Ankylosing Spondylitis and Yoga (Not Yoga for Ankylosing Spondylitis)

by Shelly Prosko, PT, PYT, CPI

Sunflower in Bouquet

I recently had a physical therapist colleague ask me for some advice for some yoga poses that might help her client who has ankylosing spondylitis (AS). I explained that there are certainly some poses I would share with her that could potentially address some of the general commonalities of the symptoms of AS and how people with AS may present in similar ways, but I also explained I thought it was important for her and her client to understand that: 

1. Therapeutic yoga is so much more than prescribing poses for a particular dysfunction or special population.
2. The phrase "yoga for ankylosing spondylitis" (or any diagnosis) tends to suggest, in my opinion, that we are using a reductionist approach and falling into the trap of treating/addressing a diagnosis instead of a person who is a living, breathing, moving, thinking, feeling and reacting being, who is connected to and affected by the surrounding environment. Every being consists of complex systems and layers, each one influencing the other, including the nervous system, digestive system, musculoskeletal system, hormonal system, immune system, integumentary system, and emotional, social and spiritual layers, just to name a few.

That being said, there are certainly some common physiotherapy exercises and yoga methods that can be used for people looking to optimize spinal and rib mobility and alignment, maximize breath patterns, improve pain management, and/or calm the nervous system. But I suppose that would be a really long title for this article.  

I can appreciate how it's easier to simply say "Yoga For ( diagnosis )"; and I would assume we all understand that we're making generalizations that aren't to be used as prescriptions or individual therapies, but simply outlining some potentially valuable guidelines in order to help people. So, for the record, this article is not meant to be interpreted as “Yoga for Ankylosing Spondylitis.” I want to be clear that I strongly believe in “Yoga For the Individual Person” and his or her unique physical, mental, emotional, energetic, and spiritual states, which are constantly changing and responding.

Keeping this in mind, I'd like to share the response to my colleague's request. One of my yoga students, who happens to also have AS, was willing to demonstrate some physio and yoga techniques that I chose for this case. A short interview with him is also included at the end of the video about how yoga has helped him manage his AS symptoms. I hope you find the video valuable and perhaps even worth sharing with someone who you think may benefit from it: 

About Ankylosing Spondylitis

AS is a chronic inflammation of the joints of the spine and is considered to be an autoimmune disease. For reasons we do not know (although, there is speculation and theories presented) the body receives a trigger that tells it to “attack” itself. The body can potentially then go into repair mode, causing excess bone formation, which explains the fusion of joints that is sometimes seen in advanced AS.

Some of the symptoms and complications of AS are:

• pain experienced in the areas of SI joint, spine, hips, shoulders, knees, ankles 
• stiffness/reduced mobility of spine
• reduced chest/rib mobility or expansion, resulting in decreased efficient breathing patterns
• fatigue
• osteopenia/osteoporosis
• digestion problems (IBS)

Some of the intentions of PhysioYoga therapy in this case are to:

• reduce the chances or severity of secondary complications as above
• help improve management of symptoms as above
• maintain and optimize joint mobility and alignment
• optimize muscle health and function
• maximize efficient breathing patterns (which can help improve movement)
• improve self management of pain
• increase self-efficacy
• optimize feelings of joy, pleasure, and gratitude
• maximize functional capacity and quality of life

Certain yoga poses, movements and breathing methods can help address posture, alignment, mobility, and stability as well as potentially address the energetic layer (combat fatigue, improve sleep) or produce a calming effect on the nervous system, which can help with such problems as pain management. Mindfulness or meditation practices, such as awareness, visualization or other methods of focus, can also potentially help with pain management, change the pain experience, and perhaps even reduce the chance that the genes associated with inflammation are expressed. Ram's previous posts "Chronic Inflammation and Yoga" and "Meditation: Effects on Gene Expression" shed further light on these topics.

There is currently no formal test to actually diagnose AS. The Arthritis Society states that although most people who have AS carry the HLA-B27 gene, most people with the HLA-B27 gene do not get AS. So, just because you have the gene, it doesn't mean you will get AS. The Arthritis Society states, "in fact, only a very small number of people with this gene will ever develop AS."

If your physician suspects you have AS, it is a good idea to get a referral to a rheumatologist to help guide and manage your care. PhysioYoga can be used as a valuable and beneficial complementary therapy to your current medical treatment. I highly recommend following and continuing with your medical treatment plan, in addition to finding a physical therapist or health care professional in your area who is trained in integrating yoga therapy and nutritional therapy into his or her treatment sessions (online directories of practitioners across North America are here and here). Or perhaps a yoga therapist or teacher in your community can work together with your physical therapist and health care team for optimal success and safety.

With education, supportive treatment as needed, and guidance, people with AS can have active, meaningful, happy lives and relationships filled with vitality and longevity. 

Disclaimer: This article and video is not meant to diagnose, treat or act as medical advice. Please consult your health care provider for clearance and guidance before following or participating in these activities.

Shelly Prosko is a Physical Therapist, Yoga Therapist and a Certified Pilates Instructor. She received her Physical Therapy degree at the University of Saskatchewan, Canada in 1998, her Yoga Therapist training through Professional Yoga Therapy Studies in North Carolina and her Pilates certification through Professional Health and Fitness Institute in Maryland. 

Since 1998, Shelly has been integrating yoga principles and methods into her physical therapy treatments. She has treated a wide variety of musculoskeletal, neurological and cardiorespiratory  conditions while working in private orthopaedic clinics and long term care facilities across Canada and the United States.


