the two books you’d like most to win. It’s okay to vote for topic that someone else has already suggested because multiple votes for the same idea will tell us which suggestion is the most popular. We’ll have two winners: the one with the idea we like the best, and a commenter selected at random.

You have a week to enter the contest, and we’ll announce the winners at the end of next week. Now go forth and get creative!

or maybe you want this!

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Ankle Sprains

by Baxter

Yesterday, I provided you with a basic overview of the anatomy of the ankle joint (see Getting to Know Your Ankles). Now let’s turn our attention to the most common injury to ankles, the ankle sprain. Suffering one sprain to an ankle, if mild, is usually no big deal. But many times, there will be several sprains over the course of time, often on the same ankle. This can lead to looser ligaments from repeated micro tears and stretching, resulting in overall less stability in the affected joint, and the tendency to have more twists down the road. Yikes! The vast majority of ankle sprains involve the action described about as “inversion” (which I defined yesterday), so are known as inversion sprains. Due to the foot rolling under and the ankle bowing outward in this case, the ligaments on the outer ankle and foot area are stretched and/or torn a bit, resulting in local swelling and pain in that area around the lateral malleolus. A small but important ligament in this area known as the anterior talofibular ligament is almost always the victim of the trauma. The case of the ankle rolling in is much rarer due to the longer fibula bone as the lateral malleolus tending to prevent that, so I won’t address this specific situation here.

On a practical level, when we suffer an acute ankle sprain, we get local swelling, tenderness over the area to touch and discomfort when we stand or walk, to varying degrees. The typical recommendations from your doc areto elevate your foot and leg above the level of your heart and to use ice can help to diminish the swelling associated with the trauma, so are a good idea to try. And since there are lots of yoga poses that are done lying on your back with the legs elevated, your asana practice could assist in the healing process.  In the acute phase of injury, poses such as Legs Up the Wall pose, Chair Shoulderstand, Easy Inverted pose, and similar poses may be all you want to try. All of these poses are also helpful if you suffer intermittent or chronic swelling of the feet and ankles, another common condition.

Legs Up the Wall pose (Viparita Karani)

Easy Inverted Pose

Once the acute phase symptoms have diminished, you can turn your attention to a more typical asana practice, as well as adding in last week’s seated ankle rolls and alphabet spelling exercises (see Ankle Circles).  At this point, you are ready to focus on the strengthening aspects of the poses for the ankle and foot area, so add special attention to activating as many of the muscles surrounding your ankles and feet as you do your standing poses. A modified Mountain pose Tadasana) sequence I learned at the Krishnamacharya Center in India years back also comes in handy for strengthening the ankles after injury. You begin in a good Mountain pose, and on an inhale, lift your heels up and balance evenly on the balls of your feet, taking your arms up and overhead. As you exhale, lower your arms and heels to the starting position. Do this slowly and mindfully six times. Don’t be surprised if you find that you roll in or out onto the ball of the foot, but work to even this out.

As always, cultivate patience with your body to gently guide it back to a healthier place and listen deeply to its requests to honor its limitations.

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Getting to Know Your Ankles

by Baxter

Like many joints and areas of your body, if your ankles are healthy and doing their job well, you don’t give the area way down there by your feet much thought. Yet, when an ankle is not healthy or functioning optimally, it can be hard to think of anything else! Once I began to practice yoga asana regularly, I noticed that my teachers would often have us do ankle rolls as a preparation for Thread the Needle pose (a nice hip opener), and I started to become more aware of the area of my ankles. I was not having any acute problems with my ankles at the time, but I began to notice patterns of tension, tightness and lack of coordination that were previously outside my conscious awareness. In retrospect, I now know that this is exactly one of the benefits of yoga:  to make what is not known knowable. 

Like many of my students, I have suffered the occasional ankle sprain in the past. Since this is the most common injury to ankles, I’ll be addressing this in a separate post (coming soon). In addition to these common sprains of the ankle area, the other fairly common problem is that of significant trauma to the area that results in fracture or severe tears of the ligaments and tendons. People with this problem have often undergone some sort of surgery to reconstruct and heal the damage. This surgery can be profoundly beneficial; however, people who have had surgery often complain about persistent aches, limited movement and even weakness. I’ll also talk about this group in a separate post, and propose some strategies for you to work with.

But to start, I’d like to step back for a moment and take a closer look at the ankle joint. This joint connects your foot to your lower leg, and is intimately involved in our ability to stand on two legs as well as our ability to walk and run effectively. The ankle is often thought of as a “hinge” joint, which allows for flexion (like the ankle position in your Downward-Facing Dog pose) and extension (like the front leg ankle in your Triangle pose). These actions are also known as dorsiflexion (the Downward-Facing Dog ankles) and plantar flexion (pointing of the foot).

The bones involved in creating the ankle joint include your lower leg bones (tibia and fibula) meeting the two big bones at the back of your foot (talus and calcaneus). The tibia and fibula extend down and around the sides of the talus and calcaneus, and their distant ends become our inner and outer ankle bones, technically called the medial malleolus (on the inside of the ankle) and the lateral malleolus (on the outside of the ankle bone).

If you look at how far down your two leg bones go, you may notice that the outer one extends farther down toward the foot than the medial one. This will come into play later when we talk about ankle sprains.

