Changes in the Blog Format: Healing in Progress

A Sign on the Trail by Melina Meza

Sorry I changed the format of the blog so suddenly! It was actually a mistake on my part—I got a bit overly enthusiastic on Friday afternoon. I will be working on fixing the blog all weekend. But I realize that some of you may be confused.

To read the rest of this (or any article), simply click anywhere on the portion of the article that is displayed on the home page. You can still search the blog and you can still subscribe, but it may not be so easy to figure out. So here's a little help.

SEARCHING: To search with a text string, use the search box at the very top of the page. To search the archives, hover your mouse over the thin black rectangle at the upper right of the page (the dock) until you see the file cabinets. Click on the file cabinets to display the archives. To view the index (list of labels), however you mouse over the thin black rectangle at the upper right of the page until you see the tag symbol. Click on the tag symbol to see the index. For detailed information on searching, click the How to Search tab at the top of our home page.

SUBSCRIBING: To subscribe by email or RSS, hover your mouse over the thin black rectangle at the upper right of the page (the dock) until you see the "connection" symbol and the word "Subscribe." Click to open the Subscribe box. To become a Google follower, hover your mouse over the dock until you see the Followers icon and the word "Followers." Click to open the Followers box and click the Join this site button. For detailed information on subscribing, click the How to Subscribe tab at the top of our home page.

In the meantime, if you have trouble subscribing and want help, use the Contact Us at the top of the page to email me and I'll sign you up. After I sign you up, I'll send you a message telling you how to confirm your subscription (the confirmation process is one that I can't turn off). 

—Nina

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Friday Q&A: Can You Help Us?

Hidden by Melina Meza

Q: Baxter and I would very much like to write a book on “Yoga for Healthy Aging” in the near future. And we’re betting that a lot of you would also like to see to a book on that topic by the two of us, along with input from our crew of regulars.

However, recent discussions with an agent and a publisher made us realize that these days publishers expect you to “bring your audience along with you.” So when you write a book proposal or pitch an agent, you actually have to give provide all your numbers, including your blog subscribers and numbers of hits, Facebook followers, and so on. And while we love all the subscribers and readers that we already have, we both feel our blog has the potential to reach a much larger audience. Recently we received this lovely message from a reader:

"Just a note to thank you all at YFHA for the helpful content you publish; it's no understatement to say that your site is, I feel, one if the top five yoga resources on the web - a true hidden gem."

So how about it, dear reader? If we promise to continue being a “gem,” will you help us out come out of hiding and find a larger audience for our blog?

—Nina

A: If your answer is yes, you can help by trying to get as many of your family members, friends, students, coworkers, etc. turned on to the blog. You can do this by sending email links to our posts and sharing links on Facebook and Twitter, asking the people you’re sharing with to do the same. If you’re a yoga teacher and it feels right to you, talk about our blog to your students and encourage them to become subscribers.

Finally, we’re open to your suggestions! So if you have any ideas, let us know either by commenting on this post or using the Contact Us tab at the top of the page.

(We have already outlined the book by the way, and we’re both feeling pretty excited it!)

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Tension Headaches and Yoga

by Baxter

Let me start off today’s post by personally wishing you all a Happy New Year! We are seven days into 2014 already, and Nina and I are excited to continue our work here at Yoga for Healthy Aging in the coming year. Today’s post comes out of something a few friends mentioned the day after their NYE celebrations: a lot of them had hangover headaches! Surprise, surprise! But I just happen to be preparing a workshop on headaches for the upcoming Yoga Journal Conference in San Francisco in a few weeks, and when I reviewed what we have written on the topic, I was surprised to find that we had not specifically talked about the most common form of headache that people experience (fortunately not hangover headaches): tension or musculoskeletal tension headaches. Sure, we alluded to it on our pretty thorough discussion on Yoga and Migraines last year, but I thought it would be well worth a focused look at tension headaches today. So here we go!

Tension headaches are indeed the most common headaches people experience, although the exact causes are not yet entirely clear. According to the Mayo Clinic website:

“A tension headache is generally a diffuse, mild to moderate pain in your head that's often described as feeling like a tight band around your head.”

