Relax Frequently. Very Frequently.

by Nina

“When we’re renewing, we’re truly renewing, so when we’re working, we can really work.”—Tony Schwartz

On this blog, we’ve talked till we’re blue in the face about how important it is to reduce stress to support healthy aging. After all, chronic stress can cause everything from heart disease and stroke to depression. But when people are busy with their everyday lives, it’s often difficult for them to make lifestyle changes to support a long-term goal. But according to a recent editorial in the New York Times Relax! You’ll be More Productive, there is also a short-term payoff to relaxing on a regular basis:

“A new and growing body of multidisciplinary research shows that strategic renewal—including daytime workouts, short afternoon naps, longer sleep hours, more time away from the office and longer, more frequent vacations — boosts productivity, job performance and, of course, health.”

Yes, author Tony Schwartz says that relaxing on a regular basis “it’s possible to get more done, in less time, more sustainably.” He goes on to say that human beings didn’t evolve to expend energy continuously but rather to pulse between spending and recovering energy. This is a reference to the fight or flight response vs. the relaxation response, which we’ve discussed in previous posts (see Chronic Stress: An Introduction and The Relaxation Response and Yoga). This is not big news to us, of course. What got me intrigued, however, was Schwartz’s statement that “strategic renewal” ideally should come every 90 minutes.

“during the day we move from a state of alertness progressively into physiological fatigue approximately every 90 minutes. Our bodies regularly tell us to take a break, but we often override these signals and instead stoke ourselves up with caffeine, sugar and our own emergency reserves — the stress hormones adrenaline, noradrenaline and cortisol.”

Among other studies, Schwartz cites the work of Professor K. Anders Ericsson and his colleagues at Florida State University. Dr. Ericsson studied elite performers, including musicians, athletes, actors and chess players, and found that in each of these fields, the best performers typically practice in uninterrupted sessions that last no more than 90 minutes. They begin in the morning, take a break between sessions, and rarely work for more than four and a half hours in any given day.

Legs Up the Wall Pose (Better Than Sleep)

 Of course most of us can’t take a nap every 90 minutes—something Schwartz recommends—at work. Besides, unless you’re sleep deprived, sleeping probably isn’t the best way to relax and restore yourself (see Conscious Relaxation vs. Sleep). So—wait for it—how about doing a little bit of yoga every 90 minutes? Maybe shut your office door and do a restorative pose or two (see Mini Restorative Sequence). Legs Up the Wall (Viparita Karani) would be my pose of choice. And if you don’t have a door (yeah, I worked in one of those cubicle thingies back in the day) or feel like being active instead of resting, try some of our office yoga poses. We’ve got a sequence you can do in your office clothes (see Mini Office Yoga Sequence) and a series of seated poses you can do right at your desk (see Chair Yoga Mini Sequence). And, of course, you could always meditate, even in a noisy environment (see Achieving Stillness in Turbulent Situations)!

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Aging, Diabetes and Yoga: Stereotypes That Are Truly Dangerous

by Melitta Rorty

Tracks by Brad Gibson

When most people think of diabetes, they think of diabetes associated with obesity (particularly abdominal obesity) and older age. When the mass media uses the term diabetes, it almost always is in reference to Type 2 diabetes, but never stated as such. Yet fully 20-25% of all cases of diabetes are Type 1 diabetes, formerly called juvenile diabetes, which is an autoimmune disease that can occur at any age, including in the elderly, and which requires exogenous insulin for survival.

The stereotypes, widely held both by the general public and medical doctors, are that Type 1 diabetes is strictly a childhood disease and Type 2 diabetes is a consequence of older age and obesity. A particular danger for those who acquire Type 1 diabetes as adults is that they will be misdiagnosed as having Type 2 diabetes, an altogether different disease with different genetics, causes, treatments, and potential cures. The consequences of misdiagnosis are extreme:  rapid onset of diabetic complications and even death.  Fully 10% of people diagnosed with Type 2 diabetes have the autoantibody markers for Type 1 autoimmune diabetes and have been misdiagnosed; that equates to millions of people in the United States alone who are misdiagnosed.

