Friday Q&A: Marijuana and Yoga

Q: With the legalization of marijuana in the news I thought it would be a good time to bring up the question of marijuana use during yoga practice. I find that if I smoke after work that I suddenly become much more aware of my body and that I am more motivated to do poses to counteract what my body has gone through throughout my working day (I am a housekeeper). Also, when I want to commit to a good lengthy home-practice session, using marijuana has facilitated holding my intention that I set before practice throughout the entire practice, and has ultimately aided in making breakthroughs in my yoga practice. I don't like to smoke everyday in my personal life, nor every time that I do yoga. What are the ramifications for an older person who uses marijuana? Are there opinions in the yoga community regarding spiritual and physical ramifications of marijuana use?

I am not looking for a reason or an excuse to use marijuana. I am simply trying to gather informed opinions on its pluses and/or minuses and make appropriate choices for my future.

A: Baxter and I wondered whether we should even answer this question—it seemed somewhat controversial—but here we are on a Friday and this is the only question that came in this week, so what the heck. So we talked it over in person, and Baxter said that he does not really have any knowledge or expertise in this matter (and he’s the yoga teacher/doctor). He suggested that as there is a lot of scientific information about the long-term use of marijuana—apart from the yoga practice issue—you should search out that information on your own to answer your question about the ramifications for an older person who uses marijuana.

As far as the yoga community goes, I know you can find modern yoga teachers in both camps, some for and some against the use of marijuana or other mind-altering drugs during practice. I’ve certainly known both types, myself (my lips are sealed!). In a way it might depend on why you’re practicing yoga. If you are practicing to quiet the “fluctuations of the mind,” which is how the Yoga Sutras defines “yoga,” then using a mind-altering substance would seem counterproductive. In fact, for the ancient yogis, purity of the body was a very important aspect of achieving enlightenment. (Original hatha yoga included a great many cleansing practices, such as shoving a strip of cloth down your—oh, never mind.) However, if you’re practicing yoga asana as a form of exercise, maybe this is not such an issue. My one concern is that it is possible that practicing while you are high might cause you to be less mindful and injure yourself—for example, would you practice drunk?—but I have no proof of that. Mainly, to be honest, your question reminds me of the questions in the New York Times “The Ethicist” column. People usually write in to The Ethicist when they have qualms about something.

If anyone else wants to weigh on it this issue, please do! Baxter says he hopes you will.

—Nina

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Featured Pose: Easy Inverted Pose

by Nina (with a little help from Baxter)

Supported inverted poses are some of the most wonderful yoga poses for reducing stress. By physically inverting yourself (having your heart higher than your head), you employ the natural physiology of your body (the mechanisms that control your blood pressure—see Blood Pressure: Talking About Baroreceptors and Yoga) to invoke the relaxation response. However, in order for an inverted pose to work its magic, you not only need to be able to do it, but it also must be comfortable for you. If you’re in pain or even just uncomfortable you’ll be slightly stressed, so the relaxation response won’t be triggered and you won’t be able to relax completely.

So what’s a person with a bad lower back (a problem for Supported Bridge pose and standing forward bends with head support), tight hamstrings (a problem for Legs Up the Wall pose), or tight shoulders or neck issues (problems for Supported Shoulderstand, Half Plow pose, and Supported Downward-Facing Dog pose) supposed to do? And what about people who are afraid of being upside down or have been recommended to avoid it due high blood pressure or heart disease?

The answer, my friends, is today’s pose, which Baxter and I like to call Easy Inverted pose. Resting your calves on a chair with a support under your pelvis puts your body into a slightly inverted position, so the blood flows from your legs down toward your heart (the opposite of standing upright). So Easy Inverted pose is a very calming inversion, which is also very restful for your leg muscles. (In fact, I find it so effective that I can feel myself start to relax just thinking about it!) And, yet, Easy Inverted pose is so comfortable and accessible, almost everyone can do it (hence the name). If the support under your pelvis irritates your lower back, you can simply do the same pose without it. And one of my favorite MDs (that would be Baxter, of course) assures me that this is a safe pose, too, even for people who have controlled high blood pressure, managed coronary artery disease, or glaucoma (see below for a few cautions).

You can practice this pose on its own for stress management or as an alternative to Savasana at the end of any longer practice. When I’m teaching supported inversions, this is my “back pocket” pose. When a student can’t get comfortable in any of the other poses, I pull this one out for him or her and so far have always found success! I hope you do, too.

Instructions: To set up for the pose, find a chair either with an opening through the back you can put your legs through or one your can turn sideways to let your feet dangle off of. Place a blanket or folded yoga mat on the chair on the chair seat to soften the surface. (If your legs are long, you may need to place extra padding on the chair seat.) Next, if you are not practicing on a carpet, you may wish to set a yoga mat on the floor in front of the chair (we don’t show that in the photo). Then stack one or two blankets folded length-wise about a foot or so from the chair legs (you’ll have to experiment for your body type to find the exact length). This will support your pelvis when you are in the pose. Finally have another blanket, towel or thin pillow nearby to put under your head.

To get into the pose, sit sideways on your pelvis support. Then, using your hands on the floor to stabilize yourself, swing your calves up onto the chair seat. Finally, with your legs resting on the chair seat, lie back and place your head under your head (but not under your neck or shoulders). Allow your arms to rest on the floor, slightly away from your body.

Make sure that your pelvis is close enough to the chair seat so your calves can actually rest comfortably on the chair seat (they should be completely relaxed). But be far enough away from the chair so your thighs are at a good angle (not perpendicular with the floor). Now close your eyes and allow your body to relax. (If you wish, you can put an eye pillow or silk scarf over your eyes as the final touch.)

