Friday Q&A: Physical Therapy for Hip Replacements

Q: It is good to know that even people who’ve had hip surgeries can still do yoga, although it may be limited on some poses. Can yoga be a form or alternative for physical therapy post-hip surgery as well?

A: The short answer is no. Typically post operative physical therapy takes place in the home where the client is taught how to do basic activities of daily living while adhering to specific hip precautions like getting in and out of bed, up and down from the toilet, in and out of the shower, etc. The strict post op precautions (remember anterior hip replacement precautions are different than posterior lateral hip precautions) vary by surgeon specifics. After their first post op surgeon visit, most people are told they can start limited exercise with specifications generally on what they can and can't do. Some people will have a pronounced limp after hip surgery and may need physical therapy to address their surgical residual difficulties. Some people, I am sorry to say, may even still have pain after a hip replacement.

Typically after three months of an uncomplicated recovery, people are told they can “do anything.” So going to a yoga class earlier than that is a bit overly optimistic. Everyone wants to be a fast healer, but there are certain surgical post op norms. Some people may be quicker and others slower, but you don't want to push your joint replacement prematurely because you don't want to have a revision. That said, there is no reason why having private one-on-one yoga therapy sessions with an experienced yoga teacher can't occur after your first post op orthopedic visit as long as your doctor approves. As to what your particular precautions are, you must ask your doctor before starting any type of yoga class. Lastly, if you have done yoga for years and are experienced, you should be able to modify poses even in a general class. But if you are new to yoga, you really need to start slowly with a good teacher who has experience with hip replacements. If no teachers are available in your area, then you must learn to “listen” to your hip and respect its limitations and not push your range of motion. Good luck!

—Shari

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Comments About Commenting

by Nina

Several months ago, people were complaining to me about the spam filters we had turned on for comments on our blog. Having to type the verification text in the CAPTCHA box was annoying, and sometimes it was hard to identify the letters in the box (I know, sometimes those letters get so smushed together they are impossible to read). This was discouraging people from leaving comments, even though they had important questions to ask or comments to add to a discussion.

Unfortunately, because the CAPTCHA function is automatically provided by Google (as part of the Blogger product), I can only turn it on or off, not change the way it functions. For those of you who wonder what CAPTCHA is, here is the definition from a Google web site.

CAPTCHA (Completely Automated Public Turing test to tell Computers and Humans Apart) is a type of security measure known as challenge-response authentication. CAPTCHA helps protect you from spam and password decryption by asking you to complete a simple test that proves you are human and not a computer trying to break into a password protected account.

A CAPTCHA test is made up of two simple parts: a randomly generated sequence of letters and/or numbers that appear as a distorted image, and a text box. To pass a test and prove your human identity, simply type the characters you see in the image into the text box.

Because I was concerned about making it as easy as possible for our readers to comment, I decided to turn off the CAPTCHA function as an experiment. And what happened—you probably can guess—was that I was deluged by spam. I estimate that for every legitimate comment we receive we get at least 20 spam comments. Some days all we do get is spam. You don’t see them because I moderate all comments before they are published on the blog. But the process of moderating has become more time consuming for me as a result of the spam because I carefully read all the comments to ensure that the legitimate ones do get published (some of the spam comments are pretty tricky by the way). In a way, I was willing to do this if it made it easier for our readers to communicate with us but I admit I have been getting a bit frustrated with the whole thing lately.

But the straw that broke the camel’s back was hearing yesterday about the spammers denial of service attack on Spamhaus, a volunteer organization that distributes a blacklist of spammers to e-mail providers in attempt to reduce spam. See Attacks Used the Internet Against Itself to Clog Traffic. That made me feel that I really should be blocking spam if at all possible, so today I’ve turned CAPTCHA verification back on for our comments. Sorry about that, folks! But to be honest, I feel relieved already that I’m not going to be seeing all that stuff on a daily basis.

If you would like to leave a comment but are confused about how to do so, click on the How to Comment tab at the top of the page for detailed instructions or use this link to go to our How to Comment page: http://yogaforhealthyaging.blogspot.com/p/how-to-comment.html. If you can’t read the text in the CAPTCHA box, take a wild guess. If you’re wrong, you’ll have second chance with a different phrase, and chances are that will be easier to read.

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Yoga for Better Sleep: Workshop and Tip

by Nina

Cairns by Nina Zolotow

I don’t teach workshops very often, but when I do, I focus on topics I really care about. My upcoming workshop on Saturday April 6th, 2-5pm at Brentwood Yoga Center focuses on one of my favorite topics: Yoga for Better Sleep. (to register, go to http://brentwoodyogacenter.com/workshops ) This is topic is dear to my heart because, well, it’s something I have to practice myself on a regular basis. Even small amounts of stress can disrupt my ability to fall sleep or to sleep soundly (interestingly, that’s something that seems to run in my family). Fortunately I’ve learned a number of techniques both for reducing my stress levels in general and for lulling myself to sleep while I’m in bed. And my feeling about teaching these techniques to others is that if I’ve helped just one person to achieve better sleep, than I’ve been successful!

I’ve written about this topic in general on the blog (see Day to Night and Yoga for Insomnia, Part 1). But the other night as I was lying in bed not sleeping, I realized that if I had to choose one single technique above all the others, it would be the breath practice I turn to almost automatically these days. And I decided then and there I wanted to share it with you all.

