Farewell, Timothy McCall. And Thank You So Much!

by Nina

We recently had some wonderful news from Timothy McCall: he and his girlfriend are getting married soon, and he’ll be moving to New Jersey to live there with her. Congratulations, Timothy! We’re all so happy for you.

Of course, we’ll miss having Timothy nearby in the Bay Area and seeing him on Fridays at our regular yoga class (not to mention the occasional lunch). And we’ll also miss his almost monthly posts on our blog because, unfortunately, all these major life changes means that Timothy has to step down from being a regular contributor. 

But we’re very grateful for all the posts he has written since he originally joined us (see Dr. Timothy McCall Joins Yoga for Healthy Aging! to find out more about Timothy in general). To honor him and everything he has done for us, I thought I would take you on a little tour of his posts, which are all as relevant now as when they were originally written. 

Safety. One of the important topics that Timothy tackled on our blog was the issue of safety. William Broad’s articles in the New York Times claiming that yoga was dangerous (suspiciously timed with the release of the hardcover and then the softcover versions of his book) prompted strong reactions in the yoga community. Could what Broad was claiming be actually true? Timothy, who is both a medical doctor and a certified yoga teacher (Broad is neither), was happy to take him on! Two of his posts, Is Yoga Really Dangerous for Men?  and Will Yoga Cause a Stroke? Could it Prevent One?, were in direct response to claims that Broad made. 

And while he was on the topic of safety, Timothy also tackled a couple of other issues that yoga practitioners and teachers are typically concerned about in his posts Keeping Yoga Safe for People with High Blood Pressure  and Many Right Ways to Do a Pose and a Few Wrong Ones.

Meditation. Timothy has a very strong home practice, including a long session of asana. However, an essential part of his home practice is his daily meditation session. His feeling is that meditation is the crown jewel of the yoga practice, and he explains why in his post Is Meditation an Essential Part of Practicing Yoga? And to help you get started with your meditation practice, he provided some simple instructions in Starting a Meditation Practice.

Pranayama. In his travels worldwide, Timothy was surprised to find how few yoga practitioners practiced pranayama (breath awareness and breath control). So he made it his mission to introduce our readers to some simple, powerful practices. Because he believe that the Bhramari (buzzing bee) Practice is a safe, accessible practice, he did two separate posts on it: Pranayama for Everyone: Bhramari Breath Practice  and Bhramari Pranayama with Mudras. He also recommended Alternate Nostril Breathing in this post Balancing Your Nervous System with Alternate Nostril Breathing.

Home Practice. Like me, Timothy is a great believer in home practice. He says, “If you are taking yoga classes but not practicing at home, you may be missing the best—and potentially most therapeutic—part of yoga. Your personal practice is where the deepest work happens, when you go inward and go at your own pace." He explains why—and cites a scientific study—in his post Home Practice: The Best Way to Improve Your Health and Well-Being. And he also wrote two posts with recommendations for home practitioners Wondering to What to Practice at Home? Consider a Private Lesson  and Cultivating Healthy Posture with a Simple Restorative Pose. 

Other Passions.  The other three posts Timothy wrote might not appear to you to fit neatly into a single category, but if you knew Timothy as well as I know him, you’d realize that they’re all on issues that he feels strongly about. I’d have to say I was strongly influenced in my ideas about the importance of stress management by Timothy (we met many years ago when he was co-teaching a workshop on Yoga for Depression with Patricia Walden) and you can see why in his post Stress, Your Health, and Yoga. Timothy is also passionate on the subject of Ayurveda, which he has studied extensively in India. So even though we typically don’t have articles on that topic, I did let him share his some of his thoughts about the value of the Ayurvedic approach in his post Autumn, Healthy Aging and the Ayurvedic Dosha Vata. And, finally, most of us know about Timothy’s strong beliefs in the value of yoga therapy; after all, he wrote an entire book on the topic, Yoga As Medicine. In his final post for us, he reported on a symposium at which he spoke Medical Yoga Symposium at the Smithsonian, reporting that he witnessed there a growing acceptance of yoga as a therapeutic modality, saying that while it didn’t mean that yoga is already fully integrated with modern medicine, that we are getting there much faster than he would have predicted 10 or 15 years ago.

Timothy is not only a very knowledgeable person, with wide-ranging interests; he’s also an excellent writer. So if you’re new to the blog and unfamiliar with his work, I hope you’ll check out some of these posts. And if you’re a long-time reader, it’s worth checking to see if you missed any of his great writing. For information about Timothy's upcoming workshops, see our Timothy's Workshops page.

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Medical Yoga Symposium at the Smithsonian

by Timothy

Greetings from India! I've come to Kerala once again to study with my Ayurvedic doctor and to get some treatments. It is so nice to be back in this lush, semi-tropical setting and to see my teacher and many old friends. But just before I left the States, I had the privilege of taking part in a weekend symposium on modern and medical yoga at the Smithsonian, in Washington, DC. The symposium was held in conjunction with their groundbreaking exhibition, Yoga: The Art of Transformation. (The symposium is available for online for on-demand viewing.)

The event started off with a keynote by Dean Ornish, in which he summarized his more than 30 years of scientific research that has found that a yoga-based program, including a yogic vegetarian diet, can reverse heart disease. More recently his work has focused on men with prostate cancer, and is again showing very encouraging results. And due the similarities between breast and prostate cancers, Ornish believes that his comprehensive lifestyle program may benefit woman with breast cancer. That's speculation at this point, but other research is finding beneficial effects of yoga for those with the disease, including allowing them to tolerate chemotherapy and other medical treatments with fewer side effects.