I, myself, experienced the harsh reality of misdiagnosis. In 1995, at the age of 35, I was hospitalized in diabetic ketoacidosis (DKA), but because of my age, I was misdiagnosed as having Type 2 diabetes (by an endocrinologist who is a medical school professor), despite having zero risk factors for Type 2 diabetes. I was removed from life-saving intravenous (IV) insulin and released from the hospital, treated only with oral medications for Type 2 diabetes, a disease that I do not have.  Thankfully, I remained misdiagnosed for only about a week, because in that time I read all the literature about diabetes that was provided to me at the hospital, and realized that the symptoms I had (extreme weight loss, diabetic ketoacidosis, blood glucose 7 times normal, massive ketones in urine) were that of Type 1 diabetes and not Type 2 diabetes. When I confronted the endocrinologist who (mis)diagnosed me, to his credit he admitted he had made a mistake and apologized. Then he changed my diagnosis to Type 1 diabetes and put me on exogenous insulin. Since that time, I have come to know hundreds of others who have been similarly misdiagnosed, and I have worked diligently to dispel the myth that Type 1 autoimmune diabetes is a childhood disease.

Sadly, not much has changed since 1995 and misdiagnosis is still extremely common today, in spite of widely available diagnostic tests that can assist with obtaining a correct diagnosis.  As stated in a recent Wall Street Journal article on the problem of misdiagnosis,

"Most of my [adult Type 1 patients] have been misdiagnosed as having Type 2," says Robin Goland, co-director of the Naomi Berrie Diabetes Center at Columbia University Medical Center in New York. "Once the right diagnosis is made the patient feels much, much better, but they are distrustful of doctors and who could blame them?"

In the United States, a medical doctor faces no repercussions if he/she misdiagnosis a person as having Type 2 diabetes when in reality the person has adult-onset Type 1 diabetes. The governing bodies (the Expert Committee on the Diagnosis and Classification of Diabetes Mellitus; the American Association of Clinical Endocrinologists) describe the different diseases that fall under the umbrella term “diabetes,” but they do not identify any protocols for differentiating amongst the different diseases. So there is no requirement to diagnose, classify, and appropriately treat the different diseases that fall under the term “diabetes.” If there were a standard or guideline, doctors would be held accountable to the minimum standard of care:  anything less would be malpractice. From my perspective, the lack of guidelines appears to be about limiting medical liability, not about enhancing patient care and saving lives.

If you or someone you care about has been diagnosed with diabetes and for any reason you suspect it may not be Type 2 diabetes, request that your doctor run autoantibody tests and the c-peptide test. Dr. Lou Philipson, Director of the Kovler Diabetes Center (University of Chicago) says:

“What I teach is that it is always important to ask oneself why a given patient has diabetes and what kind they have [Type 1, Type 2, or another form of diabetes]. Do not assume. If you have doubts, get another opinion, or get a referral to a see a specialist. Persistence can be life-saving.”

How does all this relate to yoga and healthy aging? I started practicing yoga six months before my first symptoms of diabetes. When I was newly diagnosed, I was in extreme despair—I thought my life was ruined. But yoga saved my life then by allowing me some space and freedom from constant thoughts about my disease. And yoga continues to save my life today by helping me stay calm and focused despite the daily grind of self-care that those of us with Type 1 diabetes must do. I recommend yoga to anyone who has to live with the stress of chronic illness.

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Friday Q&A: Yoga and Bursitis

Q: I have a 65 y.o. student with bursitis in right hip next to Greater Trochanter. After x-ray &  MRI to rule out other complications, her Doc says give up the vigorous gym workouts and do more yoga classes!  She has been regular once a week yoga for 14 years in classes small enough to adapt poses as needed. What actions or poses are contraindicated during the healing of the inflammation? What else to consider during healing process?  Love that her doc recommends more yoga!

