Healthy and Unhealthy Stretching Sensations

by Nina

Flames by Melina Meza

Ever hear someone else groaning in a yoga class? Or maybe that you? Yes, when you are stretching a tight area of your body, you can experience quite a bit of sensation. And while healthy stretches can provoke an intense feeling, it’s a good idea to pay attention to the type of sensation you’re experiencing because this may indicate you should back off the stretch.

As we discussed in previous posts (see What is Flexibility, Anyway?), stretching a muscle or muscle group and fascia is healthy and beneficial, but stretching a tendon or ligament can cause an injury, such as a tear, inflammation, tendonitis, or tendonosis. In addition, compressing a joint when you are stretching can pinch the tissues caught between the bones closing in toward each other, which cause pain and lead to inflammation. So it’s important to learn to tell the difference between the sensations of healthy stretch of a tight muscle versus the pain, pinching, or “smashed together” feelings that are warnings of potential injury. 

Healthy Sensations. You will feel generally feel healthy stretch of a muscle in the mid-portion of a muscle, farther away from the tendons and ligaments are located close to joints. A good place to become familiar with this type of sensation is the hamstring muscle at the backs of your thighs, which you stretch in Standing Forward Bend (Uttanasana) and Reclined Leg Stretch (Supta Padangusthasana). As most of you know, the intensity of the stretch sensation there can be quite strong, and yet it generally doesn’t mean you are injuring yourself. So when you experience this type of sensation, as long as the stretch is a moderate one, take a deep breath and try to relax into the stretch. 

Unhealthy Sensations. You will generally feel an unhealthy stretch of muscle, tendon, or ligaments closer to a joint, such as your hip, knee, shoulder or elbow joint. And the quality of feeling will be different than a healthy stretch, maybe burning, sharp, stabbing, throbbing, or tearing in quality. For example, with the hamstring muscles, if you feel a tender burning sensation up toward your buttocks, this could be an indication you are overstretching the attachments. In all cases, when you experience these types of sensations, you should immediately back off the stretch if possible to see if that helps. If not, come out of the pose entirely.

It is possible to feel this burning, sharp, stabbing, throbbing, or tearing sensation in the muscle body as a result of a sudden, intense, quick stretch, so that is why we always recommend moving slowly and with in control into your stretches. 

Joint Compression. Sometimes when you are stretching a muscle, the joint that is bending can become compressed. For example, when you deeply bend your knee joints, as in Child’s pose (Balasana), the tissues at the back of the knee joint can become pinched together. This is potentially dangerous because the compression could produce tissue damage and inflammation, or even could injure nerves or blood vessels, leading to acute or chronic pain and dysfunction.

In general what you’ll feel when a joint is compressed is either a sensation of muscles, skins, tendons, fascia, and/or bones being “smashed together” or a pinching sensation. For example, some of less flexible folks feel smashed together or pinching sensations in our front hip when doing Extended Side Angle pose (Utthita Parsvakonasana) with our hand on the floor. Both of these sensations indicate that you are overdoing it, and you should back off the stretch, possibly by adding a prop. If you can’t eliminate the joint compression, come out of the pose. 

Compression can also put pressure on blood vessels and nerves, so if you have an unusual pressure sensation in the joint or feel numbness and tingling downstream from the compressed area, that is an indication that you are overdoing it and should back off the stretch or come out of the pose.

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Friday Practical Pointers: Who Should Avoid Certain Knee Movements?

by Baxter

Flexion and Eternal Rotation by Melina Meza

Our tour through the body’s major joints continues today with a look at who should avoid certain knee movements. When it comes to possible movements, the knee joint is a quite a bit simpler than the hip and the shoulder as it is mostly about bending and straightening. But because of its role in standing, walking, and running, the knee is one of the most commonly injured joints and very frequently affected by the wear and tear of osteoarthritis. 