The program included Richard Miller and Larry Payne, long-time yoga therapists and the co-founders of the International Association of Yoga Therapists, which has become the leading organization in the field.  Miller has garnered significant experience in recent years using the guided meditation practice Yoga Nidra with veterans with Post Traumatic Stress Disorder (PTSD). Payne founded and directs the graduate program in yoga therapy at Loyola Marymount University in Los Angeles.

Also significantly represented were top yoga researchers, including Sat Bir Khalsa of Harvard Medical School and Lorenzo Cohen of the M.D. Anderson Cancer Center and the University of Texas. As those of you who read my online newsletter know, Khalsa, Cohen and I, along with the world's most prolific yoga researcher (with more than 100 published articles!), Shirley Telles of the Patanjali Yogapeet in Hardiwar India, have agreed to co-edit the first medical textbook of yoga therapy. (We're just getting started, so it will likely be a year or two until it's published.)

The event was hugely popular, filling the Smithsonian's auditorium and selling out months in advance. More than 100 people attended my Yoga As Medicine workshop on Sunday, and I was struck by how many physicians and other health care professionals were present. One incentive was that, under the auspices of the event's co-sponsor, the George Washington University Medical School, physician attendees were awarded Continuing Medical Education (CME) credits, highly unusual for a yoga conference!

All of this speaks to the growing acceptance of yoga as a therapeutic modality. Indeed, there is now so much yoga research being published that Sat Bir, one of about a dozen full-time yoga researchers in the U.S., says he can't keep up with it all. This doesn't mean that yoga is already being fully integrated with modern medicine, but we are getting there much faster than any of us would have predicted 10 or 15 years ago, so stay tuned….

By the way, if you were unable to see the show at the Smithsonian, which was fabulous, it will be coming to San Francisco's Asian Art Museum from February 21 to May 25, 2014  and then travels to the Cleveland Art Museum from Sunday, June 22 to Sunday, September 7, 2014.

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Keeping Yoga Safe for People with High Blood Pressure

by Timothy

Monterey Cyprus by Melina Meza

I recently taught a course on Yoga for High Blood Pressure on Yoga U Online. During the program I suggested that doing certain inverted poses such as Headstand (Sirsasana) may not be a good idea, even for some people whose blood pressure (BP) is “well controlled” by medications. But one listener had heard during her teacher training that inversions were okay in this situation. Her instructors had consulted a local cardiologist and shown the doctor the poses in question, and he had said he didn't have a problem with them in people whose BP was under control.

The concern is that when you go upside down, the pressure in the head increases, which could at least theoretically increase the risk of a stroke. I say theoretically, because actually no one really knows how large the risk is, though it's likely very, very small. As I've written elsewhere, more than likely yoga greatly decreases the overall risk of a stroke. But that doesn't mean it's a good idea to push your luck.

Interestingly, blood pressure is one area where yoga teachers are sometimes more conservative than doctors. Aadil Pahkivala, the teacher I worked with on the high blood pressure chapter of my book Yoga as Medicine, has found that some people with well-controlled BP nonetheless demonstrate jitteriness when they do some inversions and strong backbends. This nervous system agitation, which can be visible to the teacher and palpable to the student  (at least the ones who have developed their internal awareness though their yoga practices), suggests a potential problem.

In medical school, we were taught to always weigh risks vs. benefits of any test, drug or medical procedure under consideration. In medicine, this comes under the category of “first do no harm.” In yoga, we've got the same idea with the notion of ahimsa, non-harming, which is considered the foundation of any yoga practice. Again, the risk of a stroke when inverting with “well-controlled” high blood pressure is likely very small, but even a tiny risk of something very bad should be factored in when deciding whether or not to do a particular yoga pose. In yoga, a crucial way to assess safety is to study your student—or yourself, if you're the student in question—as they do the practice in question.

So rather than simply saying, “The doctor says it's okay to do Headstand so let's do it,” a more prudent approach is to let that be the beginning of your evaluation. If you're a teacher, consider the following questions: Does the student appear to have the strength and flexibility to do the pose safely? How is their breathing in the pose? Do they look uncomfortable? Are they able to maintain a healthy curve in the neck? Are their neck veins bulging? How do they say they feel in the pose? It is even possible, if you've got a blood pressure device, to measure the pressure to make sure it isn't spiking in the pose or poses you're concerned about. And if you're a student concerned about high blood pressure, ask your teacher to help you do this evaluation.

Especially when the risks are uncertain, the more information you can get the better. And after you have all the information, it’s time to practice ahimsa.

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Bhramari Pranayama with Mudras

by Timothy

Recently in a post (Pranayama for Everyone), I wrote about the "buzzing bee breath," Bhramari. I taught a simplified version so that people could get used to it, and feel this practice's almost immediately palpable soothing effects. A reader wrote in with a question about the mudra (in this case meaning a hand position) often taught as part of the practice. So today, I'll teach two more advanced versions of Bhramari, in which the hands are used to deepen the effects.

The fifth limb of the eight-limbed path of yoga as taught by Patanjali is pratyahara, which I like to translate as "turning of the senses inward." Most of us living in the modern world lead lives of nearly constant sensory overload. Phones ring and buzz, TVs blare in the background, and even gas pumps impose video commercials on us. It's hard to escape the visual and aural onslaught. A beautiful antidote is Bhramari, particularly when it's taught with Shanmuki mudra.

Shanmuki mudra is designed to close the gates of perception: the ears, eyes, nose and mouth. It noticeably heightens the power of Bhrmari to internalize the awareness, and you'll notice that the buzzing sounds louder. But before we try the full mudra, let's begin with a modified version.

Bhramari with Modified Shanmuki Mudra

Sit in a comfortable seated position, with the spine upright but relaxed. Place the pad of each index finger on its respective ear, on the tragus, the skin-covered tab of cartilage near the front of the ear, just above the earlobe.

Using gentle pressure, use the tragus to block sound from entering the ear. Try a few rounds of Bhramari, making a medium-pitched buzzing sound on each exhalation. Compare the effects when you occlude the ear and when you lift the fingers.