The ankle joint is held in close proximity by lots of small, short ligaments that run between the 4 bones. The talus bone, which sits just atop the calcaneus bone (the heel bone), is unique in that it is only attached to the bones around it by ligaments. There are no muscles directly connected to it.

Muscles from the lower and upper leg bones cross by the talus and connect onto the heel bone, such as with the famous Achilles’ tendon, or head further down to connect to other bones in the foot.  When these muscles contract, they create the movements of the ankle joint.

One other tidbit about the flexion and extension of the ankle joint: the joint is more stable the more dorsiflexion there is, as in squats and Downward-Facing Dog pose, and less stable the closer the joint gets to plantar flexion, such as coming up onto our toes in Mountain pose.

Although it would be neat and tidy if those were the only two movements at the ankle, it would limit our movement capabilities. And indeed there are other movements the joint enjoys, such as turning in and out a bit (adduction and abduction), as well a combination of plantar flexion and adduction known as supination, and a combination of dorsiflexion and abduction known as pronation.  Folks who stand on the outer edge of their feet have a bit more supination going on, and those with “flat feet” do a bit more of the pronation action. And often when people come up onto the ball of the foot, the combination of plantar flexion, adduction and supination cause an inversion of the joint. In the opposite scenario, when the ankle is dorsiflexing, abducting and pronating, an eversion is produced. This will become more important when figuring out ankle sprains, which I’ll address in my next post on ankles.

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The Effect of Yoga Poses on Your Mood

by Nina

“To sit in Lotus Pose and gaze at one’s nose is said to be a spiritual practice; to do Lotus Pose and concentrate on the coccyx or elsewhere is said to be a physical practice. Where is the difference? How can Hatha Yoga be only physical and Raja Yoga only spiritual?” —BKS Iyengar

Iyengar sounds a bit cranky in that quote, doesn’t he? I think that’s because back in the 60s he was getting tired of explaining his somewhat radical point of view that doing yoga poses was a form of meditation. Traditionally yoga poses were seen as physical exercises to purify and strength the body for meditation and other spiritual practices. But Iyengar argued that the poses themselves were a spiritual practice.

“A posture can be considered as much a mantra or as much as meditation.” —BKS Iyengar

I thought of this recently when I read an interesting article about a study about the affects of meditation on moods (see Meditation Induces Positive Structural Brain Changes). When I first heard about the article, I thought it was going to be about a study of traditional seated meditation, and I was excited about the possibility that there was proof that traditional meditation helped improve our moods. Instead, I found the study was done using a special form of Chinese meditation called Integrative Body-Mind Training (IBMT) that “differs from other forms of meditation because it depends heavily on the inducement of a high degree of awareness and balance of the body, mind, and environment. And the study found:

“Building on results from a study they published in 2010, investigators found that healthy college-aged volunteers who practiced IBMT for 4 weeks showed significantly improved mood changes compared with those who did not practice the meditation technique.

The researchers note that these mood changes coincided with improved axonal density and expansion of myelin in the anterior cingulate part of the brain, a region that is implicated in self-regulation. Previous research has linked deficits in this brain area with attention deficit disorder, depression, schizophrenia, dementia, and addiction.”

Orchids in the Mist by Michele Macartney-Filgate

Exciting results, certainly. But doesn’t IBMT sound like Iyengar yoga? I mean, isn’t the practice of yoga poses with a mindful focus on alignment and physical sensations the same as “awareness and balance of the body, mind, and environment”? So it’s pretty easy to extrapolate from this study that Iyengar yoga would have similar effects as this Chinese meditation technique.

Of course I don’t really need a study to tell me what I know from personal experience. My asana practice definitely affects my moods. I usually feel better after practicing almost any sequence, and when I’m feeling depressed or discouraged or stressed, I can intentionally design a practice that can improve my mood. But it’s always nice to find out about studies that back up what I know intuitively because, well, it seems I’m on a mission: I want you, whoever you are, to start practicing, too. Your moods will improve and your stress levels will be reduced, and your overall health will benefit as a result. And now there is the intriguing possibility the practice could also help with dementia (as well as attention deficit disorder, schizophrenia and addiction)!

“Yoga is the harmony of the body, senses, mind, and intellect. That’s why there is no difference between physical and spiritual yoga.” —BKS Iyengar

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Friday Q&A: Sleeping on an Airplane

Q: Wait, what is "good sleeping alignment" on an airplane? If I could figure that one out, I'd be golden!

A: Well, I'd be happy to share this with you! I believe I was first introduced to this idea from Washington state based teacher Aadil Palkhivala some years back. And I have taken what I learned from him and maybe modified it a bit.  I use this sleeping alignment when I plan on trying to sleep on a plane. Ideally, you should try to get a window seat, so you will be less likely to be disturbed by your neighbors, and make sure to bring along certain props:

• A small support for your lumbar spine, which could simply be a piece of clothing rolled up, that you can place in the small of your back.
• A yoga strap.
• A neck pillow (the horseshoe-shaped ones).  I have one that is filled with buckwheat husks, which is great because I can remove or add some to get just the right support for my neck.
• Optionally, eye shades and/or ear plugs.

If the airline offers blankets, ask for two, one you can use for your lumbar support and the other to cover up with.