Movements of the Knee Joint

Flexion: Bending your knee (moving the lower leg bones backwards toward the upper leg). You make this movement when you move into bent-knee standing poses such as Warrior 1, 2 and Side Angle Pose when the front leg goes from straight to bending the knee over the ankle. The movement is also essential for bending your knee more deeply, such as when sitting in Hero pose (Virasana) or Child’s pose (Balasana). 

Extension: Starting from a bent knee position, straightening your knee (moving the lower leg bone forward and away from the upper leg). The opposite movement of flexion is extension, so anytime your knee is bent and moves towards straightening, your knee is going into extension. You make this movement when you exit from Warrior I or 2 (Virabradrasana 1 or 2) or Extended Side Angle pose (Utthita Parsvokanasana) or in the transition from Warrior 1 to Warrior 3. You also make this movement when you lift your back leg in Hunting Dog pose, come into Cobra pose (Bujangasana) from Child’s pose (Balasana), or move into Downward-Facing Dog pose (Adho Mukha Svanasana) from all fours. 

Internal Rotation: When your knee is bent, rolling the lower leg bones in, towards the midline of your body. The lower leg can internally rotate a small amount at the knee joint only when the knee is in flexion. You make this movement in Hero pose (Virasana), both seated and reclined versions, as well as in the many seated poses that have one leg in Hero pose. 

External Rotation: When your knee is bent, rolling the lower leg bones outward, away from the midline. The lower leg can externally rotate a small amount at the knee joint when the knee is in flexion. You make this movement in many bent-knee seated and reclined poses, including simple ones like Cobbler’s pose (Baddha Konasana), both seated and reclined, more complex ones like Half and Full Lotus poses (Padmasana). 

Note: When the knee joint is in full extension, such as in Mountain pose (Tadasana), your lower leg cannot independently rotate from the knee, either internally or externally. In this case, when your upper leg rotates from the hip, your lower leg goes along for the ride. You can see this when you turn your front leg out to prepare for pose a standing pose like Triangle pose (Trikonasana) or in a straight leg seated pose, such Wide-Angle Seated Forward Bend (Upavista Konasana).

Cautions for the Knee Joint

Now let’s look at who should avoid or minimize certain knee movements. Keep in mind, however, that we want to maintain as much of our full range of movement of the knee joint as possible. So, in many instances, my caution will not mean “don’t” or “never,” but rather approach cautiously and stop if the movement worsens pain. In general, you should avoid or minimize any knee movement if you have:

1. Acute painful injury to the knee area that gets worse with that movement, whether from a sports activity, such as acute ligament sprains, or a problem like acute bursitis that is the result of bumping your knee cap or over use.
2. Chronic issues that flare with that movement, such as those with knee joint arthritis or those with meniscal and ACL ligament injuries that have not been repaired or even, in some cases, that have been surgically repaired. 

Now for the specific movements. Who should avoid or minimize the following movements?

Flexion

1. Those with significant swelling in the joint, whether from an acute injury or the flare of a chronic condition, such that the swelling actually inhibits movement or elicits significant pain when movement takes place.
2. Those with Patellar Femoral Syndrome, a fairly common condition affecting the knee cap and knee joint, which often is worse with flexion.
3. Those with arthritis of the knee that become more painful with flexion.
4. Those with bursitis at the kneecap area or with a Baker’s cyst at the back of the knee.
5. Those with ACL repairs who need to avoid extreme flexion, such is in full Child’s pose (Balasana).

Extension

1. Those with tears to the ACL ligament need to avoid sudden strong extension, such as stepping from Lunge pose (Vanarasana) to Downward-Facing Dog pose (Adho Mukha Svanasana), or jumping from Standing Forward Bend (Uttanasana) to Downward-Facing Dog pose.
2. Those with hyperflexible knees may want to avoid full extension in straight leg poses to avoid wear and tear on the internal knee structures and ligament over-stretching.

Internal Rotation 

1. Those who experience increase pain in the knee in poses where the knee is both flexed and internally rotating, such as Hero pose (Virasana), both seated and reclined, and the seated twists where one leg is in Half Hero pose (Adra Virasana).
2. Those with tears to the meniscus (the half moon cushion of the knee) where increased pain or locking of the knee occurs with flexion and internal rotation.

