Techniques for Improving Balance

by Shari and Nina

Elizabeth Cooke, Age 57

Because of something I'm working on—you can probably guess what—I wanted to learn more about specific techniques for improving balance. So I turned to one of my favorite local expert on the topic, our very own Shari Ser, yoga teacher and physical therapist. I asked her a set of questions regarding techniques for improving balances, and thought today I'd share the results with you. Thank you, Shari! —Nina

NINA: Let’s say you’ve decided that you want to focus on improving your balance, where should you start? Let’s talk about the person who has really poor balance first. Then maybe talk about someone who doesn’t have balance problems per se but just wants to improve and/or maintain balance?

SHARI: I’ll start with the individual who doesn’t live with a constant fear of falling and is relatively mobile, though not necessarily agile.

We always start at the beginning and my reference point for the beginning is Mountain pose (Tadasana). Tadasana is a symmetrical pose that is never mastered and there are endless variations you can practice. Varying your foot position by bring your feet closer together challenges your balance. Start by standing with your feet hips-distance apart. Then, if your knees allow it, gradually work toward the classic Tadasana foot position, with your feet together (big toes touching, heels slightly apart).

You can also vary the pose by closing your eyes, changing the position of your head, by looking up or looking down, and by turning your head. Other movements include raising your arms overhead and side bending.

Next try changing the surface you are standing on. Try standing on a sticky mat that is folded multiple times, on a couch pillow on the floor that is very cushy, on an inflated but soft air mattress, and so—I think you are getting the picture here.

A favorite balance challenge on mine is to put a foam block on your head (like the old fashioned postural exercises some of our moms may have taught us) and first just stand in Tadasana. Then add arm movements out to the side and overhead, trying to keep the block from falling—that can be a lot of fun. For those of you who have a fairly symmetrical walking pattern, walking while in Tadasana with a block on your head is a challenge as you examine how your transferring of weight may influence your postural stability and the ability to keep the block on your head.

NINA: What types of poses should your practice include?

SHARI: I always focus in the beginning on standing poses to challenge balance because they are so much fun and very gratifying because improvements are really noticeable. The standing poses that I would recommend for balance and also to increase leg strength include: Warrior 1 and 2 (Virabradrasana 1 and 2), Triangle pose (Trikonasana), and Extended Side Angle pose (Utthita Parsvakonasana).

Something else to consider is that different yoga traditions enter into and exit out of standing poses with a prescribed sequence. To challenge this habitual pattern—mental agility, folks!—you can change how you step into Warrior 1 or 2. Stepping back from Tadasana with one leg into a Warrior pose then back into Tadasana (repeating on the second side) is a balance challenge. Likewise, stepping forward from Tadasana into the pose from then back into Tadasana, switching sides rhythmically is also balance challenge. Adding rhythm in how you move in and out of a pose from Tadasana with a metronome can be fun, changing between faster and slower tempos. The concept here is NOT to do your entry and exit the same way every single time.

Another way to not only increase balance reactions and leg strength is to link poses together in a flow sequence. Baxter has done a few posts on mini vinyasas with standing poses (see Warrior 1 and Warrior 2 Mini Vinyasas), but  you can also make them up yourself by linking poses together. For example, try going from Warrior 2 to Extended Side Angle to Triangle pose and back again (repeated on the second side) is one way to approach this idea.

I also think it is crucial to make transitions from standing to the floor and back to standing smoothly and gracefully. You don’t want to move quickly through transitions because speed can increase the risk of falling because you aren’t moving mindfully but just trying to get to the next step. If you have difficulty getting down to and up from the floor, using a chair to assist you is fine but make sure you control the descent and ascent. If initially your legs are too weak or due to orthopedic issues they don’t “bend the way they used to,” it is fine to use your arms to help support your legs.

After working with the standing poses, you should also practice traditional standing balance poses, such as Tree pose (Vrksasana), Half Moon pose (Arda Chandrasana) and Revolved Half Moon, and Warrior 3 (Virabrdrasana 3). Starting with the right amount of support is important; improvement in balancing will bring the gradual lessening of the support that you need.

I also like some floor balance poses for challenges, such as Side Plank pose (Vasithasana), which you can make accessible by practicing the variations (see Featured Pose: Side Plank Pose). Other ideas are Boat pose (Navasana) and Hunting Dog pose, both of which have accessible variations. For more experienced yogis who have been practicing inversions like Shoulderstand (Sarvangasana), Headstand (Sirsasana), and Forearm Balance (Pinca Mayurasana), just the act of doing these poses is challenging your balance, but I don’t recommend them at all for beginners.

