Judith Lasater on Yoga and Aging

After the Fire by Brad Gibson

As Shari and I were discussing our series on menopause and perimenopause, Shari had the idea of contacting her former teacher, well-known yoga writer Judith Lasater, to see if she had some advice for us. To our delight, Judith agreed to do a brief interview with us for the blog. After some back and forth, we decided to ask her a single question. We love her answer, and hope that you will find it inspiring. —Nina and Shari

Q: You've been practicing yoga since you were a young woman. As you went through peri-menopause and menopause, how did you change your personal practice to address your symptoms and adapt to your changing body?

Judith: When I began my yoga practice in 1970, I had the idea that I would pretty much be following the same practice routine forever that I had established from the beginning.

Nothing has been further from the truth. At the beginning I adapted my life to fit my practice. I started going to bed earlier so that I could awaken to practice in a quiet morning environment. I changed my diet, what I read, who I hung out with, and soon, my job, as I decided to begin teaching yoga.

But over the years, the opposite has happened. Gradually my practice has evolved to fit my life. There were adaptations with pregnancy, motherhood, and, of course, with peri-menopause and menopause.

Hopefully with aging one becomes more naturally introspective and less influenced by the external world. As I entered peri-menopause, I noticed a definite shift of my interest. It was as if a “natural” pratyahara was taking place.

I wanted to meditate longer, practice pranayama longer, and my asana practice changed as well. Soon fifty percent of my practice consisted of supported backbends and supported inversions, especially Viparita Karani (Legs Up the Wall pose), Supported Sarvangasana (Shoulderstand) on the chair and Supported Halasana (Plow pose) on the Halasana bench.

I found I needed this intense internal focus time in my life to integrate not only the physical changes that I was experiencing, but also the life changes of parenting teenagers and young adults. Additionally I was becoming the major emotional and familial support for an aging mother.

When I chatted with other women yoga teachers my age, we found we were all moving in the same direction with our practice. We began to eschew so much action in the practice and instead were increasingly nourished by cultivating the receptive consciousness of quiet poses for at least half of our practice of asana.

The most important thing I learned about this process is a lesson I still learn repeatedly. I would distill this lesson into a “mantra” of these three words: Trust yourself first. This will guide you well as you transition through life’s stages.

Note from Nina: For photographs of Judith's favorite poses and more information on them, see Judith Lasater's Favorite Poses.

Judith Hanson Lasater, Ph.D., PT, has taught yoga since 1971. She is a founder of Yoga Journal magazine, President Emeritus of the California Yoga Teachers Association, and was selected by Natural Health Magazine in 2010 as the only yoga teacher out of five people honored for their contribution to promoting natural health in the US during the previous 40 years. She has written eight books on yoga including the most recent: What We Say Matters and YogaBody. See judithlasater.com for more information about Judith, her teaching schedule and her books.

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Yoga and Menopause: Frozen Shoulders

by Nina

When I was doing research for my post on menopause and headaches (see Yoga for Menopause: Headaches), I was very surprised to learn that the most common complaint that Japanese women have during menopause is not headaches (which is what I previously thought) or hot flashes (the most common complaint in the US) but frozen shoulder. As many of you probably know by now, I experienced two bouts of frozen shoulder during perimenopause/menopause. Although I knew this condition was common among women my age, no one I consulted about the condition really tied it directly to menopause, although there was some speculation that it might be related to hormonal changes. That's because they all said  no one really understands what causes this temporary (though very painful) problem. So it was very interesting for me to learn that in Japan it is considered a problem related to menopause. And because we've been focusing recently on menopause and I'm very, well, experienced, with this particular problem, I decided this would be a good time to write about it. (By the way, men also get frozen shoulders, and all the advice in this post will pertain to them as well.)

So to start, what exactly is frozen shoulder? According to the Mayo Clinic web site:

"Frozen shoulder, also know as adhesive capsulitis, is a condition characterized by stiffness and pain in your shoulder joint. Signs and symptoms typically begin gradually, worsen over time and then resolve, usually within one or two years.

Treatment for frozen shoulder involves stretching exercises and, sometimes, the injection of corticosteroids and numbing medications into the joint capsule. In a small percentage of cases, surgery may be needed to loosen the joint capsule so it can move more freely.