Very encouragingly, the site states, “managing a tension headache is often a balance between fostering healthy habits, finding effective nondrug treatments and using medications appropriately.” Why do I find this encouraging? I am always excited when modern western medicine discovers that lifestyle and non-drug therapies are the better first choice in addressing a health concern. Bravo!

It is important, before we discuss yoga options for tension headaches (TH) to be clear on what constitutes a tension headache, and how it is different from migraines, for instance. A tension headache typically has the following qualities and presentations:

• dull, aching head pain
• sensation of tightness or pressure across the forehead and sides and back of head (headband distribution)
• tenderness on the scalp, neck and shoulder muscle

I am sure some of you can identify with this and are likely massaging those areas right now! Modern western medicine splits tension headaches into two categories, those that are episodic and those that are chronic. Episodic tension headaches can last from 30 minutes to a week. The more frequent they are, the more likely they are to become classified as chronic. If your headaches occur 15 or more days a month for at least three months, you are bumped up to the chronic camp. Let’s hope that is not in the cards for you!

Tension headaches can be hard to distinguish from the less common migraine headaches, and can even occur in people who also suffer from migraines. The Mayo Clinic points out some helpful distinguishing features between the two:

“Unlike some forms of migraine, tension headache usually isn't associated with visual disturbances, nausea or vomiting. Although physical activity typically aggravates migraine pain, it doesn't make tension headache pain worse. An increased sensitivity to either light or sound can occur with a tension headache, but these aren't common symptoms.”

The fact that physical activity does not usually worsen tension headaches is helpful to know when you are considering whether or not to do an asana practice when you already have a headache. And it is a way to test out your particular headache to see if it is tension or migraine.

It is still not clear what the underlying cause is for these common headaches. Some specialists link them to muscle contractions anywhere above the shoulders that might be encouraged by emotions, tension or stress, even though research does not support muscle contraction as the cause. The most common theories suggest that people with tension headaches have a heightened sensitivity to pain and stress. And related to that, stress turns out to be the number one trigger of tension headaches. Statistically, according to one study, 90% of women and 70% of men experience tension headaches at some point in their lives, with the peak incidence in people in their 40s.

The gang at Mayo Clinic did disappoint me a bit. Following their initial statements about non-drug treatment, they launch into medication choices before discussing lifestyle and alternative therapies—you all came so close! But when they finally do get to the non-drug options, stress management and improved posture are two of the three main recommendations. We have discussed this in many other posts, so by now we all realize that yoga rocks for addressing these options. And yoga does get the nod as a possible preventive treatment option for tension headaches.

Nina did a nice job in her headache prevention posts Preventing Migraines (and Other Headaches), Part 1 and Part 2 in outlining good yoga options for migraines and tension headaches (see also Peaceful Poses for Stress, Anxiety, Neck Pain and Headache Prevention). In general, because tension headaches are not typically worsened by physical activity, an active asana practice could be appropriate for when you have a headache as well as for headache prevention. I cannot tell you how many times students have come into class complaining of a headache, only to state on departure that their headache was now gone. And since most of the classes I teach include some short vinyasa portions, either reclining or standing, such as Sun or Moon Salutations for a few rounds, as well as static poses, a short pranayama session and a 10-minute Savasana (Relaxation pose), I can conclude that a well-balanced yoga practice can be both preventative and prescriptive.

Here are some of my favorite specific approaches for treating and/or preventing tension headaches:

Releasing muscle tension in neck and head. Even though muscle contraction does not appear to be the main cause or clear cause of tension headaches, I’d still focus much of the yoga asana practice on the area at and above your shoulders to release any excessive muscle tightness. Our shoulder series Opening Tight Shoulders, along with Owl and Curious Dog neck movements (see Neck Muscle Strain and Spasm) would be excellent additions to a daily home practice.

Refining your asana choices. Monitoring the effect of certain groups of yoga poses to see if they aggravate or improve headache symptoms is always a good idea. The more you start to understand how your body interacts with the practice, the better your personal practice will develop to support lessening your chances of getting tension headaches.