NINA: Should we be doing leg strength poses as well as balancing poses?

SHARI: Absolutely we should be doing leg-strengthening poses. Balance is an integrative full body system, and the leg muscles are part of the system. Strong legs mean you are able to lift your body weight with your legs. That means being able to stand from a standard height chair without using your arms to help. This in itself is a training activity. A yoga pose you can use is Powerful pose, either by sliding off a chair into the shape of Powerful pose or starting in Mountain pose and moving into Powerful pose. There are many ways to vary this pose (see Featured Pose: Powerful Pose).

Standing on one leg with adequate balance support and then over time removing the degree of support will also really work on strength, especially the outer hip muscles which help keep your pelvis level when your lift one leg off the ground.

To increase strength, increase your hold times you start to feel just a bit “uncomfortable” and there is more effort required. (I am NOT talking about staying in a pose and “working with the pain.” Effort does not equal pain, and, if it does, then you need to immediately come out of the pose.)

NINA: How often should you do the poses? How long should you hold the poses?

SHARI: I suggest practicing daily for even five minutes as a good way to begin. Developing the habit of practice is the key—what you do during your five minutes is more open. For someone just starting to work on balance, in a five minute practice you could start with Tadasana and Tree pose, which I recommend doing every day. Then add in one or two other standing and/or balance poses, which you should vary throughout the week to maintain a balanced diet of yoga poses.

As far as how long to hold a pose, I would recommend a simple approach. Hold a pose till you notice your leg is quivering and then try to hold 2-3 seconds longer. Come out and rest a few seconds before repeating on the second side. 

NINA: And when you get the basic balance poses down to long, steady holds, where should you go from there?

SHARI: The first thing I remove is vision because removing visual acuity really affects balance! So try either practicing in a darkened room or closing your eyes. Once you master the visual challenge, try adding head motions while keeping your eyes steady—find a visual focal point and keep your eyes on that object but add head rotations. 

Next, return to another visual challenge. Keeping your head steady, move your gaze around the room in every direction you can comfortably take it. Once you’ve mastered that, try moving your eyes in one direction with your head is turned in the opposite direction.

Another technique is to vary the surface you practice on. Try standing on a cushy or unstable surface—like an air mattress on the floor that is underinflated—and do standing poses like Warrior 2 or balance poses for a definite balance challenge! When practicing balance poses like Tree pose, as Baxter has recommended, try variations with moving your arms and head.

Other ways to vary your practice is to change where you do your practice. I, for one, am very partial to yoga on the beach. There is something about the movement of the air as well as the movement of the water that I find very nurturing. Watching moving objects while trying to remain still and steady is definitely a balance challenge.

NINA: Is there anything else you can do to improve your balance?

SHARI: Whenever possible, increase your foot sensitivity. Massaging the soles of your feet is important—there are numerous tools you can use for this. I also recommend stretching your toes individually and feeling all the small joints in the toes and how they move  (this also allows you to keep a close check on the state of your feet, especially if you are a diabetic).  You can also do toe exercises from a seated position, like trying to individually lift and replace each toe, which is quite challenging.

And as long as you don’t have diabetes or peripheral neuropathy, walking with bare feet in the house and in safe outdoor environments, such as at the beach or on the grass, is invaluable for keeping your feet health, supple, and responsive. So take off your shoes!

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Preparing for Knee Replacement Surgery

by Shari

Deciding to undergo a total knee replacement (TKR) surgery is not an easy decision to reach. There are many factors that lead us to undergo this elective surgery. Most often it is because our quality of life is poor and we become frustrated with what we are unable to do. Also, having chronic pain can be very wearing and there comes a point when we really can’t tolerate it anymore. 

It is at that point that we agree to have this surgery (see Knee Replacements and Yoga). Because many of us are pro-active in our health care and expect to be equal partners with our health care providers, we’ve been asked to write about how best to prepare for this surgery.

In general, when you consider practicing yoga for a specific condition or goal (which is when it crosses over into yoga therapy), for best results you should be global in your approach. Just muscle strengthening for a particular joint (knee) is not enough, as I will discuss below. So I’m going to break down pre-operative preparation into three basic categories.

Preparing for Emotional Health

The first area to consider is your emotional health and wellbeing. Setting your intentions is very important. Being able to do visualization, meditation, and basic breathing (pranayama) for stress management is critical pre-operatively. Practicing these skills so they become habitual will set the scene for a successful surgery and post-operative recovery. See The Relaxation Response and Yoga for information about using yoga to manage your stress.