Frozen shoulder typically develops slowly, and in three stages. Each of these stages can last a number of months:

Painful Stage: During this stage, pain occurs with any movement of your shoulder, and your shoulder's range of motion starts to become limited.

Frozen Stage: Pain may begin to diminish during this stage. However, your shoulder becomes stiffer, and your range of motion decreases notably.

Thawing Stage: During the thawing stage, the range of motion in your shoulder begins to improve."

I'd like to expand on this a bit. First of all, your range of motion, especially if you're a fairly flexible yoga practitioner like me, is drastically reduced. Basically, at the frozen stage you can barely move your arm, in any direction. Even lying on your back, with your arms resting directly on the floor can be painful because your arm needs to be in a completely neutral Tadasana position to be pain free. And the pain is really pretty bad! Sleeping is difficult unless you prop your arm up on a pillow so it doesn't hurt, and of course if you move your arm around in your sleep, pain may wake you up. Some ordinary household tasks are difficult or impossible because you can't raise your arm or carry heavy objects, like shopping bags. Eventually lack of use makes your arm weak, so when you're over the frozen shoulder, strengthening is important.

It's essential to have an expert diagnose you for frozen shoulder because other shoulder problems, such as a torn muscle, are treated very differently. But the tests for frozen shoulder are very simple and not invasive, because with a torn muscle, someone else can move your arm for you, but with a frozen shoulder, your arm just won't move at all. So your doctor or physical therapist, will simply move your arm for you in various directions.

Once you have a diagnosis, how can yoga help? Well, first yoga provides a lot of good shoulder stretching exercises, which are recommended by the Mayo Clinic. The sequence that Baxter and I developed for tight shoulders (see Featured Sequence: Opening Tight Shoulders) was partly influenced by the routine I developed for myself to stretch my frozen shoulder. Try poses 2 through 7 from this sequence. Of course, when your shoulder is frozen, your arm will not be able to be straight up the wall as in the photos, but even if you have to bend your elbow and creep the frozen arm just partly up the wall, that will still be a good stretch. This is one case where moving into the pain is actually beneficial rather than harmful. And I actually found that stretching left me feeling better afterward, so that helped motivate me to practice through the pain. And, hey, look at me now! (See Living Proof for my testimonial about the effectiveness of shoulder stretches.)

To continue with your regular yoga practice, you'll need to modify your arm position in standing poses. For example, in Tree pose have your arms in namaste, in Warrior 2 pose have your hands on your hips, and Triangle and Extended Side angle poses, when your frozen arm is on top, just keep it tucked against your side or with your hand on your hip. In seated forward bends, you'll need to support your frozen arm, perhaps on a block, as you won't be able to reach for your feet. In restorative poses, be sure to place a folded blanket under your arms to support them so the frozen arm doesn't fall into a painful position. For poses you just can't do, like inversions or backbends, come up with an alternative. I did Standing Forward Bend and Widespread Standing Forward Bend with my head on a block instead of Headstand and Legs Up the Wall pose instead of Shoulderstand. You won't be able to do most backbends, so try practicing a passive, supported backbend of some kind to maintain mobility in your spine during this period. If you're in class, ask your teacher to help you find appropriate alternatives.

For the stress and pain associated with this condition, practice conscious relaxation in your favorite form (see The Relaxation Response and Yoga). When asana just seemed too hard for me because almost anything made my arm hurt, I experimented with a long version of yoga nidra.

Finally, after your shoulder is back to normal, your arm is going to be very weak from lack of use. Now is the time to do some arm strengthening poses! See Upper Body Strengthening the Easy Way and our featured upper body strengthening poses for ideas.

Of course, it is no fun going through this, but a frozen shoulder is a temporary condition. And with the help of yoga you can regain both flexibility and strength. Hey, I'm even back to doing arm balances!

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Yoga for Menopause: Joint Problems

by Shari

Shari's Go-To Pose

I feel a little foolish presenting this topic because until quite recently I didn’t associate my various injuries or aches and pains as part of menopause. I didn’t really connect the dots; I just figured that I must be doing something wrong to cause myself injury. This has really come home to roost with my current knee injury that could be something I might have to address with surgical intervention! And my conversations with Nina about menopause prompted me to take a closer look at this problem that isn’t just my own personal issue.