For most of us, what is happening when we’re lying in bed sleepless is that our minds are churning, thinking about the day’s events, ruminating about the past or worrying about the future, which stimulates our nervous systems. Turning our minds to a neutral focus, such as the breath, allows us to let go—at least temporarily—of those disturbing thoughts and helps calm the nervous system, switching on the relaxation response. And in my case, after 10 to 20 minutes of breath practice, I almost always end up drifting back to sleep.

Start by practicing simple breath awareness. This means focusing your mind on how your breath moves in your body, perhaps on how your belly rises and falls with your breath or, if it’s easier, how your chest moves with your breath. You could also focus on the more subtle sensations, such as the feeling of your breath moving in and out or your nostrils or, if you prefer, the sound your breath makes in your body. I actually like to lie on my back with my hands on my  belly because that makes it very easy for me to feel the movement in my abdomen.

For some of you, this simple practice may be enough. For myself, I like to use a more structured technique of extending my exhalation. Extending the exhalation in particular helps calm the nervous system (your heart rate slows on your exhalation) but I also find it engages my mind more completely. To do this, when you reach the end of your exhalation, simply add a beat or two—without straining—before turning on to your inhalation. Keep it relaxed and easy. And if the practice aggravates you, simply return to your natural breath.

If at any point you realize your attention has wandered from your breath (it will, of course), simply—and without self judgment—bring your attention back to your breath.

I confess that, in addition to all that, I also count my breaths. I got the idea from Baxter who showed me a technique using your fingers that he learned when he studied at the Krishnamacharya Yoga Madiram. This really helps me keep my mind engaged, and when I start to really lose track of where I am, that’s when I’m starting to fall asleep. However, this may be, well, too anal for you. (Hey, I’m just trying to be honest about what I really do—and what really works for me.) Basically, you need to experiment and see what works for you. Maybe you’ll even come up with new variations. If whatever you are doing is working, then it’s right for you.

You can do this breath practice every night when you get into bed or just on those nights when you start to realize—it sometimes takes a while catch yourself—that you’re having trouble falling asleep or are wide awake in the middle of the night.

I have more tricks up my sleeve and hope to share them with some of you in person at my April workshop, but in the meantime, if I help just one person.....

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

by Baxter

Another View from 1/2 Mile Marker by Brad Gibson

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

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

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

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

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

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

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Santosha: Happiness and Longevity

by Ram

Chicken on Hawaii Beach by Brad Gibson

In the Sadhana Pada of the Yoga Sutras by Patanjali we are introduced to the eight rungs/limbs/steps of yoga whose practice helps us to develop attention as a tool to discriminate between ignorance and awareness and truth from illusion which is the means for liberation or enlightenment. The first two of these rungs or limbs are the yamas and niyamas that can be looked at as universal morality and personal observances. The practices of yamas and niyamas lay the foundation from which to develop all the other subtle practices. The second limb contains the five niyamas or observances/practices of self-training, and deals with how we relate to ourselves inwardly. One of the five niyamas is santosha, which means contentment or true happiness.

Santosha Anuttamah Sukha Labhah
From an attitude of contentment/true happiness (santosha), mental comfort, joy, and satisfaction (anuttamah sukha) are obtained. —Swami Jnaneshvara  

To be contented and happy, even while experiencing life’s difficulties, becomes a process of growth through all kinds of circumstances (see Yoga and the Pursuit of Happiness). We should accept that there is a purpose for everything and we cultivate contentment to accept what happens. It means being happy with what we have rather than being unhappy about what we don't have. Humans seem to always be seeking satisfaction in the materialistic world and our internal fantasies. However, if we are contented with our wants, wishes and needs and truly happy with our lifestyle and what we currently have, it will help us in the journey to absolute truth and the highest realization. Discontentment and unhappiness arises when we get caught up in this materialistic world. Our desires and needs for material possessions, if left unfulfilled, create frustration, anger and loss of mental peace, leading to a disharmonious life (see Anger Management: Philosophy, Science and Yoga).

People are looking for ways to bring that peace and santosha in their lives, and so not surprisingly santosha seems to be the most sought after "principle" in the world today. Your own test for santosha would be about whether you respond through the five senses and react to the changes in all the circumstances of life or whether you listen to your inner voice and are not swayed by the material instincts.

In my previous post  I emphasized the principle of karmayoga or selfless service (see Selfless Service for Harmonious Longevity). Karmayogis are known to constantly live in a world of true happiness. What could you possibly achieve by experiencing true happiness? Among several other benefits, true happiness is now known to extend longevity. Happy people have an advantage over unhappy ones—they are not only healthier but they may also live longer. This is the conclusion drawn from a review published in Applied Psychology: Health and Well-Being thus confirming the need to be happy for a healthy living as advocated in the yoga sutras. The research study compared 160 studies that examined several types of emotions defined as subjective well being (SWB). These included life satisfaction, optimism, hopefulness, sense of humor and other positive emotions. The summary of the findings include:

1. Happy people exhibited a high SWB as compared to less happy individuals.
2. Happy people with a high SWB had better health and longevity.
3. A high SWB (exhibited by happy people) was related to lower mortality rate in both healthy and diseased populations.
4. Unhappy and stressed people (having a low SWB) had higher blood pressure levels and low immune response as compared to happy people with high SWB.

