Featured Sequence: Wrist Flossing for Wrist Care

by Nina

In Baxter's post on wrist care (see "Wistful Wrists: How to Keep Your Wrists Safe"), he recommended a wrist "flossing" sequence developed by Tom Alden that was featured in Timothy McCall's book Yoga As Medicine. This is a wonderful sequence you can do if you over-worked your wrists doing yoga, have wrist problems, such as carpal tunnel syndrome, or just want to give your hands and wrists a break during a marathon typing session. There are three different "flossing" movements:

1. Palms Down. Start by interlacing your fingers and turning your palms to face the ground. Move your elbows out the sides, so both arms are parallel to the floor. Gently pull your wrists apart, so you feel a slight traction, then raise your right arm and lower your left, bringing your right wrist into a forward bend and your left wrist into a backbend. Allow your right arm to do all the work, while your left arm is passive.

Repeat the movement on the other side by using your left arm to do all the work while your right arm is passive. Go back and forth any number of times.

2. Palms Facing You.  Start by interlacing your fingers and turning your palms in to face the ground. Move your elbows out the sides, so both arms are parallel to the floor. Now turn your palms inward, to face you. Gently pull your wrists apart, so you feel a slight traction, then move your right arm outward and your left inward, bringing your right wrist into a forward bend and your left wrist into a backbend. Allow your right arm to do all the work, while your left arm is passive.

Repeat the movement on the other side by using your left arm to do all the work while your right arm is passive. Go back and forth any number of times.

3. Palms Facing Away. Start by interlacing your fingers and turning your palms to face the ground. Move your elbows out the sides, so both arms are parallel to the floor. Now turn your palms outward, so they face away from you. Gently pull your wrists apart, so you feel a slight traction, then move your right arm inward and your left outward, bringing your right wrist into a forward bend and your left wrist into a backbend. Allow your right arm to do all the work, while your left arm is passive.

Repeat the movement on the other side by using your left arm to do all the work while your right arm is passive. Go back and forth any number of times.

See http://www.tomalden.com/ for information about Tom Alden. For information about Timothy McCall and his book Yoga As Medicine, see http://www.drmccall.com/.

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What is an Advanced Yoga Practice?

by Nina

Year-Old Snow and New Snow by Philip Amdal

A number of years ago, I encouraged a close friend of mine, M, to join me in taking Rodney Yee’s advanced class. Even though she had a muscular, athletic, and stiff body that made doing super bendy poses difficult, if not impossible, I knew that she understood how to take care of herself in class, that she would adapt the poses for her particular body type and keep herself safe, so I wasn’t worried about the class being too hard for her. She was interested, however, she expressed some concerns about not being “advanced” enough for the class. I decided to discuss the matter with our teacher himself, feeling fairly sure of what he was going to say. But what he told me when I asked him if she was “advanced” not only took me by surprise but has stuck with me all these years, transforming my thinking about the asana practice in general. What he said was this:

“Of course she’s advanced enough. M does yoga more mindfully than any student I’ve ever seen.”

And here I’d been thinking that being advanced meant being capable of doing difficult poses, like 10 minute headstands or extreme backbends, at some level or another! But doing yoga “mindfully”—now, here was goal we could pursue for our lifetimes and no matter our level of physical capacity was, we would always have the the ability to go deeper and deeper into the practice.

I’m thinking about this today because I’m helping a new friend of mine adapt her practice to allow her to heal from an ongoing injury. It’s taken her a long time to even be ready to temporarily give up certain poses and ways of practicing, because she felt such regrets about excluding poses from her practice that she used to be able to do with such great enjoyment. 

But as Baxter mentioned in his post on Wristful Wrists: How to Keep Your Wrists Safe, sometimes rest is the best way to heal from an injury. So being willing to adopt mindfulness as a goal in the practice rather than achievement is a necessary element in being able to heal from an injury.

People who are aging may find themselves in a similar position, not necessarily due to injury but simply due to the physical changes that come along with aging. To be honest, I used to have what I sometimes call a “semi-fancy” yoga practice. But in the last few years, I developed arthritis in my right hip that makes it impossible to do seated poses that involve a lot of external rotation. Lotus and half lotus are now impossible for me, and seated forward bends and twists that require certain leg positions are painful and difficult. And I now need props in many of the standing poses now. Still there is no question I consider my practice more advanced these days than it was in the years when I regularly took the East Bay’s most “advanced” yoga class.