External Rotation

1. Those who experience pain in the knees where the knee is both flexed and externally rotating, such as Cobbler’s pose (Baddha Konasana), both seated and reclined, Half and Full Lotus poses (Padmasana). 
2. Those with tears to the meniscus (the half moon cushion of the knee) where increased pain or locking of the knee occurs with flexion and external rotation.

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Protecting Your Joints

by Baxter

Today I’d like to review the idea of protecting your joints via your yoga practice. I will share with you why this is a good—maybe essential—idea, and then provide info about how and when to do it. 

Why Protect Your Joints

Our joints are the pivot points by which our myofascial system moves our bodies around. So healthy joints means healthy movement. I define a healthy joint as allowing for the full range of movement—whether it is weight bearing or not—that is smooth and pain-free. Learning to protect your joints while they are still healthy has a preventative benefit over time. After all, we have all heard by now that the protective surfaces of joints, coated with cartilage, are subject to wear and tear over time, especially if we do a lot of repetitive movements at certain joints (you runners out there perking up?). And of course, many joints (think ankles, knees, shoulders, and wrists) are subject to acute injuries that our yoga practice might also help prevent with good technique. Finally, if we have already developed joint issues, such as osteoarthritis or a joint injury, protecting the joints could allow for healing, reduced pain, and improved movement. 

How to Protect Your Joints

Supporting Your Joints. One technique you can employ in your yoga asana is to protect your joints by consciously firming the muscles that support the joint. This is beneficial for problem joints as well as for protecting healthy joints. 

Nina described technique in her post Why and How to Activate Your Muscles in Yoga Poses. She said that, for example, if you have knee arthritis, firming the muscles on all sides of your thighs in Extended Side Angle pose (Utthita Parsvakonasana) will help support your knees. And for people who are overly flexible and can bend easily into deep forward bends and backbends, consciously activating the muscles that are supporting you in the pose will prevent you from hanging from your joints, which can cause injury. For example, instead of passively dropping into a pose where you bend backward or forward from the hips, such as Camel pose (Ustrasana) and Standing Forward Bend, (Uttanasana), you can protect your hip joints by activating your upper thigh and lower buttock muscles. (For flexible folks this will actually mean focusing more on firming the muscles and not going as deep into a stretch as they can actually go.)

For joint safety, you want to emphasize strength and stability rather than promoting more flexibility. So practice as you would for increasing bone or muscle strength by firming the muscles that support your joints. For example, to protect your front knee in Warrior 2 pose, you might shorten the distance between your feet so you are not bending your front knee through such a deep range of motion, and then, when your knee is positioned over your ankle joint, focus on firming the muscles on all sides of the knee joint toward the bone. 

If you have healthy joints now, you can use this technique to support any joint that is weight bearing, such as the joints of the legs in standing poses or the joints of the arms in poses where you are supported by your arms, such as, Cat/Cow, Downward-Facing Dog pose, and Upward Facing Dog pose. Although this technique will be easier to turn on in poses that you hold for longer periods of time, with practice, you may be able to bring a bit of this feeling into even some dynamic work.

Making Space. In addition to this firming technique that Nina described, I also recommend the technique of “making space” in the joints for people who are having problems. For ankles, knees, hips, wrists and elbows, to make space in the joint, lift the bone immediately above the joint, relative to gravity. For example, if someone with knee pain from arthritis is working in standing poses, you would lift your thighbones (femurs) away from the lower leg bones as you are entering, holding, and exiting a pose. In inverted poses, this same person could move their shinbones up away from their thighbones (even though in non-weight bearing positions the knee might be symptom free).

This internal action of lifting one bone away from another creates a bit more space between the boney surfaces of the joint and can provide improved pain-free range of motion. I find it personally helpful with my left hip that may have some early arthritis changes and many of my students have adopted it for their affected joints.