The above together with other findings suggest that happiness measured as subjective well being causally influences health and longevity. So how about bringing that santosha in your own lives as well? It’s no wonder that Bobby McFerrin gyrated and swooned to the tunes of “Don't Worry, Be Happy.”

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Friday Q&A: Yoga Nidra, Restorative Yoga, Meditation and Savasana

Q:  I recently started listening to Rod Stryker's Yoga Nidra CD. I shut my office door at lunch, lay out my mat and this week have finally made it through the short session without falling asleep. (I don't like writing "made it", as that sounds like a burden and it's not, it's wonderful). This started me wondering about the difference in the expected results between Yoga Nidra, the restorative yoga that I sometimes do at night, meditation (which I'm definitely a novice at), Savasana...
 
I want to thank all of you for your efforts in sharing your thoughts. It is a gift that I appreciate very much.”

A: Thanks for this great question, about which I could quite honestly get long winded, since several of the topics are quite complex.  I will try to be succinct in sussing out a few helpful distinctions.  I’d like to start by talking about restorative yoga for a moment. The name kinda gives this one away: the practice of these supported asana are said to be restorative for the practitioner.  Well, on what level?  Could be physically, mentally, emotionally, or even spiritually restorative. These postures are usually done on the ground either sitting or reclining over supportive props. A few we have looked at on this blog include Supported Savasana, Supported Reclined Cobblers Pose, and Supported Child’s Pose.  Once you get set up in the pose, you are simply allowing your body to rest in the position you find yourself in. From there, you could conceivably do some sort of meditation or listen to a recorded yoga nidra, as this writer has been doing lately.  To view and read more about restorative yoga, check out Judith Lasater’s classic book Relax and Renew.

Savasana, which has come to be associated as the final pose of the physical practice of yoga in most classes around this country, is done in the supine position.  In its simplest form, you simply lie down on your back without any support other than your sticky mat. However, you could do a more restorative version, or at least more supported version, like our version with the shin bones up on a chair seat. Its purpose can be to simply provide a brief rest for the physical body following your active asana practice, or it could be an opportunity for a guided meditation led by your teacher or a recording, or a self-guided meditation such as simple moment-by-moment breath awareness.  It has been proposed by several of my teachers that Savasana has the purpose of allowing the practice to be integrated into our bodies and minds to assist in gradual changes brought about by yoga. It is likened to letting a cake “set-up” on the counter after baking in the oven to allow the flavors to fully blend and mix before biting in for a taste. I love those food metaphors!  Now I want a piece of cake!

Meditation is a huge topic, but suffice it to say that we often do several simple meditation techniques in modern yoga classes that are “mindfulness exercises” in which we keep bringing our awareness back to a predetermined focus for the period of the meditation. Paramount among several possible purposes is the famous one from the Yoga Sutra of Patanjali, to quiet the mental chatter or “fluctuations of consciousness” (as one translator put it).  However, there are other purposes both in the hatha yoga tradition as well as aligned traditions, such as the Buddhist tradition, including using your meditation to transform the suffering of others into an inner peacefulness.

And finally, the yoga nidra we practice today was developed by Swami Satyananda Saraswati in the 1940s, and is discussed in his book Yoga Nidra. In his book, he claims to have developed this yoga nidra technique, which I feel is a kind of near subliminal suggestion or learning, by blending a seated meditation practice that is very old with more modern psychology techniques. And, just as in the CD our questioner has been listening to, even though you are encouraged to stay lightly awake and attentive during the session - which is usually from 20-45 minutes in length (a whole lot longer than our usual Savasana!) - you supposedly still get benefits even if you fall asleep.  In addition to the deep sense of relaxation that usually results, you are asked to set an intention or sankalpa at that the start of the yoga nidra. You are choosing, essentially, something that you want the yoga nidra to help you bring to fruition. You are asked to remind yourself of the same intention at the very end of the practice as well, so it is at the forefront of your consciousness when you are done.

So, these four tools of yoga share some similarities, yet they each have some unique distinctions as well. Hopefully this discussion will start to bring greater clarity to each of them for you. And they are all wonderful to practice, so try them out this coming week in your home practice to see what differences you can observe yourself.

—Baxter

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The Power of Fact Checking: Timothy McCall on Elephant Journal

by Nina

Buddha Waiting for Spring by Michele Macartney-Filgate

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

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

My favorite fact is this one:

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

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

I also love Timothy’s conclusion:

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

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

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When to Transition to a Gentler Practice, Part 2

by Nina

"At ninety-three, he could still perform difficult asanas--including variations on the headstand many younger "masters" could not. When he was ninety-five, however, he fell and broke his hip. Because of the reputation of Krishnamacharya, several leading surgeons offered to operate—but he would have none of it. Instead, he rigged up pulleys and ropes by his bed and began to experiment with new Yogic techniques for his own rehabilitation. Within two months he was able to walk, but the loss of full freedom of movement depressed him." —from Health, Healing and Beyond by T.K.V. Desikachar (about his father Krishnamacharya)

In Baxter’s post yesterday When to Transition to a Gentler Practice, he quoted a letter we received from a reader asking for advice about when to transition to a gentler asana practice. This is not the first time we’ve received such a question; in fact, this is probably the most frequent question we get here on Yoga for Healthy Aging. I suspect that most people with this question are hoping for some kind of formula from us, saying for example, if you can no longer do x, y, and z poses, it is time for your transition or most people should make the transition by age 65. But as I said to Baxter, I really feel that if you are asking the question, it’s not time yet. Because when the time comes, you will know it. Maybe you will be like Krishnamacharya, who had to change when he was 95. Or maybe you will need to transition much earlier, the way I did.