Currently, Shelly resides in Sylvan Lake, AB and travels across Canada and the United States offering specialty Physio-Yoga Therapy workshops, classes, private sessions, lecturing at University and College programs as adjunct faculty of Professional Yoga Therapy Studies, teaching at YTT’s and actively promoting the integration of medical therapeutic yoga into our current healthcare system. She believes that bridging the gap between Western and Eastern healthcare philosophies is essential in order to achieve optimal health. Her treatments are individually based and are a unique blend of both approaches. Please visit www.physioyoga.ca for more information about Shelly’s mission and services, and to read a variety of testimonials of how PYT has profoundly influenced many people’s lives.

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Drawing Inside and Quieting: Roger Cole on Savasana, Part 2

Drawing Inside by Melina Meza

Here is the second excerpt from the interview that Leslie Howard did in 2008 with yoga teacher Roger Cole. In this excerpt he talks about his own practice of Savasana, compares seated meditation with Savasana, and gives his recommendations for setting up and practicing the pose.

And speaking of Savasana, this will be our only post this week, as we're  on vacation. Even bloggers need to take a rest. —Nina 

 Leslie: Have you had any special experiences with the pose, either in your own practice or with students?  

Roger: Not really. There isn’t one that stands out for me. Restorative asana experiences—Ssavasana being one of them—many times I have had resting poses or Savasana in which I just really feel like this is exactly what I need and what everyone needs—everyone needs to do this sometime. Take the time when you would not ordinarily be sleeping, and lie down and just stop. It is different from seated meditation. Seated mediastion is wonderful in its own way. In Savasana and the other more reclining poses, the brain just shuts off. In the seated pose you are very, very alert. Seated meditation is really good for this deep realization in which you you see the connection between things. In Savasana it is more like you are drawing inside and quieting, and you are observing the quietness. There is a lot less activity in Savasana.  

Leslie: Do you always practice Savasana in your own practice?

Roger: Ideally, yes but in reality no.  

Leslie: When you take the time to do it, what is your preferred method?

Roger: First of all, I am very big on restorative poses and sometimes I will substitute a restorative pose for Savasana. Now ideally Savasana is the last pose because it is the most neutral; no part of the body is elevated over the other, nothing is particularly stretching, especially if you support the arms and stuff. So if I had the ideal Savasana, I would be almost completely neutral, with maybe a little elbow flexion so I could stay longer, maybe padding under the head not to lift the head but to make it not hurt. I personally don’t need padding under the knees but padding under the heels so that the heels don’t hurt. So I make it comfortable. 

The other thing that a lot of people don’t realize about Savasana and other restorative poses is that temperature is extremely important. You get cold. And if you get cold it is just not a relaxing experience. So I am very conscious of the room temperature, and if you need to be covered with a blanket in Savasana and other restorative poses, you need to cover the hands and feet. Don’t just cover the trunk and have the hands and feet sticking out. So in my practice of Savasana ideally it would be the last pose even if I do a lot of other restorative poses. But in reality there is a time limit so if I end up staying in another pose longer well than Savasana gets shortened. Same thing when I am teaching; ideally I would like to put it at the end of every class but sometimes I just run out of time.  

Leslie: Are there any special circumstances or conditions for which you think Savasana is particularly valuable? 

Roger: One of things is that Savasana is the quickest, most generic pose. When it comes time to relax, just lie down. You can do it on a bed, which is actually very important. Bedrooms are set up with a bed so you can lie on them. Of course they have blankets and such, but the availability of having a space to do it is extremely important. If you just lie down on a dirty floor you might not relax, or if its cold or too light or in a traffic area, the bed takes care of all that. Of course, it is a little soft but its there and its available. 

In a yoga class situation, with students that have never done yoga you don’t what to do some strange thing with them in Savasana, maybe with support under the knees because that is very non threatening and it’s very intuitive. So, it’s got a lot of benefit. It doesn’t have a lot of the problems of being uncomfortable or they can’t hold it or their knees hurt or whatever. But if you are going to put people in it a long time, you are going to have to prop them up. So I think it would be particularly valuable for quick relaxation. Also, some kind of relaxation is valuable, but it doesn’t always have to be specifically Savasana. 

You asked me if there were times Savasana should be avoided. So with some kinds of back pain, such as when people have a facet joint injury, it’s too much back bend, but you can modify the pose. Generally it is a pretty easy pose to do. Also if the nose is congested, prop them up and it can be used to drain the nose. 

What about emotionally? Emotionally if someone has had a trauma, like after an earthquake or something like that or a terrorist attack, people are often afraid to close their eyes, to lie there with their eyes closed is very frightening. Also I have had a couple of deaf students and they don’t like to close their eyes because once they close their eyes in Savasana, they don’t know what is going on in the world, although they will do it. They can hear enough through their hearing aid to know when there is shuffling around, but it’s a little tricky. 

So in those instances Savasana with eyes open is a good pose and if their eyes close, apparently they have gotten over it. 

Leslie Howard is an Oakland-based yoga teacher, specializing in all things pelvic. She leads workshops and trainings nationally and internationally, and is the director of the 200 hour Deep Yoga program at Piedmont Yoga. With a state certification in massage, she also practices cranial sacral therapy. To learn more about Leslie, visit: www.lesliehowardyoga.com.  

Roger Cole, Ph.D. is an internationally recognized, certified Iyengar yoga teacher trained at the Iyengar Yoga Institutes in San Francisco and Pune, India. He is also an accomplished scientist educated at Stanford University and the University of California, with specialties in the science of relaxation, sleep, and circadian rhythms. Roger has taught yoga since 1975. He has authored dozens of articles on yoga teaching, practice, biology and therapeutics, including Yoga Journal's Anatomy Column, Master Class Column and Ask Our Expert Column, Yoga International's Asana Solutions Column, and special feature articles on the prevention of yoga injuries, the physiology of stress, relief from back pain, and the science of keeping your balance. He has trained thousands of yoga teachers and taught yoga as a healing art to physicians, physical therapists, medical students and patients. He offers weekly classes in Del Mar, California, and conducts workshops throughout the U.S. and abroad. His specialties include yoga teacher training, yoga anatomy, yoga physiology, restorative yoga, and promotion of better sleep. See rogercoleyoga.com for more information.