A: Funny you should ask! This is a very common cause of pain in the hip area, and just last week one of my students on retreat in Mexico mentioned that she had been having pain near the bony prominence at the side of hip known as the greater trochanter of the femur bone. I asked if she had had it evaluated yet, and she said no. But the location of her pain brought your student’s condition to mind. I see this a couple times a year in my students and patients. According to the Cleveland Clinic:

“Trochanteric bursitis is inflammation of the bursa (fluid-filled sac near a joint) at the outside (lateral) point of the hip known as the Greater Trochanter. When this bursa becomes irritated or inflamed, it causes pain in the hip. This is a common cause of hip pain.”

It might be helpful to provide some information about the condition before we dive into my yoga recommendations. First off, what are the most common symptoms of the condition? Well, the most helpful in differentiating it from other causes of hip pain would be the location, as described above, along with pain in that area when lying on that side of pelvis or when touching over the greater trochanter. Less specific but still helpful symptoms include pain when getting out of a deep chair or out of your car, or when walking up stairs. And pain located on the lateral thigh or in the buttock area could still be this kind of bursitis. Normally the bursa, a fluid-filled sac that usually lies between tendons and bones to provide more cushion and smooth movement over the bones, is not very big and doesn’t hurt. 

Bursitis, when the bursa becomes inflamed and painful, can result from a variety of situations. An acute injury to the hip joint, via a fall onto the hip, bumping the hip into an object, or lying on one side of the body for an extended period, can result in acute bursitis. Overuse of the area via play or work could also lead to this condition, especially if activities include running up stairs, climbing, or standing for long periods of time. Incorrect posture that results from scoliosis or lumbar spine conditions, or leg length discrepancies could also lead to bursitis.

Other health conditions not specifically related to the hip, like rheumatoid arthritis, gout, psoriasis, thyroid disease or an unusual drug reaction, could also be the cause. In rare cases, bursitis can result from infection. And any previous surgery around the hip, including hip replacement, could increase the risk of developing it.

Usually, most cases of bursitis of the greater trochanter resolve on their own with little or no intervention in a few weeks. In all likelihood, your student either had persistent or recurrent bursitis that led her to seek medical attention. Western medical treatments start with modified activity and anti-inflammatory medications like ibuprofen. If that does not work, a steroid injection into the affected bursa and/or physical therapy to maintain range of motion would follow, adding splinting if necessary. In rare cases, surgery might be recommended. 

And what about preventive approaches for the Western model? The Cleveland Clinic says that because most cases of bursitis are caused by overuse, the best treatment is prevention. So avoid or modify the activities that cause the problem, and correct underlying conditions, such as leg length differences, improper posture, or poor technique in sports or work, that cause the problem. They also make the following specific recommendations:

• Take it slow at first and gradually build up your activity level.*
• Use limited force and limited repetitions.*
• Stop if unusual pain occurs.*
• Avoid repetitive activities that put stress on the hips.*
• Lose weight if you need to.
• Get a properly fitting shoe insert for leg length differences.
• Maintain strength and flexibility of the hip muscles.*
• Use a walking cane or crutches for a week or more when needed.

* The recommendations above that I marked an asterisk are great guidelines for how to approach your student and her practice, as well as for most students in general.

Approach Cautiously...

 As to your approach to yoga, the most obvious places to avoid or use caution would include any side lying positions, such as Anantasana (Vishnu’s Couch pose), where you put direct contact on the greater trochanter. Fortunately, there are not a lot of poses like that in our modern yoga practices.  However, in an acute phase of bursitis, even a strong stretch over that area could slow or reverse healing, so poses such as Standing Side Stretch (sometimes called Half Moon pose) shown on the left, the back hip in Triangle pose, and the top bent leg hip in Marichyasana 3 and Ardha Matsyendrasana should be approached cautiously, and propped a bit higher then usual. You’d want to ask your student regularly if any pose is worsening the symptoms, and play with variations to eliminate the pain.