It turns out there is actually a term for this experience: arthralgia. A diagnoses of arthralgia is given when the joints become swollen, stiff or painful during menopause. Joint pain associated with menopause is also referred to as “menopause arthritis.” It can affect hips, knees, back and extremities (how about the whole body?).  In the journal "Semin Arthritis Rheum 2009," the researchers state that genetic alteration, menopause-related estrogen deficiency and aging cause changes in joints with resultant cartilage damage. The changes in the joint are what physicians call osteoarthritis but they don't classify it beyond that. However, these researchers recommend that primary osteoarthritis be classified in the three categories listed. The literature also presents some disagreement in the usage of arthralgia and arthritis. In one source arthralgia is classified as non-inflammatory and arthritis as inflammatory. But pain is experienced in both situations.

Menopausal joint pain is often described as increased stiffness with joint swelling that increases at the end of the day. For some women, the pain may shoot down an extremity as well as feel hot within the surrounding area, which gets worse (not better) after exercise. In menopause and perimenopause the radical hormonal fluctuations are affecting the joints but researchers can’t say exactly how. They do state that changing levels of estrogen play a major role in joint pain caused by menopause. It is known that estrogen helps control joint inflammation and as estrogen levels decrease, inflammation can increase. Concurrent with the sensation of pain experienced in menopausal joint pain, range of motion may become limited (such in as the condition called "frozen shoulder").

So if it's possible that menopause is causing sporadic back or neck pain, the questions some of us may then grapple with are: "Do I investigate hormone replacement therapy?" and "Do I make dietary changes to work with my changing hormonal levels?" These are personal issues that we all grapple with, but the context of this blog is to address our menopausal symptoms with the practice of yoga! In general, for joint pain—whether menopausal or not—there are certain issues our yoga practice should address:

1. pain management
2. range of motion
3. muscle strengthening
4. acceptance

Pain Management: The key point here is how we can manage the pain (maybe not alleviate it) so we can function. What I am learning in my own pain management is that it is counterproductive to ignore it. I have to use the pain response to guide my own movements in asana. For instance, I cannot squat to the floor as I am used to doing, nor can I sit in Hero pose (Virasana) anymore (with any combination of prop usage). Do I need to sit in Hero pose? No, I don’t. Do I need to squat? Well, I do need to bend my knees to get up and down from the floor to practice yoga as well as for functional tasks. So I have learned how to do it so I don’t hurt my back and I can smoothly execute my tasks. When I do try to test things out, my knee responds with increased swelling and a nasty ache that is not fun, but I'm learning to adapt. For asana, I try to keep the injured body part within its comfort zone, and if that is not possible, I do something else in my practice. For me standing poses have always been a favorite part of my home practice, but now I find that seated forward bends are better. Certain twists are challenging for a sore knee but with a bit of creativity some of them can be nicely modified. If I was a student in a class and my teacher could not come up with a modification for me to safely do a pose, I would not do that pose and would wait until I could rejoin the class.

Yoga postures where the blood is flowing toward the heart also help with pain management, especially for swollen extremities. That means inverted poses. Try to figure out which inversions feel good to you, and then practice them daily.  For me, my go-to pose is Shoulderstand with a chair. In the past I would always choose the active Shoulderstand, but now the more passive version is more nourishing for me. When all else fails, Legs Up the Wall pose (Viparita Karani), either with straight legs on the wall or bent legs on a chair—anywhere you can make your legs higher than your heart—is lovely.

Range of Motion: As we've mentioned many times on this blog, to keep your joints healthy you need to move them through their range of motion (see Range of Motion: Yoga's Got It Covered). But too much movement into and out of pain is counterproductive. So finding the amount of motion you can do without increasing your pain response is crucial. And non-weight-bearing positions generally work better than weight-bearing poses. What does this mean? Well, lying on your back and bending your knee to its limit is non-weight bearing. Standing and putting weight on your legs to bend them is weight bearing, and when we bear weight, we compress the joint. When there is inflammation and swelling, weight-bearing compression just aggravates the inflammation and things feel worse. Time is also an important factor. Let’s say I can bend a body part for five seconds without a pain response, but if I hold it for fifteen seconds I get pain. The idea is to hold the joint in position and release it before a pain response occurs. If you have immediate pain, then that position probably should be avoided for now. In asana, using a chair for standing poses can still allow you to experience the benefits of the pose but can decrease weight bearing on the lower limbs to help you avoid increase of pain while still working with your range of motion.