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The Mind Coming Into Equilibrium: Roger Cole on Savasana

Circle of Light by Melina Meza

This week and next I'll be posting excerpts from yet another interview from the never-written book on Savasana that I was—at one time—working on with my friend yoga teacher Leslie Howard. Back in 2008, Leslie did a good long interview with one of my favorite teachers, Roger Cole,. Let’s start today with their conversation about the benefits and importance of Savasana.

And speaking of Savasana, this will be our only post this week, as we're on vacation. Even bloggers need to take a rest. —Nina 

Leslie: What is Savasana and how does it differ from just lying down? 

Roger: The first difference is intention. When you lie down, you intend to be conscious, be aware, and be present. Lying down the mind tends to drift. So with your intention in Savasana comes the alignment—you get your physical body set up so you can be still and consciously observe your thoughts. Your intention is a type of meditation.

Leslie: What are the benefits of Savasana and why is it such an important pose?

 Roger: Part of it is physical and part of it is mental. But let’s just talk about what happens in your brain. You are processing impressions—the mind is doing things, observing things, or observing the results of your doing things, or memories are already in the mind while minimizing new input or effort. When you are in Savasana, we actively stop actively working in the world muscularly, and if our mind is set right, we can observe what is in the mind. It’s not that we stop processing—the mind is always going—but it’s going in a way that doesn’t require this executive function in the brain (the part of you that says, now I must do this , now I must do that). It doesn’t involve “I” at all. It’s an egoless watching, and with that I think what happens physiologically is that information gets processed—connections between nerve cells that need to be strengthened, connections that aren’t used much tend to diminish—so we actually change the brain patterns or they change or reorganize themselves.

I like to think of the impression of a forest, an ancient forest. It has been there for so long—holding still for so long—that everything is sort of coming into its own balance without anyone directing it. And so our own mind—if we just leave it alone—will come into its own equilibrium. We stop pushing it around, adding things to it. So a lot of the benefit of Savsasana is allowing the time to for the process to take place. 

It's also restful for the body; you give your heart and your muscles a chance to recover. Internal recovery function is analogous to what is happening in the brain—think of cells healing themselves as an information process. The brain is organizing proteins, reestablishing them, getting rid of waste. So it’s a rest period for the body and a reorganization period for the body.  

Leslie: Is there an ideal time of day and duration for Savasana?  

Roger: If I had to give a number I would say 15 minutes AT LEAST, and I think longer is actually better. If you stay in classical Savasana for say more than 20 minutes, things start to get uncomfortable, the back of your head gets uncomfortable, your arms by being straight get uncomfortable and possibly also the back, depending on how tight your hip flexors are. It tends to arch the back.. Judith Lasater will set up Savasana with the arms bent, support behind the head, knees slightly flexed, and leave you there for an hour. If you can stay in Savasana for an hour, that takes you to a whole other level. Which is a wonderful thing to have happen. Now, we should talk about sleep because I am a sleep scientist. So I have my particular point of view on sleep in Savasana. Regardless of the intention to stay awake, people do drift off to sleep. If the conditions are set up for sleep, people will fall asleep. The primary condition we all suffer from is not enough sleep in our daily lives. So we are all running around in a “sleep debt.” It’s like if you are hungry, you are going to eat, and when you are sleepy, you are going to sleep. It is an involuntary process. Almost any adult that is put into a dark room and told to lie in bed for 40 minutes and stay awake will fall asleep. I think a lot of sleeping goes on in Savasana, so even a small amount of sleep refreshes them enough so that they can actually practice the Savasana well. Of course, it’s also possible to go completely out.  

Leslie: When you have a student that is sleeping do you let them sleep, and if you have to wake them up how do you do it? 

Roger: My feeling is they need to sleep. Sleep first, then do your Savasana. To avoid this, firstly, get enough sleep or take a nap and then do Savasana. Don’t do Savasana right after getting up due to sleep inertia (left over sleepiness). Usually 10 or 11 in the morning is an alert time a day for most people where they haven’t been awake long enough to really get sleepy.

If you want an alert Savasana practice it in the morning; if you want to fall asleep in Savasana do it in the afternoon. In the evening it is a mixed bag because on the one hand you have been awake all day. On the other hand you have been awake all day and your body’s clock is alerting you. So your body clock has its strongest alerting effect in the evening, and if you have had enough sleep that usually overcomes the sleepiness and you are wide awake at 8 or 9 o’clock in the evening. But if you have a sleep debt, then you are going to fall asleep. The evening is a mixed bag but mid-afternoon most people will fall asleep in their Savasana. So if someone falls asleep in a class situation, and they are not snoring or disturbing everyone, I just leave them. If they are disturbing the class then I will have them rollover and do something face down or a forward bending posture because people are less likely to sleep in one of those positions. 

Leslie: When you are approaching someone that is disturbing the class, how do you wake them up without startling them?  

Roger: I try not to startle people. The first thing I do is walk past their head and often they hear me walking. That sound is a subtle noise and that often wakes them up. If that doesn’t work I might try just tugging their blanket. I try whatever I can not to jar them. 

Leslie: Do you always talk your students through Savasana?  

Roger: No, I usually don’t. I usually put people in the pose and then let the pose do the talking. Now I do have a story about that. I had a student once that came up to me and said I’m fine in Savasana until you stop talking and then I essentially start to freak out. When you are talking I go along and relax, but when you stop talking then I go to a place in my mind that I really don’t like and it’s very disturbing. So probably if one person told me that there are likely others that have had that experience and haven’t told me. But I am pretty non-directive. My whole approach with asana and Savasana is the postures are designed to create an effect. And if you do the postures well, the breathing that you need to do comes in the posture and the Savasana just comes naturally. So my ideal savasana doesn’t need any instruction.  