Finding the best stress practices for you. In addition to the more active practices of yoga, experimenting with quieter options is also essential in preventing and treating tension. A weekly restorative class or home practice (see Mini Restorative Practice) or the periodic use of Supported Relaxation pose (see Savasana Variations) and a yoga nidra recording (see Yoga Nidra and Deep Physical Relaxation) will work nicely for many. Pranayama practices such as 1:2 ratio breathing (the inhalation is 1/2  the length of the exhalation) or gradual lengthening of both inhale and exhale equally are great beginning breath practices to try. Short sitting or reclining meditation practices for 5 to 10 minutes are also great stress reducers.

Resetting pain sensitivity. Just as regular stretching of the hamstrings in Standing Forward Bend (Uttanasana) tends to lower the intensity of the perceived stretch discomfort over time, a general yoga practice has the potential to lower the heightened pain sensitivity that some people may have. There is no study to presently prove that last assertion, but it seems reasonable to observe in your own situation if adding in a regular, reasonable home practice begins to change the frequency and intensity of your tension headaches.

Please let us know what you find out if 2014 is the year you ramp up your practice with the intention to improve your tension headaches!

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Starting to Move Again

by Nina

Recently Shari and I wrote a post recommending a sequence to someone who had lost confidence in her body after a fall (see Regaining Stability—for Free!) Another reader left a comment on that post that made me realize what an important topic this was:

Omgosh. I ....this took my breath away. This is exactly what happened to me! I was this vibrant, moving being....then a stupid, nasty fall (via a piece of gravel on the sidewalk) ended all that. And my subsequent life mirrors your friend's. Thank you SO much for giving us hope!

It seems that after experiencing a fall, many middle-aged and older people may become fearful, which can lead to inactivity. That inactivity in turn leads to stiffness, weakness, loss of balance and/or loss of agility. So I decided to learn a bit more about the woman who left this comment, and to see if there was something we could do to help her regain her confidence and start to move again. Everyone has different issues, so before making recommendations, I asked her to fill me in on any physical problems she had. Here’s a condensed version of her reply:

My sacrum got cocked (like it often does) and that triggered a bout of sciatica - the two sent me to the ER. The cocked sacrum was the result of some incorrectly done crunches plus my bete-noire, a fibroid that spans the entire back of my uterine wall.

I've had two motorcycle accidents (about 20 yrs apart) and now just have that North Dallas Forty thing going  (the opening scene, with Nick Nolte in the bathtub - painful).  Also, I have had shoulder surgery (torn rotor cuff with a bone spur sticking through it)— that one is healed.

Last thing that happened was about 18 mos. Ago—striding down the street, I twisted my ankle on a piece of gravel and went down like a sack of potatoes.  Banged up my left knee and hip (that poor hip gets so much grief), wrenched my back, and damaged the OTHER shoulder in the fall, which is why I have no flexibility or confidence whatsoever. So I can’t extend my right shoulder much. I also have two discs in my neck that are bone on bone, though I keep those pretty limber, most days.

So that's the litany of ick.  Other than that stupid fibroid and the post-injuries I’m actually pretty healthy and very strong (except for that shoulder – but I can still lift between 50-100lbs with my arms at my sides – just not extended).  Mostly I'm just stiff and achy and need to get back to moving around - your post on 'regaining stability' resonated so deeply, Nina.  

After learning about our reader’s situation, I decided to take her case to Baxter, who pointed out to me that certain physical problems, such as the fibroid and the new shoulder injury, needed to be addressed by a medical professional. He agreed that while our reader was seeking medical help, she would also benefit from a gentle yoga practice that allowed her to start moving again. A short, daily, gentle yoga practice would be helpful to her allover physical health and would allow her to start increasing her flexibility, as well as her confidence.

In her case, because she has a history of low back and other problems, he recommended that instead of having a single sequence, she should alternate between three different sequences. I was happy to find that two of the sequences were already on the blog! (So if you’re a new reader and want to start practicing some short sequences on your own, be sure to poke around through our archives to see the various sequences we’ve been posting.)

The three sequences are:

1. Baxter’s classic Low Back Care Practice (see Low Back Care Practice). Because hip openers are helpful for low back problems, this sequence includes stretches for leg and hip flexibility.

2. Baxter’s classic Mini Restorative Practice (see Mini Restorative Practice). A restorative practice will help reduce stress. Long-held passive poses also gently stretch your muscles.

3. Our new Gentle All-Around Practice (see Gentle All-Around Practice), which I'm just posting today. This practice includes shoulder stretches to increase upper body flexibility and standing poses to improve balance and stability.