Bhramari with Full Shanmuki Mudra

In full Shanmuki mudra, instead of the index fingers, use the tips of the thumbs to push down the tragus. The index fingers exert mild pressure on the upper, inner eyelid. Be careful not to press too hard. You want the pressure to feel soothing to the eyes. The middle fingers are placed on either side of the nose, above the nostril and below the nasal bone. You'll know you're in the right place, when gentle pressure on the fingers slightly occludes the passage of air through each nostril. The ring and pinky fingers are placed on either side of the midline just above and below the lips, respectively.

Once you've successfully got the mudra in place, try anywhere from one to five minutes of Bhramari, then lower the hands. You may want to continue to sit in meditation for a few minutes after you finish.

Therapeutic Benefits

Bhramari very quickly shifts the autonomic nervous to parasympathetic dominance. The practice can be useful for anyone with a stress-related condition, and particularly when demands and sensory input make you feel overwhelmed. It may be especially useful conditions like anxiety and insomnia, and even autoimmune conditions.

If you're using Bhramari to reduce symptoms of a cold or sinus infection, either skip Shanmuki mudra entirely or only use the modified version above. Ditto if you feel claustrophobic with the mudra.

While high blood pressure can have multiple causes, many cases of so-called "essential hypertension" (which make up the vast majority of cases), are characterized by heightened activation of the stress response. Thus the regular, ideally daily, practice of Bhramari and other calming yoga techniques may be very effective both at keeping your blood pressure down, and helping reduce it if it's high.

Note from Nina: For more about the yogic approach to high blood pressure, please check out Timothy's upcoming webinar on Yoga U, at an online educational resource. It will be held on two consecutive Saturdays at 12:30 eastern and 9:30 pacific time, starting November 30, 2013. Click this link for more information.

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Balancing Your Nervous System with Alternate Nostril Breathing

by Timothy

Mountain, Sky, Clouds by Melina Meza

In my last post Pranayama for Everyone: Bhramari Breath I wrote about the importance of pranayama (yogic breathing practices) and introduced one of my favorites, Bhramari, the buzzing bee breath. Today, I'm going to tackle the pranayama I consider the most important: alternate nostril breathing (Nadi Shodhana or Anuloma Viloma).

It turns out that almost all of us breathe primarily through one nostril for parts of the day, and then switch to breathing primarily through the other nostril at other times. The ancient yogis knew wrote about this and modern science has confirmed it (see p. 62 of my book Yoga as Medicine for details). Research has confirmed that breathing through the right nostril is linked to the sympathetic nervous system (SNS), whereas left nostril breathing activates the parasympathetic nervous system. This is pretty much exactly what's described in ancient yogic texts, albeit using metaphoric language. The left channel ida [pronounced ee DAH] is the feminine, lunar, cooling side, the texts say, whereas the right channel pingala [pronounced peen gah LAH] is the masculine, solar, heating side.

Many people in the modern world have an imbalance in their nervous systems, usually too much activation of the SNS, the flight or fight response. Others, such as some people with chronic fatigue syndrome, have too much parasympathetic tone. In either case, alternate nostril breathing can be useful. In Ayurveda, Nadi Shodhana is felt to be good for people of all constitutional types. I have found it particularly useful for students with an increase in the vata dosha (see Autumn, Healthy Aging and the Ayurvedic Dosha Vata), which is especially common now as we move into the cooler weather of the fall season.

If you have never tried alternate nostril breathing, you may have seen pictures of yogis using their fingers to alternately close of one nostril, then the other. Typically the thumb of the right hand is used to close off the right nostril and the fourth finger (or sometimes the fourth and fifth together) is used to block the left nostril. This "digital pranayama" is a wonderful practice that I've done daily for many years. But not everyone can do it.

For example, some people with arthritis find it too cumbersome or painful to use the fingers this way. If you've got a deviated septum or nasal congestion, digital alternate nostril breathing similarly may not work well due to the obstruction to air flow. In these instances, mental alternate nostril breathing, where you simply imagine to air going into one side and out the other is a great option. And the practice is so simple and safe that I often teach it to beginners.

To practice mental alternate nostril breathing, sit as you would for meditation, relaxed but perched high enough that your lower back can have its healthy inward curve. With your eyes closed, slowly breath in and out a couple of times. Then imagine you are inhaling through the left nostril and that you are exhaling through the right nostril. Next imagine inhaling through the right nostril, and exhaling through the left. Continue this pattern:

1. Inhale left
2. Exhale right
3. Inhale right
4. Exhale left

If you're new to pranayama, try this practice for just a minute or so. If it feels comfortable, you can continue for five minutes or longer. Since you began by inhaling on the left, end your session after an exhalation out the left nostril. Did you notice that your breath followed your intention?

If you are comfortable, I'd suggest you sit quietly for a few minutes after you finish or, if time allows, do a meditation practice. The ancient yogis taught that the balancing effects of Nadi Shodhana make it the perfect prelude to meditation, helping your meditation be calmer and more focused.

If you are an asana practitioner who tends to skip both pranayama and meditation, I have a challenge for you. For the next two weeks, try to do two minutes of mental Nadi Shodhana, followed by three minutes of sitting every morning before eating (or another time that suits you), and let us know how it goes. I suspect you'll be pleasantly surprised by the results.

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Pranayama for Everyone: Bhramari Breath Practice

by Timothy

Bee and Flower by Melina Meza

One of the dirty secrets of the yoga world is how few yoga practitioners—and how few teachers—do pranayama, yogic breathing exercises. It's better in some yoga traditions than others, but overall I've been shocked to see how few of my colleagues practice pranayama regularly. This is a shame!