Leslie: Is that presupposing that the student is more advanced? 

Roger: No, it's not. It is not presupposing anything about the student except that they are human, because my belief is if you get the right sequence of postures for that person at that time, the right posture set up the right way. The intention is still there. So I say we are going to lie still now with initial instruction. Or, if the people have been coming to my class for a while, I may not even give instructions because they know my instruction intention is that they are going to lie there and be awake and very, very relaxed and whatever happens happens. And you are free, your mind is free to think of whatever you want without anyone’s directions. The only thing that makes it this practice is that you are going to stay there in the pose.  
Leslie Howard is an Oakland-based yoga teacher, specializing in all things pelvic. She leads workshops and trainings nationally and internationally, and is the director of the 200 hour Deep Yoga program at Piedmont Yoga. With a state certification in massage, she also practices cranial sacral therapy. To learn more about Leslie, visit: www.lesliehowardyoga.com.  

Roger Cole, Ph.D. is an internationally recognized, certified Iyengar yoga teacher trained at the Iyengar Yoga Institutes in San Francisco and Pune, India. He is also an accomplished scientist educated at Stanford University and the University of California, with specialties in the science of relaxation, sleep, and circadian rhythms. Roger has taught yoga since 1975. He has authored dozens of articles on yoga teaching, practice, biology and therapeutics, including Yoga Journal's Anatomy Column, Master Class Column and Ask Our Expert Column, Yoga International's Asana Solutions Column, and special feature articles on the prevention of yoga injuries, the physiology of stress, relief from back pain, and the science of keeping your balance. He has trained thousands of yoga teachers and taught yoga as a healing art to physicians, physical therapists, medical students and patients. He offers weekly classes in Del Mar, California, and conducts workshops throughout the U.S. and abroad. His specialties include yoga teacher training, yoga anatomy, yoga physiology, restorative yoga, and promotion of better sleep. See rogercoleyoga.com for more information.

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Friday Q&A: Brad's Recipe

Flaked Coconut

Q: The optional evening session we had with Brad during the YFHA intensive, where he talked with us about what aging is and what is really understood about the aging process—and patiently answered all our questions—was really wonderful. But even more wonderful were the cookies and brownies that he made for us! Would it be possible for him to give us his recipes?

A: So glad you liked the optional session on aging! That was something we put together at the last minute, when Brad generously offered his time. And I can't blame you for wanting his recipes because they are truly excellent. Fortunately, he's happy to share. To start, here's the macaroon recipe.—Nina

Chocolate-Chip Macaroons (Accidentally Gluten Free) 

These are five ingredient macaroons. Because they are so simple, the quality of ingredients is key. Be sure to use unsweetened coconut, which you can find at a health food store. And if possible use the thick-cut flaked coconut (we know you all loved that), rather than the thin shreds. Also splurge on high-quality chocolate chips. Finally, the almond flavoring is what really takes it to the next level so don't omit that! 

Ingredients

2 large egg whites (about 4 oz.)
160 grams white sugar (about 1 cup)
225 grams flaked or shredded unsweetened coconut (about 3 cups)
1/2 teaspoon almond flavoring
1/4 teaspoon kosher salt
130 grams small semisweet or bittersweet chocolate chips (about 1 cup)

Instructions 

1. Preheat oven to 350. 
2. Line two baking sheets with parchment. Beware: You need parchment paper (not wax paper) or the cookies will stick.
3. In one large bowl, whip the egg whites for about 20-30 seconds first, just to get them a little foamy.  Then slowly add the sugar and salt, and beat for another 20-30 seconds until its smooth and thickened a little.
4.  Now add the flavoring and coconut.  Mix well, then fold in the chocolate
5. Using a large spoon scoop cookies on each baking sheet. Use wet fingers to shape scoops into lightly heaped rounds.
6. Bake 15 minutes and rotate pans. 
7. Bake about 8-12 minutes more or until the coconut is nicely golden. If you like the coconut darker, leave them in the oven a few minutes more. (When Brad bakes in a convection oven, he sets the oven to 330 F, and the cookies are usually done after a total of 20 minutes.)  
8.  Let cool on the parchment.
9. You will have to peel the paper from the cookies, but they will come off. Move to a rack to cool completely. 
10. Store in an airtight tin with parchment between the layers.

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Neck Position in Camel Pose (Ustrasana) and Other Backbends

by Baxter and Janet Rae Humphrey

Margann Green, Age 77

We received this excellent set of safety recommendations for Camel pose for older adults from Janet Rae Humphrey, E-RYT, of YogaForStability.com in Scottsdale, Arizona, and wanted to share it with you all: 

Dear Nina and Baxter, 

As a yoga teacher who specializes in older adults ages 70 to 95, I would like to comment on your post Are Backbends Stimulating or Relaxing?

The photograph of Margann Green doing Camel inspires me to write about precautions that are necessary when teaching people over 70. At age 77 Margann’s ability to do a full Camel pose is remarkable and certainly shows the advantages practicing yoga as one ages. I see a distinct difference between the residents of senior living centers who have exercised all their lives and those who have not. The first group is far stronger, more flexible, and is less likely to use assistive devices. Those that begin a yoga practice in their later years also benefit greatly by the increased mobility that yoga offers. 

Camel is frequently performed and photographed with the chin up to the ceiling or the head tilting back even further. In yoga we follow the principle of doing no harm. Camel, therefore, as well as other poses, needs to be modified as we age. 