To come out of the pose, bend your knees and move your feet to the edge of the chair seat. Then slowly, slowly, slowly roll over onto your right side for a couple of breaths. From there, slowly, slowly, slowly use your hands to push yourself up to a seated position, leaving your head for last.

Cautions:  Baxter says that although this is a generally safe pose, if you are on blood thinners or tend to have blood clots, don’t stay in the pose more than 5 to 10 minutes. For lower back problems, instead of using the lift under your pelvis, try turning the blanket the opposite away to support your torso, from your tailbone up through your head.

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Yoga for Every Body: An Interview with Janet Wieneke

by Nina

September Photo from 
the Yoga for the Larger Woman Calendar

“Around the same time, the thought hit me that I had been dragging this body around for all these past 50 years instead of really living in it. It came to me that I had not claimed this body, not moved into this body. I was renting it, but I didn’t live there. I didn’t want to live there—in the “undesirable” section of town.
 
“That began to change though when I realized no amount of wishing, bargaining or promising will change the fact that this is my body and that it benefits me greatly to “step up” and partner with my abilities, instead of wishing that things were different.” — Janet W

I was so moved by this quote from Janet Wieneke from the Yoga for the Larger Woman Calendar that Baxter mentioned in his post Healthy Eating and the Digestive System that I decided I just had to interview her. For I believe it’s so important for everyone to understand that anyone, of any age or body type—small or large, flexible or stiff, strong or weak—can not only do yoga, but will all benefit tremendously from it. Now, let's hear what Janet has to say!

Nina: What was your life like—and your relationship with your body—before you started doing yoga?

Janet: For the first 40 years or so of my life I didn’t think too much about my body. In fact I made an effort to avoid seeing or connecting with it. I had a lot of aches and pains but figured it was my own fault for being so fat for so long. I did get some exercise—I did Volkswalks for a while, did jazzercise for a few years, swam laps at the local pool and even joined a gym a few times. None of it was something I was really enthused about but did it because I knew I needed to keep moving.

My diet then was probably better than people would assume. I usually tried to “shop around the edges” at the supermarket and visit farmers’ markets and avoid heavily processed foods. I had a few food sensitivities at that time (citrus primarily, whole wheat) but nothing to difficult to deal with.

Then, in my early 40’s I started having more GI problems. I tried all sorts of OTC drugs to deal with the pain/gas and nausea but nothing really made it better. I had my gall bladder removed as that was assumed to be the problem. After that things got worse and my diet options narrowed considerably. I spent a couple of years trying to force my body to accept and process what I wanted to eat. My body fought back by upping the intensity and frequency of the gut “attacks.” It was a continual battle. It got to the point that I realized if this was going to be the rest of my life, it didn’t want it.

Nina: How did you get started with yoga, and how did it change you?

Janet: I got started in yoga when I realized I really didn’t have an exercise plan that I wanted to do. There were lots of things I could or should do, and I did, on occasion. I enjoyed taking the occasional class through our local community college, and one day when I was leafing through the booklet I saw “Yoga for the Larger Woman” advertised. I thought, “Wow, I’d have half a chance!” I was in a book group that met at the same time though, so I just shelved the idea away. The next term I looked again to see if perhaps they had changed the time. They hadn’t. I decided to back out of the book group and give yoga a try. I really didn’t think I’d like it that much as I’ve never been very flexible.

The first few times were a struggle. I was so ashamed of bending over in front of others, exposing my extra-large ass to the masses. I cringed inwardly anytime it was suggested.  Then Vilma started doing the “Sellwood salute,” which is basically Downward Dog at the bar, where we would envision “beauuutiful tail feathers” that we would proudly display in a waving motion. It cracked me up every time. Gradually as I quit forming opinions of myself that I could fob off onto other people, I looked around and noticed I didn’t stand out so much in class. Sure most of the women were smaller than me but a few were larger, and—big picture—it really didn’t matter. Within a few months I noticed I was having far less back pain and even my gut “attacks” were less frequent.  I started to really pay attention and noticed other things, like how great a stretch felt from the inside out or which muscles activated when I raised my leg. I started to consider my body and excess flesh with more awareness and less judgment. During this time I was also doing some counseling and the two modalities together brought to light how I was “caring” for myself, and I began to question if what I was doing was actually working for me or if I was just existing on habitual thoughts and habits.

Eventually I realized the more time I spent on my matt, the more attached I felt to this body, in a positive way. I started to care about what I was eating and was more willing to accept the responsibility of my actions. This last year I began seeing a naturopath who put me on a regime of nutritional supplements and I continue to feel better. Today I still struggle with eating what my body needs/tolerates over what I want to eat, but I feel my yoga practice gives me support in making better choices.

Nina: A couple of our readers wanted me to ask if you’d seen any improvements in your balance and flexibility.

Janet: I have noticed a slight improvement in flexibility, nothing dramatic—my nose will never meet my knee cap. But after the first year of yoga though I headed out to do a good spring clean up in the yard and reached down for something and literally smashed my fingers on the ground. I remember how surprised I was as the year before that never would have happened! My balance may be slightly better as well. I’m certainly more confident on my feet but whether that is a balance thing or just general alignment I can’t say for certain.

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

Janet: I’ve always been more of a thinking person than a feeling person. Now after having a fairly regular practice for a few years, it’s almost as if a third way of being has come into play. It is more of an intuitive way of being. It’s something I cannot fully explain with words or isolate within my body. It’s almost a middle ground—a balance? When I can operate from this level, my stress level decreases, I make better choices from everything between what I eat to how I show up for others and it is far easier to live in this body. I wish I had “discovered” yoga long ago.