Now you are ready to set yourself up. First, scoot your butt as far back into the seat as you can. Tip forward from your hips a bit, then place your lumbar support in the small of your back and lean back into it. Feel free to tinker with it so it feels just right for you. Then put your seat belt on and tighten it snugly across your hips. This is actually important so that you don't slide forward and end up collapsed in the lower back.

Next, make your yoga strap into a loop and place in around your legs, slipping it up to your mid-thighs and tighten it until your thighs are about parallel. This will help to keep your legs aligned and prevent you from dropping your knees to the right or left. If you have any history of developing blood clots, skip the strap part. It is also helpful to have ear plugs (really inexpensive) or noise canceling earphones (not so cheap). If you do, put them in now. Then place your neck support and lean your head back. Finally, if you have a pair of eye shades, put those on last.

You are now set up very evenly in your seat. Ideally, your forearms are both on the armrests (not always possible with neighbors, of course).  Once you wake up, you will still want to do some movement to relieve the stiffness of sleeping in a chair, but you may be surprised by the quality of the rest you get with this set up. Happy Flight!

—Baxter

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Featured Pose: Ankle Circles

by Baxter and Nina

This office yoga pose is a very versatile ankle exercise that enables you to address a typically neglected joint. Many of us have stiff, swollen, or weak ankles, or tend toward ankle sprains. Depending on how you practice this simple pose, you can focus either on loosening and releasing tension from your ankles or increasing the strength of the muscles around your ankles. You could also use this pose to improve circulation in your feet; if your feet tend to fall asleep, this pose may quickly wake them up. And because the seated position for this pose has you cross your ankle over your knee, the pose can help increase mobility in your knees and hips (it's a mild hip opener).

Ankle circles are simple and easy to do, and you can do them almost anywhere you can sit down, at the office, while traveling, while using a computer, or at home on the couch.

Baxter prescribes this for:

•    stiff ankles
•    weak ankles, including ankle sprains
•    swelling in your ankles, legs, or feet
•    intermittent numbness in your feet or toes
•    tight hips
•    antidote for sitting too long, either at a desk or while traveling.

Instructions: Start by removing your shoes (don't worry—if removing your shoes is not possible, you can still do it with your shoes on). Then sit on the front edge of your chair with your knees bent and your legs parallel to each other, and your feet directly underneath your knees and hips-distance apart. As always, follow Baxter’s Prime Directive! Lift from your sitting bones through the crown of your head, to protect your back as you do the pose.

Now bring your right shin bone onto the top of your left leg, just above the knee, so your outer ankle bone is just to the left of your thigh allowing your foot to move freely.

For those with stiffness or swelling in the ankles, try variation 1. Simply make easy circles with your foot, circling six times in one direction and then six times in the opposite direction.

For those with weak ankles, try variation 2. Imagine that your big toe is drawing a circle in space off to your left side. Move slowly and deliberately, as if you’re meeting some resistance, like moving through like warm sand. This will activate the musculature around your ankle joint and can help to build strength for those with ankle weakness or a history of ankle sprain. Do six circles, and then repeat in the opposite direction.

Another option for improving muscle strength (borrowed from the world of physical therapy) is to trace in the air the letters of the alphabet with your big toe. This has a similar effect as variation 2, but because are executing different patterns, you are potentially activating different muscle groups.

When you’re done with your ankle circles, return your right foot to the floor and repeat with your left foot. Take a moment to notice whether your feet and/or ankles feet any different.

Cautions: If you have knee or hip issues and can’t comfortably bring your ankle onto your opposite knee, try a different variation. Place a second another chair in front of you so you can rest your calf on it while your ankle and foot hang off. Then do your ankle circles with your leg supported and straight in front of you. Otherwise, this pose is pretty safe!

More on ankles is coming soon!

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Summer Solstice

by Nina

“Life is an ever-rolling wheel

And every day is the right one.” —Mumon Gensen

For us in the northern hemisphere, today is the summer solstice. I don’t know about you, but I always have mixed feelings on this day. On one hand, the solstice heralds the beginning of summer, and summer in Northern California, with its cool foggy mornings and bright, warm afternoons, its sprawling vegetable gardens and blooming roses, jasmine and herbs, is my favorite season. 

White Wisteria by Michele Macartney-Filgate

But on the other hand, because the solstice is the longest day of the year, I also feel a twinge of regret that soon the days will become shorter and the year will begin to wane.

Shadows from a lingering sun

blur into dusk—
falling cherry petals
—Soko

And as I’m well into the second half of my life, I can’t help but take some time to consider my own mortality as well as that of people close to me. The losses I’ve already experienced. The losses that are certain to come. Then I turn back to my practice and the Bhagavad Gita.

This is true yoga: the unbinding

of the bonds of sorrow. Practice

this yoga with determination

and with a courageous heart.

—Bhagavad Gita, trans. by Stephen Mitchell

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Neck Muscle Strain and Spasm (Part 2 on Neck Pain)

by Baxter

As promised last time (see A Literal Pain in the Neck), I want to look at a more specific cause of neck pain today and talk about ways to approach it with your yoga practice. And as in “life imitates art,” I was on a red-eye flight last week, and despite my use of the neck pillow and good sleeping alignment, my four-hour plane nap left me with a very stiff and sore neck. In all likelihood, the source of my discomfort was my neck muscles suffering a mild strain from the unnatural immobility I placed them in. Muscle strain and spasm is probably the most common source of neck pain in all ages, young and old.  But although it holds the number one spot, the good news is that it is also the one that is most likely to resolve quickly, especially if addressed appropriately. You can bet your bottom dollar I was doing some of the exercises described below the next day!