The breath is probably the single best way to affect the autonomic nervous system, which in turn controls the function of every internal organ, as well as systems like digestion and immunity. Pranayama can also be the gateway into meditation and higher yogic practices. Furthermore, there is a potential synergy: the regular practice of pranayama can make your asana practice subtler and more refined, and your meditation deeper and more concentrated. For therapeutic purposes, I believe there is synergistic benefit from doing some asana, along with pranayama, meditation, and other yogic practices.

Some schools teach that only experienced practitioners should attempt yogic breathing practices. There is wisdom in being careful, as pranayama done incorrectly—and especially if it's done too aggressively—can lead to problems with the nervous system and, in extreme cases, to psychological decompensation. But there are a few basic pranayama practices that I have found are safe for virtually everyone, and I'll be writing about them in this and my next few blog posts.

I'll begin today with one of my favorites: Bhramari [pronounced brah mah REE], which means the "buzzing of the bees." Although, in my experience, this is one of the pranayama techniques that's rarely taught (at least in many traditions), it's simple, safe, and has tremendous therapeutic potential.

To do a simple version of Bhramari, sit in a comfortable upright position as you would for meditation. Keeping your mouth closed, with your exhalation make a low- to medium-pitched humming sound in your throat. As you make the sound, which should last the entire length of the exhalation, tune into the literal vibration of the sound waves in your throat and even in your skull and brain. Then inhale through your nose, and if you're comfortable, repeat. Try to make your transitions into and out of each humming exhalation as smooth as possible.

At first, you might try Bhramari for a minute, but if it's goes well you can progress to a few minutes at a time. Depending on your breath capacity, the exhalation might vary from short to quite long. I'd suggest doing as long an exhalation as feels completely comfortable. At all times, each subsequent inhalation should be smooth, without any breath hunger. If you are feeling at all short of breath, you've likely pushed harder than you should, and if so, simply take a catch up breath and then resume Bhramari. If you feel at all agitated, I'd suggest you suspend the practice for the day and try it again another time with shorter exhalations.

Most people who do Bhramari as I've described it above will find the practice soothing. Since you will be lengthening your exhalation relative to your inhalation, the Bharmari breath activates the parasympathetic nervous system, and within a few breaths can bring you to a greater sense of relaxation and calmness. According to the classic text Hatha Yoga Pradipika, "with regular practice of bhramari, bliss arises in the heart."

A recent study Immediate effect of a slow pace breathing exercise Bhramari pranayama on blood pressure and heart rate suggested that the practice can lower blood pressure. In my yoga therapy work, I've found it useful for stress and various stress-related conditions, including insomnia (try a low-pitched sound). It's also useful for nasal congestion due to colds, allergies or sinus infections (use a slightly higher-pitched sound so that you can feel your nose and sinuses vibrating).

I even sometimes recommend Bhramari as a meditation alternative for people who find their minds so distressingly busy when they sit that they can't do the practice. It's harder for the monkey mind to go wild over the racket the buzzing of the bees makes internally, allowing you to settle in something moving in the direction of meditation.

Next up: Alternative Nostril Breathing.

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Medical Conditions Benefited by Yoga

by Nina

Just a quick post today to let you know that Timothy McCall has updated his list of medical conditions that are benefited by yoga (as demonstrated by scientific studies). There are 75 conditions!

1.    Alcoholism and Other Drug Abuse
2.    Anxiety
3.    Asthma
4.    Atrial Fibrillation
5.    Attention Deficit/HyperactivityDisorder (ADD/ADHD)
6.    Autism
7.    Back Pain
8.    Balance Problems
9.    Breast Cancer
10.    Cancer (General)
11.    Carpal Tunnel Syndrome
12.    Chronic Fatigue Syndrome
13.    Chronic Obstructive Pulmonary Disease (COPD) e.g. Emphysema
14.    Congestive Heart Failure
15.    Depression
16.    Diabetes
17.    Drug Withdrawal
18.    Eating Disorders
19.    Epilepsy
20.    Fatigue
21.    Fibromyalgia
22.    Gait (Walking) Problems
23.    Guillain-Barré Syndrome
24.    Heart Disease
25.    Hemorrhoids
26.    High Blood Pressure
27.    HIV/AIDS
28.    Hypothyroidism
29.    Infertility
30.    Inguinal Hernia
31.    Insomnia
32.    Irritable Bowel Syndrome
33.    Kidney Failure
34.    Lymphoma
35.    Mental Developmental Impairment
36.    Menopausal (and Perimenopausal) Symptoms
37.    Menstrual Disorders
38.    Metabolic Syndrome
39.    Migraine and Tension Headaches
40.    Multiple Sclerosis
41.    Muscular Dystrophy
42.    Neck Pain
43.    Neuroses (e.g. Phobias)
44.    Obesity/Overweight
45.    Obsessive Compulsive Disorder (OCD)
46.    Organ Transplant
47.    Osteoporosis
48.    Osteoarthritis (Degenerative Arthritis)
49.    Ovarian Cancer
50.    Pain (Chronic)
51.    Performance Anxiety
52.    Pleural Effusion (Fluid in Lung Lining)
53.    Polycystic Ovarian Syndrome
54.    Post-Heart Attack Rehabilitation
55.    Post-Joint Replacement
56.    Post-Polio Syndrome
57.    Post-Operative Recovery
58.    Post-Stroke Rehabilitation
59.    Post-Traumatic Stress Disorder (PTSD)
60.    Pregnancy (both normal and complicated)
61.    Psoriasis
62.    Restless Leg Syndrome
63.    Rheumatoid Arthritis
64.    Rhinitis (Inflammation of the Nose)
65.    Schizophrenia
66.    Scoliosis (Lateral Curvature of the Spine)
67.    Sexual Function
68.    Sinusitis
69.    Smoking Cessation
70.    Stroke
71.    Total Knee Arthroplasty
72.    Traumatic Brain Injury
73.    Tuberculosis
74.    Urinary Bladder Dysfunction
75.    Urinary Stress Incontinence

Timothy has created a special PDF document that lists these conditions along with the scientific publications that confirm the benefits that yoga provides. And he has generously granted permission for copying and distributing this document. You can find it on his web site: http://www.drmccall.com.