The years I’ve spent wishing I looked different, acted different, was different—all a waste of time but apparently held the lesson/s I needed to learn. I never felt that yoga was available to me, a fat person. Yoga was the domain of the lithe and “enlightened.” While I think that is still the predominant thought, I KNOW yoga is available to anyone willing to let go of their “cerebral” inner voice and listen to the wisdom of their own body. It’s a tough sell, especially if you’re fat, but it is so worth the effort.

Janet Wieneke is a native Portlander, works in health care as a dosimetrist, and is the personal servant to two animals (one cat and one dog). Her favorite pastimes are fused glass, yoga, photography and being out in nature. She studies yoga with Vilma Zaleskaite at The Yoga Project in Portland, Oregon,  and she is “Miss September” in the Yoga for the Woman Calendar, which you can purchase here.

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New Study Supports Our Personal Bias! Yoga is Good for Older Adults!

by Baxter

Baxter in My Yoga Room by Nina Zolotow

One of the benefits of our blog is that we get to keep up on all the latest developments in research on yoga and aging. Just the other day, Nina came across an abstract from the National Institutes of Health that piqued my fancy, which was titled “The effects of yoga on physical functioning and health related quality of life in older adults: a systematic review and meta-analysis.” Man, is that a mouthful! What the authors were interested in finding out was how yoga compared to other forms of physical activity. Well, let me have them tell you what their goal was:

“The goal was to review systematically the comparative effectiveness of yoga, compared with other exercise interventions, for older adults as shown on measures of health and physical functioning.”

Okay, so once again, researchers are limiting their look at yoga to the physical level of yoga asana, but to me, any advancement in acknowledging the benefits of yoga for aging is a step in the right direction.

So, how did they go about figuring out the answer to their question? Well, they scoured the studies that had already been done; in other words, they looked back to see what other folks had already done, instead of designing a new study of their own from scratch. This can be a helpful way of answering some questions, especially if you can find enough studies out there that meet your criterion to include in your analysis. In this case, they looked for studies published in English, done between 1950 and 2010, which were a certain kind of study that is considered more objective, and they looked in a variety of sources, including ones like PubMed. When all was sifted through, they found 18 studies that qualified and met their specific standards.

What their analysis of the data from these 18 studies yielded sounds pretty promising, with a few caveats where either the data was not so strong or just didn’t support yoga helping at all, like with cognitive issues such as Alzheimer’s Disease. Here’s what they found:

“[our analysis] suggested that the benefits of yoga may exceed (emphasis is mine) those of conventional exercise interventions for self-rated health status, aerobic fitness, and strength. However, the effect sizes were modest, and the evidence was mixed for yoga's effect on depression, sleep, and bone-mineral density. Studies did not find an effect on cognition.” 

As is almost always to case, they go on to say that while these findings are encouraging, what is needed is more studies, well-designed, with a lot more participants involved. Good news for future yoga therapists wanting to do research, but mixed news for the rest of us. But again, overall, any news like this is encouraging for those of us doing yoga regularly that our efforts do bear some good fruit. Perfect timing for this harvest season! And if we are lucky, Brad might lend us his scientific take on this study in a future post.

To read the abstract in its entirety, see here.
   

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Authentic Yoga

by Nina

On Friday evening, Brad and I went to the Rubin Museum of Himalayan Art in New York City, an exquisite, small museum with a very impressive collection of Hindu and Buddhist art. Our primary reasons for being there were to take a break from our hectic, urban vacation in the peaceful oasis that the museum curators have created and to revisit the permanent collection, which we remembered loving from an earlier visit. And I highly recommend this special museum to anyone who is visiting the city. However, as I gazed at the life-sized facsimiles of an entire sequence of 18^thcentury murals from the Lukhang, the Dalai Lamas’ Secret Temple near the Potala Palace in Lhasa, Tibet, I was struck in particular by a section of one mural (shown above) that depicts meditation and yoga practices in vivid color and detail. Because they were: perfect, clear images of authentic yoga from the 18^th century.

You see, by chance, I’m currently reading The Yoga Body: The Origins of the Modern Posture Practice by Mark Singleton, which traces the development of the asana practice that most of us currently consider “yoga” from its hatha yoga roots to the revolutionary work of the early twentieth-century yoga teachers, such as T. Krishnamacharya and Swami Kuvalayananda. I’ve already known for a number of years that, contrary to what is commonly claimed by some teachers and publications, the “yoga” we do these days is primarily a 20^thcentury invention. But this mural from the 18^th century (not so long ago, right?) really brought home the message. For what do we see here? Mostly versions of Lotus pose (some with interestingly asymmetrical spines), along with a few standing forward bends and a one-legged standing pose. And I know from my studies, that when the ancient scriptures, such as the Yoga Sutras, refer to “asana,” the poses pictured here are more likely to be what they referred to than the Downward-Facing Dogs, Triangle poses, and Sun Salutations that many of us now consider essential yoga poses. (For further information, see The Yoga Tradition of the Mysore Palace byN.E. Sjoman.) I was quite excited to be able to view these images, which were in some ways what I imagined ancient yoga to be and in other ways completely different than what I’d imagined (such as the dancer-like positions of the torsos in some of the seated poses)

I may write about this more in the future, but for now I just wanted to share this dramatic illustration with you. For you can see at a glance how much yoga has changed in just a few hundred years. 