Now here comes an overarching principle that will likely apply to other causes of neck pain we will cover down the road: when your neck is hurting, avoid putting direct pressure on your skull and neck structures. That is, avoid poses like Shoulderstand, Headstand, Plow pose, Rabbit pose and the like while you are hurting. Especially in the case of muscle-related neck pain, you should be able to return to these poses when your muscles return to working order. I also have a secondary caution for certain standing poses, in which your neck is hanging out in space and your muscles are fighting gravity to keep your head in the requested alignment of the pose. The two examples of basic poses include Triangle and Extended Side Angle poses, which can then be extrapolated to Half Moon, Revolved Half Moon, Revolved Triangle and Revolved Side Angle. To keep your head in the traditional position in these poses you need to work multiple muscle groups in harmony.  Even Warrior 3 could be a challenge if the offending muscles are on the back surface of your neck. And in reality, you will need to carefully assess all of your asana that requires significant contraction or stretch of the neck muscles.

So now that you have a few cautions to consider, what can you do when you get a muscle spasm or strain the muscles in your neck? On way to assess and to begin to encourage gentle movement in your neck is to lie down in Constructive Rest position (lying on your back with your knees bent and feet on the floor).

From there, decide if you need a little lift under your neck and head in the form of a folded blanket or if you are comfortable simply resting your head on your yoga mat. Then, as you inhale, gently roll your head toward your right shoulder, and then exhale back to center. Repeat this to your left. I strongly recommend that you roll only a few inches in each direction at first, feeling your way gradually to increase the arc of movement to a point of gentle stretch, but without pain. I’d do at least six rounds of back and forth, and see how that goes. Make sure you are not sliding the back of your head as you do this, as this requires far more muscular contraction than you want for this first exercise. 

Another way to influence your neck somewhat indirectly, or maybe less obviously, is to work on arm movements that involve neck muscles. So, from Constructive Rest, inhale your right arm up and overhead to floor behind you, and then exhale your arm back down to your side. Repeat with your left arm. Keep your arm straight, creating an even arc of movement in what is referred to as, in anatomical terms, flexion and extension at the shoulder joint. Do this about six or so rounds. When you finish, pause for a few moments and see how your neck is feeling. If things are quiet, proceed to the next exploration, which combines the two previous exercises.

Still in Constructive Rest position, inhale your left arm up and overhead, and as you do so, gently roll your head to the right shoulder. As you exhale, bring your head and arm back to the starting position. Repeat on the second side, doing a minimum of six rounds. Upon completion, pause and re-assess.  If you are doing fine at this juncture, move on to Dynamic Bridge pose, as way of assessing your neck’s ability to safely bring your chin to your chest, or to flex your cervical spine.  From Constructive Rest, move your heels about four inches from your hips, with your arms resting at your sides. On an inhalation, lift your hips up just two to three inches off the floor. On your exhalation, lower down.  Repeat for six rounds, gradually lifting up a bit higher each round as your neck permits. When dealing with an injury like this, check in with your neck after completing each series of movements before moving on.

To assess and work with the opposite action, extension of your head and neck (the movement you use to look up to the sky), try a low Cobra pose. Flip over onto your belly and rest your forehead or chin on the floor, depending on which action feels better your neck. Place your hands palms down on the floor beneath your shoulders, and as you inhale, gently lift your head, neck and chest up a few inches into low Cobra pose. In this low back bend, try to keep your head and neck in line with the gentle curve of your spine.  Exhale and lower down. If that felt ok, on the next time up, let your chin lift up an inch higher, so your neck is taken into gentle extension.  Repeat this process, you guessed it, six times, finding the most appropriate amount of extension of your neck and not going past that. Rest and assess before going further.

If all is well, I’d recommend you sit up in a comfortable seated position and follow the Prime Directive, that is, lift from your sitting bones through to crown of head.  From here, repeat the gentle rotation movement you did lying down by inhaling as you rotate your head gently to the right and exhaling it back to center.  Repeat to the left.  Do six rounds. I call these Owl turns, for obvious reasons. 

Curious Dog Tips are next. As you inhale, side bend your right ear towards your right shoulder, then exhale back to center. Repeat on your left side. It is helpful to do these in a mirror to make sure you are not adding in any rotation of the neck.  Do six rounds and assess.  This last movement stretches and contracts the scalene muscle group in the neck, which is a frequent culprit in muscular neck pain.

From here, you can start to explore some of your more basic poses. Two that I like for their gentle tractioning qualities on the neck are Standing Forward Bend (Uttanasana) and Downward-Facing Dog. In both cases I would encourage you to let your head dangle towards the floor so gravity can help to passively stretch your neck.  If you feel okay in these positions, you might shoot for 90 seconds in order to give your muscles the maximal chance of lengthening.