Ardha Chandrasana (also called Half Moon pose) comes to mind as a potential challenge for both legs, but for different reasons: the top leg because the muscles over the greater trochanter are pulling down on the bursa, and the bottom leg due to possible compression in that area of the hip. Since stair climbing and getting out the car can worsen the pain, approach Fierce pose (Utkatasana) and Garland pose (Malasana) with a watchful eye, especially when the student returns to a standing position.

Because physical therapists teach range of motion exercises for this condition, doing yoga warm ups for the hip in a reclining position would be helpful. In addition, a few of the recommended stretches I found online from a physical therapy site included Marichyasana 3 and Thread the Needle pose, which are part of many yoga classes. For strengthening, they recommended abduction the affected leg while standing, such as the action of the top leg in Half Moon.  So, some of the poses you need to be cautious with during the acute phase may end up being important as healing progresses for either stretching or strengthening the area. Take your time, go slow, and progress gradually.

And tell her doctor if things improve quickly. Let’s get more of those MD recommendations for yoga!

—Baxter

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Taking a Sick Day Today

by Nina

Fallen Log by Brad Gibson

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Tension versus Compression: the Safety Line for Yoga

by Baxter

An essential ability to cultivate when adding yoga asana to your health regimen is the differentiation between sensations that are potentially good for you, such as the healthy stretch of a tight muscle, and those that are potentially injurious to you, such as overstretching a tendon or ligament, or compressing structures to the point of injury. We are going for the former and trying to avoid the later.

Two of these sensation creators, tension of a stretched muscle and compression of soft tissue or bony prominences, have been the subject of a quite fascinating yoga video by Paul Grilley, entitled “Anatomy of Yoga.”I viewed this DVD many years ago now, but this essential differentiation between feeling tension and compression and its importance to practicing safely has stayed with me. I’ll let Paul tell you more about it in this youtube video:

Experiencing tension or stretch sensation in a muscle is generally a desirable feeling to become familiar with, especially if it is experienced in the mid-portion of a muscle, farther away from the almost inelastic tendons and ligaments that tend to be located closer to the joints. A typical place to become familiar with this kind of body sensation is the hamstring muscle at the back of the upper legs. I chose this intentionally because it is an area that most students feel some sensation when in Downward-Facing Dog or Standing Forward Bend, just to name a few poses that stretch the hamstrings. As most of you know, the intensity of the stretch sensation can be quite strong, and yet it usually does not mean you are injuring yourself. 

The hamstrings are located on the posterior part of the hip joint, so when we are doing a stretch of this muscle group, the structures on the opposite side of the joint, here being the front of the hip joint, are brought into close proximity to one another in Standing Forward Bend. The closer the pelvic bone and the femur bone come together, the greater the chance for everything in between those two bones are to be compressed or smashed together. As far as differentiating between the sensations of stretch and compression, my personal experience is that they feel distinctly different.  Compression really does feel like things (muscles, skin, tendons, ligaments, fascia and bones) are getting smashed together. And sometimes it creates a kind of pinching sensation as well. This pinching sensation is one that I tend to back away from pretty quickly if it shows up in any yoga poses. And because compression could also put collapsing pressure on blood vessels and nerves, if you start to have an unusual pressure sensation in the joint, or start getting numbness and tingling downstream from the compressed area, that is another good indication to release out of the pose a bit.

The hip joint, especially the front of the hip, is one of the main areas to watch out for this.  Poses like Lunge pose and Pigeon pose are two regularly practiced poses where you’d want to be alert to unusual pressure, numbness or tingling kinds of feelings in the front leg. The good news is that if you do experience compression sensations, propping up just a bit higher could completely relieve the more worrisome kind of compression that could lead to injury. As an example, if you normally do Lunge pose with your palms flat on the floor, coming up onto your fingertips or, even better, onto a pair of blocks, might slightly open the front hip joint and relieve the compression. The same thing goes for Pigeon pose; by setting yourself up on folded blankets, with a block or a bolster under the front leg sitting bone, you can probably relieve compression in the front hip joint.