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Starting a Meditation Practice

by Timothy

Berries by Melina Meza

In my last blog post (Is Meditation an Essential Part of Practicing Yoga?), I wrote about why meditation may be the most powerful tool in the yoga toolbox for improving health and well-being. Yet meditation is not part of most yoga classes, which tend to focus almost exclusively on asana. Indeed, many yoga practitioners who have become interested in meditation have looked to Buddhism or elsewhere to learn how to meditate because they weren’t finding it in the yoga world.

But, as I mentioned previously, meditation was traditionally an integral part of yoga practice, and within the yoga tradition there are dozens of different techniques. Contrary to popular belief, in yogic meditation you are usually not trying to make your mind empty, but instead the process begins by learning how to concentrate your focus. To facilitate this, it helps to focus your attention on one thing, perhaps a word or phrase (a mantra), an object like a candle or a picture of a teacher or deity, or simply on your breath itself. With sustained attention, you may slip into a meditative state.

So, strictly speaking, we do not sit down to meditate, but rather we sit to foster the state that may lead to meditation. Since the mind tends to wander—even among experienced meditators—there may not be much (or even any) actual meditation in any particular session of sitting. Still, this movement towards meditation all by itself brings physiological and health benefits. And, of course, with sustained practice, more and more actual meditation can happen. At first, it may just be for a moment now and again, and that’s just fine.

The first question then is how do you sit? Despite the pictures you’re likely to see of people meditating, you do not need to sit cross-legged on the floor, though if you can that may be one of the best ways. Kneeling in Virasana (Hero pose), perhaps with a block under your sitting bones, is an excellent alternative. What’s important is that you maintain your normal spinal curves, particularly the inward curve of your lower back (the lumbar curve). This is difficult for most people to do if they try to sit cross-legged on the floor, which is why one or more cushions should be placed under the sitting bones, allowing the healthy forward tipping of the pelvis that facilitates maintaining an easy lumbar curve. When you’ve got the height right, your thighs will angle down slightly toward the floor. If you've propped yourself up high to do this, you may need to put additional support underneath your thighs to remain comfortable. Getting all of this right is an art, and if you’re not sure how to proceed I suggest you seek the help of an experienced yoga teacher.

For many people, it will be much easier and much more effective to sit in a chair for meditation. You’re only going to be able to concentrate and/or meditate if you can remain in a comfortable upright position, and if you’re not comfortable sitting on the floor, it’s best to try a chair. For those sitting in a chair, I recommend scooting to the front of the seat, because if you sit back, most chairs encourage a flattening or rounding of the lumbar spine. If your feet don’t reach the ground comfortably, place blocks, thick books, or folded blankets under them. If your legs, like mine, are long, you may need to place a folded blanket on the chair to raise the seat. But no matter the position you choose, if possible, your head should be directly over your shoulders and pelvis. If you get it right, there should be very little work required to stay upright.

Although it may not be ideal, for those who can't sit comfortably, it is possible to meditate lying down. Some people in the yoga world would take exception to this, but I have found it to be useful in the yoga therapy work I do. One of the principles of teaching yoga is that we try to meet students where there are, and this is where some people are: they cannot sit comfortably. Yes, there is a greater tendency to get sleepy or zone out while supine, but we should not let the perfect be the enemy of the good.

The simple yet powerful practice I often suggest for beginners (and experienced students as well) is a meditation technique known as So Ham (sometimes written So Hum because that’s how it's pronounced). Settle into a seated position that balances ease and an upright spine, and notice the flow of air in your nostrils. Begin to focus on the sound of your breath. The ancient yogis felt they could hear in the inhalation the sound “Soooooooooh” and in the exhalation “hummmmmmmmm.” They didn't make the sound so much as they tuned into the sound that the breath naturally makes, believing it to be a mantra that’s built in. In Sanskrit so ham means “I am that,” which to the yogis signaled their connection to the greater whole. Try to stay focused on that sound, noticing your breath but not trying to control it. If you discover your attention has wavered, simply observe that without judgment, and gently bring your focus back to So Ham.

I'd recommend trying to stay for 3-5 minutes initially, working up gradually to 20 minutes or longer daily. As with all yoga practices, a little bit every day will bring greater benefits than longer sessions done intermittently.

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Is Meditation an Essential Part of Practicing Yoga?

by Timothy

Patterns in the Sand by Brad Gibson

Do you need to meditate? Can you achieve all or most of the same benefits from just practicing asana, restorative yoga, Savasana, and/or pranayama? Is it worth even trying if you feel like you're no good at it? We get questions like these at the blog from time to time, so I figured I'd tackle them today.

I can't help but notice that people often talk about yoga and meditation as two separate practices. But according to Patanjali, the great codifier of yoga, meditation was an integral part of the practice. By yoga, of course, most people in the U.S. mean asana, which is why people say yoga and meditation. And since most asana classes don't include any meditation, many yoga practitioners have looked outside of yoga, often to Buddhism, if they're interested in learning more. There's nothing wrong with that, but I think people forget that the Buddha was a yogi before he became the Buddha!

Meditation gets a lot of press as an effective tool to de-stress, to calm the mind and the nervous system. That's certainly true, but if that were all meditation had to offer, you could hardly view the practice as vital, since we've got so many tools in yoga that can foster relaxation: asana, breathing practices, chanting and restoratives to name a few.