Simply doing this complete group of explorations as an initial return to yoga for a while is a good way to start the healing process. Folks always want to know how often to do this routine, but this really needs to be individualized.  However, having said that, I’d do it every other day for a week and see how you are progressing. I always find the following time periods helpful in assessing the safety and appropriateness of my plan: 

•    a few hours after the practice
•    before bedtime the day of practice
•    the next morning
•    24 hours after practice

The less pain at each of these intervals the better! If you are feeling your neck pain diminish, gradually add more poses in, saving the caution group for last. Many of these same exercises will be helpful for other causes of neck pain, but modifications will apply for situations such as arthritis of the neck, which we will take up next we visit neck pain and yoga.

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The Way Home: Yoga for Grief

by Nina

View of Jade Green Pond by Nina Zolotow

Bonnie Maeda is one of the teachers I trained with when I was in the Advanced Studies program at the Yoga Room in Berkeley, CA, and lately I've been taking a series of classes from her and Shari Ser on yoga therapeutics. I've known for some time that Bonnie was a hospice nurse as well as a yoga teacher, and that one of her specialties was teaching yoga for grief. Intrigued by the compelling possibilities of this aspect of yoga, I asked Bonnie if she would agree to an interview on this topic.

Nina: Why did you decide to start teaching about yoga for grief? 

Bonnie: It was a month following 9-11.The entire nation was in a state of shock and grief. My youngest son, Steven, age 29, was murdered. It paralyzed me. I could not move.

At the time I was working as a hospice nurse, and completing The Advanced Studies Program at The Yoga Room. It was purely the love and kindness extended to me and my family that allowed me to put one foot in front of the other. The yoga community surrounded me, and gave me strength. I was determined and committed to complete the program by June of 2002, although I didn't know how. I kept practicing.

In the midst of my early grief, I did graduate in June. That same year my dear friend and yoga mentor died of metastatic breast cancer. I kept practicing. But it was only 3-4years later, as I began to feel the healing process from multiple losses and devastating grief, that I began to understand how yoga had influenced the way home to my body and self.

I believe grief needs to be felt fully, and the process of grief given as much time as it needs. It then began to create a workshop to share my yoga experience of grief and loss called "Moving through Grief." 

Nina: Bonnie, all I can say is thank you so much for sharing your story with me, and our readers. Can you tell us more about how yoga can help with moving through grief? 

Bonnie:The practice of yoga is a practice of remaining present with what is. I wanted and needed to be present with my grief without allowing it to consume me. This was not always possible, but I do believe yoga gave me a sense of balance in this area as well.

Also, there are some common physical manifestations of grief such as fatigue, a sense of heaviness, anxiety, and lack of motivation, which I believe the practice of yoga can support and even improve. I believe each of our emotions have an energy that presides in the body. Yoga, with its movement and focus on the mind -body connection, can support an individual's experience of their personal grief response. 

Nina: What are some of your favorite poses and/or practices for moving through grief? 

Bonnie: My favorite poses vary depending on where the student is in their grieving process. This is not necessarily a chronological time. It is more how they are processing their emotions, and the physical manifestations at the time. But in general what I have found to be beneficial working with students are the poses that soothe the nervous system. Forward bends, such as Parsvottanasana to a chair or blocks, seated forward bends, and supported Shoulderstand. I also link two or three standing poses together in a flow-like sequence to create a rhythm for the body and the breath.

Breathing awareness is an important aspect of moving through grief. Bringing attention to the breath encourages the life force of prana to be felt. But I do not teach any prayanama for this class, as I am cautious in this area. 

Nina: Is there anything else you'd like to say to our readers?

Bonnie: I'd like to share my Ardha Chandrasana story. It was four or five years after Steve's death. I was at a yoga retreat, and we were practicing Ardha Chandrasana. My balancing poses had continued to be a challenge for me. My teacher was talking about the strength of the standing leg, and I felt a shift in my whole being. I began to open my body and my heart, prana was flowing throughout. I knew then as I know now, life was forever changed, and I was learning how to manage my grief. I will keep practicing. 

Nina: Thank you so much, Bonnie, for being so open, direct, and heartfelt. This whole whole interview is very powerful and inspiring, and I hope we'll be able to talk more about this, and other topics, in the future. 

Bonnie Maeda, RN, is a trained Iyengar-style yoga teacher. She graduated from The Advanced Studies Program of The Yoga Room in 2001. Her approach is gentle yoga for health and healing as well as restorative yoga to promote relaxation and to manage stress. She believes in the benefits of yoga for every age, body type, and ability. See yogaroomberkeley.com for information about the classes Bonnie teaches at The Yoga Room in Berkeley, California.

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Friday Q&A: Ganglion Cysts

Q: I get a ganglian cyst at the top side of my wrist and sometimes the top of my hand from doing poses that put pressure in those areas. Plank positions, Upward-Facing Dog, etc. Any recommendations?

A: Dear Ganglion Cyst,

Thanks for writing in about this. I, too, have had a cyst in my wrist area many years ago that was of the ganglion cyst variety. These cysts are considered benign, and may grow up out of the tendons of the wrist and hand bones. Scientists still do not know what causes them, so prevention is not an issue.  But dealing with them once they arise is an issue, especially if they interfere with your regular activities.

First off, I'd recommend that you confirm your diagnosis of this common and benign form of a mass that can appear on and around the hands and wrists. A trip to your family MD should do the trick,  with the caveat that they may recommend an ultrasound or drawing a bit of fluid from the mass to confirm that it is indeed fluid filled.