In my forties I had a rather strong, what I like to call “semi-fancy” asana practice. I took an advanced yoga class, did challenging poses like arm balances, full Lotus, advanced backbends, etc., practiced about two hours a day, and did long inversions almost every day (including a ten-minute headstand with variations and a ten minute Shoulderstand). I quite enjoyed the athleticism of my practice, and the feeling of strength and physical wellbeing it brought to me. By my fifties, however, I developed certain physical problems, probably brought on by menopause, which forced me to change my practice. Mild arthritis in my right hip meant that I could no longer do Lotus or even half Lotus and that I had to start using props in certain other poses. And two rounds of frozen shoulder (who knew you could get it more than once?) temporarily restricted my range of motion in my shoulder so that I was very limited in what I could do with my upper body, and after the frozen shoulders abated, I was never able to get my full range of motion back (though I’m still flexible in that area, compared to some).

I practiced asana throughout all these difficulties, adapting my practice as my restrictions increased and then decreased. While my shoulder was frozen, I couldn’t even do Downward-Facing Dog pose, much less Headstand, Handstand, or Upward Bow pose. So my practice was by nature very gentle. After I got better, I began to gradually ease my way back into the poses I couldn’t do with my temporary injury, and I’m still working on getting back to where I was (realizing, of course, that I may never get there).

Hidden Waterfall by Brad Gibson

When I was able to do Headstand again, I made a conscious decision not to do it as often or as long as I used to. I felt that it was a pose I enjoyed so much, I didn’t want to risk losing it again, and I knew that both Headstand and Shoulderstand would be pretty hard on my neck. So I decided to practice it only about twice a week and only for about 5 minutes each time, instead of the way I used to practice it. I had absolutely no scientific evidence that this was a good idea, and it was not suggested to me by any of my teachers, it was just a feeling I decided to follow. And it can’t hurt to be cautious, right? Removing the long inversions from my practice also made it shorter, so now my practice is more in the 1 1/2 hour range (and sometimes shorter, if I’m tired). As it happens, I never had to leave my regular (intermediate) yoga class. That’s partly because I know how to make modifications to my poses (or do alternatives) when there is something I can’t do. But it’s also because my teacher has been very supportive and understanding. (Once he said something about me—thank you, Donald—that I’ll never forget: “Nina never gives up!”)

The point is, my transition has been a very organic process, in which I’ve responded to signals from my body (some rather loud, others perhaps not) and made adaptations along the way. It hasn’t all been a one-way process, either. During times of difficulty, my practice was very gentle, and when I was more able, I returned to a stronger practice. And I also know, the transition process is not over yet. Who knows what the future holds. Will I be still be doing Headstand at 95 like Krishnamacharya? Or will I have to give it up much earlier?

Baxter, too, has gone through a similar process, with physical problems (including a touch of hip arthritis) prompting him to modify his practice. And that’s how I think it will turn out for most of you, dear readers. Perhaps you will have an injury or illness that forces you to change your practice, either temporarily or permanently. Or perhaps you will simply reach a point (who knows at what age?) when you can just no longer do the poses you used to be able to do or get through an entire class the way you used to, and you’ll know deep down inside that now is that time for a change. Like the future, this process is both inevitable and completely unpredictable. But it is your own body that will guide you through it.

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When to Transition to a Gentler Yoga Practice

by Baxter

Meadow, Forest, Fog, Sky by Brad Gibson

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

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

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

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

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

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

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

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

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Range of Motion: Yoga's Got It Covered!

by Nina and Shari

Moving the Shoulder Joints

In the spirit of trying to focus on the benefits of yoga practice (see We Didn't Mean to Scare You) and not just potential problems, I’ve asked Shari Ser to work with me on a series of posts about the special benefits of yoga asana practice. One of the special benefits of yoga asana practice that I’ve really come to appreciate in recent years is how helpful it is for maintaining and/or improving range of motion in our joints. Yeah, I know that sounds kinda nerdy—and “range of motion” is definitely a technical anatomical term. But I really feel it is worth understanding this concept and why it is one of the ways in which yoga is such a wonderful and versatile form of exercise. I decided to start by asking Shari to go over the basics.

Nina: What is range of motion?

Shari: Our bodies move through space because of the unique construction of how our bones fit together to form joints. Muscles are what make these joints move through space; physical motion is caused by muscle contractions. All joints in the human body have an optimum amount of motion, but specific joints in the body, such as hip joints or shoulder joints, don’t move the same way due to unique architectural constructs. When we describe joint motion we are talking about how much movement occurs at a specific joint, and this motion is called the RANGE OF MOTION (ROM).