The only potential downside to this technique is that the joints above and below the joint where you are creating more space will cinch down a bit, so you lose some space in those healthier, non-arthritic joints. So don’t use it for problem joints if it doesn’t provide you with relief. And don’t use it regularly for your healthy joints. 

Although this technique will be easier to turn on in poses that you hold for longer periods of time, with practice, you may be able to bring a bit of this feeling into even some dynamic work.

If you have joint problems now, see if this technique is helpful for you. You can use this technique alone or in combination with the muscular contraction technique if it works for you. Although we don’t recommend using the making space technique regularly for healthy joints, you could also experiment a bit it, just to have it in your bag of tricks should you need it down the road. 

Propping in Restorative Poses. One of the best features of restorative poses is that once you are set up, you get to relax your body and let the pose, props, and gravity do the work of stretching your body. This does not mean, however, that your joints are necessarily safe in all restorative poses. Although you do not want to use our two joint protection techniques in restorative poses—as it goes against their underlying principle of relaxing your muscles—you should still make sure that you are not noticing any compression sensation, pinching sensation, or pain at your joints. A classic example where this can happen is pain or pinching in the knees in Supported Childs pose. In such a case, add just enough additional lift for your body so that the pinching or pain goes away, even if that means feeling less of a stretch.

And just as over-stretching can cause joint problems an active pose, it can do so also in restorative poses, leading to potential strain on the joints. Therefore, if you notice pain in your joints after practicing restorative poses with less support, we recommend that you add in more support, aiming for a lighter feeling of stretch. 

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Friday Practical Pointers: Who Should Avoid Backbends?

by Baxter

Star Rosser, Age 52

Before I make recommendations on who should avoid or be cautious with back-bending the spine, I’d like to briefly discuss “spinal extension.” Spinal extension is the movement required for essential active backbends such as Cobra and Sphinx poses (Bhujangasana), Locust pose (Salabasana), Bridge pose (Setubandha Sarvangasana) and Warrior 1 pose (Virabradrasana 1), as well as all supported backbends. The areas of your spine that have the greatest ability to “extend” (go into a backbend) are, in descending order, the neck (cervical spine), the lower back (lumbar spine) and the rib cage spine area (thoracic spine).

Who should avoid back bending poses? Those with:

• Lumbar facet arthritis.
• Lumbar spondylolisthesis, a condition where the vertebrae bone above slides forward of the one below.
• Chronic low back pain that worsens with backbends.
• Anxiety that worsens with backbends.
• Cervical arthritis (if you need to avoid taking your neck and head back)
• Vertigo that is sensitive to extension of the neck
• Osteoporosis. Avoid extreme backbends. 
• Wedge fractures. Avoid all backbends, even shallow ones.
• Abdominal hernias or diastasis recti (abdominal wall separation). 
• Untreated hypertension (high blood pressure). Avoid longer holds of active backbends. Supported backbends (such as Bridge pose on a block) or restorative backbends are fine.

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Friday Practical Pointers: Forward Bending of the Spine

by Baxter

We are often asked by someone if they should avoid certain movements in the joints when doing yoga poses, especially if that person has something going on a particular area. Perhaps the most common area that I get asked about is the movements of the spine (see All About the Spine: Anatomy and Movements for info on spinal movements) These include forward bending (known technically as flexion of the spine), back bending, (known technically as extension of the spine), twisting (known as rotation of the spine), and side-bending (often referred to as lateral side-bending of the spine). There are, of course, possible combinations of these movements in complex everyday activities, such as reaching into the back corner of a deep car trunk to grab a bag of groceries, which includes forward bending, twisting and a bit of side bending, and in real life we rarely do a single spinal movement at one time. But, in general, if there is a particular movement you shouldn't be doing on its own, you should not do it combined with other movements.