You can also prepare spiritually for your upcoming surgery. Start by honestly confronting your own fears and emotional responses to having the surgery. Imagine what life will be like post operatively. The essence of yoga is cultivating equanimity in the face of difficulty. You might not always like what you have to accept but to surrender to it fully is how you can come to grips with difficult decisions.

So commit to your decision to undergo Knee Replacement Surgery as you would to any other form of work or practice (see Tapas: Working with Dedication). Choosing this surgery and doing the work to accept and fully believe in the success of the surgery sets your neural immunological system for success in a good surgical outcome. Your brain, emotions and belief systems are all part of your inherent healing mechanisms.

To address your psycho-emotional health pre-operatively, you can also examine your current sleep habits. Healthy sleep is imperative both pre-operatively to prepare us for the surgery as well as in the post-operative period.

Whether you employ principles of deep physical relaxation, practice good sleep hygiene habits, or both depends on you. See 5 Tips for Better Sleep for information.

Preparing Your Energetic Body

To prepare your energetic body for surgery, look at your breathing patterns and postural habits. When observing your breathing patterns, notice how you breathe and what you do with your breath when you are fearful or anxious versus when you are safe and relaxed. Observe what happens to your breathing pattern and overall postural holding when you imagine the surgery and the necessary care and work that will follow the surgery. Knowing your typical breathing patterns will allow you to cultivate breathing patterns to promote your sense of safety and relaxation.

To cultivate breathing patterns that promote safety and relaxation, I recommend taking a simple, comfortable position like Savasana and practicing simple Ujaii breathing with no retention or manipulation of the breath pattern.

Learning to identify your physical holding patterns can also aid your physical comfort both pre- and post-operatively. Pain is a stressor and affects you physically, so it is important to practice breathing to relax both your physical body as well as your mind.

Preparing Your Physical Body

Preparing physically for the operation is not just about strengthening your knee muscles; you should give attention to several physical areas, including your core, your hips, your legs, your ankles, and your upper body. And, obviously the way you can do asana will vary from person to person, as some of you can still get down to the floor while others cannot. But if you want to practice supine or seated poses and can’t get down to the floor, trying practicing on a tabletop. (Scoot your butt onto the table and then swing your legs up and onto the tabletop.) 

The key to your preoperative management from a yogic therapy perspective is to consider your entire body. You may be having the surgery on “just your knee” but the effects of the procedure are global in how you will recover and heal.  

Core. For basic core strength, practice Boat pose (Navasana) and variations. 

You can do leg lifts in Construction Rest position (on your back with knees bent and soles of the feet on the floor) or Bridge pose. March by lifting foot leg off of the ground and holding it up for a count of 5, and then repeat on the other side. Continue to alternate until your hips are fatigued.

Hips. To strengthen your hip abductors, price side-lying leg lifts (sometimes known as “clamshell”). If you can lie on your belly, practice left lifts in Locust pose (Salabasana).

Also, lie on your back with pillows under your knees to support them in a bent-knee position, and then, one leg at a time, lift from your heel to straighten your knee.  

Knees. For your problem knee, you can work on cultivating range of motion. You will either be having difficulty bending your knee (flexion) or straightening it (extension). 

If you have problems bending your knee, try sitting on the edge of a chair with your leg stretched out in front of you. Then slowly step your foot backward the chair, gradually bending your knee, as far as you can. You can also try working with Dancer’s pose (Natarajasana), balancing on your good leg and slowly lifting your problem leg behind you in a bent knee position. 

If you have problems straightening your knee, you can work with your leg in Krounchasana (Heron pose), either on the floor or seated on a chair, slowly straightening your upright leg as much as possible. Or, you can sit on one chair with another chair directly in front of you. Bring your problem leg onto the second chair seat so it is fully supported (your foot can be hanging off the edge), and slowly straighten your leg as much as possible, coming into a slight forward bend if desired.  

Ankles. Simple ankle circles are excellent for circulation. 

For ankle flexibility, try sitting on the edge of a chair legs stretched out in front of you and, keeping the soles of your feet on the floor, walk your feet slowly back toward the chair until you feel a stretch on your calves and heel cords. 

To strengthen the calves, practice rising onto your toes in Mountain pose. Start in Mountain pose with your soles of the feet completely on the ground and on an inhalation, rise up onto the balls of your feet. Exhale, and return to Mountain pose and repeat the cycle several times. This will also help cultivate your ability to balance. If it’s not possible to do this standing, you can make the same movements while sitting on the edge of your chair, with your feet on the floor in front of you. 