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Holiday Week

Angel Watching Man by Brad Gibson

This is Thanksgiving week in the US, so the staff at Yoga for Healthy Aging will be taking the week off from posting. In Belgium, where this photo was taken, they've just celebrated Saint Nicholas' day and are preparing for Christmas. Wherever you are, we wish your holidays are happy ones, and we'll be back with you in about a week.

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Friday Q&A: Savasana Vs. Seated Meditation

Q: I've gone through all your articles regarding meditation and savasan :) What is the difference between the state of mind during the centering in the beginning of yoga practice (meditation) and savasan? The different position of the body is obvious, but what about the mind? Thank you and namaste, Linda

A: What a fascinating question! And also, it turns out, a tricky one. In fact, it led to an interesting email exchange between me, Nina, and Dr. Timothy McCall. Before I share that exchange with you, I’d like to say that in comparing seated mediation with the practice of Savasana, it is important to understand that:

• The short meditation done at the beginning of a yoga class, though “centering,” is not the full practice of seated meditation, which is traditionally done for much longer periods of time.
• The short Savasana (Corpse pose or Relaxation pose) done at the end of a yoga class, though relaxing, is not the full practice of the pose, which is traditionally done for much longer periods of time and always has a mental focus (such as the breath, a physical sensation of the body, a peaceful image, progressive relaxation, or even a mantra) and is not just “lying down in Savasana.” Of course, if you tend to fall asleep in Savasana, then you are indeed just sleeping and therefore your mental state in the pose can’t be compared with that of seated meditation.

Done properly, both these practices have been shown to lead to state of conscious relaxation. Scientists who have studied conscious relaxation have found that alpha waves (slow brain waves) increase in intensity and frequency during conscious relaxation, but are not commonly found during sleep. During Savasana or meditation our brain waves may slow to the alpha rhythm (8-12 cycles per second), during which we remain quietly aware of ourselves and our surroundings without a lot of self-directed mental processing, or they may slow even further to the theta rhythm (4-7 cycles per second), during which we may get a “floating” feeling, dreamlike mental imagery, and withdrawal from the outside world. Much is still unknown about these unique states, but what it is known is that regular practice of conscious relaxation helps foster ongoing feelings of serenity, contentment, and even happiness.

Now for the debate!

Nina: Timothy, I was wondering if you had any thoughts about this question. I was going to answer it, saying that with a mental focus (breath, progressive relaxation, yoga nidra, mantras, whatever), Savasana creates a similar state of mind to seated meditation. However, without a mental focus, it is primarily physical relaxation (with the body in anatomic neutral) enhanced by a postural relaxation response (because you assume the position for sleeping, which is less stimulating to the nervous system than sitting upright or standing). But I wanted to check with you to see if you had any other thoughts about it.

Timothy: I think the mental relaxation you can get in Savasana is fabulous but to me it's qualitatively different from what happens in the long-term practice of meditation, which I view, as traditional yogic thought says, potentially deeply transformational. Of course the state you can achieve in a brief check-in before yoga isn't really meditation, but just coming inside for a minute, so a good Savasana is probably way deeper than that. Savasana, of course, can also be transformational in its way, but to me it's different. I agree that some kind of awareness, which can even be just mindfulness of whatever arises as in Vipassana, is crucial to Savasana, or otherwise it's mostly a nice rest!

Nina: So why would your physical position make a difference? I feel confused about this. If you practiced lying down meditation every day for 20 minutes, would that not have the same effect as seated meditation?

I don't agree that Savasana is mostly a nice rest. That's just how most people use it these days. When I was working on our book proposal for Savasana, we interviewed all kinds of long-time teachers who told us about getting into meditative states with Savasana (done properly). Old descriptions of the pose include reciting mantras as you moved your consciousness to different parts of the body, etc.

I might include your quote while saying there are different points of view on this one (unless you can explain to me how/why it is qualitatively different).

Timothy: No I'm saying it's only a nice rest if you space out. If you maintain relaxed awareness, or use some of the tools you mentioned, it's definitely much more than that. Most yoga experts I've heard believe that sitting meditation is different. One theory I've heard it that the vertical arrangement of the chakras is important. I've heard others, including Desikachar, who I interviewed in Chennai one year, say that you can meditate lying down if sitting is not possible, and indeed I did that for a while when I had the thoracic outlet syndrome, and you can do it. I guess what I'm talking about is the effects of a regular long practice. So after I finish pranayama every morning, I sit for one hour, and I've been doing that much or almost that much daily for a long time. The cumulative effect of that seems very different to me that what I've had for doing briefer Savasanas after asana practice for about 15 years. I'm sure some advanced yogis (partially from doing seated mediation I'd guess) can reach some amazing meditative states in supine positions. So yes, there's some difference of opinions, and it's all valuable, so I normally don't obsess on all this hair splitting. Good luck!

Readers: Do you have any thoughts about this? And, Linda, perhaps you should try doing some experiments!

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In Gratitude or With Thanksgiving…Stress and Digestion

by Baxter

Next Thursday is the official kick-off of the holiday season in the US, or maybe more appropriately the Feasting Season, or perhaps the Excessive Cream Cheese season.  Whatever you refer to the next seven weeks as, eating is center stage, and most often, with abundant quantities of food.  And although gratitude and togetherness and love and joy are also the focus of our gatherings and feasts, which seem like lovely qualities and potentially beneficial, we can still experience an increase in overall stress this time of year. And an increased perception of “stress” can have a noticeably negative impact on your digestion. 