For now, I’d like to keep it simple and address each one of those basic spinal movements over the coming weeks. Today, let’s take a look at those who should avoid forward bending of the spine, as encountered in yoga poses where you bring the front of your torso toward your legs, such as Child’s pose (Balasana), Standing Forward Bend (Uttanasana), Seated Straight Legged Forward Bend (Paschimottanasana), and many others. Forward bending of the spine includes bending from any point in your spine, from your neck all the way to the top of your pelvis. (You can also forward bend strictly from the hip joints, a movement I’m not addressing today.) 

So who needs to avoid the forward bending spinal movement?

Always Avoid For:

• Osteoporosis of the thoracic (rib cage area) spine 
• Herniated discs anywhere along the spine (most commonly at the cervical or neck area of the spine and the lumbar or lower back area of the spine)

Avoid if Pain is Acute or Symptoms Worsen For:

• Low back pain that is worsened by forward bending of the spine 
• Acute strain of the lower back if you notice pain with forward bending 
• A history of degenerative discs in the spaces between the lowest spinal bones, the vertebrae, if you notice pain with forward bending 
• Spinal stenosis, if you have been instructed by the doctor to minimize forward bends 
• 2nd and 3rd trimester of pregnancy, if you notice pain with forward bending 
• Abdominal hernias or abdominal wall separation if increased bulging in those areas is created by forward bending 
• Hamstring tendonitis, if you notice any pain in your hamstring muscles created by this movement 

For those of you who cannot forward bend your spine, note that you can still practice certain “forward bend” poses by folding forward from your hip joints while keeping a neutral spine. For example, you could practice a seated forward behind with a straight back or a “half” version of Standing Forward Bend (Ardha Uttanasana) by coming forward with a straight back and placing your hands on high prop or on your legs. 

If any of you can think of other conditions that we should include on this list, please let us know!

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Friday Q&A: The Safety of Headstand (Sirsasana)

Q: There is a lot of controversy these days about the safety of Headstand. What is your opinion about its safety?

A: Just recently, I read an article by Grace Bullock, Ph.D., E-RYT 500, Headstand and Neck Safety in Yoga: What You Need to Know about a recent study Sirsasana (headstand) technique alters head/neck loading:Considerations for Safety in the Journal of Bodywork & Movement Therapies.

In the study, researchers in Austin, Texas, observed a group of experienced yoga practitioners entering Headstand (Sirsasana), maintaining the pose for 5 breaths, and then exiting the pose, using specialized techniques and technology to measure the forces at work on the neck and head area. The practitioners had one of three ways of moving into Headstand, as shown in the illustration above: 

1. straight legs going up together
2. bent knees going up together
3. bent knees, going up one at time

In all three groups, the amount of weight born by an individual’s neck and head was 40-48% of his or her total body weight. This is in contrast to the assertion is often made by yoga teachers that in this pose the neck and head bear very little of the body weight and the arms bear most of it. Now, can you imagine a 163 lb. person, like me, regularly carrying a 65-78lb. weight around on the top of his head and it not leading to problems in his neck?

They also observed that the longer the practitioners were in the pose, the more weight their heads and necks were bearing, and they were only in the pose for 5 breaths, around 30 seconds or so. Now, most classes I attend that include Headstand have you in the pose for a minimum of two minutes. So, using myself as an example again, this would mean that as time goes on the weight on my head might start to be more like 80-90 pounds.

The investigators also were able to observe side-to-side shifting of the weight on the head and neck during all three the phases of the Headstand, and although it was less noticeable in those that could go up and down with both legs straight, this side-to-side shifting did happen in all three methods of moving into and out of the pose. And the more side-to-side shifting that occurs, the higher the risk of injury is to the neck structures and tissues.

Keeping in mind that these were all experienced practitioners in the study, I can surmise that new and inexperienced practitioners are likely to be putting much higher pressures on their necks and have a lot more shifting of the weight on their necks in the learning process, thereby increasing their chance of injury.