Lunge Pose using Fingertips

Other joints may be less likely to experience compression, but one that I watch out for is the front leg in Triangle pose (Trikonasana) and Pyramid pose (Parsvottanasana) at the back of the ankle joint. This is especially likely to pinch if the feet are too far apart. If the knees are generally healthy, compression of the back of the joint, such as in Child's pose, is not usually an issue for most students. 

Another place that painful compression is often experienced, especially by male students, is in the shoulder joint while doing Upward Bow pose (Urdva Dhanurasana).  Many men have limited flexion of the arm bone at the shoulder joint, and when they follow typical instructions to keep the elbows in while coming up into Upward Bow, they are unable to fully straighten the elbows, not because of elbow issues, but because the back of the shoulder joint experiences a painful compressive pinch.

It is important, as you master the basic yoga poses and begin to try out some of the more challenging poses, to take your time and notice where you feel sensation while in the postures. By once again focusing on mindfulness in your poses, you are more likely to notice poses that are not feeling “right” to you, so you can bring this to the attention of your teacher for recommendations on how to modify properly. Be patient with yourself, allow for slow steady progress in the mastery of your poses, and you will begin to discern the differences between tension in a muscle and compression around a joint.

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Yoga for Neuropsychiatric Disorders

by Ram

"The demand for clinically efficacious, safe, patient acceptable, and cost-effective forms of treatment for mental illness is growing. Several studies have demonstrated benefit from yoga in specific psychiatric symptoms and a general sense of well-being." —Balasubramaniam, et al

Among the vedic sciences, Ayurveda is considered the healing side of yoga, and yoga the spiritual side of Ayurveda. Both these sciences are considered as two sides of the same coin, as they emphasize a complete approach to the well-being of the body, the mind, and the spirit. Both yoga and Ayurveda describe the disease process as taking its roots first in the mind. If we fail to recognize the disease process in the mind and continue to make wrong choices, the disease overflows into the physical body as specific symptoms. Thus, symptoms are simply the body’s voice communicating that we are living out of harmony. When we live out of harmony we suffer. When we change our life to bring greater harmony, our bodies reflect this change and there is less suffering.

Turn to yoga philosophy and one of the main tenets in the Yoga Sutras is:

Yogas chitta vritii nirodhah

yoga =union, to join; chitta = mutable thoughts of the mind-field; vritti = mental fluctuations/ modifications, nirodhah = coordination, regulation, channeling.

Swami Jnaneshvara translates this as: Yoga is the control (nirodhah, regulation, channeling, mastery, integration, coordination, stilling, quieting, setting aside) of the mutable thoughts/modifications (gross and subtle thought patterns) of the mind field. In other words, when you achieve a union of the body, mind and spirit, all mental fluctuations and turbulence cease.

The Shady Side of the Mountain by Brad Gibson

Dissect this tenet in more simple terms and this is the message: human being as a whole is a combination of body, mind and spirit, with physical, mental (psychological) and spiritual dimensions. When we just think of ourselves as a physical body and lose our connection with the mind and spirit, we become susceptible to mental and physical diseases. If this theory is hard to follow, understand that we share a close relationship with our environment, the world around us. If an individual is living in harmony with the environment, optimum health is possible. However, the further out of harmony an individual is living, the less likely it is that they will reach their full life potential in either length or quality of life. Healing is the process of returning to harmony by becoming one with our environment. Once back in harmony, the body and the mind have no reason to communicate symptoms. The body is at ease; the mind attains peace.