When we are in good balance on a holistic level, which would include physical, mental and emotional balance, our digestive system, at least theoretically, should reflect that balance as well. The digestive system has it’s own nervous system, sometimes called the gut brain, known as the enteric nervous system, which can influence the function of the gut from the stomach all the way to parts of the large intestines. Without any direct input from the brain and the spinal cord, the enteric nervous system can move food along and continue with the digestion and absorption of fuel from our food. 

However, there is also interplay between the conscious parts of our brain, as well as the background operating system of the body known as the Autonomic Nervous System (ANS) on our digestion as well. When we are in balance, the Parasympathetic portion (PNS) of the Autonomic Nervous System, prophetically known as the Rest and Digestion system, supports good digestion. However, when you are under stress, whether via truly threatening situations or everyday worries and anxieties, the other half of the Autonomic Nervous System, the Sympathetic Nervous System, dubbed the Fight, Flight or Freeze system, exerts dominance over your enteric brain. The result is a negative effect on the movement of food through the gut, a decrease in the blood sent to the gut for digestive purposes, which inhibits absorption of nutrients out of the gut, while acidity may simultaneously build up in your stomach, increasing the likelihood of indigestion and heartburn.

With ongoing stress, some people begin to crave complex carbohydrates (none of those around for the holidays, right?) as they can trigger the release of calming substances in the brain, at least for short periods of time. The unwanted side effect of such shifts in eating habits is sometimes weight gain.

By activating the Rest and Digest part of your Autonomic Nervous System via yoga asana and other yoga tools, you can guide yourself back into better balance and improve your digestion and decrease those unwanted symptoms like heartburn and bloating. In the spirit of gratitude for your readership this past year, we want to once again share with you one of my favorite poses to do just that: Reclining Cobbler’s Pose. A few months ago, we posted this short video on youtube, which we link to here again with the hopes you’ll watch and try it. It is a reminder to slow down, do some yoga and take good care of yourselves and your digestion this holiday season. I look forward to checking in with you after our break for the Thanksgiving week!

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Arthritis of the Knee and Yoga

by Baxter

While in Montreal for a weekend workshop, I found myself attending a modern dance performance. I’d say the average age of the performers was about 30, and all looked very fit and flexible. As part of their performance, they did a move in which they leapt forward while spinning and landed on the floor in a Pigeon-pose like stance. The first time they did this, I found myself wincing, as I imagined the impact on their knees on the firm, uncarpeted dance floor. I’d have to guess they did this at least five more times, and usually always landing on the same knee. My host and I spoke about this after the show, and we were both of the opinion that no good could come of this for the future health of these dancers’ knees.

Trauma to the knee is one of several risk factors for the development of arthritis of the knees later in life. It was no coincidence that one of the attendees at my weekend Anatomy and Yoga workshop has arthritis in his knees at the ripe age of 40, as he had been dancing for over 20 years and had suffered numerous injuries to both knees over that time. But since starting his yoga a few years back, his knee pain had improved to the point that after a hiatus of almost 10 years, he was gradually returning to some dance.

In addition to trauma, other risk factors for developing osteoarthritis (the most common form of arthritis) of the knee include: 

• weight, as in more body weight, more stress on the knee joint 
• sedentary lifestyle, as it seems that some activity is better for the knee joint than no activity 
• work or hobbies that involve repetitive demands on the knees, such as horseback riding, which encourages a bowing outward at the knee joint and places unusual stress on the knee joint 
• bone abnormalities, which some people are born with and could include skeletal issues such as bow legs or knock knees 
• other diseases like hypothyroidism and Paget’s disease, which could lead to arthritis over time advancing age 
• gender, that is, women, for reasons that are not yet clear, have a higher incidence of arthritis than men 

Typically, in a healthy knee joint, just as in the hips, the surfaces of the top bone, the femur, and the bottom bone, the tibia, are covered in a layer of protective connective tissue known as cartilage. The cartilage acts as both a shock absorber when the bones move close to one another, as when you are walking or running, and also as a smooth, slick surface for the bones to slide over one another when you are doing any knee bending activities.

If any or several of the risk factors are present, the usually smooth surfaces can become rough, like sandpaper, which may or may not produce pain, but could produce some grinding sounds from the knees. Eventually, the cartilage could wear through and expose the underlying bone, which is even rougher. When bone on bone contact starts to occur, it usually results in inflammation in the joint, which then swells, can become hot to touch and limited in movement and painful. Since the condition usually worsens over time, especially if you don’t seek help for it, it could eventually lead to significant immobility and pain. I am going to assume you have had the common sense to see you family MD to get an accurate diagnosis and have tried some of the western treatment options, such as medications, physical therapy, and braces, and such and are looking for alternative ways to work with the knees to avoid worsening of your situation and surgery.

Yoga is both helpful in addressing the acute problems of swelling and pain, and the longer-term issues of improving mobility, strength and stability of the knee joints. 

In acute situations, restorative practices or reclining sequences can allow for you to maintain some gentle movement of the knee while reducing the effects of gravity on the knee that occurs when you stand. A regular favorite when the knee is swollen is any reclining posture that elevates the leg higher than the chest. My personal favorite is Legs Up the Wall pose (Vipariti Karani). Another is the door jam version of Reclined Leg Stretch (Supta Padangustasana_, where you lie down on the floor on your back at a doorway, your hips lined up with the doorway, and take the affected leg up in the air and rest the heel on the door jam. This allows for a more passive approach to this pose that we usually do with a strap on the foot of the lifted leg.