To many dedicated yogis, however, meditation is the crown jewel of the practice. They recommend asana mostly because it prepares the body for meditation, to sit up straight comfortably for long periods of time. All the high levels of samadhi—absorption as it is sometimes translated—the eighth of the eight limbs of yoga that Patanjali describes in the Yoga Sutras, are said to happen only in meditation. And, more specifically, from its long-term practice over the course of years, even decades.

I have been meditating for a long time, and it has become in many ways the most delicious part of my practice. It didn't start out that way. My mind was very busy when I began, and it was extremely difficult for me to keep my attention from flitting from idea to idea. And it was hard to find comfort sitting in one place, without frequent position adjustments and fidgeting. Many people who try to meditate get discouraged at this point and give up. That, I believe, is a mistake. As with a lot of other areas of yoga, hanging in when things are challenging, even discouraging, can bring rewards. Yoga teaches that it is by strengthening our weaknesses that we become more balanced.

Meditation can be a fabulous tool to study your mind and slowly gain more control over it. (I'm not just talking about the conscious mind, which is mostly what gets dealt with, often quite helpfully, in psychotherapy, but the unconscious mind, which hugely impacts our behavior and happiness.) The first lesson for most of us on the meditation cushion is just how unruly our minds are, and how hard it is to maintain our focus for more than a few seconds. Seeing that reality may be uncomfortable, but it's the first step toward eventually changing it.

And there is real benefit in feeling your mind running all over the place, wanting to get up and move, and continuing to stay seated anyway, trying to bring your attention back to whatever you're focusing on, whether that's your breath, an image, or a mantra. Studies of the Relaxation Response, which were performed on people practicing a demystified form of yogic mantra meditation, have shown that even when practitioners don't feel they are doing it well, they gain the physiological benefits of lower blood pressure, heart rates, etc.

Even after years of practice, some days my mind is still all over the place. But usually, if I stay at it, things eventually settle down. One reason why some experts recommend 20 minutes of meditation daily is that it often takes about that long to settle down. But the more you practice the easier it gets.

You might wonder where you will find the extra time to add a 20-minute practice to your already busy schedule. Well, first off, you don't need to do it for that long. Even a few minutes in the beginning starts to build up the habit. Over time you can slowly increase the time you sit. Interestingly, about a decade ago when I upped my practice to an hour a day, I discovered that I began to need about an hour less sleep each night, as if the meditation were giving me some of sleep's restorative effects. It felt like I was getting to meditate for free, without carving any time out of my day!

In my yoga therapy work, I often recommend meditation, but not always. Sometimes when someone is very anxious or seriously depressed, if they attempt to close their eyes and go inward, they may go into an unpleasant—and potentially counterproductive—state of mind. But if we can use other tools, like breath and asana, to improve the acute situation (along with whatever medication, therapy or other tools they are employing), I will often try to add meditation later. I have come to believe that for the long-term care of anxiety and depression, meditation may be the most powerful tool we have. It gets to places that asana simply can't, as powerful as asana can be.  But unlike a lot of meditators, I don't think you should give up your asana practice once you get into meditating. Because asana also gets to some places that meditation can't, like your hip flexors, for example!

The bottom line is that the different yogic tools appear to work together in a synergistic fashion. Meditating can make you a better asana practitioner, and doing asana can help deepen your meditation. And regular pranayama can help both of them!

In my next post, I'll give more specifics on how to begin a meditation practice. If there are particular themes you'd like to me address, please let us know.

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Many Right Ways To Do A Pose and a Few Wrong Ones

by Timothy

Branches and Roots by Brad Gibson

I got involved in a conversation the other day with Nina after class with our teacher Donald Moyer. Another student was wondering about the “correct” way to do forward bends. She’d just read an article in Yoga Journal by a highly respected teacher who said that the only correct way to do forward bends was with a concave lower back, that is, maintaining a normal inward curve of the lumbar spine. Although Donald sometimes prepares for forward bends like Uttanasana by doing the pose with a concave lower back, in the final pose, he suggests we allow a nice, even rounding of the spine, that is, completely reversing the lumbar curve.

Inherent in the student’s question is the notion that there is only one correct way, that everybody in all circumstances, should do any pose. The reality is that it always depends. What are you trying to achieve? What poses have preceded it and what do you plan to do after it in your practice? Are there contraindications you need to consider? Are there quirks in your anatomy or injuries you need to work around?

We could do this analysis for any pose but, since we’re on the topic, let’s stick with forward bends.

There are times when it is definitely not a good idea to fully round the spine. If you have a herniated lumbar disc, for example, rounding is generally contraindicated. When you round forward, the front surfaces of adjacent lumbar vertebrae come together which tends to push the disc material toward the back of the body, near where nerves exit the spine. This rounding the lower back could lead to nerve compression and sciatic pain.

For a similar reason, rounding the back in forward bends is generally not recommended for those with osteoporosis. Compression fractures of the spine happen when the front surface of one vertebra collapses under pressure from a neighbor. But forward bends done with a concave lower back can actually be therapeutic for those with thinning bones, and were part of the routine Dr. Loren Fishman used in his ground-breaking research (still ongoing for those interested in enrolling in the study) that is documenting yoga’s powerful ability to increase bone mineral density.

For those who lack such contraindications, rounding the spine the way Donald teaches may lead to deeper relaxation and more quieting of the nervous system. When looking at students from an Ayurvedic standpoint, long holds of rounded forward bends can be deeply calming to the vata dosha (the imbalance often tied to stress and over-activity). Long holds of such forward bends are part of yin yoga, and can be a wonderful way to open tight hips, for example, to prepare the body to sit comfortably for long periods of time in mediation.