All joints of the human body have a prescribed degree of movement. Range of motion is described very precisely by medical professionals, and they have determined specifically how much motion a shoulder joint has, a knee joint has, a thumb joint has, and. These measurements are considered the "normal" range of motion of the joint.

When a joint moves more than the prescribed degree of normal movement, that joint is called “hypermobile.” (Have any of you had a yoga teacher tell you that one or more of your joints is hypermobile?) When a joint moves less than the prescribed degree of normal movement, that joint is called “hypomobile.” There is also a basic principle regarding joint movements: the more flexibility, the less stability; the more stability, the less flexibility.

For those who have an overly mobile joint, we can practice yoga to gain stability and strength to control our excessive flexibility and ROM.

For those who have limitations in ROM, which can be caused by muscle weakness, muscle tightness, arthritic boney changes where some barrier is stopping movement (like bone spurs), inflammation and swelling from acute injuries, yoga can be used as a therapeutic modality for ROM gain. 

Nina: Yes, I have often heard from my teachers, that students who are overly flexible need to build strength and stability and students who are tight need to work on increasing flexibility. And since we have both stretching and strengthening in yoga, it’s perfect for both groups. But let’s talk now about why range of motion is important for healthy aging.

Shari: A yoga teacher once said to me, “I do yoga so I can do the other things in my life that are important to me.” I don’t think I understood her comment way back then, but now in my 50’s I definitely do! To maintain optimum ROM throughout all my joints allows me to continue to be independent and take care of my business. Several posts back, Baxter talked about independence in seniors when he visited nursing homes or assisted living facilities (see Transferring and Yoga: Wisdom from Jane Fonda). It is the little things that we take for granted, like bending down to pick up a paper clip or tying our shoes. If I didn't have full mobility in my shoulders, hips, back, knees, or the dexterity to do a fine task like tying my shoes, I would either have to change my style of footwear or ask for assistance! The other objective in keeping up your joint ROM is "use it or lose it." Putting your body into positions (asana) that it might not do daily allows for ROM maintenance, keeping arthritis at bay, keeping muscles strong and healthy, and encouraging full body circulation by the squeezing and soaking that asana encourages.

Nina: Why is yoga better than other forms of exercise in maintaining ROM in joints?

Shari: If you have limited time to exercise and are looking for the best type of exercise for ROM, yoga is often recommended. But why wouldn't another type of full body exercise like walking or swimming be just as good? In our yoga practice we rarely do the same routine daily. For a well rounded yoga practice—whether we are in a class or practicing on our own—we vary what we do. We emphasize different motions to cause our joints to move in many different ways and directions. Some days we might choose to do standing poses and focus our practice on hip motions or our spinal motions like twists or forward bends, or backbending. Other days we might emphasize our shoulders and spines in backbends or inversions. Our choices are practically limitless and often depend only on our skill set, time and focus. In other types of exercise like walking, we might vary our walks by emphasizing a hilly walk or a walk with a lot of stairs. We can vary our speed of walking and our stride length. We can certainly walk to increase our heart rate, and we can definitely bring our hearts into a training zone. But walking does not improve our ROM and quite often can actually make us less flexible. Swimming, another full body exercise is also quite popular, and while it definitely can improve ROM through varied strokes and resistance, it does not fully involve all our joint ROM like yoga.

In addition, the beauty of yoga for ROM maintenance and improvement is the adaptability of asana to meet us where we are. With a skilled teacher almost every single yoga asana taught to a beginner can be modified to take into consideration ROM loss. With the usage of different props and static holding of an asana we can improve flexibility and motion significantly over time. The only downside is that yoga changes are slow and take patience.

Nina: That’s a great point about how all the poses can be practiced in one form or another, even by beginners, because that means that all the benefits for joint range of motion are available to every practitioner. So what kind of yoga practice would you recommend for someone who is concerned with maintaining and/or increasing range of motion in their joints?

Shari: Your practice should include a wide array of poses that are kept lively, with focusing on a different concept each time you practice. No daily practice should always be the same because we will not improve our abilities and an unvarying practice can lead to overuse injuries.

To maintain or increase ROM in a particular joint, such as your hip or shoulder joints, we need to challenge the joint we are focusing on. Taking the joint into a stretch and statically holding the stretch for up to 30 seconds will cause scar tissue to begin to stretch. The key point here is to make sure that the stretch feels broad and there is NO RIPPING sensation. This is when props might be suggested to make a pose more accessible, and then once the pose is understood, slowly removing the prop support so you have to "work a bit harder." There are plenty of techniques for stretching which all of us have touched on in the past so you might want to review these posts again (see How to Stretch among others). Also when there are ROM limitations on one side only, please only go into the range of movement for the stiff joint and limit the more flexible side. This will help you keep symmetrical in your practice.

Nina: Thanks, Shari! For me, at this point in my life, I really value how yoga includes such a rich variety of poses and ways of practicing that allow us to take our joints through a variety of motions. For example, the various standing poses, many with a feet-wide-apart stance, take your hips and shoulders through forward bending, twisting, backbending, and so on. I can’t do them all every day, so I try to balance my week by doing different standing poses on each of the days so by the end of the week, I’ve gotten through most if not all of them. I also do regular hip stretches to maintain ROM in my arthritic right hip—and so far, that’s been working well! 