Muscle Strengthening: We have to keep our bodies strong because as menopause progresses our ability to build healthy bone is affected and weight-bearing activities are what stimulates the bone to remodel. A simple technique for building strength is timing your poses (see Arthritis, Exercise and Yoga). But it may not be immediately obvious where you need strengthening. My current physical therapist (who is not a yogi) is addressing my knee injury not by strengthening my knee, but instead working on my hips. That means buttock muscles and hamstrings. Interestingly, my hips (on both sides) were a lot weaker than I thought, and I'm someone who was aerobically walking two miles a day and had a strong standing pose practice! So I am humbly learning how to do exercises that target specific muscle groups. I personally am finding this more challenging than I thought, so here is when I am trying to employ some yogic principles of breathing into the challenge and trying to engage my mind to embrace my hip abductors. If you want to work on strengthening, it might be a good idea to consult a professional, such as a physical therapist, so see which areas you should focus on.

Acceptance: We all grieve when we suffer a loss. For some women menopause is a period of grief because of the loss of the ability to bear children. I felt that acutely when my youngest child was weaning himself from breast feeding. He was 3 ½ and it was time for both of us. It was very smooth, but in my heart I did feel sadness because I knew I would never nourish my children that way again. The feeling of loss in menopause is very subtle for some of us and not so subtle for others. We are changing and there really isn’t anything we can do about it. Some of us dye our gray away because that holds our fears of aging at bay. Others have cosmetic procedures to deny the changes in our aging bodies. We all cope differently, but eventually we all do look at ourselves in the mirror and come to accept what we see. And as Nina talked in her recent post about fatigue (see Yoga for Menopause: Fatigue), sometimes we have to accept that we can’t do things at the same pace as we have always been used to. When we experience joint pain in menopause and have made our individual choices of how we want to live our menopause, yoga allows us the opportunity to explore avenues of acceptance. We will all find our way eventually.

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Yoga for Menopause: Headaches

by Nina

Tough Weed by Melina Meza

My sister in law, who never suffered much from headaches before, found that menopause brought on debilitating migraines. Other women find that normal, tension headaches become more frequent with hormonal fluctuations. In fact, although the most common complaint women in the US have during perimenopause and menopause is hot flashes, in Japan (where hot flashes are less common) women complain much more frequently about headaches.

Baxter and I have already written on the blog about migraines and other headaches, both on how to prevent them (see Preventing Migraines and Other Headaches, Part 1 and Part 2) and how to practice when you have one (see Yoga and Migraine Headaches). Unfortunately we don't know of any special techniques for treating hormonally triggered headaches (in the book The Woman's Book of Yoga and Health, in the chapter on menopause, Patricia Walden simply recommends her standard headache practices for headaches experienced during menopause). However, I thought it might be helpful for those of you who are suffering from hormonally induced headaches if we provided links to our earlier posts on headaches in a central post on menopause.

In my sister-in-law's case, it wasn't yoga that helped her with her migraines (she doesn't practice yoga). Eventually, she realized that it was her diet that was triggering the migraines, and that diary was a trigger. Many of us assume that because we didn't have food sensitivities when we were young, that we must not have them now. But personal experience has taught me that many of us do develop new food sensitivities during perimenopause/menopause. So if you're suffering from headaches, it may be time to practice yoga for healthy eating. To do this, use mediation and mindful asana practice to help you tune into your body and observe how your eating habits affect your health. See Meditation and Healthy Eating and Got Mindfulness? among other posts on this topic.

And if you are having trouble avoiding the foods that turn out to be triggers for you, try using yoga for stress management to help you resist temptation and make better food choices. See Healthy Eating, Stress and Self Control for some ideas.

Take good care of yourselves, dear friends.