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Wistful Wrists: How to Keep Your Wrists Safe

by Baxter

Following last week's hoopla around the New York Times article "How Yoga Can Wreck Your Body" and my interview on San Francisco public radio’s KQED last Thursday (see Can Yoga Be Bad For You?), Nina and I realized that it might be helpful to look at the most commonly injured areas of the body (from yoga or otherwise—more often otherwise!), and see if we could recommend a few helpful ways of avoiding injury or working with trouble when it arises.

I already mentioned Loren Fishman’s survey of 2009, in which he identified the areas of the body most likely to get injured. Wrists ranked number one among yogis surveyed. The main risk factor for modern yogis is the fact that contemporary hatha yoga, the practice of postures, relies heavily on poses that bring lots of pressure and force onto the wrists. The list of these poses includes such favorites as Cat/Cow, Plank Pose, Downward-Facing Dog, Upward-Facing Dog, Push-up Pose (Chaturanga), most of the arm balances (which we should rename accurately hand and wrist balances), and even the bottom hand in the asymmetric standing poses like Triangle pose.

There are very few manual labor jobs anymore that require us to have our hands on the ground supporting our weight. In fact, from an evolutionary point of view, we have evolved to our upright posture so having our hands on the ground is no longer necessary for our survival, except for that precious few months before we begin to walk as pre-toddlers. And modern society places our value as workers squarely on having a functional brain and adept hands to plug into our computers and produce! So the rest of our body is superfluous to the economy. Forgive my tendency to be hyperbolic, but we are stuck between and rock and a hard place. Yoga is wonderful way to reconnect with our whole self, and yet we must simultaneously be cautious with the delicate wrist area. And in fact one could argue that yoga asana is helpful in conditions such as osteoporosis in actually requiring us to bear weight on the wrists, a common area affected by thinning of the bones.

A Rock and Beyond by Philip Amdal

What’s a yogi to do? Well, from the start, gradually introduce weight to the hands and wrists if you are new to yoga. This came up again and again in last week’s discussion: beginners should start at the beginning with a competent guide (aka teacher) and gradually advance and integrate the yoga asanas. Secondly, consider the wrists you bring into your practice, taking into account any preexisting conditions that could put you at greater risk of injury while doing yoga, such as a history of carpel tunnel syndrome, other repetitive stress injury to the area, family history of arthritis, and so on.

You might want to invest in slightly thicker yoga mat to give your hands and wrists a bit more padding. When placing your hands on your mat, make sure to have equal pressure on the first knuckle area of your hand (what I call the ball of the hand) and the heel of your hand (which is closer to the wrist joint). It can be helpful to create a slight lift under the heel of your hand using either the front of your yoga mat rolled under tightly, or by placing a wedge under the front of your mat so it slopes toward the front of mat. There are also specialized gloves that have a small built in wedge in the palm of the glove that can be helpful, as well as a prop called the Gripitz. (For the latter, I find it is helpful to go over the use of the Gripitz with students to keep it helping and not aggravating their wrists.)

And there is nothing better than rest for an angry wrist, so if you have one, consider designing a non-hand weight bearing practice with your teacher that you can do as your wrists settle down. It should not be difficult to create a satisfying practice with the myriad poses that do not require much support directly from your wrists and hands. 

Another factor to consider as that many of the poses mentioned earlier require your wrists and hands to do a movement called extension (the wrist is bending back toward the arm), and there is a risk of hyperextension if you are not paying attention. Conversely, the opposite action of extension, flexion of the wrist (with the wrist bending forward away from the arm), is sorely missing in the asana practice. Practicing flexion of your wrists is a helpful counter-pose for wrist health. So if you are having wrist problems, you might start practicing the “wrist flossing” exercises described in the book Yoga as Medicine by Dr. Timothy McCall, featuring the wrists of moi. My students and I have found them helpful over the years in balancing our wistful wrists!

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Does Yoga Wreck Your Body? A Scientist's Perspective

by Brad

There’s been a lot of buzz after the Sunday Times article on yoga and injuries, "How Yoga Can Wreck Your Body." My own take on this is that this is pretty shoddy journalism. The writer should have looked no further than the New York Times own Science Times format for Q&A.  Maybe a question like “Does yoga cause more injuries than similar exercise regimens?” would have been more appropriate? I suspect the answer would have been “no.”

In any case what’s the control here? No exercise at all, running, or lifting weights at the gym? All of these have both intended and unintended consequences on your physical well-being and injury status, especially as you get older. When I was a graduate student at MIT, I remember one of my professors invoking his own law to explain missteps in some scientific papers: “if you think you know the answer beforehand, you will undoubtedly find it.”  He used this to explain why some scientists misinterpreted their results by either overly fitting data to some preconceived notion, or ignoring or explaining away other types of information that was inconsistent. Makes for a good story, but this is not good science. Not good reporting, either.