And, dear readers, I hope this discussion helps deepen your appreciation of yoga asana practice. And if your practice isn't already filled with variety, I hope you'll be encouraged to start to mix it up!

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Qualifications in fitness for Mauritians. By Vic Goyaram

Qualifications in Exercise and Nutrition for Mauritians

Researched and composed by Vic Goyaram

Fitness qualifications

I decided to write this article after having received several queries from friends in Mauritius about fitness qualifications that they can obtain. To my knowledge there isn't any institution offering courses yet in Mauritius. I am sure there will be in the future given the growing interest in fitness education and the number of qualified and experienced people. We need more qualified professionals in Mauritius because we need to reach out to the maximum people, not only those in bodybuilding. 

I am putting together whatever I know about courses and qualifications in this article. It has been many years that I haven't been in Mauritius and if there has been any change, please feel free to add your own input.  Although I am writing this article from a Mauritian perspective, many readers from other countries may also benefit. Rest assured that there is something for everyone, irrespective of educational background. 

How can qualifications help you?

First of all, let it be clear that having qualifications does not qualify you automatically to be an expert. We have all known people who can be classified as follows:

• People who flaunt their qualifications but whose level of knowledge is rather low. There are lots of personal trainers who don't even look like they are into any form of exercise, let alone lift. 

• People who do not have any qualification but whose genuine interest for learning and long experience in the field really shows in how much they know in the field.  

• People who have no interest in the fitness world but who view fitness-related jobs as a way to make quick money and one good day decide to pursue a personal training course. A couple of weeks down the line you will see them teach the wrong things in gyms.

I have personally learned a lot from people whose qualifications I didn't care to look up. From their knowledge it is evident that they know a lot from experience, continuing study and open-mindedness to consider new ideas. Knowledge is constantly accumulating, more new things are becoming known and a lot of old ideas and beliefs are being disproved.  Therefore, we must be flexible enough.  

Qualifications can help you in the following ways:

• If you want to become a personal trainer, advisor, PE teacher or have a gym and want to give better coaching to others.

• If you are an athlete and want to increase your knowledge on sports training and nutrition that can give you an edge.

BUT NEVER FORGET THAT learning never stops. Even if you have a PhD in Exercise/ Nutrition Sciences there is still room to learn. You can even learn from someone who has no qualifications. Remain humble even in a situation when others are wrong and you may be right. There are so many new research findings in the fields of exercise and nutrition that there is so much more to learn. Don't give your qualifications a bad name. 

Routes to qualifications

1. The academic-formal education route

There are two ways to go about with this one. The first way is as follows:

Specialised degrees

Doing an undergraduate degree in the field of Biology, Biochemistry, Nutrition, Physiology and allied disciplines. After this degree you can either go into other professions (industry, teaching etc) but this qualifies you to a number of certifications that you can pursue which require that you have a degree in the above disciplines. I will tell you more about these later.

Courses at the University of Mauritius

The University of Mauritius offers good quality undergraduate courses in disciplines that prepare you for sports/ exercise related fields. Undergraduate education at the University of Mauritius is very good. Don't let anyone tell you that their degree is not good. The one who discourages you from studying a field you are passionate about deserves a slap.

There may be shortcomings at the postgraduate level in certain fields but undergraduate education at UoM is very good. A lot of UoM graduates remain unemployed in Mauritius but once they decide to let go of mommy and daddy's house and stand on their own feet abroad they will see the edge their UoM degree gives them. Even if foreign universities may require you to do equivalence exams you will be better than most students abroad. The following are the qualifications from the University of Mauritius that I have short-listed.

1. The Diploma in Sports Science & Recreational Activities. click for details

2. The BSc (Hons) Physiotherapy: Physiotherapists are key people in sports. Respect to physiotherapists. They are also trained to help children and elderly as their training is not sports-specific. I have a friend who is the physiotherapist for the South African Canoeing national team. She is very good and has a gratifying career. More details on the UoM BSc (Hons) Physiotherapy course click here. 

3. The BSc (Hons) Biology: This is the degree that I did with UoM 12 years ago. It is an excellent degree with the curriculum encompassing all aspects of living systems and the environment. With respect to our field you will be adequately trained in biochemistry, cellular biology, physiology as well as plants of pharmaceutical importance. With this degree in your pocket you will be equipped to go into any field dealing with living things.  For my final year I did my research project on human nutrition (mineral bio-availability). I was also able to do mini-research projects on plant antioxidant biochemistry. Personally speaking, this qualification helped me obtain employment in the field of Agriculture, horticulture, plant pathology and medical diagnostics before I undertook exercise biology as my future career course. Every single thing that I have learned from my degree has helped me subsequently. Click here for more details. 