Baxter identified how aging affects the cardiovascular system in his post The Aging Heart: How Aging Affects the Cardiovascular System:

• Baroreceptors (see Why You Should Love Your Baroreceptors) become less sensitive with aging, which can contribute to sudden drops in blood pressure when you move from reclining to sitting or standing, and general dizziness. 
• The walls of the smallest blood vessels, the capillaries, can get thicker with aging, which could contribute to slower exchange of fuel and waste into and out of our body’s tissues. 
• Both the main artery leaving the left heart, the aorta, and other arteries in the body start to have changes in their connective tissue layers. This can lead to the vessels becoming stiff and less flexible, which in turn can make the heart work harder. 
• Arteriosclerosis, or hardening of the arteries (mentioned in #8 above), in which fatty plaque deposits inside the blood vessels cause them to narrow and which can totally block blood vessels. 
• Transient ischemic attacks or strokes can occur if blood flow to the brain is disrupted, as a result of arteriosclerosis, arrhythmias, and other factors in the CVS. 

These types of changes may affect the ability to do and/or the safety of a person assuming certain physical positions or yoga poses. 

I worked in the neurology department at several teaching hospitals and have seen the damage done by someone over 70 tilting their head back. Think stretching a piece of rubber tubing with fluid running through it. The shape changes from round to flat and the opening is greatly restricted. When the stretching stops, the fluid gushes through with increased pressure. 

When the head is tilted back, the carotid arteries in the neck become flat and the flow of blood to the brain is restricted. This can lead to a stroke or transient ischemic attack. Furthermore, when the head is lifted, blood rushes to the head, increasing the blood pressure. This becomes more problematic with aging because the baroreceptors are less sensitive to changes in blood pressure, the walls of the blood vessels are thicker, fatty deposits in the vessels further restrict the blood flow, and the capillaries in the brain are more likely to burst when they are under high pressure. 

One of the more common places for older women to have a stroke is in the beauty parlor when their hair is being washed. I mentioned this in a class I taught and one of my older students said that was where she had a stroke. 

I encourage your readers who teach people 65 and above to remind students to keep their chins tucked and not allow their head to fall back during back bends. One way to do this is to put one hand behind the head to support the head during a backbend. 

A second reason for older adults not to tilt their head back is the changes in the discs between the vertebrae as we age. Baxter discuss these changes in his post Degenerative Disc Disease and Yoga: 

"Degenerative disc disease is a process of change to the cushion-like discs found between the vertebrae or spinal bones. It most commonly affects the discs in the neck/cervical region and the lumber/lower back region. There is some ongoing debate on whether the deterioration of the discs is a natural part of the aging process (since it is seen in people without symptoms of back or neck pain in gradually increasing percentages as we age) or whether it is directly related to an abnormal condition of change in the discs. It is really part of the general wear and tear arthritic changes we see in other joints, as the discs represent a unique kind of cushion structure that is similar to the cartilage caps found on the ends of other bones in major joints of movement. But it is different from the regular cartilage in other joints in that it is a larger structure, not adherent to the vertebrae above and below it, as well as having a unique structure that distributes the intense force of gravity that travels down the spine in a specialized way. 

Not only do the discs degenerate, but they also lose moisture and become thinner and denser. Their cushioning ability decreases. A sponge fresh from the package is tall, soft and pliable. An old sponge that has been sitting on the counter is thin, dense and hard. The same is true for the discs as we age. The thinning of the vertebral discs is the major reason why we become shorter as we age. The natural padding in the spine degenerates with age and the cervical vertebrae can be crushed together when the head is tilted back. Older adults, both men and women, have a much higher risk of osteoporosis and can easily get compression fractures of the spine. Forward bends and twists can be hazardous for someone with osteoporosis because these postures can cause painful compression fractures of the spine. "

Poses performed in a supine position can also cause neck problems in older adults. If the student has hyperkyphosis or a tight front chest, their shoulders will not reach the floor in the same way that the shoulders of a younger students do. Because of the excessive curving of the thoracic area, the student will be lying on their spine and just the tips of their shoulder blades. In this position the neck is elevated off the floor and the chin is higher than the forehead because the entire back of the head does not reach the floor. One end of a folded blanked can be rolled to go under the neck and the other side folded to support the head so the forehead and chin are at the same level thus maintaining the correct cervical curve. 

These precautions are most important for people over 70, but they are good to consider in regards to younger students who have neck injuries, arthritis of the spine, tight shoulders, over developed musculature of the shoulders, arterial sclerosis, high blood pressure or other medical conditions that could cause changes in the arteries and the shape of the upper back. 

I remind my students, “Keep your neck in a normal cervical curve and in line with your spine. Being safe is more important than looking like the picture in the yoga book.” 

—Janet Rae Humphrey, E-RYT

Thoughts on Janet’s advice: 

First off, I am grateful to Janet for sharing her wisdom and experience with us regarding safety precautions specifically for Camel pose (Ustrasana), in which the head and neck are often taken into extension along with the rest of the spine. And I generally agree with her recommendations for modifications for those over 70 and even for younger adults who may have skeletal issues like cervical problems, pronounced thoracic kyphosis (rounding of the upper back), or osteoporosis. 

Keep in mind, however, that these are not hard and fast rules, and that those who older and are healthy and without risk factors for such problems (no diabetes, hypertension, hardening of the arteries, history of past heart attacks or strokes, arthritis, osteoporosis, etc.) and have good flexibility and strength may still be able to approach the full pose, under expert guidance. 

One key factor to consider is how long you are in such poses. It seems the risks of serious adverse events rise the longer you are in such an extended position, for example, longer than 5-10 minutes. I’d recommend, if you choose to try Camel with some head and neck extension, that you do it for very brief timings, say 10-20 seconds, and use support to start with. Or, as I do now, do it with the chin tucked to the chest and enjoy the backbend in the rest of your spine! 

Also, please note that Janet is referring mostly to neck awareness and cautions for Camel pose, which involves dropping the head back in space into the pull of gravity. I don’t have the same concerns for backbends like Cobra (Bhujanghasana) and Locust (Salabasana), where you are lifting your neck up and so have different forces acting on the neck. Taking the head and neck into extension in these backbends is generally not going to put you at risk for strokes and compression fractures of the cervical area. 