Once you have a confirmed diagnosis, it is important to decide if modifying your practice is needed. The main reason to do so is if the cyst is causing you pain,  especially in the poses you mentioned. If it is,  you may be able to avoid those aggravating poses until the cyst gets smaller. Over half of all ganglion cysts will resolve on their own without specific treatment. So we are talking about any pose that bears weight on the hands and wrist joint and takes the wrist into full extension.  As noted, plus a few more, such as, Plank, Chaturanga, Upward-Facing Dog, Handstand, and most other arm balances done on the hands could all make things worse before they get better.

Avoid the old folk remedy of smashing the cyst with a bible or any other large book for that matter. This has not been shown to beneficial and the cyst can return and be harder to treat if treatment is ultimately necessary. If you want more information on the western medical approach to ganglion cysts, check out this website: emedicinehealth.com. And let us know how things unfold for you and your cyst.

Namaste,
Baxter

A: Since your pain symptoms could be worsened by excessive pressure on the wrists, you should modify the poses that cause pressure. The way to think about pose modification is to look at your wrist and if your wrist "folds" are visible, then there is pressure on the wrist itself.  I might use a chair for Dog pose or do Dog pose with the forearms on the floor (or chair) . The same modification can be used to do Plank pose. Shoulderstand would also have to be modified. Doing the chair version of Shoulderstand, which is less active, would keep the wrists from being vulnerable and keep them in a neutral position. Standing poses, forward bends and twists don't  need modifications. But as long as the cysts are present, I would avoid active Dhanurasana (Upward Facing Bow pose) and other backbends where you use your hands to support yourself and wait till they reabsorb. Passive backbends would still be possible. —Shari

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A Pathway in the Mind

by Nina

Between Two Rocks by Nina Zolotow

Yesterday Timothy posted the following quote from Thoreau on his Facebook page (you can find him there at Dr. Timothy McCall Yoga), and it got me thinking: 

As a single footstep will not make a path on the earth, so a single thought will not make a pathway in the mind. To make a deep physical path, we walk again and again. To make a deep mental path, we must think over and over the kind of thoughts we wish to dominate our lives. —Henry David Thoreau

This reminded me so much of the post I wrote about samskaras (see Meditation and Brain Strength). And I wasn’t at all surprised to see a quote from Thoreau that echoed yoga philosophy. After all, Thoreau read The Bhagavad Gita and other yoga scriptures, and even wrote that he considered himself “a yogi."

Free in this world as the birds in the air, disengaged from every kind of chains, those who practice the yoga gather in Brahma the certain fruit of their works. … Depend upon it that, rude and careless as I am, I would fain practice the yoga faithfully. … The yogi, absorbed in Contemplation, contributes in his degree to creation; he breathes a divine perfume, he hears wonderful things. Divine forms traverse him without tearing him, and, united to the nature which is proper to him, he goes, he acts as animating Original matter. … To some extent, and at rare intervals, even I am a yogi.

That being said, I had, a first, a mixed reaction to this quote. I tend to get a bit put off when I hear phrases like “we must think over and over the kind of thoughts we wish to dominate our lives.” As a creative writer, I think it’s important not to censor your thoughts and to allow yourself to think about anything and everything. And I tend to rebel at being told to be more positive. But then, just a few hours later, I realized that in some ways I had already been putting Thoreau’s advice into practice for a number of years. 

As a person who used to react to stressful situations with anxiety, I have found it very helpful to repeatedly remind myself of this quote (and this translation) from the Bhagavad Gita: 

You have a right to your actions,

but never to your actions’ fruits.

Act for the action’s sake.

And do not be attached to inaction.

Self-possessed, resolute, act

without any thought of results,

open to success or failure.

This equanimity is yoga.
—trans. by Stephen Mitchell

So while I haven’t been censoring my thoughts per se, when I notice myself starting to get stressed out about something, I have been developing the habit of turning my thoughts toward a more helpful way of viewing my life. I thought of this cultivating this habit more as using a new muscle that gets stronger and stronger with each repetition, not as creating a deep mental path or a samskara, but my little epiphany yesterday was: of course! It’s all the same thing.

This is why I think that yoga philosophy, which is indeed is intended to “quiet the mind,” can be as helpful for reducing stress as all the inverted poses and conscious relaxation practices that I also recommend. What do you think? Is there a piece of yoga philosophy that you find yourself turning toward over and over?

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A (Literal) Pain in the Neck

by Baxter

Brad’s post Probability, Aging and a Pain in the Neck got me thinking about the very common complaint of neck pain that my students often share with me. Neck pain can arise from a myriad of circumstances and causes, from something as commonplace as sleeping the wrong way on your neck to traumatic events such as car accidents. It can be a result of longstanding postural changes, such as sitting with your head forward in front of the computer screen (I just corrected my own posture!) to doing seemingly beneficial activities like riding a road bike, where your head is often lifted into extension to view the road ahead. There are familial tendencies towards certain neck problems; both my dad and one of my brothers suffered rupture of one of the intervertebral discs in the neck. And there is the simple process of aging and its wear and tear effect on the bony structures and soft tissues of the head and neck area. I have even had some one-sided problems that stem from holding a violin tucked under one side of my jaw since I started playing at age five.