4. Specialised Physiology/ Biochemistry/ Nutrition/ Food Science degrees: If you decide to be a specialist from undergraduate level itself then you need to fly abroad to study. There are many options in the UK, the Americas, Australia and other European countries but not everybody has the money to go to such countries. An excellent foreign study option remains India. There are many good universities in India that you can afford with more or less the same amount of money you'd spend for a degree in Mauritius. There are also South African universities that rank among the world's finest but the downside is that they are quite expensive, although not as expensive as Europe/ US/ Canada/ Australia. An undergraduate degree may cost about Rs. 1.5 million. I recommend the following universities in South Africa:

University of Cape Town

University of Kwa-Zulu Natal

University of Stellenbosch

Some can take it further and go on higher degrees. The job prospects are numerous provided one is versatile. University Lecturer/ researcher in exercise science, formulations R&D scientists for supplement companies, scientific writer for magazines, scientific coaches. It takes so much time and massive efforts that sometimes it pains and you have to be really passionate about it or else don’t do it. It is really tough. You may need to spend 10 years at a university to reach this level and spend a boatload of money and undergo sacrifice. This is especially true if you choose to be independent or do not come from a family who has money. Ask me about it. 

For people having degrees in other fields

If you are pursuing a degree in other fields (commerce, accounting, engineering etc) and are interested in getting a training/nutrition certification then it is possible as there are many reliable ones that you can acquire that do not require a specialised degree. You will learn more about these below.

2. Online Accreditations

You have to be very careful with online course providers. There are many scam artists on the Internet offering one-day fitness certifications. In my opinion, one of the best online course provider is the International Sports Science Organisation (ISSA).  It is based in the USA among it's panellists are Dr. Sal Arria, Dr. Fred Hatfield, Dr. Thomas D. Fahey, Dr. John Berardi, Dr. William J. Kraemer as well as highly knowledgeable bodybuilding legends like Bill Pearl and John DeFendis. I have helped friends obtain their ISSA qualifications, especially their nutrition certification. 

The ISSA offer training and nutrition certifications and it is not difficult to pass exams provided you put the effort in. With an SC certificate these courses can be done from Mauritius itself. For more information:

Click here to visit the ISSA website

2. Professional Certifications

a. The International Society of Sports Nutrition (ISSN)  

Click here to visit the ISSN website

The ISSN was founded by Dr. Jose Antonio, Dr. Richard Kreider, Dr. Susan Kleiner, Dr. Doug Kalman and Anthony Almada. It is a non-profit and academically-based society for the promotion of sports nutrition and applied nutrition. The ISSN is recognized by leading organisations and universities worldwide and also has a scientific journal where research and reviews are published by researchers worldwide. ISSN is the real deal. 

The ISSN offers two main sports nutrition certifications, namely the:

• The Sports Nutrition Specialist (SNS): If you have an HSC and are above 18 you can do the SNS.  You require a knowledge of basic exercise training, general nutrition and sports supplements. If you are in Mauritius you will need to get a Biology/ Health professor at a university invigilate you while you write the exams at a pre-determined time.  The SNS is definitely worth the investment. For more details about the SNS click here. (Yo! I didn't mean "lick" but click)

• The Certified Sports Nutritionist (CISSN): If you have a master’s degree or a 4-yr undergraduate degree in the related disciplines you can do this. If you have a degree in an unrelated field there are some conditions that should be met.  You must get a professor to invigilate you for the exams or you can take the exams in America at the ISSN conference (expenive). For more details on the CISSN credential and how to obtain it please click here to find out more. 

b. National Strength and Conditioning Association (NSCA)

Click here to visit the NSCA website

When it comes to training certifications honestly I don't know better than the US-based NSCA which has been founded in 1978. The NSCA bridges the gap between science and its application and its certifications are the most sought-after in the industry. NSCA certifications are also recognised worldwide. The famous Journal of Strength and Conditioning research (JSCR) is the published by the NSCA.

Below are the major certification courses offered by the NSCA:

The NSCA-CPT (Certified Personal Trainer)
To become an NSCA-CPT you will need HSC plus some experience in training. You will have to take an intensive exam at an examination centre. The closest for Mauritius is South Africa. The NSCA qualifies CPT specialists as follows:

"Health/fitness professionals who, using an individualized approach, assess, motivate, educate and train clients regarding their health and fitness needs. They design safe and effective exercise programs, provide the guidance to help clients achieve their personal health/fitness goals and respond appropriately in emergency situations. Recognizing their own area of expertise, personal trainers refer clients to other health care professionals when appropriate". More details here.

The NSCA-CSCS (Certified Strength and Conditioning Specialist)

This uses a more scientific approach to training and coaching. It requires a post-secondary qualification. Exams are held abroad. South Africa is the option for Mauritians. A lot of professionals have it. The NSCA qualifies CSCS specialists as follows:

"Professionals who apply scientific knowledge to train athletes for the primary goal of improving athletic performance. They conduct sport-specific testing sessions, design and implement safe and effective strength training and conditioning programs and provide guidance regarding nutrition and injury prevention. Recognizing that their area of expertise is separate and distinct, CSCSs consult with and refer athletes to other professionals when appropriate". More about the CSCS certification". More details here. 

The NSCA-CSPS (Certified Special Populations Specialist)

People with special needs like those with disabilities or medical conditions can also benefit from exercise. Special populations specialists are well equipped to attend to these people. The NSCA qualifies CSPS specialists as follows:

"fitness professionals who, using an individualized approach, assess, motivate, educate, and train special population clients of all ages regarding their health and fitness needs, preventively, and in collaboration with healthcare professionals. Special populations include those with chronic and temporary health conditions. CSPSs design safe and effective exercise programs, provide the guidance to help clients achieve their personal health/fitness goals, and recognize and respond to emergency situations. Recognizing their own areas of expertise, CSPSs receive referrals from and refer clients to other healthcare providers as appropriate". More details here.