Mention the mind-body relationship to a scientist or a medical doctor and you will immediately notice their discomfort as this relationship lacks sufficient scientific backing. In addition, I have noticed that the general public is less likely to embrace some of these theories and alternative therapeutic interventions unless they have been proved by science. At one of the national Ayurveda/Yoga conferences, I had suggested some yoga modalities for ADHD patients but since I could not provide a scientific rationale, my suggestions were met with skepticism.  So does it surprise me now when a review published in the journal, Frontiers in Psychiatry titled Yoga on our minds: a systematic review of yoga for neuropsychiatric disorders by Balasubramaniam, et al describes yoga to be “highly promising” as a complimentary care to medication for psychiatric disorders (the authors examined the literature for a gamut of psychiatric illness) but without the negative side effects that come with pills? Not in the least. Because all psychiatric disorders have a mind component, a mind-body integrative program, such as yoga, can definitely assist people in their pursuit of peace and calmness, and bring greater wholeness and integration in their lives.

Unfortunately, if you just mention this 5000-year-old ancient practice as a standalone solution, you will have skeptics. Bring in statistics, scientific methodology and other modern applications, however, and people will start believing you.

"There is emerging evidence from randomized trials to support popular beliefs about yoga for depression, sleep disorders, and as an augmentation therapy. Limitations of literature include inability to do double-blind studies, multiplicity of comparisons within small studies, and lack of replication. Biomarker and neuroimaging studies, those comparing yoga with standard pharmaco- and psychotherapies, and studies of long-term efficacy are needed to fully translate the promise of yoga for enhancing mental health."—Balasubramaniam, et al

But whatever it takes, the mind-body connection definitely needs to be considered seriously!

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Friday Q&A: The Right Teacher for an Older Student

Q: Has the subject come up about some teachers disliking seniors in their classes? I'm getting the feeling that older Yoga students are not welcome in Yoga classes. It is getting disheartening. Yoga has changed my life. Yet it's as if these teacher are worrying that I will have a heart attack or stroke during a class, or worse, flat out die. Maybe it's an insurance thing, but I wish teachers would simply tell older students to go somewhere else.

A: Thanks for the question, although it is sad to hear that you have witnessed such behavior towards any student in class. I certainly am not aware of this as a trend in the yoga classrooms, but on a certain level, I am not surprised. I say this because many yoga teachers are not adequately trained to work with students who may have special needs, like an older student might. If you add on to that relative inexperience and youth, you may have a teacher who has not considered the realities of getting older for others or even themselves, and therefore reacts as you have witnessed in your class, with a kind of “emotion of discrimination” towards the older student.

I had just the opposite experience two weeks ago at the Yoga Journal Conference, where I led an all-day intensive on Yoga for Healthy Aging. Not only was the group mature in thought as well as age, but half a dozen of the attendees teach special classes for older students. They were so excited to meet one another that they all had lunch together to share ideas and enthusiasm. So, all older students should know that there are classes designed just for them, and that does not necessarily mean they won’t be challenged. Just that their teachers will not only welcome them to class, but will have a lot to teach them!

—Baxter

A: This question also made me sad. You deserve a teacher who respects you. And you also deserve a teacher whom you respect. This is true for everyone, old or young, male or female, slim or overweight, flexible or stiff, healthy or ill. While some people simply go to whatever yoga studio is closest to home or work and take from whichever teacher teaches at a convenient time, I always recommend that people spend some time looking for the right yoga class. Do some research and ask your friends for recommendations, and then give some of the recommended teachers a try. Audition them, and see if they’re good enough for you! Then go with your gut. If the teacher seems disrespectful, inconsiderate, reckless, or poorly trained (or, as sometimes happens, behaves inappropriately with students), scratch that one off and go on to the next teacher. Eventually you’ll find someone right for you, whose classes you look forward to. It’s similar to looking for a therapist or medical doctor; you find out pretty quickly when you click with someone.

If you are reasonably able and in good health, you may not need to find a teacher who specializes in teaching older students; you just need someone with the right attitude! Keep looking and I know you’ll find one.

—Nina

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