According to medical experts at the Mayo Clinic, the most common causes of neck pain include: muscle strains, especially from overuse of the neck muscles; wear and tear resulting in osteoarthritis of the bones in the neck; nerve compression as a result of stiffened discs, herniated discs or bone spurs; injuries such as whiplash from car accidents; pain secondary from other illnesses or diseases, such as rheumatoid arthritis, meningitis or cancer.

Perhaps part of the reason why the neck is so vulnerable to painful conditions lies in its structure and anatomy. The top portion of the spine is called the cervical spine, and it spans from the top of the thoracic spine, where the ribs attach to the spine, up to the base of the skull.  Relative to the bones below it, the cervical spine vertebrae are smaller and have small cushioning discs between them. Granted, the cervical spine only has to balance the weight of the head above it, so its bones don’t need the bulk of, say, the fifth lumbar vertebrae that has the entire head, torso and belly to hold up. But given the weight of the head, which is between 10-15lbs, and the amount of movement that the cervical spine allows (a lot in all directions), those smaller bones and discs along with all the muscles and ligaments have a constant and challenging task. And there are nerve bundles and important blood vessels traverse this small region that can also be affected if things are not in proper working order.

When I think about how yoga practices can help improve the function of this area, and how they can allow for healthier aging, I start with the most basic posture, Mountain pose or Tadasana. Applying my Prime Directive, the inner lift from the sitting bones to the crown of the head, immediately impacts the postural alignment of the head and neck region for the better! In fact, if you can master this very rudimentary alignment, you are well on your way to improving how the neck feels on a day-to-day basis.

It can be helpful to work with a friend to find out if you can reclaim this vertical line in your body. One way to assess your overall posture and the cervical region in particular is to have your partner stand to one side of you as you do Mountain pose. Have your partner hold a yoga strap or rope in line with the center of your ear, allowing the rest of the strap to fall down to the floor, in line with the side seam of your body. This is referred to as the “plumb line,” and can give you valuable information about not just your neck area, but your entire spine and legs as well. In this case, you are particularly interested in the span between your ear and the center of your upper arm bone. If the rope falls in front of your humerus bone’s center point, you may have developed the Head Forward position so common in our culture, which puts high demands on the muscles at the back of the neck and can lead to overuse neck strain. If the rope falls behind your shoulder point, there may be flattening of your natural cervical curve, which should normally mirror the curve in your lower back. This situation often occurs following trauma to the neck, especially with whiplash injuries accompanied by muscle spasms in the neck. For each of these different scenarios, a well-balanced asana practice can help bring your neck back into healthier alignment and may help to resolve the pain and limitations that are present at the start of your journey.

The next time I revisit the topic of neck pain, we will look at specific asana practices and how they can apply to regaining a healthy neck and maintaining it is you age.  Until then, stand in a good Mountain pose whenever and wherever you can!

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Zainal Arif studio shots by Meor.

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Dr. Timothy McCall Joins Yoga for Healthy Aging!

by Timothy

Chives in Flower by Michele Macartney-Filgate

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.

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!

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Reclined Cobbler's Pose: The Video!

When we first envisioned this blog, we had the idea we could include videos that demonstrated the yoga poses we were recommending. But first we had to buy the camera and learn how to use it, clear out a room where we could shoot the video, figure out how to use youtube, and, well, you get the picture. In the meantime, we decided to go ahead and start the blog without the videos, but we never gave up on our original vision.

So now at long last, we've made our first video, which you can view here. It's Baxter demonstrating how to set up for, practice, and come out of Reclined Cobbler's pose (see here for further information about the pose, including benefits and cautions). We hope you find it helpful! And since it turned out to be easier to make a video than we expected, we plan to make more in the future. If there any poses or practices you'd like us to demo, do let us know either in the Comments section of this post or by contacting us (Click the Contact Us at the top of the page).

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Friday Q&A: When to Change Classes

Q: I have been in one yoga class for a long time. I am not finding myself having more difficulty with poses as the years go on, but I’ve started thinking about when that might happen. If at some point I can no longer do most of the poses in class, I would of course know it’s time to move to an easier class. Do you have other thoughts on when/why to change classes? I’m not talking about responding to a sudden change in physical status, such as having broken or strained something, but rather thinking about longer term changes that are likely (?) to come.

A: Dear Stable Student,

This is a very interesting question. In a sense, you are asking about how one prepares for the inevitable changes that accompany aging. Obviously, we all are aging every day, and at some point, more significant limitations in our physical abilities will arise. In some eastern traditions, as a way of confronting these changes, the student is taught to meditate on change, aging and even death. The fear that can accompany these things is considered an obstacle on the path of yoga, and if addressed and worked with and through, is considered progress towards yoga's goals.

And more specific to your inquiry, although you might choose to attend an "easier" class as time goes on when poses that were once easy become too much or just no longer appropriate for you, you may not need to change classes. As an example, I attend an advanced class once a week, and many of the seasoned practitioners in that class no longer do certain poses that come up in the course of class, but still find it valuable to be with the teacher and the community, simply substituting appropriate alternatives when needed. Since taking public class is so much more than simply the performance of difficult poses, and you may be getting a lot from being in the presence of a mature teacher and wonderful fellow students, don't be quick to jump ship, just because your vessel is getting a little older!