So my way of thinking is that there is more than one correct way to do forward bends, all depending on the overall situation and what you are trying to accomplish. But that said, there are also certainly wrong ways to do poses. In my mind, any way of doing a pose that unduly increases the risk of injury, or which puts the joints or other bodily tissues in compromised positions is wrong. In forward bends, one common incorrect method is to bend from the waist rather than hinging from the hips. Although not all yoga teachers would agree, I also advise against any knee locking in the poses.

Of course, this just begins to describe all the thinking on forward bends found among different yoga teachers. Some people sit up on folded blankets or other props, which allows them to get more forward tipping of the pelvis, but not everyone needs to do this. Some people hold their toes, some hold a strap looped around the soles of their feet, and some place their hands alongside their legs. Ultimately, good teachers learn to look at students, ask them questions and determine a reasonable approach.

To me the final arbiter of whether a yoga technique is right or wrong is the breath. If you’re able to do the pose and the breath can remain smooth, deep and even, more than likely you're doing it a right way (though probably not the right way).

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The Power of Fact Checking: Timothy McCall on Elephant Journal

by Nina

Buddha Waiting for Spring by Michele Macartney-Filgate

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

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

My favorite fact is this one:

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

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

I also love Timothy’s conclusion:

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

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

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Will Yoga Cause a Stroke? Could it Prevent One?

by Timothy

There has been concern—and for some even fear—in the yoga community regarding the risk of strokes from doing yoga. How realistic is this?

Much of this fuss was set off by the New York Times writer William Broad, who warned that all the stretching of the neck in various yoga poses like Cobra and Shoulderstand could lead to tearing of the linguini-like vertebral arteries that run along either side of the neck bones, which could then lead to bleeding into the brain. But as I (and others) have written (see Man Bites Down Dog), Broad's analysis was alarming, lacked data to back his extraordinary contentions, and in all likelihood was way off. Still, it may be worth discussing the risk of strokes and what thoughtful yoga practitioners and teachers can do to prevent them.

Arteries of the Neck (from Gray's Anatomy)

Vertebral artery tears and resulting strokes often happen when someone makes an unaccustomed neck movement. The example that is often cited is when an elderly woman drops her head back into the hairdresser’s sink. In such a case, the movement in question is an extension of the neck (the cervical vertebrae), not so different from what happens in backbends like Cobra pose and Upward-Facing Dog. But it’s also at least theoretically possible to tear the artery when you go in the other direction and flatten the neck vertebrae, as in Shoulderstand and especially Plow pose. Even twisting poses could cause problems if you crank the head too far. Outside of yoga, such strokes also have been reported to happen when people simply turn their heads to the side or suffer minor trauma. It is estimated that 1.5 people out of every 100,000 suffer vertebral artery-related strokes every year.

I have observed many yoga students who hyperextend their necks in poses like Cobra and others who flatten their neck in poses like Shoulderstand and Plow. In the case of backbends, many students have the habit of over-arching from the neck. They compress the backs of their necks, and often arch too much from the back of the skull (the occiput), at the atlas-occipital joint. (The atlas is another name for the first cervical vertebra.) This habit is common in those with tight thoracic spines. When the thoracic spine is stubborn, people sometimes overcompensate by overarching the more flexible cervical and/or the lumbar spines. In other words, when one link in the chain is tight, people tend to move more than they should from the links above and below it.

When instructing backbends, I encourage students to try to keep the back of the neck long. Rather than looking up in a pose like Cobra, I encourage those with the habit of neck hyperextension to keep their gaze forward, which tends to keep them from tipping the head back too much. It’s also useful to think of originating the movement in your neck from the middle of the thoracic spine and the lower cervical vertebrae (where the neck attaches to the back).

Poses like Shoulderstand and Plow pose tend to flatten the neck. This is especially problematic if the student tries to move the chin towards the chest (an unfortunate instruction that some yoga teachers use). Instead, I encourage students in these poses to lift the front of the chest toward the chin, and actually slightly move the chin away from the chest. If you try this, you may notice that it lessens the feeling of pressure at the back of the neck.

In the traditional hatha yoga Shoulderstand, known as Viparita Karani (not to be confused with the restorative pose that uses the same name), the legs are in a jack-knife position. In other words, the pelvis is behind the spine and the feet are forward of the spine. This pose can be done safely without any props, especially if you follow the instructions of moving the chin slightly away from the chest. This is the version of Shoulderstand I’ll do if I wind up somewhere with no props.

Rare is the yoga practitioner who is flexible enough to do the modern, more-directly vertical version of the Shoulderstand—in which the legs are stacked directly over the hips and shoulders—without blankets or other props to raise the shoulders off the ground. To keep suppleness in your neck, the number of blankets required varies. For example, I use four folded blankets under my shoulders. Try to place your shoulders near the edge of the folded blankets so you graze the skin over C7, the lowest cervical vertebra, while you work to lift C7 away from the ground. Your breath should be soft, slow and even throughout the pose, and if at any point you can’t breath smoothly, or otherwise feel uncomfortable come down.

Plow pose is even more challenging to the neck, and I recommend the same blanket set-up. If you notice any discomfort at the back of the neck, however, I recommend either skipping the pose entirely or placing your feet higher, for example, on the seat of a chair.

In twists, try not to lead with your head. In other words, the turn should come from the vertebrae all along your spine, with no twist whatsoever from the atlas-occipital joint. One instruction I give if students feel any tension in the neck is to turn the head ever so slightly (say 1 millimeter) in the opposite direction of the twist. What this accomplishes is to stop people from trying to twist the skull on C1, a motion those joints are not meant to do. Even more conservative, is to not let the chin turn any more than the chest, in other words the nose and chest point in the same direction.