Balance. Although balance is important to continue to cultivate, standing on your pre-operative leg in traditional yoga balance poses may not be possible due to pain and instability. So try this two-legged balance pose, which is a version of Mountain pose. Start in classic Mountain pose, with your feet parallel to each other. Then step your right heel in front of your left toes, so your two feet are in line with each other. To come out of the pose, step your right foot back to a parallel position with your left, and then repeat on the other side by stepping your left heel in front of your right toes.

You can also work with other aspects of balance and proprioception. Try Mountain pose with your eyes closed, for example. You might not realize how much you use your sight to balance, and removing sight from the equation helps foster other balancing abilities. Add in arm and/or head motions to challenge your balance even further. 

Upper Body Strength. Because your arms will typically have to bear more weight after your knee replacement (because you can’t fully bear weight on the leg with the new knee replacement), working on upper body strength in advance will help you be more mobile after the operation.

To build upper body strength, try the chair version of Upward Plank pose. This helps build the muscles you’ll need for walking with crutches or a walker post-operatively.

You can also work with either full Plank pose or the version on the forearms, which build both upper body and core strength.   

Standing Poses. Depending on your pain levels, full weight bearing may be limited for you and not causing pain or further joint deterioration is important. So learning to be flexible in how you do your standing poses is key. Rather than giving up these poses temporarily, you can continue to practice your standing poses with the aid of a chair. For example, you can do Warrior 2 pose with your pelvis on a chair seat, the bent front leg to one side of the chair and the straight leg stretched behind you on the other side. Other standing poses, including Warrior 1, Extended Side Angle, and Triangle pose, can be done in the same manner. 

Inverted and Restorative Poses. Supported inverted poses like Legs Up the Wall (Viparita Karani) are great for reducing swelling in the legs both pre- and post-operatively, as well stress management. However, you may not be able to get down to the floor to set up for and practice this pose. In this case, the easiest way to do Legs Up the Wall pose is on your bed, with your legs supported either by the headboard or the wall. Figuring out how to do this pose pre-operatively is a good idea because it will really help with edema management post-operatively.

For Savasana and reclined restorative poses, again, even if you have trouble getting up and down from the floor, you need not give up these important poses. One option is to practice these poses on a tabletop. Another option is to practice the poses on a firm bed that is not the one you usually sleep in.

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Yoga for the People (and Healthy Bones)!

by Shari

With the recent passing of BKS Iyengar (the teacher of my teacher, Donald Moyer) and the exponential growth of yoga inspired by Mr. Iyengar, I have been thinking a lot about health outcomes and why yoga is such a powerful self-help tool. You see, in my day job as a home health physical therapist, health outcome is measured very differently than it is in a complementary alternative health care model that yoga falls within.

My patients too often don't get better. My job in aiding their recovery often feels like I am trying to put a small Band-Aid on a gaping wound. I can’t change the situations that lead to their poor health. They suffer from the chronic life challenges of poverty. Years of poor health management, from an uncaring overworked, depersonalized, underfunded health care delivery system, and the chronic stress from living marginalized lives lead to chronic health issues. To often these patients are living in polluted urban environments, where walking is not done by choice because it is unsafe. They also are victims of poor health from years of eating processed, nutritionally void meals. The places where they live are commonly food deserts, where fresh food is unavailable without having to take public transportation via circuitous routes. Many of my patients don’t have cars. My care often feels inadequate because I can’t change their life circumstances even when they are doing all they can do to regain their health.

For example, J was in her early 80's when I met her. She was a homemaker, a long-time smoker who had remained physically inactive though very slim. She had been diagnosed with osteoporosis in her 60's and her family started a walking program with her. They also enrolled her in a senior exercise class at the near by senior center. She was pretty stabile for about 15 years and maintained independent living in her own home. But then her husband became ill, and she couldn't care for him any longer, so he was institutionalized. He died approximately one year later. After that she had a bout with pneumonia and her long history of smoking finally caught up with her; she was diagnosed with chronic obstructive pulmonary disorder and became oxygen- and steroid-dependent for respiratory management. She was also placed in an assisted living facility by her family because of frequent falls due to leg weakness. I was her home health PT. She was compliant with her exercises but wasn't really walking more than a couple of steps because of extreme fatigue. Also, she suffered from several osteoporotic fractures from "hugs" from her family. She was really upset by this because she felt like she was crumbling from the inside out. The pain from the osteoporotic fractures and the immobility from not walking and being pushed in her wheelchair by staff further eroded her overall health. She died in her sleep—with no major medical cause—several weeks after I discharged her. 