In addition, a whole slew of other reclining poses can be performed that are safe for the knee and allow you to get some of the stress-reducing benefits of a regular home practice (see Timothy’s post from yesterday Home Practice: The Best Way to Improve Your Health and Well-Being). On top of helping to quiet down an inflamed knee, you can use your practice to strengthen the muscular/tendonous support around the knee. Engaging the muscles that surround the knees simultaneously has been shown to benefit the joints, as Shari noted in a post a while back on hips. So I recommend starting with poses in which the knees are extended or straight, as this reduces sheering actions on the cartilage. This includes Mountain pose (Tadasana), Triangle pose (Utthita Trikonasana), Pyramid pose (Parsvottanasana), Wide-Spread Standing Forward Bend (Prasarita Padottanasana), and such. If these are done successfully, without aggravating your knees, and are hopefully bringing some gradual improvement in your symptoms, you can add in standing poses with knees bent. This will require that you pay special attention to the trajectory of the knee as you flex it. Ideally, you will want to bend the knee directly in line with your mid-foot, so the knee is tracking in the most anatomically correct way. You may want to have your local yoga teacher help you to figure this out, as it is a bit difficult to sense on your own at first.

Another potential way to modify seated poses to allow you to do them pain free is to use some sort of a spacer tucked into the back of your knees before you deeply flex (bend) the knees. You can use a rolled up washcloth, or a thinly folded yoga blanket. Once you place the spacer in the fold of the back of the knee, mindfully bend the knee and see how it feels. There should be no pain. If you have a history of ACL repair (anterior cruciate ligament), then never use a spacer, as it could loosen this precious repaired tear.

Since every arthritic knee is going to be a bit different, these suggestions are offered to get you thinking about ways yoga could be helpful for you. As I always say, it would be a good idea to do some one-on-one work with an experienced teacher to guide you safely on your way.

And skip the Flying Twist Dropping Pigeon from your repertoire until next lifetime!

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Total Hip Replacements and Yoga

by Shari

Nina asked me to add to Baxter’s post Arthritis of the Hip Joint about what the next step might be when your own self care management techniques are not as effective and your quality of life is severely impacted. I thought I would give some background about the elective procedure of total hip replacement and why people might elect to have it done. I see a lot of total hip replacements in my work as a home health physical therapist, and I also do have yoga students who come to my class either after the procedure or before hand as they are preparing themselves for the surgery.

X-Ray of Hip Replacement from Wikimedia

As background, here is what the Mayo clinic says about hip replacement surgery:

"Hip replacement surgery, also called total hip arthroplasty, involves removing a diseased hip joint and replacing it with an artificial joint, called a prosthesis. Hip prostheses consist of a ball component, made of metal or ceramic, and a socket, which has an insert or liner made of plastic, ceramic or metal. The implants used in hip replacement are biocompatible — meaning they're designed to be accepted by your body — and they're made to resist corrosion, degradation and wear.

The goal of hip replacement surgery is to relieve pain and increase the mobility and function of a damaged hip joint. If a stiff, painful hip joint has forced you to cut back on everyday activities, successful surgery may allow you to resume them. Conditions that can damage the hip joint, sometimes necessitating hip replacement surgery, include:

• Osteoarthritis
• Rheumatoid arthritis
• Broken hip
• Bone tumor
• Osteonecrosis, which occurs when there is inadequate blood supply to the ball portion of the hip joint

To perform a hip replacement, your surgeon:

• Makes an incision over the front or side of your hip, through the layers of tissue
• Removes diseased and damaged bone and cartilage, leaving healthy bone intact
• Implants the prosthetic socket into your pelvic bone, to replace the damaged socket
• Replaces the round top of your femur with the prosthetic ball, which is attached to a stem that fits into your thighbone

Your new, artificial joint is designed to mimic the natural, gliding motion of a healthy hip joint. "

Artificial Joint from Wikimedia

Techniques for hip replacement are evolving. As surgeons continue to develop less invasive surgical techniques, the hope is that these techniques might reduce recovery time and pain compared with standard hip replacements. However, studies comparing the outcomes of standard hip replacement with those of minimally invasive hip replacement have had mixed results.

Choosing an orthopedist to perform your surgery is a very personal decision and we all research our concerns in different manners. Please, though, when you have found a surgeon that you want to work with, make sure you discuss the different types of hip replacement surgeries that they may perform so you understand clearly the advantages and disadvantages that each surgical procedure presents. Be particular that the surgeon understands your own particular yoga practice and what it entails. Bring pictures of poses that you currently do (or have done) and make sure the doctor understands the stresses you place on your hip joint. Telling a physician who doesn’t do yoga “I do yoga” isn’t enough, so show him or her the positions your hip needs to be able to move through.
The surgical options that exist are very different in what the post operative limitations are and the longer standing limitations that the post replacement hip might present you with.

The basic categories of total hip replacement are either:

• posterior lateral approach
• anterior lateral approach
• anterior approach
• minimally invasive anterior approach or minimally invasive posterior approaches

These are all different, but as far as hip precautions go there are no hip precautions for the anterior approaches.

Now this important for the practice of yoga. Which approach is recommended for your particular situation is going to affect your asana practice. Please ask your surgeon what your post-operative physical limitations are and for how long. Make sure you learn how to safely get up and down from the floor so as to not dislocate your new hip and that you learn the specific precautions associated with your category of hip replacements. The key is that you learn to identify what position is your hip in when you do your poses and you need to think of both legs when you do each side (don’t just focus on the surgical side).

In the more traditional posterior or posterior lateral approach there are limitations on hip flexion, adduction and internal rotation. That means that if you combine these three positions you are more apt to dislocate your prosthetic hip because the muscle support is weakened by the surgical procedure. That is definitely going to affect your asana practice. Poses you might want to not do for approximately six months would be: Standing Forward Bend (Uttanasana), Eagle pose (Garudasana), Cow-Face pose (Gomukhasana), and Child’s pose (Balasana). Gentle backbends generally are okay for posterior/posterior lateral hips.