My hope is that practicing these sequences on a regular basis will, over time, restore her flexibility, balance, and feelings of self confidence, and allow her to be a “vibrant, moving being” once again.

And although we came up with this set of sequences for a particular person, all of them would be suitable for just about anyone who is starting a home practice. And it just so happens we’re in the first week of the new year! So if any of you have made resolutions to start practicing yoga at home, give any or all of these sequences a try and let us know how it goes.

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Featured Sequence: Gentle All-Around Practice

by Nina

This short sequence is designed for anyone who wants to get started with a short, gentle home yoga practice. This sequence is a great complement to our Low Back Care Practice and Mini Restorative Practice because it focuses on upper body flexibility, strength and balance, which are not addressed by the other sequences.

Although I originally designed this practice, Baxter reviewed it and made a modification—so it is officially Dr. Baxter Bell approved. We both hope you enjoy the practice!

1. Standing Shoulder openers (see Opening Tight Shoulders).

Releasing tight shoulders is important for the upper back and neck health, and is an important antidote for time spent in front of computers, driving, gardening, or other activities where you are reaching forward all day. If you have limited range of motion in one shoulder, just do the best you can, even if that means, for instance, taking your hand only half way up the wall rather than all the way. To make the sequence shorter, you could skip some of stretches (and alternate on different days of practice).

2. Half Dog pose at the Wall (see Half Dog Pose at the Wall). 

This pose is a wonderful all-over stretch because as it opens your shoulders it also stretches the sides of your torso, and, if you straighten your knees, it stretches the backs of your legs as well. It’s a perfect warm-up for standing poses!

3. Warrior 2 and Warrior 1 Mini Vinyasas (see Warrior 1 and Warrior 2 Mini Vinyasas).

Warrior 1 and Warrior 2 are classic standing poses that improve your balance (due to their wide leg stance), build leg strength (due to the bent front knee) and increase upper body strength (due to holding arms out to the side or over head). Practicing these as mini vinyasas (moving in and out of the poses with your breath), will improve balance and agility, and are a gentle versions of these poses. (Though this is not as strengthening as holding the poses for extended periods.)

For the Warrior 1 vinyasa, if you can’t hold your arms overhead, you can keep them in Namaste (prayer position) in front of your chest or place your hands on your hips.

4. Tree pose. 

Depending on your self confidence and your ability to balance, you can do this pose in any number of ways. If doing the pose in the middle of the room causes stress, stand in Tadasana (Mountain pose) with your left side near the wall. Shift your weight to the your left leg—if needed use your left fingertips on the wall to balance—and lift your right foot into any of the following positions:

• toes of the right foot on the floor, rest of the foot off the floor
• right foot on top of your left foot— but try not to have your right toes touch the floor
• sole of the right foot pressing against your left calf
• sole of your right foot pressing against your left thigh (above the knee)

5. Chair Twist (see Simple Chair Twist).

This pose releases back muscles that are stiff or sore from sitting at a desk or from traveling, or from everyday activities that stress the back, such as gardening and painting, and increases the rotational mobility in your spine. Twisting also helps nourish the spine—movement of the spine helps maintain the health of the discs—and also strengthens the bones themselves as your back muscles pull on the bony insertions of the spine. And it also strengthens the oblique muscles of your core. If you have a history of low back problems, please do this pose with a block between your thighs and twist only from the navel on up.

6. Easy Inverted Pose (see Easy Inverted Pose).

Resting your calves on a chair with a support under your pelvis puts your body into a slightly inverted position, so the blood flows from your legs down toward your heart making this pose a very calming inversion, which is also very restful for your leg muscles. If the support under your pelvis irritates your lower back, you can simply do the same pose without it.

NOTE: If you're reading this on the day it was posted, keep your eye out for a second post that recommends a weekly routine (including this sequence) that would be beneficial for anyone with back problems or who just wants to start practicing yoga at home.