My own experience with yoga suggests a different perspective on this question. I started yoga when I turned 50 because I thought that it would be more age-appropriate and not lead to as many injuries. In my case (Caution! N=1), I never injured myself in nine years of practice.  One reason was I had a good teacher (Baxter Bell), who did not push his students too far, and who also paid attention to preexisting injuries to tailor their practice. He was also well-trained and knew about anatomy and physiology. Not all yoga teachers have the appropriate training, so this is one of the most important first decisions in your practice:  choose a good teacher.  Finally, I did not push myself beyond what I thought was appropriate (if it hurts, back off a bit—you're not trying to prove anything to the teacher or other students).

A Crow by Philip Amdal

While I did not injure myself in yoga these last nine years, I can’t say the same about other activities. I have suffered from tennis elbow injury (overzealous gardening and foosball), heel pain (bad shoes as a kid leading to something called Haglund’s deformity), and lower back pain (digging all day with a shovel a year ago to clear a section of the yard).  What’s interesting is how yoga has helped to alleviate and moderate these injuries. Downward Dog and other similar poses have helped stretch my Achilles heel and tendon, considerably reducing my foot pain. I use a strap around my arms now for various positions, and this has seemed to both strengthen and better align my arms and elbows. And, lastly, I have noticed that my lower back feels better after a yoga practice than before—as long as I don’t overdo things.  So, at least in my case, I can honestly say that yoga has helped alleviate injuries, not caused them. Maybe someone should write a follow up article, “How Yoga can Help You Recover from Injuries?” Not as sensational, but....

And speaking of shoddy journalism, Dr. Timothy McCall tells us that although he was quoted in the article, he was not actually interviewed by the author and that the quote from him was taken out of context, from an old article. To read his rebuttal and his advice about practicing headstand, see his website http://www.drmccall.com/ and read the article "How to Not Wreck Your Body Doing Yoga or, How I Really Feel about Headstand" on the home page.

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Friday Q&A: Propping for Shoulderstand

Q: For years I've read & been told at the Piedmont Studio (great teachers as you know) that I should use a blanket while doing Shoulderstand. Yet, when I'm home on a carpet surface w/mat I'm very comfortable doing the Shoulderstand with no blanket/s. When I use one or two blankets, it's actually uncomfortable on my neck. Yet, I respect what I've been told and am concerned that suddenly one day an injury will pop up just because I was too lazy to get up & get the blankets! I use them at the studio because I know I'm expected to, but at home much more comfortable w/out.

A: Thanks for your question regarding the correct propping of shoulderstand. Shoulderstand may need to be approached differently for different people, due to many factors. These can include age, level of practitioner, history of injury to the neck or other health issues that could require caution, such as newly diagnosed high blood pressure. But to cut the crux of your question, to support the shoulders with blankets or not, let's talk for a moment about the normal range of motion of the cervical spine, specifically in flexion or taking the chin to the chest. If you were to observe a friend or family member from the side as they actively brought the chin toward the chest, you would see that the neck bends about 45 to 50 degrees forward. This is a far cry from the almost 90 degree angle that occurs when we invert in Shoulderstand. This is called active range of motion, that is, how far you can move the joints using just the muscle contraction.

When you come into Shoulderstand, gravity adds an additional amount of movement, resulting in what is know as passive range of motion. But just because you have the potential to bend the neck further does not make it a good idea! Why not? Well, first off, it is not designed by nature to bear your full body weight. And because of that, the neck is at risk for sudden or gradual injury if we are not careful. And that could be anything from a temporary muscle stain to a more serious disc rupture or, even more rarely, a stroke (a few have been reported!). By using one, or my preference, at least 2 firm blankets, you stay closer to the active range of motion of the neck and decrease the chances of injury. So, although the carpeted floor seems to feel pretty good for your head, neck and shoulder today, it ultimately is a risky way to experience this advanced posture. I hope this helps to motivate you to grab those blankets, even at home!

—Baxter

A: I think it's important for you to figure out why you are uncomfortable using blankets because the aim of using props is to make you comfortable (as well as safe). Is it possible your shoulders are positioned incorrectly on the blankets? When you are up in the Shoulderstand, the tops of your shoulders should be near the edge of the blanket, while your neck is completely free of the blanket, sloping down to the floor. In order to make this happen, before you go up, you need to start with your shoulders about two inches from the edge of the blanket (feel with your hands to check your position), because as you go up, your shoulders tend to shift a couple of inches toward the edge of the blanket (and will go off the edge if you start out too close to it). Or maybe you are starting with your shoulders too far from the edge, so some of your neck is flattened on the blanket after you get up. Again, you can try to feel with your hands after you're up (or ask someone to look at you). It's kind of a Goldilocks thing; you've got to get your shoulders positioned on the blanket "just right."