For anterior lateral hips the precautions will be very different. Typically hip extension and hip abduction will be affected and you don’t want to be aggressive in these combined movements. So start thinking about your backbends and standing poses. Remember that the position of the front and the back legs are very different in the standing poses. The front hip may be placed into positions of flexion and external rotation and abduction but the back hip may be in extension with external rotation.

For anterior hip replacement surgeries the doctor will typically tell you that you have no restrictions but that doesn’t mean you are going to jump back into your asana practice. The hip is going to be sore and painful because of the surgical trauma (though it is less in this procedure than some of the other ones I talked about because there is no actual muscle cutting in this procedure but the muscles are certainly stretched as they are moved for the surgery).

So now armed with your knowledge of what type of hip surgery you have had, and what your physical restrictions are and for how long, consider the critical importance of studying with a teacher who can assist you in practicing safely. Knowing what props to use and when are important, and so is knowing how deep to go into a pose. In addition, different surgeries have different time frames for returning to asana practice but the rule of thumb to return to any activity post operatively is how you feel. You can get time estimates on when to resume an activity but the bottom line is your own healing process and energy level. As always respecting your energy level and not be overly aggressive as you return to your asana practice is crucial.

In my clinical experience I have never had a client tell me that he or she is sorry to have undergone this surgery. In all medical procedures, knowledge, mental and emotional preparation and conviction in your choice of action go a long way towards healing. That certainly sounds like an engaged yoga practice off of the mat!

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

by Timothy

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

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

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

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

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

Bed in a Mirror by Nina Zolotow

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

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

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

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

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Friday Q&A: Eye Floaters

Q: I have several students who have “eye floaters.” They are wondering if there is anything they can do for them.

A: First off, how many of you out there reading this have ever had an “eye floater”?  I’ll bet loads! Even though they are considered an age-related eye phenomenon, I had one long ago, perhaps in my twenties or thirties. But before I get too far ahead of myself, let me define what we are talking about here.

According to the Mayo clinic, eye floaters are spots in your vision. Eye floaters may look like black or gray specks, strings or cobwebs that drift about when you move your eyes. And typically, when you go to look at the floater, it will frustratingly move out of your field of vision. The gall! But, usually, this common condition is more annoying than threatening to your health.

Eye floaters, again via our friends in Minnesota, are considered a result of age-related changes that occur as the jelly-like substance (vitreous) inside your eyes becomes more liquid. When this happens, microscopic fibers within the vitreous tend to clump together and can cast tiny shadows on your retina, which you may see as eye floaters.

Usually, this is not a sign that you have to worry about or that portends dangerous changes to your vision. However, there are several worrisome additional symptoms that you need to watch out for, as they could indicate a more serious problem called retinal tear, which can lead to retinal detachment (not the desirable vairagya kind we aim for in yoga!) that can lead to loss of vision. So, if you notice a sudden increase in the number of eye floaters, contact an eye specialist immediately—especially if you also see flashes of light or lose your peripheral vision. These can be symptoms of an emergency that requires prompt attention. To re-iterate: usually a couple of eye floaters are not of any immediate concern, although if you have not had an eye exam in a while, it might be a good time to see your ophthalmologist or optometrist. Go immediately if any of these show up, too:  many more eye floaters than usual; a sudden onset of new floaters; flashes of light; darkness on the sides of your vision (peripheral vision loss). 

In addition to age changes already mentioned and the more serious tear to the back of the eye, occasionally floaters can be a result of inflammation on the back of the eye or bleeding into the center of the eye. These would likely cause more symptoms than just a floater, and you’d likely feel compelled to see you eye doctor soon than later.

If you’ve never had an eye floater, but now that you’ve read about them you’ll be worrying about them (this used to happen to me all the time in med school—I’d read about some deadly illness for the first time and start to imagine I was getting symptoms of the condition!), here are the risk factors for developing them:

•    age over 50 (yikes!  I’m in trouble again!)
•    nearsightedness (got this one, too!)
•    eye trauma
•    complications from cataract surgery
•    diabetic retinopathy
•    inflammation in the eye

In order to rule out the bad eye situations, your eye doc will do a full eye exam, including dilating your pupils with drops so he/she can get a clear look at the inside and back of your eye. Surgery is typically reserved, for situations of retinal tear or detachment. There are some experimental procedures using lasers to zap floaters if the floaters are really big and annoying to you. But these are still considered experimental.

In most cases, no treatment is recommended. You are simply asked to get used to the floaters and try to ignore them. Now, if they are kinda annoying for you, you could try applying your yogic skills of observation, attention and focus to the floaters, and incorporate them into your present reality, which according to yogic philosophy, is always changing. That means these guys could actually start to disappear, and you will be aware of it when it happens.

A quick look at the many websites that claim that yoga can help resolve eye floaters tend to recommend a balanced practice of standing poses, seated poses, supine and prone poses, with both forward bends, backbends and twists, but tend to strongly swear off inversions. Pranayamas recommended include Skull Brightening, Alternate Nostril and Solar Pranayama, inhaling on right nostril, exhaling out of left.  One site recommended Trataka, or gazing practices, using a candle, your shoulder or the tip of your nose for your focus. However, I could find no research on the benefit or risk of any yoga tools for eye floaters.