So you might be wondering, could yoga have helped J? I believe that if it had been a part of her activity regimen when she started her walking and exercise class that it would have. Yoga could have helped J with her sense of physical and emotional loss as she lost her independence and her home. Guided strength training for specific bone strengthening positions might have slowed her progressive osteoporosis. Unfortunately I will never know for certain because her care was limited by her HMO insurance company and I was only given four visits and told to "get her back onto her feet." 

In my more cynical moments I am disgusted by the public degree of privilege that American yoga seems to support. The visual images of perfect woman and occasionally men shine from the glossy covers of popular mainstream yoga magazines, with headlines urging pursuit of the “perfect yoga body” and touting delicious organic recipes, not to mention hyping over-the-counter supplements for “health” or lovely yoga fashions to enhance your practice of yoga.

So when the accolades of the wonders of yoga are constantly cited sometimes I can’t take it. But then I remember B.K.S. Iyengar and how he really did bring yoga to the people and how he did make it accessible to everyone. I also remember that yoga is more than asana—that it truly is a credo on how to live your life for the greater good.

So in this spirit of inclusivity and my own belief that the best way to deal with health challenges is through personal empowerment, I am starting a new beginner-level yoga class focusing on bone health called Yoga for Healthy Bones, both to honor J and to support my general yoga students who, as they are aging, are being diagnosed with bone loss from either osteopenia or osteoporosis. This class will provide camaraderie, creating a community of mutual support as well sharing, which the class members can engage in if they so desire. There is nothing better in self care than learning what worked or didn't for individuals with similar diagnosis. And, most importantly, this will be a venue where people can practice yoga without fear of hurting themselves.  

I am personally very impressed with the work and level of dedication that Dr. Loren Fishman has provided for his patients through his ongoing medical study on the efficacy of yoga in building bone density. This class will incorporate some of his basic principles of bone stimulation as well as focusing on many of the safe beginner level standing and seated poses for osteoporotic individuals. If you live in or are visiting the San Francisco Bay Area, come and join us on Sunday afternoons from 4:00-5:30pm at the Yoga Room in Berkeley, California (see yogaroomberkeley.com).

Namaste.

Shari

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Learning to Sit On the Floor, Part 1

by Shari

We recently received a question about learning to sit on the floor without support. Because we often write about the benefits of sitting on the floor (see To Sit or Not To Sit (on the floor)?), we thought having a little guidance for people who are currently unable to sit comfortably on the floor would be useful for a large number of people. So we decided to dedicate an entire post to the topic of how you can learn to sit comfortably on the floor. But let’s begin with the question:

Q: I’m a stiff Western guy who was brought up sitting on chairs and finds it really uncomfortable to sit crossed-legged on the floor even for a few minutes. Now I find that for my wedding, which will be a Hindu ceremony, I will be expected to sit on the floor for several hours. What can I do to get in shape for this? (My normal exercise routine includes running and weight lifting—I don’t do yoga yet at this point.)

First off, may I say congratulations on your upcoming wedding. How exciting for you, and you are to be complimented in your thoughtfulness for your desire to fully participate in your wedding's rituals. I don’t know anything about Hindu wedding ceremonies except what I have read about or seen in various movies but I do know that though you will be on the floor you won’t be totally motionless. What I don’t know is exactly what type of sitting posture you will be required to do for certain lengths of time. I would encourage you to discuss this with your fiancé but let us propose that you may be in kneeling or cross-legged positions all without external back support.

For you, and everyone else who wants to work on sitting without support, it might be helpful to break down the components of unsupported sitting. Which areas need to be both flexible and strong that you can work on during the upcoming months? We also need to discuss the role of breathing in enabling you to sit unsupported.

The vertebral spine and the diaphragm are major supporting internal structures of the human body. The spine consists of four curves that when properly stacked upon each other can withstand a significant amount of gravitational force to maintain the solidity of the curves. The curves allow the spine to move as well as to maintain stillness. Nestled deep within the pelvis—which connects the vertebral spine to the lower limbs/legs—is a very important bone called the sacrum. The sacrum and the two pelvic bones (ilia) are literally the bridge that forms the base of support that we need to sit. The femurs (thigh bones) connect into the ilia at the hip joint to widen the base of support. To sit unsupported in a cross-legged fashion, we need to provide good contact of the outer heads of our femurs (thighbones) with the ground.