—Baxter

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Yoga Is Just As Safe As Other Exercise

by Nina

Sally Halbett by Melina Meza

It turns out that Baxter, Timothy, Brad, and I weren’t the only ones who were seriously skeptical about the claims that New York Times writer William Broad made about the dangers of yoga (suspiciously timed with the releases first of the hardback and then of the paperback versions of his book about yoga). I’ve just learned from Yoga Is Just As Safe As Other Exercise, Study Finds that Dr. Holger Cramer, director of yoga research at the University of Duisburg-Essen in Germany, read Broad’s article “How Yoga Can Wreck Your Body,” and concluded that it “reported on some cases, but it was not systematical.” And since no meta-analysis—a systematic review of other studies—yet existed on yoga injuries, Cramer decided to do one himself. Thank you, Dr. Cramer!

And guess what? Dr. Cramer’s completed study The Safety of Yoga: A Systematic Review and Meta-Analysis of Randomized Controlled Trials, published in the American Journal of Epidemiology, found that yoga was just as safe as other forms of exercise.

“No differences in the frequency of intervention-related, nonserious, or serious adverse events and of dropouts due to adverse events were found when comparing yoga with usual care or exercise.”

Yes, that’s basically what we’ve been saying all along (see Man Bites Downward-Facing Dog, Is Yoga Really Dangerous for Men?, and Is Women's Flexibility a Liability in Yoga?, among other posts responding to William Broad's claims). No, yoga is not perfect. And, yes, you can injure yourself while doing it, so it’s wise to use common sense when you are taking a class or you’re practicing on your own (see How to Stay Safe While Practicing Yoga). But you can also get injured running, walking, playing tennis, biking, lifting weights, gardening, etc. And even being sedentary has its dangers. How many people do we know who got injured just sitting at their desks or developed serious health conditions due to lack of exercise?

We’re pretty sure that Broad didn’t do a methodical study of any kind (he’s a journalist, not a scientist). On the other hand, according to Yoga Is Just As Safe As Other Exercise, Study Finds, Dr. Cramer looked only at randomized controlled trials—considered the highest quality clinical trial.

“Studies qualified if they compared any kind of yoga with no treatment, usual care or an active treatment, and if they reported on adverse events like injuries. In the end, 94 studies—which looked at a total of 8,430 people—made the cut.

Only 2% of people who did yoga experienced any adverse events, and some of those who did already had severe diseases. The study didn’t look at the types of injuries, but other data suggests that the most common kinds of injuries are musculoskeletal, like back pain, Cramer says. Other adverse events include aggravation of glaucoma in patients with the disease, especially in headstand or shoulder stand poses.”

No surprises there. We know that people can get musculoskeletal injuries from pushing themselves too hard in a pose or from practicing the same poses over and over (see Not All Yoga Poses Are Created Equal and Getting Clearer on Yoga and the Risk of Injury). And we always caution people with glaucoma and certain other conditions about practicing inversions like Headstand and Shoulderstand (see Friday Q&A: Cautions for Inversions). But Dr. Cramer also confirmed what we’ve observed—both about ourselves and our students—that while serious yoga injuries are rare, benefits from the practice are much more common:

“We have really high-quality studies showing that yoga is effective for chronic low back pain in the short and long term,” he says. Other good evidence shows that yoga can ease depression and psychological distress in breast cancer patients, he says, and that yoga may be effective in lowering high blood pressure in people with hypertension and reducing cardiovascular disease risk factors in the general population and people at high risk.”

When I told Brad about this new study and its conclusions, he simply said, “No sh*t.”

Happy practicing!

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Mindfulness of Sensation

by Jill Satterfield

Seanna Browder by Melina Meza

The non-verbal language of our body is sensation. Our body communicates discomfort, fear, anxiety, depression, embarrassment, happiness, love—all through an orchestral variety of sensations.

Becoming familiar with the sensations in our body is a way to become more intimate with ourselves, by seeing sensations as a reflection of our mind and heart. Sensations can be the bridge of communication between body and heart-mind, and being mindful of sensations not only keeps the mind in the present (the body is always in the present moment) but offers a much needed respite to the overly worked and depended upon thinking mind. 

The body will sense and “say” through its language of sensations what the mind is about to think, what the heart is just about to feel. The body warns us that something big is building, and being in the body, and staying present with its current sensation is a skillful way to cut off a strong reaction or loss of emotional control. Staying with sensations—breathing into what we feel—staves off many unwanted reactions and gives us time to have a thoughtful pause, and then a response.

This short introduction to mindfulness of sensations will give you a start to noticing them without judgment, to treating the body with more kindness, and to seeing things as they are without the colored glasses of attachment or aversion.



If you're interested in learning more about embodied mindfulness, I'll be offering another Embodied Mind 200 hour teacher training at Zazen in San Francisco this fall and winter 2015/2016. See vajrayoga.com for further information.

Jill Satterfield is the founder of Vajra Yoga + Meditation, a synthesis of yoga and Buddhism that combines meditation, yoga and contemplative practices. Named “one of the 4 leading yoga and Buddhist teachers in the country” by Shambhala Sun Magazine, Jill has instigated mindful and creative educational programs for over 28 years.

She is also the founder and Director of the School for Compassionate Action: Meditation, Yoga and Educational Support for Communities in Need, a not-for-profit that trains teachers, psychologists and health care providers to integrate mind and body practices into their professions. SCA also provides classes to people in chronic pain, with illness, those suffering from PTSD, and at-risk youth. Jill teaches workshops internationally, is a faculty member of Spirit Rock Meditation Center’s Mindfulness for Yoga Training and the Somatic Training in Marin, California, and is a guest teacher for many other training programs. To find out more about Jill, visit her website vajrayoga.com.