I suspect that a gentle yoga practice, with its likely benefit of stress reduction, would be a helpful way of addressing this condition if it is creating more stress in your daily life. And I, too, would suggest that you use caution with inverted poses in case an increase in pressure in the head and eyes might worsen or precipitate floaters. No definitive research is available to prove or disprove this idea, but you can monitor your own symptoms by doing gentle inversions, like Standing Forward Bend or Downward-Facing Dog, staying for only brief periods of time and noticing afterward if anything changes with your symptoms. If any of our readers have had person experience with floaters and yoga, please write a comment back to us. We’d love to hear about it!

—Baxter

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Featured Pose: Downward-Facing Dog Variation (Chair Version)

by Baxter and Nina

Like Puppy pose, which we featured last week, this variation of Downward-Facing Dog is also a good variation for upper body strengthening if you have wrist and hand issues because the angle between your hand and forearm is minimized and you have a choice of two different hand positions. Placing your hands on the seat of the chair takes some of the weight off your hands (though not as much as Puppy pose) and keeps your wrists in a more neutral position.

From the hands to the hips, this pose is similar to Puppy pose so you build upper body strength while also increasing flexibility in the shoulders. Downward-Facing Dog with a chair activates the triceps muscles in the backs of your arms and the stabilizing muscles of your shoulder blades. As a side effect, if you keep your spine neutral, you also strengthen your front abdominal muscles (and who doesn’t love that). And, compared to Puppy pose, you may find that with your knees off the ground, you get a better spinal elongation. Other benefits not provided by Puppy pose include leg stretching and strengthening, which help move you toward the full pose, and increased upper body strengthening because you are bearing some weight on your hands.

Because this version is easier than a full Downward-Facing Dog pose, it is suitable for someone who is still building up enough strength to do the full pose. It is also wonderful for someone who can’t easily get up and down from the floor, or just isn’t dressed for it. Yes, it’s an excellent office or travel pose. Airport chair that is bolted to floor, anyone?

Instructions: Before coming into the pose, place your chair against the wall, with the back of the chair touching the wall so the chair doesn’t move when you come into the pose.

Start by standing in Mountain pose about two feet from the front edge of the chair. Bend your knees slightly and take an easy forward bend from your hips. Place your hands either on the chair seat with the heel of the hand catching the front edge (not dropping down below it) or with the base of your thumb on the seat and your fingers wrapped around the fingers around the sides of the seat, whichever feels best on your wrists.

Next, keeping your knees bent and your hands pressing firmly into the seat of the chair, walk your legs back, keeping your hips over your feet, until you create an even diagonal line from your arms, to your torso, and to your hips. Those of you who are tighter in the hips, hamstrings, or ankle joints, may want to walk your feet further back than your hips (like Baxter, here).

Keep your knees bent initially, and work your hands, arms and shoulders. Press your hands down and forward on the chair as you allow your rib cage to move away from your hands. Bring a sense of firmness to the muscles around your shoulder blades. Those of you who are more flexible in the legs can then straighten your legs and allow your heels to drop toward the floor (or onto it).

If you have tight shoulders, be aware of the tendency of your front lower ribs to drop or your lower back to arch dramatically to compensate. Focus instead on maintaining your torso in Mountain pose (Tadasana) alignment.

Stay in the pose for six to eight breaths and, with practice, work your way up to 1 minute.

To come out of the pose, bend your knees and slowly walk forward toward the chair. When you are a foot or two from the chair, bend both knees and moving from your hip joint come up to standing.

Cautions: If you have rotator cuff injury or a history of dislocation of the shoulder, keep your chest lifting from the floor rather than pressing down toward the floor. Back off if you feel any pain. If you have lower back problems, make sure you keep your lower back neutral (not overly arched or rounded) in the pose.

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Yoga Philosophy of the Day, Part 2

by Nina

Almost immediately after I published my post on Monday Yoga Philosophy of the Day, which was about cultivating equanimity in the face of difficulty and “enemies,” I was sorry I hadn’t mentioned the United States election (post posting remorse?). Because for many of us Americans, this election has been extremely divisive, with the feeling on both sides that those in the opposing camp were our “enemies.” I even know people who stopped speaking to those who disagreed with them over candidates and issues. And I confess that I, too, got swept up in some very negative feelings.

Now, this morning, after very intense night, the results are in and the battles are over, for now at least. However, I find that there is still a great deal of intense feeling remaining, on both sides. Gloating, anger, bitterness. Even Big Bird wasn't being as nice as usual. So maybe it’s not too late to add to what I wrote on Monday after all!

If we practice yoga the way The Bhagavad Gita defines it, we’ll need to step back from these negative feelings. As I quoted on Monday:

He looks impartially on all:

those who love him or hate him,

his kinsmen, his enemies, his friends

the good, and also the wicked.

This doesn’t mean we shouldn’t work for the political causes we believe in. As The Bhagavad Gita says:

He who performs his duty

with no concern for results

is the true man of yoga—not

he who refrains from action.

And, after all, it was Mohandas K. Gandhi, one of the great political activists of all time, who called The Bhagavad Gita his “mother” and believed in its message of “skill in action.”

The wise man lets go of all

results, whether good or bad,

and is focused on the action alone.

Yoga is skill in actions.

Now the challenge for all of us is to put this into practice. (See my original post Yoga Philosophy of the Day for information about what The Bhagavad Gita recommends as the way to achieve this.)

I was also thinking about how cultivating equanimity in the way The Bhagavad Gita recommends pertains to healthy aging. Of course, maintaining equanimity in the face of difficulty of all kinds helps make our lives better (and our bodies healthier). But also, as older people, most of us want to make a better world for those who come after us, whether that means for our own family members or for the next generation as a whole. And this will only be possible if we can all work together, friends and enemies alike.

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