If your shoulder position on the blanket is not the problem, I recommend that you approach your favorite teacher and tell him or her that you want them to look at you in Shoulderstand and recommend better propping for your body type. Maybe a lift under your elbows, a strap around your upper arms, a little something to help you keep the cervical curve in your neck, and so on. With the right propping, your Shoulderstand should feel better, not worse. Good luck!

As to your reluctance to use props at home, I feel you! I used to say that my least favorite yoga pose was "blanket folding." It all seemed so complicated and time consuming. But since it's important for safety as well as comfort, stick with it and eventually it becomes quick and easy, almost automatic, like learning to drive a car. Years of practice later, I can now brag that I am excellent blanket folder.

—Nina

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Baxter Bell on KQED's Forum: Can Yoga Be Bad for You?

Today Baxter participated in one-hour panel discussion hosted by Scott Shafer on public radio station KQED's Forum program. Other members of the panel were:

• Glenn Black, yoga teacher featured in the New York Times Magazine article
• Jason Crandell, yoga teacher and contributing editor of Yoga Journal
• Kaitlin Quistgaard, editor in chief of Yoga Journal
• Moshe Lewis, physical medicine and rehabilitation physician at California Pacific Medical Center, St. Luke's Campus

If you want to stream or download the audio, go to the KQED web site http://www.kqed.org/a/forum/R201201121000.

To read Baxter's blog post on this topic, see Getting Clearer and Yoga and the Risk of Injury.

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Getting Clearer on Yoga and the Risk of Injury

by Baxter

If you have not had a chance to read Nina’s Monday post (see here) about the New York Times article “How Yoga Can Wreck Your Body,” please do, because she articulates some very important points to consider as you digest all this hype coming from William Broad, a New York Times writer. In addition, you’ll find my take on this issue on Yoga Journal’s blog, where I am an occasional guest blogger (see here).

Before getting into recommendations for modifying specific poses to reduce the risk of injury, I’d like to step back today, and look at what we know about key areas of the body that are at risk of injury from an unbalanced asana practice. What do I mean by an unbalanced practice? In my view an unbalanced practice is one where you are doing one or more of the following:

• Practicing at an incorrect level of difficulty for your present level of expertise 
• Doing the same poses over and over, increasing your risk of repetitive stress injuries
• Attending classes with an inexperienced teacher unfamiliar with guiding students who have special vulnerabilities or who is aggressive with adjustments
• Attending a class or pursuing a home practice that has an overly competitive quality to it

Well, you get my drift. One of the few studies that has tried to get a handle on this topic of yoga-related injuries was published in 2009 in the International Journal of Yoga Therapy by Loren Fishman, MD, et al (see here). He and his colleagues surveyed 33,000 yoga practitioners from around the world, got back 1336 responses, and compiled the results. In descending order, the areas of the body most affected were as follows, with the number of times reported in parenthesis beside it: neck or cervical spine (674), shoulder, including rotator cuff (661), low back, including sacrum, SI joint, sciatica (644), knee (597), wrist (414), back or spine, any area (392), hamstring (332), hip (112), leg, including ankle and foot (64), and groin (52). There were other areas also mentioned, but at much lower frequency, including elbows, headaches and nausea.

A Clear Day on Mount Tamalpais by Brad Gibson

What does this mean for you and me?  Should we be overwhelmed and fearful? Probably not. Remember, only four percent of the surveys sent out were returned, so we still have a relatively small sample of folks here. What we can say is that, just as Nina pointed out Monday, any physical endeavor has some inherent risk of injury to it. However, if we keep returning to the essential quality of mindfulness and honesty in our practice, we can go a long way in minimizing the risks of injury. I can honestly admit that I have injured myself on several occasions, once from inattention in class, once from being in over my head in an advanced class I was not ready for, and once when my ego decided I should do an advanced pose that my hamstring had other ideas about. But I have also had several injuries, yoga related and not, that improved and healed through mindful and attentive practice of yoga asana.

In my next post, I’ll look at Fishman’s number one area of injury, the wrists, with some ideas and recommendations on how to approach poses that are more risky for us ordinary humans! Until then, keep on practicing.

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