Beyond lessening the theoretical risk of a vertebral artery stroke, all the above advice will also tend to help avert yoga’s contributing to such musculoskeletal problems of the neck as arthritis and overstretching of spinal ligaments. Indeed, averting these problems is actually my primary reason for recommending doing the poses as I suggest. Broad generated tremendous publicity for his book by trumpeting the risk of vertebral artery strokes, and made the absurd, entirely unscientific calculation that yoga causes 300 strokes and 15 deaths per year in the U.S. My guess is that it’s more like in a one in a zillion scenario. 

Ironically, skillfully practicing the very poses that Broad recommends avoiding might actually lower the risk of the vertebral artery strokes. When you gradually stretch the arteries and surrounding tissues as could be expected with a regular yoga practice, the vessels would likely become more pliable, and resistant to tearing with sudden movement or trauma.

And the bigger picture is that vertebral artery strokes are a tiny percentage of all strokes, estimated to strike 269 people per 100,000 every year. Yoga’s documented ability to lower blood pressure, cholesterol and stress hormones, reduce inflammation, thin the blood, etc., in all likelihood greatly lowers the incidence of all types of strokes—as well as heart attacks and a host of other conditions. Just be sure to be mindful of contraindications. So, for example, if you have poorly controlled high blood pressure, you probably want to avoid inversions like Headstand entirely. The risk of having a stroke as a result is probably small, but it’s better to err on the side of caution.

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Man Bites Downward-Facing Dog: Dr. Timothy McCall Takes On William Broad of The New York Times

by Nina

Mugsy, the Yoga Dog by Nina Zolotow

Could yoga make you fat (especially if you're a woman)? Does it cause hundreds of strokes per year? Sex you up so much you'll engage in unethical behavior? Did the entire discipline start out as a sex cult? If you read The New York Times you might think so. As much as I've often disagreed with him, up until now I've been diplomatic in my responses to William Broad's writings about yoga in Times and in his book The Science of Yoga. But after his recent article in which he asserted that "yoga is remarkably dangerous — for men," I felt it was time to speak up. —Dr. Timothy McCall

In his new paper “Man Bites Downward-Facing Dog,” Yoga for Healthy Aging blogger and Medical Editor for Yoga Journal Magazine, Dr. Timothy McCall responds to William Broad’s ongoing sensationalistic claims about yoga. In his post on our blog Is Yoga Really Dangerous for Men?, Timothy addressed Broad’s most recent claim that yoga is “remarkably dangerous” for men. In this new paper, he goes further and responds to other over the top claims that Broad has made previously, such as that yoga can make you fat or that the entire discipline started out as a sex cult. He also makes it clear that he is not denying that yoga injuries are a problem; and he acknowledges that he is not in disagreement with all of William Broad's assertions.

Timothy's article is on his web site, in  PDF format rather than on a web page. So if you want to read it, you’ll need to download it and view it with Adobe Acrobat. To get your copy of the paper, you can either use the link in the previous paragraph or go to Timothy's web site www.drmccall.com. I highly recommend that you go ahead and download the paper. Then feel free to pass it on to your friends. We really want to get the word out!

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Is Yoga Really Dangerous for Men? Dr. Timothy McCall's Response to William Broad

by Timothy

Science reporter William Broad, who a year ago woke the proverbial sleeping (downward facing) dog of the yoga world with his NY Times Magazine article How Yoga Can Wreck Your Body, is back at it. This time he's claiming—based on a review of injury statistics—that men are at much greater risk of serious injury from yoga (see Wounded Warrior Pose). The claim may or may not be true, but I don’t think you can really tell from the data he presents. I plan on writing more about this topic in my next email newsletter, but wanted to respond to Nina's query for the blog today.

Man in Unwounded Warrior 3 Pose by Nina Zolotow

As Broad makes clear in his book, The Science of Yoga (from which the first Times yoga article was excerpted), the subject of his inquiry is the physical practice of yoga as found in most classes. He’s not talking about meditation, chanting, selfless service or spiritual development. Even so, styles of asana practice, different teachers and classes vary enormously. It’s my feeling that Broad's failure to account for these differences could entirely explain his findings.

Back when I was taking a lot of classes of different styles (which I'm not doing anymore, so if things have changed I’d love to get feedback from readers), I found that in the more meditative and restorative classes, I was often one of the only males in the room. But in some of the more vigorous and acrobatic classes, the gender split was closer to even. Thus, men having a higher incidence of yoga injuries could simply be a reflection of their favoring the kinds of classes where injuries seem more common, and not actually reflect any greater vulnerability to injury.

It is also my experience (and that of most yoga teachers I’ve spoken with) that people who are more flexible are generally at greater risk of injury, particularly for injuries like hamstring muscle tears, and overstretching of the ligaments. It varies from person to person obviously, but on average men are much stiffer than women, and seemingly less prone to these types of injuries.

Many yoga injuries—again based on my experience, since we lack data—happen when people are trying too hard to achieve a particular result. Your foot won’t go into Lotus pose, for example, so you pull a little harder to get it into position, and in the process tear ligaments in your knee. But before that happens, the body almost always gives warning signs, such as pain or strained breathing. If you decide to ignore them and power your way through, problems may result. Both men and women can do this, but if I had to guess I’d say men are more likely to, so in this way may be at higher risk.

William Broad loves to create controversy. Beyond claiming that yoga can wreck your body, he has also written that yoga can make you fat, and that the entire practice started out as a sex cult (neither of which is true). Statistically speaking, if Broad’s analysis is correct (and given the methodological problems in how he did his analysis—see Is Yoga Really Dangerous for Men? Dr. Ram Rao Weighs In—I don't think we can know), men may indeed be at higher risk of injuries when practicing asana, but this may miss a larger truth. My guess is that if a man practices less demanding forms of yoga, or any style of yoga in a less aggressive and more mindful way, that his risk probably isn’t any greater than that of a woman, and may even be less. Uh oh, there’s a potential future headline for Mr. Broad: Women at Greater Risk of Yoga Injuries! You heard it here first….

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