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Loving-Kindness Meditation

by Ram

Love & Love by Melina Meza

Ashtanga Yoga (Ashta=eight; Anga= limbs) refers to the eight fold path/ rungs/limbs/steps of Yoga as described in the Raja Yoga section of the yoga philosophy. Its practice helps us to discriminate between ignorance and awareness and truth from illusion, which is the means for liberation or enlightenment. The first five limbs help us develop our power of focus and concentration. Dharana or focus is the preparatory step towards attaining a deeper meditative stance. Dharana helps to reduce the chattering of the mind and filters out all irrelevant thought processes. The practice of dharana is not concentrating on the object rather it is the awareness with which you redirect the mind, again and again. This very practice—the mind running or getting distracted, you bringing it back—in essence is dharana (see Samyama: The Trinity of Dharana, Dhyana, and Samadhi). You can practice dharana at any time and at any place. Dharana gets easier as you practice it. 

Patanjali takes this concept to the highest level when he describes the process of focus coupled with intake of harmonious impressions. In the samadhi pada of the Yoga Sutras, verse 1.33 describes this relationship:

“maitri karuna mudita upekshanam sukha duhka punya apunya vishayanam bhavanatah chitta prasadanam

Focusing with perfect discipline, the mind becomes purified by cultivating feelings of friendliness towards those who are happy, compassion for those who are suffering, goodwill towards those who are virtuous, and indifference or neutrality towards those we perceive as wicked or evil .” —Swami Jnaneshvara 

I was struck with the phrase “maitri karuna” as it is loaded with a powerful message. In Sanskrit and in Pali, the term indicates loving-kindness, although in Pali the term used is Metta. Maitri Karuna/Metta (Loving-Kindness) can also mean tender, soft, good-natured, pleasant, cheerful, kind hearted among others. Basically the term connotes a deep sense of respect, appreciation, and regard.

Maitri Karuna/Metta is an act of compassion, an intention to mitigate suffering and lighten the sorrow. When our minds are clear, we are able to open our hearts and fill ourselves with loving-kindness. In the process we cultivate compassion, are able to truly see suffering, and are moved to take steps to relieve or alleviate the suffering. Loving-kindness is just not about extending selfless service to someone or something you are drawn to, it is also about bringing in the same quality to your own self. We need to love and accept ourselves just as we are; it then becomes easy to truly love anyone in an unlimited and unconditional way. Putting it simply: I am happy and peaceful, so let me extend that peace and happiness to others. As loving-kindness blooms, gone are greed, selfishness, indulgence, insatiability, wanting, and needing. At the core is the desire to be happy, peaceful, and selfless. 

Thus, loving-kindness is non-violence in all forms and practicing this virtue is committing to both yamas and niyamas. What would be your reaction if you found out that someone was not only providing unconditional love to you but also sending positive energies your way for your peace and prosperity? Unless you have fully accepted yourself, you would not be open to receiving this loving-kindness and you will only be doubting the individual’s motive. 

According to Swami Satchidananda yoga master and founder of Integral Yoga:

“Whether our mercy will help the other individual or not, by our own feeling of mercy, at least we are helped.” 

Loving-kindness meditation (LKM) is about drawing attention to the mind and heart center, and acknowledging one self’s peace, friendliness and compassion. Expressing and meditating on self’s loving-kindness sets the foundation for being able to offer selfless love to others.

The next step would be to meditate on and direct the loving-kindness to other benefactors, such as parents, siblings, friends, teachers, pets, or anyone that you know who has helped you in some way.

The third step would now involve directing your LKM energy towards any individual outside of your family or friend circle and who could be a stranger. I myself am thinking of this elderly gentleman who lives a block away from my home. We have not been introduced to each other. I see him walking at least three times daily around our neighborhood. This individual not only limps while walking, but his gait is also very unsteady, so whenever I encounter him, I immediately direct a LKM prayer towards him for his peace, physical stability, and good health.

Finally, LKM ends by directing the meditative energy towards a problematic/challenging individual. This is someone whose presence or just thinking of the individual evokes anger, rage, fear, resentment antagonism or other disharmonious emotions in one’s self. While practicing LKM on such individuals, if your emotions arise, honor and appreciate your limits of loving-kindness and return to directing the meditation toward yourself. Switch alternately between yourself and the problematic person, and reflect on the emotional turbulence pervading your psyche just from this one individual. Keep repeating the loving-kindness meditation, and you will overcome these mental turbulences such that you are no longer affected by this individual. 

Some or most of us actually do a slight variation of LKM in our asana class even though we may be unaware of its true intentions. The Om mantra or the Shanti Mantra (Om Shanti, Shanti, Shanti) that several teachers practice before, during or at the end of the asana class is actually a form of LKM where we invoke peace to the entire world. 

As a neuroscientist, I was naturally curious to know the benefits that LKM offered. The first and foremost benefit of LKM is that loving-kindness reduces the stress response. People practicing an eight-week course of LKM experienced less distress than non-practitioners. Additional benefits of LKM were reported in a study Effect of compassion meditation on neuroendocrine, innate immune and behavioral responses to psychosocial stress. that looked at the body's inflammatory and stress response system. Initially, the results did not reveal any significant physiological differences between LKM practitioners and non-practitioners. However, when the practitioners were divided into a high-practice group and low-practice group, the results were not only striking but significant as well. The high-practice LKM group saw a significant decrease in inflammation and stress response compared to the low-practice or no-practice groups. The study highlights two significant findings: 1) LKM significantly impacts the stress and inflammatory systems in the body and 2) beneficial changes are seen only in those individuals who actively engage in the practice of LKM. Practicing LKM once a week was not sufficient; it required for the individuals to practice a little of it daily. 