Feel free to write to me if you need any guidance about the fields of study to choose. Also chat with others who are experienced in this field. My email address is vicgoyaram@gmail.com.  It takes a lot of sacrifice to get these qualifications but at the end of the day it is worth it. There is no easy way out. You have to sacrifice to gain. 

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Friday Q&A: Has Yoga Changed Your Life?

A: I wanted to share with you some feedback I received from one of my Yoga Journal Doctor's Orders blog readers about a post on yoga for musicians. With the permission of the author, here is the letter:

“Dear Baxter,

I wanted to write and thank you for the great article you wrote about musicians and yoga that was posted online at Yoga Journal.

As a 53 year old musician (opera conductor since 1997, pianist since I was 4) my body certainly suffered its share of wear and tear. I’ve found most of my professional musician friends (classical and otherwise) deal with the issues you put forth.  We conductors are particularly prone to nasty issues of back and hips.

2 years ago, at the recommendation of my physician, I finally went to my first yoga class. My upper and lower back were in such chronic pain that the only way I could sleep at night was to keep my arms over my head and take ibuprofen. My sister, herself a PT, searched around the Seattle area where I live and found Aadil Palkhivala’s studio. Long story short, after one year of working with his excellent teachers, I was off the pain meds completely and sleeping comfortably in a normal position.

For me, Aadil’s slow and methodical approach with emphasis on alignment and safety was perfect. And the meditation that he and his wife encourage did wonders for my concentration and relaxation even in performances. I take a few moments to meditate even during intermissions in my dressing room and the reaction of orchestra players has been amazing. Who knows, maybe I’m giving off a different vibe or my body language is more confident and relaxed now that my shoulders are not up around my ears and my chest doesn’t cave in from holding my arms in front of my body!

I also use my time on the road to experience other styles of yoga. I’m finding that Ashtanga and some forms of vinyasa are excellent partners to the classic hatha/Iyengar style that Aadil’s studio teaches. At least for my purposes as a conductor, they encourage me to find strength and grace as well as the stillness that every conductor needs. And for the first time in my life, as a 6’3” tall gangly slim guy I actually like my body now.

Best,
One Happy Conductor”

There are several specific reasons why I wanted to share this letter with you.  First off, it is an inspiring account of a person (who just happens to be a pianist and orchestral conductor) who suffered from chronic lower and upper back pain but who now is finding amazing relief via yoga. Second, the benefits derived are both due the physical practice of asana or poses and the meditation techniques that so powerfully influence the mind. Finally, I was personally and professionally pleased to see that his physician recommended yoga for him, illustrating the increasing awareness by the medical community of the health benefits of yoga. I hope you found this reader’s letter as inspiring as I did! And it is nice to note that our happy conductor has found a blend of yoga asana styles beneficial for the various facets of the work he does!

Q: This week, for a change, I have a question for you: Has yoga changed your life?

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We Didn't Mean to Scare You!

by Nina

View from 1/2 Mile Marker by Brad Gibson

Many years ago—has it really been that long?—I was talking with Rodney Yee about yoga and safety. He was a bit fed up with the topic and impatiently blurted out something that I will never forget:

“You can get hurt sitting at your desk!”

It was so true, I had to laugh! Just think about it: physical injuries, from paper cuts to back problems and carpal tunnel syndrome, are common to desk sitters. And people who exclusively sit all day (at desks and cars and in front of their TVs) and avoid any forms of exercise, often develop life-threatening conditions, such as obesity and heart disease, as a result of being too sedentary. But all of that doesn’t mean anyone is going to tell you never to sit at a desk! In fact, as a writer, I do it every single day.

I was thinking about his statement because we recently got the following comment from one of our readers:

"Sometimes I am concerned, after reading these posts, that there is nothing left in the yoga practice that is okay to teach. My own thought about practice is, if I'm not feeling something, why bother? I know most of my students feel the same way. And I'm becoming very apprehensive about teaching anything because there is always someone for whom the posture or movement is not safe or recommended. And yet, there might be 19 out of 20 for whom it is delicious. How do I know when to hold back? And at what point, in each person's life, does one start to shift from a strong practice to something more gentle? It, obviously, is very individual, so, as a teacher, how am I to know what to recommend, collectively?"

My initial reaction to this comment—especially the phrase “there is nothing left in yoga practice that is okay to teach”—was sadness. That’s because, well, we didn’t mean to scare you! So for today, I just want to point out that yoga asana practice is indeed similar to sitting at a desk. Just as you often get some common sense tips for healthier desk sitting (such as, sitting with good posture and in a good chair, not sitting for too many hours in a row, etc.), we’ve been providing what we hoped we’re helpful tips for approaching the practice (and teaching of) yoga in a healthy way. So, my sincere apologies for scaring anyone.

We’ll be addressing more of the issues that this reader raised in the future. But for now, I’ll end by saying that when I teach yoga, I try not to worry too much about teaching every student “perfectly.” Instead, I remember back to when I was a student in my office building yoga class—I was just so grateful to be moving during my lunch break! You see, as a writer, I know from experience that one of the best ways to practice healthy desk sitting is by balancing it with a regular yoga practice!

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