There is a lot of discussion among health care professionals and yogis on what ideal sitting posture is and how to obtain it. But for our discussion we need to find you a doable position. The key is that when we sit unsupported we need to position our knees lower than our hips. This is easy to see when you sit in a chair without using the backrest. To obtain this position we typically need to raise our seat height up to widen the angle between our torso and our thighs. Typical chairs for standard height individuals have us sitting with our knees level to our hips and our torso perpendicular to the chair and this is termed 90/90 sitting position. But if we widen the angle of thigh to torso ratio to 135 degrees it is easier for us to lift up and lengthen our spines.

This is where I suggest you start. Place a pillow or folded blanket on the chair seat to raise your pelvis—this will allow your knees to be lower than your hips so your pelvis can roll over the head or your femurs (thigh bones) to re-establish your lumbar curve (your lower spine). Then you can lengthen or elongate your spine. This will help you learn to sit with your spine in a lengthened position and to support this posture from the “inside out.”

To learn how to stabilize the spine from the inside out we need to learn about our diaphragm, transversus abdominus, and pelvic floor musculature, and how they all assist in spinal stabilization, especially in a seated position.

The diaphragm is the dome-shaped sheet of muscle and tendon that serves as the main muscle of respiration and plays a vital role in the breathing process as well as internal stabilization. The origins (attachments) of the diaphragm are found along the lumbar vertebrae of the spine and the inferior border of the ribs and sternum. When we inhale, the diaphragm contracts and is drawn inferiorly into the abdominal cavity until it is flat. At the same time, the external intercostal muscles between the ribs elevate the anterior rib cage like the handle of a bucket. The thoracic cavity becomes deeper and larger, drawing in air from the atmosphere. During exhalation, the rib cage drops to its resting position while the diaphragm relaxes and elevates to its dome-shaped position in the thorax. Air within the lungs is forced out of the body as the size of the thoracic cavity decreases.

Diaphragm

Structurally, the diaphragm consists of two parts: the peripheral muscle and central tendon. The peripheral muscle is made up of many radial muscle fibers—originating on the ribs, sternum, and spine—that converge on the central tendon. The central tendon, which is a flat aponeurosis made of dense collagen fibers, acts as the tough insertion point of the muscles. When air is drawn into the lungs, the muscles in the diaphragm contract and pull the central tendon inferiorly into the abdominal cavity. This enlarges the thorax and allows air to inflate the lungs.

Due to its structural orientation, the diaphragm can be used to assist in torso stabilization for erect sitting along with contraction of the transversus abdominus muscle. The transverse abdominis muscle attaches to the thoracolumbar fascia and the deep erector back muscles between the pelvic bone and rib cage posteriorly and from the lower six rib cartilages, linea alba and the inguinal ligament anteriorly.  It extends the entire length of the anterior trunk.  Since it is the only abdominal muscle to attach to the posterior spine, it is considered the “human corset” of the trunk.

It is also helpful to work with your pelvic floor. The pelvic floor muscles create a hammock that spans the base of the pelvis from the front to the sides and to the back. Women often learn about these muscles after childbirth and are taught Kegel exercises to “strengthen” this area. You learn to engage the urogenital triangle without using the buttocks or tucking your tail to engage. In yoga mula bandha (root lock) is the “Kegel” and is taught to create strength and preserve energy of the body.

To learn how to feel the diaphragm and transversus abdominus, you can lie on the floor with your head slightly elevated and your chest opened. You can do this by folding three yoga blankets in an overlapping stepped or tiered position so the different layers of blankets support the curve of your lumbar spine, your thoraco lumbar junction and lastly your head (see Yoga Couch on gingergarner.com):

If this setup is too complex, you can try a Supported Savasana with your torso on a bolster (or folded blankets) and your head on a support. See Savasana Variations for info.

To sense the muscular actions of breathing, place your hands on the outer edges of your waist on your floating ribs. Gently firm and draw in the area just below your umbilicus and keep that area gently firm as you take a full breath in. As you inhale, notice if you can feel your lower rib angles moving out into your hands. As you exhale, continue to keep your lower belly engage as you feel your ribs return to their resting position.  Once you can do this breathing  in the reclined position, you can transition to doing it in hands and knees position and then to sitting in a chair to learn to create internal support in an upright position.

To learn where your pelvic floor is, sit on a soft but firm chair with your knees lower than your hips and gently bear down as in defecation. You should feel a slight bulging of your perineum. Then, try to lift your perineal area by tightening the muscles between your pubis and anus. You might also notice that you are drawing in your lower belly to do this, and that is okay because we often engage both our transversus abdominus and our pelvic floor muscles. Just make sure you aren’t tightening your buttocks to do this. Continue to practice this regularly while sitting in a chair until you have built up your tolerance and stamina.