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Yoga for Menopause: Fatigue

by Nina

Rose Light by Melina Meza

When I was going through perimenopause, the worst symptom I had was fatigue attacks. Although fatigue or exhaustion is a classic symptom of perimenopause, I'm pretty sure I made up the term "fatigue attack" because I needed a special term for how it felt to me. I'm a pretty energetic person who gets a lot of things done in a given day, and my yoga practice during that time was quite athletic. But during that period, once in a while, I'd suddenly feel so drained of all energy that all I wanted to do was collapse into a puddle on the floor. There was something essentially different about these hormonally based episodes of fatigue than normal tiredness, and I remembered that same feeling of utter exhaustion from my pregnancies (although those were combined with nausea). So I knew it wasn't something I could fight with energizing poses, such as backbends or sun salutations. Fortunately, I got some guidance from two different senior teachers, Rodney Yee and Patricia Walden, who both helped me figure out a good way to practice when I was feeling that way.

When I first talked with Rodney about a fatigue practice, he came up with a sequence of supported inverted poses (see Just In Time for the Holidays: Inverted Poses). However, the first pose in the sequence was Downward-Facing Dog with head support (traditionally the beginning pose in a supported inverted pose practice), and I complained to him (whined?) that when I was feeling exhausted, that pose felt like to much. So he changed the sequence to start with a long Legs Up pose (Viparita Karani) so I could have a nice rest to start and then move on to more active inversions. That was a revelation to me who had only done that pose at the end of a practice. Learning I could rest at the beginning of my practice instead of the end—that I could break a rule that wasn't even a really rule— was a revelation. I started to realize I had a lot more freedom to adapt my practice to my particular needs that I had known. And practicing was a good way to get through a fatigue attack and did leave me feeling refreshed.

Later I took a workshop from Patricia Walden on Yoga for Menopause. She, too, recommended a combination of restorative poses and supported inversions. Eventually, when the book she wrote with Linda Sparrow, The Woman's Book of Yoga and Health, was published, I started to practice her menopause fatigue practice on a regular basis. This sequence is quite long and some of the poses may not appropriate for many of you, but I'll list all the poses here just in case.

1. Supported Reclined Cobbler's pose (Supta Baddha Konasana)
2. Supported Seated Forward Bend (Paschimottanasana)
3. Supported One-Legged Forward Bend (Janu Sirsasana)
4. Simple Seated Twist (Bharadvajasana)
5. Downward-Facing Dog with head support (Adho Mukha Svanasana)
6. Standing Forward Bend with head support (Uttanasana)
7. Headstand (Sirsasana)
8. Inverted Staff pose (backbend in a chair) (Viparita Dandasana)
9. Chair Shoulderstand (Sarvangasana)
10. Half Plow pose (Plow pose with chair) (Arda Halasana)
11. Supported Straight Leg Bridge pose (Setu Bandha Sarvagasana)
12. Legs Up the Wall pose (with variations) (Viparita Karani)
13. Relaxation pose (Savasana)

Regardless of whether you try this sequence or not, it's worthwhile to look at the strategy behind it. It begins with Supported Reclined Cobber's pose (Supta Baddha Konasana), which is a very restful and relaxing pose. Next are a couple of supported seated forward bends, which are also quieting and restful but a bit more active than the first pose. The simple seated twist is even more active, and definitely stimulating. So now, after having a rest and being a bit energized, you're ready for the more strenuous poses: Downward-Facing Dog with head support, Standing Forward Bend with head support, Headstand, and Inverted Staff pose (backbend in a chair). From there, with the Chair Shoulderstand, Half Plow pose, Supported Straight Leg Bridge pose, and Legs Up the Wall pose, you are moving into the quieting, soothing supported inversions, ending with the most restful of the group. You are also getting a balanced asana practice, with a combination of forward bends, backbends, twists, and inverted poses. (I should say this my analysis of the sequence, not Patricia's.)

As with any sequence, you could shorten this sequence by leaving out certain poses (especially if there are ones you don't normally practice) but still keep the remaining poses in the same order. Or, you could come up with a sequence of your own that combines restorative and supported inverted poses in a way that allows you to rest in the beginning, move toward more active poses, and then rest again at the end. The important thing is to acknowledge your fatigue, and adapt your practice to your current condition, thinking outside the box as needed. And, remember, doing even just one pose (such as Reclined Cobbler's pose or Legs Up the Wall pose) will very likely make you feel better than doing nothing.

Naturally, if you aren't going through periomenopause or menopause (or aren't a woman!), you can still do a practice like this whenever you feel exhausted.

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