Following an incident where my car met a deer on a country road a few years back, my neck did not come out of the encounter unscathed. So I have let go of Headstand, as it typically worsens my neck symptoms. I have also dropped it from my teaching because of my concern that the risks of doing full Headstand outweigh its benefits, especially in light of the safer poses I can substitute in its stead, such as Forearm Balance (either Pinca Mayurasana or “Headless Headstand”) or using a Headstander prop. Forearm Balance and using a Headstander provide some of the same benefits of an inversion that Headstand provides, reversing the blood flow and encouraging return of venous and lymphatic fluids, all without the risk of cervical injury. In addition, using the Headstander prop for longer holds adds the calming and grounding effects some people experience with Headstand.

So this new study confirms my personal and professional preference in this regard. And, in her article, Grace points out several other contraindications to doing Headstand that are important to remember: osteoporosis/osteopenia, hypertension, glaucoma, detached-retina, pregnancy, menstruation, cervical injury or dysfunction, heart conditions, or other serious medical diagnoses.

Regular readers of our blog know that I believe yoga is generally safe and well tolerated by most people. But there may be a few exceptions, such as Headstand, where we need to be more discriminating about who learns and practices it. If you are going to practice Headstand, you may want to work towards the straight legs entry and exit, as that method had slightly lower pressures on the neck than the other two ways. Grace provides some good guidelines in her article, which I agree with, that you can check out on your own at Headstand and Neck Safety in Yoga: What You need to Know.

—Baxter

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Honesty and Contentment in the Yoga Room

by Nina

Friendship, Love and Truth by Currier and Ives*

Yesterday, Ram’s post about arjava and being honest in your yoga practice spoke directly to something I’ve been thinking about recently. (I love it when that happens!) In Arjava: Cultivating Honesty, Ram said, “on the mat you have a choice to be honest to yourself by respecting and listening to your body or disregarding the harmful warning signs from your body.”

In our post How to Stay Safe While Practicing Yoga, we recommended safety guidelines that you should follow whether you are practicing at home or in a class. In all honesty, I have to say that practicing wisely according to those guidelines may often mean there’s a pose, group of poses, or practice you cannot or should not be doing, sometimes temporarily and sometimes permanently.

This can be hard. It’s natural to feel left out when other people in your class or other people you know are doing a pose that you cannot or should not do. It’s also challenging for us long-time practitioners to say goodbye to poses that we used to be able to do (see Goodbye, Lotus Pose for info). But rest assured that you are not missing out on anything essential. Regardless of your limitations, there are still effective ways to foster strength, flexibility, balance, and agility, and to manage your stress levels. That’s why we have four versions of every pose we recommend, as well as alternate poses. And, of course, the experience of practicing asana mindfully, as a moving meditation, is available to everyone, no matter your limitations. Simply bring your awareness to your breath or to any other physical sensation as your practice. (See Practicing Yoga Mindfully for more information on practicing yoga mindfully.)

Practicing arjava in the yoga room is also an opportunity to experiment with cultivating contentment in the safe space (see Yoga Philosophy: Contentment). After you are honest with yourself about what you should and should not be doing, gently remind yourself that you can be content with what you have and what you don’t have. You’ll then find that you can enjoy your time on the mat, no matter which poses you can’t do. (I know this, because I've been through it myself. There are some poses that I used to practice that I can no longer do, such as Lotus pose, Half Lotus, and certain backbends. And there are some poses I'm temporarily avoiding at the moment due to lower back strain, such as seated forward bends and kicking up into certain arm balances. Yet even during my worst periods of limitations, such as when I had a frozen shoulder and could barely move my arm, I have never failed to find a satisfying way to practice.)

And cultivating contentment in the yoga room will strengthen your equanimity muscles while you strengthen your physical ones. You can then take your experience of becoming content with what you have and what you don’t have out into the world at large. 

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Neck Position in Camel Pose (Ustrasana) and Other Backbends

by Baxter and Janet Rae Humphrey

Margann Green, Age 77

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

Dear Nina and Baxter, 

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

—Janet Rae Humphrey, E-RYT

Thoughts on Janet’s advice: 

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

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

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

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

—Baxter

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