Now let’s look at the more visually obvious muscles you need to work with. To sit erect for long periods of time—whether on a chair or floor—you need to have strong back muscles. These include deepest paraspinal msucles that run the entire length of your spine from head to tail, the deep spinal muscles that are longer and broader, and the more superficial larger back muscles, such as the latissimus dorsi, trapezius. A good way to begin to strengthen these muscles is by practicing simple backbends like Locust pose (Salabasana) with various arm positions and leg lifts (see Locust (Dynamic Version) for a few ideas) and Bow pose (Dhanurasana). 

You might also want to work on your back in Bridge pose variations (Setu Bandha Sarvangasana), especially working with the deep spinal stabilizers, which you can do with One-Legged Bridge or Marching-in-Place Bridge. You might want to have someone watch you when you do these positions to make sure that you can keep your spine neutral and not sag or twist. Also an all-fours position (see Hunting Dog Pose) with opposite arm and leg lifts will work the deep spinal stabilizers. Using a stick that is placed from your head to tail along your spine gives you nice feedback that you are maintaining a neutral spine. Please remember when you start doing these active training positions to use your deep abdominal/diaphragmatic /pelvic floor stabilizing breathing that was described earlier.

Next let’s look at flexibility of your spine. Begin with passive backbends that are nice and easy, such as lying over a bolster to arch your spine into a reverse “C” curve. Keep it gentle—don’t be too aggressive in increasing your arch. More is definitely NOT better. Work with nice deep belly breaths here, not your stabilizing breathing pattern. Cobra pose (Bhujangasana) is also a good way to build spinal flexibility as well as a gentle Cat/Cow pose.

Now it’s time to turn to the lower body and learn to stretch our hips, buttocks, and legs. Thread the Needle/Figure Four pose (Sucirandhrasana) will help you begin to stretch your tight outer hip muscles. Happy Baby Pose (Ananda Balasana) will also help begin to stretch your gluteal muscles and tight lower back fascia. You can practice version one of Reclined Leg Stretch (Supta Padangusthana), but you may find that a sustained single leg stretch through a doorway with one leg up the doorway and the other leg straight on the floor through the doorway is a nice way to hold a hamstring stretch for a longer time period without your hands getting tired gripping a strap. Different poses to stretch your hip rotators such as seated Cow-Face pose (Gomukasana) or Pigeon pose (Kaptosana) preparation are also helpful. To stretch your rhomboids (mid-back muscles), consider adding upper back stretches, such as Garudasana (Eagle pose) arms, to your seated poses.

Finally, we need to move to standing. Begin at the beginning with Mountain pose (Tadasana). You need to learn to stand erect first before you can sit erect.

From here, learning to do Half Downward-Facing Dog pose at the Wall begins to teach you how to integrate your arms, legs and torso.

Then we do have to move onto standing poses! I think by this time you may realize that it would be helpful for you to join a beginner yoga class and to learn to do a home practice. When you find a class that you like, I would recommend privately talking with the teacher and perhaps meeting with him or her to help you devise a doable home practice to target all the areas that you need to stretch and strengthen. With patience, perseverance and a sense of humor you will accomplish your goal! 

For more on learning to sit on the floor (including photos of props you can use), see Learning to Sit on the Floor, Part 2.

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Spinal Movements: How to Keep Your Spine Safe

by Shari

We recently received this query from a reader about contraindications for spinal movements:

When are extension and flexion of the spine contraindicated. I have a patient who has issues with L5 and L6. I guess extension (backbends) would be contraindicated, correct? Also what about folks who have issues with inter vertebral discs? And what about people who have a hump in the cervical-thoracic region?

These are actually very complex questions but I will try to stay on track here. My previous post All about the Spine  gave some background on how the spine changes shape in various movements, including forward bending, back bending, twists, and side bending. Now I like to think about the spine as a train where the head on the neck is the “engine, the subsequent vertebra are the train, and the coccyx is the “caboose.”

All these separate vertebrae are connected to each other by numerous ligamentous attachments. Anterior is a long ligament that runs down the front of the vertebrae from C1-S1 and posterior is long ligament that runs down the back portion of the vertebrae. This sandwiches the vertebrae so they don’t slide forward or backward in relation to the individual top- and bottom-connecting vertebra. There are also many other types of connecting ligaments between different portions of the spine. Again, the function of all the ligaments is to keep the spine stable, and to allow coordination of movement but not too much movement at specific vertebral levels!