What about its impact on the brain structure? In Regulation of the neural circuitry of emotion by compassion meditation: effects of meditative expertise. Richard Davidson from the University of Wisconsin recruited two groups of subjects: a) those who had at least 10,000 hours of LKM practice and b) those who were new to meditation. Using fMRI measurements, Dr Davidson noticed that LKM impacted several important brain regions including the insula and the temporal parietal junction that are mostly involved in empathy and our ability to attune to the emotional states of others. The group with 10,000 hours of LKM experience showed significantly more activation and experienced higher levels of compassion compared to newly practicing group. What is striking about these studies is that the beneficial changes happen in a short period of time with a constant, sustained practice of LKM. 

Take home message: Maitri Karuna (LKM) paves the way for a peaceful and harmonious living! 

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Yoga Relaxation Techniques: They're Not Interchangeable (Rerun)

by Nina

Patterns in the Sand 2, by Brad Gibson

Okay, I admit it. It’s probably my fault. I’ve been going around saying that you can trigger the Relaxation Response (see The Relaxation Response and Yoga) using any of the following: restorative yoga, inverted poses, Savasana, pranayama, meditation, and yoga nidra, etc. as if all those practices were somehow interchangeable. This has led to questions like the following comment left on a Friday Q&A: Yoga Nidra, Restorative Yoga, Meditation and Savasana:

It is very helpful to read the distinctions between these four practices as I try to practice all of them, but it's hard to find the time. I'd be really interested to get your thoughts on whether it's important to do all four? For example, if you do restorative while listening to a nidra CD, do you also need to meditate? I'm interested to know what the various benefits are of these four practices, or are the benefits all the same? 

Let me start by saying that what I said previously—that you can use any of these practices for stress management—still holds true. And it is also true that you can choose whichever techniques you prefer to trigger the Relaxation Response. However, these practices each have different roles to play in a balanced yoga practice. 

The role of meditation in a balanced yoga practice is particularly important. That’s why I asked Timothy to write an article on the purpose of meditation (see his absolutely wonderful post Is Meditation an Essential Par of Practicing Yoga?). Basically, although you can use meditation for stress reduction, its role in classical yoga is to quiet the mind to allow union with the divine or “liberation”: 

1.2 Yoga is the cessation of movements of consciousness.
1.3 Then the seer dwells in his own true splendor.

— from Yoga Sutras, trans. B.K.S. Iyengar

Meditation is also, as Timothy mentions, a “fabulous tool to study your mind and slowly gain more control over it.”

Pranayama is also an important component of classical yoga, which precedes meditation as one of eight steps on the path to samadhi (union with the divine). It is considered an instrument to “steady the mind” and a gateway to dharana (the first phase of meditation).  

“Pranayama removes the veil covering the light of knowledge and heralds the dawn of wisdom.

Its practice destroys illusion, consisting of ignorance, desire and delusion which obscure the intelligence; and allows the inner light of wisdom to shine. As the breeze disperses the clouds that cover the sun, pranayama wafts away the clouds that hide the light of intelligence.” — Sutra 2.52 trans. by B.K.S. Iyengar

On the other hand, the two types of asana I recommended for triggering the Relaxation Response, restorative yoga and supported inversions, are brilliant 20th century inventions, mostly developed by B.K.S. Iyengar, which are designed specifically to maximize physical relaxation and reduce stress. Judith Lasater, one of the most renowned teachers of restorative yoga, writes in the introduction to her book Relax and Renew: 

“The antidote to stress is relaxation. To relax is to rest deeply. This rest is different from sleep. Deep states of sleep include periods of dreaming which increase muscular tension, as well as other physiological signs of tension. Relaxation is a state in which there is no movement, no effort, and the brain is quiet.

"Common to all stress reduction techniques is putting the body in a comfortable position with gentle attention directed toward the breath.”

Likewise, yoga nidra is also a 20th century invention (though you may see some claims to the contrary) developed by Swami Satyananda Saraswati. The first sentence of his book Yoga Nidra defines the practice like this:

“Yoga nidra, which is derived from the tantras, is a powerful technique in which you learn to relax consciously.”

In yoga nidra, you lie in Savasana while the voice of a teacher (or a recording) guides you through a physical and mental relaxation process. So, like restorative yoga, yoga nidra is specifically intended as a relaxation technique, and as such does not replace meditation or pranayama in a balanced yoga practice. This would be true of any form of Savasana in which an external voice is providing instructions and/or imagery for you. Unlike other relaxation techniques, yoga nidra includes a sankalpa (an intention) that allows you to influence your subconscious (or so it is claimed). For example, “I will awaken my spiritual potential,” “I will be a positive force for the evolution of others,” or “I will be successful in all that I undertake.” So this may be something you wish to take into consideration when choosing your relaxation practice.

Unlike the modern restorative postures, Savasana is a much older pose. Based on what I’ve read about the original practice, I’m going to go out on a limb here and say that Savasana is a reclining form of meditation. For some traditional yogis, it was a meditation on death, hence the literal translation of the name Savasana is “Corpse pose,” and it was sometimes even practiced alongside actual corpses. To practice Savasana properly, however, you must actually do the work of meditating while you are in the pose (and make sure you don’t fall asleep). If you don’t actually meditate while in Savasana, then, well, you are simply relaxing. But that's okay, too, if that is what you are after.

So there you have it. Which of these practices you decide to adopt really depends on what your goals are as well as your preferences. If you’re just after stress management and better health, it doesn’t really matter which you chose. However, if your goal is the “liberation” that is yoga’s ultimate aim, both pranayama and meditation are essential steps along the path.

Sorry if I caused any confusion! 

Ultimate liberation is when the gunas, devoid of any purpose for the purusa, return to their original [latent] state; in other words, when the power of consciousness is situation in its own essential nature. —Yoga Sutra 4.34 —trans. Edwin Bryant

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