Finally, I believe somewhere in my past posts, I have spoken about the stages of life and the recommended adjustments in practice that Krishnamacharya and Desikachar recommend (see here), and in their estimation, there is a natural and expected shift away from so much asana as we age, and doing more meditation and pranayama as we get older and are, in many ways, more prepared and ready for these more subtle practices. That may be something to start working towards now, while you are fit and able.

—Baxter

A: In my opinion if you’re exhausted after your class then it is time to reevaluate your goals in going to yoga. It is okay to like a bit of a challenge but if every pose is challenging and you are having a difficult time keeping up with the rest of the class, then it is time to change classes. I recommend that you discuss your concerns with your current teacher and if this isn't possible, like it is a gym yoga class, then I recommend you find a class where you can get more individual adaptations to your  physical abilities. It also sounds like maybe you are a bit bored in your class and the routine may be very predictable, so perhaps you might want to try some other forms of yoga that encompass the whole of the physical spectrum.

—Shari

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Featured Pose: Reclined Cobbler's Pose (Restorative Version)

by Baxter and Nina

One of our favorite restorative poses, the supported version of Reclined Cobbler’s pose is a deeply relaxing pose for both body and mind. Because your head is higher than your heart in this pose, for most of you, the pose allows you to relax without falling asleep, thereby reaping the benefits of conscious relaxation (see Conscious Relaxation vs. Sleep for information about the benefits). The rest and relaxation the pose provides restores your energy as it rejuvenates your mind.

Reclined Cobbler's pose an excellent alternative to seated meditation, as you can do pranayama or any mediation practice while reclining. Because the pose is so comfortable, your mind is free to concentrate on a particular mental focus, such as your breath or any object of meditation. As your body relaxes, your mind quiets.

Reclined Cobbler’s pose is a gentle, supported backbend, which doesn’t require muscular effort. So it’s a perfect antidote for people who spend hours in forward bending positions, including cyclists as well as desk-bound people. Because backbends are typically uplifting, the supported backbend can even promote positive mood states.

Having your arms are out to the sides broadens your chest, bringing openness to your pectoral muscles. The leg position stretches and lengthens your hip and leg muscles, especially the inner surfaces of your thighs, so the pose is beneficial for people who have tight hips or inner thighs, and helps prepare you for seated postures.

With correct propping Reclined Cobbler’s pose is accessible to most people, so almost everyone can do it. And it is so gentle that it makes a great transition into regular practice from illness or injury

Baxter prescribes this pose for:

•    digestive problems
•    tight hips
•    tight spine
•    stress in general
•    fatigue
•    convalensence from illness
•    insomnia
•    cooling from overheating
•    menstrual and PMS practices

Instructions: Start by assembling your props. You will need two blankets, a bolster, and a block, as shown below. Roll one of the blankets into a long, thin roll. Fold the second blanket into a square and set it aside. And place the block under the bolster so the bolster is at an angle. If you don’t have a block to put under the bolster, you can use a thick book, a piece of wood, or whatever. If you don’t have a bolster, you can make a thick roll of two blankets or perhaps use a couch cushion. Be creative!

After you have set up your props as shown above, sit down in front of your bolster (but not on it!). Now bring the bottoms of your feet together into Cobbler’s pose, with your knees dropping out to the side.

Next, take the rolled blanket and place it on top of your feet and then pull the ends around and underneath your ankles. Check to make sure your legs can rest comfortably on the blankets. If your hips are very tight, you may need additional support, such as blocks or a thicker blanket roll.

To come into the pose, place your hands on the floor by your hips and slowly lower yourself so your back is resting on the bolster. Now take your folded blanket and slip it underneath your head and neck (but not under your shoulders), making sure your head is tipped so your chin is pointing toward your chest. Rest your forearms and the backs of your hands rest on the floor out to your sides. If your elbows don’t make it down to the floor or if you arms are strained, try uses extra blankets or towels to support your arms.

While you are in the pose, to help you quiet your mind (and trigger the Relaxation Reponse), choose a focus for your mind. You can practice breath awareness or focus on the gradual relaxation of your body, or you can practice pranayama or any form of mediation that you prefer. Stay in the pose 10 to 20 minutes, setting a timer to make sure you don’t fall asleep.

To come out of the pose, bring your hands to your outer legs to use your hands to bring your knees back together. When your feet are flat on the floor, roll slowly onto your side, rest there for a couple of breaths, and slowly come up to sitting.

Cautions: If you have active low back pain, try reducing the arch in your back in this pose by putting a folded blanket under your hips or by moving your hips forward an inch. If you have shoulder injuries, having your arms out to the side could cause pain, so add support, such as folded blankets or towels, under your arms. If you have neck stiffness or arthritis of the neck, you may need an additional blanket under your head.

If you have arthritis of the hip or a hip replacement, make sure that dropping your knees out to the sides is not painful. Try adding more support under your legs (blocks or a thicker blanket roll), but if you can’t get comfortable, come out of the pose. The combination of a backbend with your legs out the side in this pose can compress your sacroiliac joints. Adding more support under your legs might help, but you may want to avoid this pose if you are currently having SI problems.

Keep in mind that this pose is not for everyone. So if it doesn’t work for you, try some other restorative poses instead, either those that we’ll be presenting in the coming weeks or ones your teacher recommends.

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