Anterior and Posterior Long Ligaments of the Spine

Now the interesting thing about ligaments is that they don’t have much stretch to them. In fact they don’t really stretch at all because they are stabilizing structures. What that means is that they limit movement in the spine. This is a good thing since the spine houses the spinal cord.We really don’t want to tug or pinch our spinal cord because it is the main power house that connects our brain literally to our bones and muscles and allows us to move when and how we want to.

Between each vertebra sits a cartilaginous structure called an intervertebral disc that is connected to both the top and bottom vertebra. The discs are the shock absorbers of the spine and they absorb the motion at each vertebral level.

Lumbar Vertebrae (L1-L5)

Now lets talk about what happens when there is a problem at a specific vertebral level. We can have “cranky” backs and sometimes it doesn’t take a whole lot to have your back “go out” (actually I dislike this expression because the back isn’t going anywhere so it can’t really go “out”). However, there can be areas of the spine that are more sensitive to movement. The question asks about L5 and L6 specifically. Now there aren’t a whole lot of people who actually do have an L6. Typically we only have 5 lumbar vertebrae (L1-L5), and L5 is often injured or fragile in a lot of people from different causes.

When there is a specific vertebral level that is injured, it is important to understand what the actual injury is because then you can understand how to take care of it.

There are specific spinal conditions where forward and backward bends should specifically avoided, including recent spinal surgeries, recent or acute disc injuries, or any acute injury where pain is a true warning sign not to proceed. For spinal instabilities like spondylolisthesis  back bends should be avoided, and if you have facet arthritis of the spine in lower back or neck, backbends may aggregate this kind of arthritis pain. Also, with rheumatoid arthritis and other conditions where ligaments are adversely affected, all yoga postures will need modifications to avoid over stressing ligamentous attachments.

But specific level vertebral injuries can be challenging because you can’t just stop that area from moving Movement allows the intervertebral discs to get nutrition and hydration. When the spine is prevented from moving whether from medical intervention (like surgery) or wearing a rigid brace to prevent movement, sometimes the injured area heals but due to immobility a lot of other areas of the body aren’t very happy. When there is a disc injury, allowing some flexion and extension is encouraged but the issue is the degree of motion. So what you can do is to learn how to move without causing further injury.

When I say it is important to learn how to move, what I mean is that often when people do forward- or back-bending asanas, the movement isn’t well distributed along the spine and certain areas take more of the movement in an unhealthy way. When vertebrae are stiff or there is a particular loss of motion in one area, another corresponding adjacent area will move more to correct the motion loss. This isn’t a conscious action but the body learns how to make due with what happens. So if the L5 doesn’t move well then the vertebra above it, L4, will begin to move more to compensate for the loss of movement at L5, and S1 (the top of the sacrum) will also move more than it should to also compensate. This motion loss can occur anywhere along the spine, though certain areas are more predisposed to motion changes and this is how problems develop.

But in situation described by the reader (issues with L5 and L6), should the student practice forward and back bends? Well, there isn’t really a simple answer. Remember, the spine needs to move. So, the answer is yes, but with careful attention to form and detail. I like to think about making the movement long and soft, not short and tight. There is always a quality of “work” in every active asana, but the key is how much work is safe? There should never be sharp point of specific pain and there should never be asymmetrical pain.

Now the last part of the question, about the hump in the cervical/thoracic region, In a previous post Kyphosis (Dowager's Hump), Baxter described several causes for this rounding of the upper back. While it is sometimes caused by a structural issue like scoliosis or osteoporosis, other times rounding of the upper back is due to long-standing postural habits and a long life of sitting at a desk working with the head in a down position. At a certain point the individual may no longer be able to correct the curvature by standing up straight. In these instances, where there is no actual medical contraindication, then gentle passive backbends are a wonderful approach to the upper back rounding.

A passive backbend over a bolster or blanket roll (lying on your back with your knees bent using a bolster or a blanket roll perpendicular to the torso) to help change the upper back curve is beneficial as long as the neck and lower back are protected so they don’t arch too aggressively. Also, learning to relax as well as stretch the diaphragm  are also helpful, which you can do with a gentle Cobra pose or  supported Upward Bow (Urdhva Dhanurasana) with a chair. Another very accessible backbend for the upper back is Supported Bridge pose (setu Bandha Sarvangasana on low blankets (one for torso and one for legs, with or without a belt tied around the legs).

Ultimately, to keep healthy, your spine needs to move daily through a full range of motion. Our daily lives limit our motion dramatically, so this is where your yoga practice plays a powerful role in spinal health. With attention to your breath, intention of non aggression in your practice, and a healthy dose of common sense we can encourage our spines to move safely in our practice. Then the key is to take these skills back into our daily lives to encourage more healthy motion.

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