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Overcoming Addiction through Yoga and Meditation

by Ram

Red by Melina Meza

Addiction is a continued repetition of a behavior or practice or action despite adverse consequences that is beyond voluntary control. People with an addiction do not have control over what they are doing, taking or using and thus resort to an addictive behavior that interferes with daily responsibilities including family, work, relationships, or health. People with an addiction cannot control their addictive behavior; they become completely dependent or preoccupied with the substance or behavior, and may not be aware that their behavior is out of control thus causing problems for themselves and others. Examples of addictions include but are not limited to smoking, drug abuse, exercise addiction, food addiction, sexual addiction, computer addiction and gambling. The difference between addiction and habit is clear. Addiction is a psychological/physical component where the individual is unable to control the aspects of the addiction while a habit is done by choice and the individual is in a position to stop it successfully if he or she wants to. Habits do not have adverse consequences or a serious psychological/physical component as with an addiction.

Furthermore, with addictions, the body and the mind “wire in” the continuous repetitive task by incorporating it as a “normal” function. This creates the conditions of tolerance and withdrawal. When the addiction is to smoking or drug abuse, the body continually adapts to the substance and requires increasingly larger doses to achieve the distinctive effects. This is “tolerance” On the other hand, “withdrawal” refers to physical and psychological symptoms that arise when reducing or abstaining from the addictive behavior on which the body has become dependent. Withdrawal symptoms kick in due to biochemical and hormonal imbalances due to the lack of the addictive behavior. Thus, an addictive behavior may be associated with an immediate gratification but is also characterized by a delayed harmful effect (short-term reward versus long-term penalty).

The consequences of an addictive behavior on the body and brain include a large range of injuries, health problems, brain damage, and birth defects. Substance abuse and dependence trigger negative outcomes including injuries, illnesses, accidents, domestic violence, disabilities, medical problems and death. Treatment options include self-help groups, detoxification-inducing drugs to combat addiction, antibody therapy, vaccine therapy, and deep brain stimulation among others. However, true recovery is a very long journey. Some individuals will remain steadfast, some will relapse, and some will always be “chronic relapsers.”

But now there’s the good news that rehabilitation therapies that use yoga and meditation are likely to have a higher success rate when it comes to helping overcome addiction and relapse. The practice of yoga and meditation exert positive influence on addictive behaviors and helps addicts to understand their true nature. In addition, yoga and meditation helps addicts develop a detached awareness of thoughts since any attachment to them becomes the cause for suffering. Individuals with an addictive behavior and who have a regular practice of yoga and meditation have less blame and disrespect toward themselves and exhibit more respectful, caring, and loving behaviors.

Yoga and meditation also appear to be beneficial in specific type of eating disorders that constitute addiction as they change the addict’s perspective of their own disturbing personalities. In one such study, Exploring the therapeutic effects of yoga and its ability to increase quality of life, female yoga practitioners not only exhibited positive feelings and sense of well-being but they also reported less self objectification, greater satisfaction with their body images and reduced messy eating attitudes compared to non-yoga practitioners. Similarly in a recently published paper A computational hypothesis for allostasis: delineation of substance dependence, conventional therapies, and alternative treatments, a group of scientists used a computational model of addiction, a literature review and an in silico experiment to suggest that rehabilitation strategies that include yoga and meditation with drug and behavior therapies are more helpful than all other methods to help people overcome addiction. The authors argue that a combination therapy that include yoga and meditation alter the reward-anti-reward states of the addict’s neural network system, which in turn help to provide higher cessation rates and lower relapse rates. In addition to overcoming addiction, yoga and meditation also stimulate the three aspects of healthy aging namely: decreased morbidity, independence and mental equilibrium or equanimity (see Meditation: Effects on Gene Expression). What a cheap but effective method to empower ourselves. A perfect New Year’s resolution is to incorporate yoga and meditation into our lives! Don’t you agree? 

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Acute Orthopedic Injuries

by Shari

In my role as a physical therapist and yoga instructor, I see lots of clients and yoga students who have experienced both acute and chronic orthopedic injuries. In western medicine, an injury is considered acute rather than chronic when it is less than three months old from onset. In general, an acute injury is an injury that occurred as a result of a traumatic event, including:

• Muscle pulls
• Ligament sprains
• Fractures
• Dislocations
• Contusions (bruises)

Signs of an acute injury generally include one or more of the following:

• sudden, severe pain
• swelling, often with the inability to place weight on a limb
• extreme tenderness on palpation of limb or other body part
• inability to move a joint through full range of motion,
• extreme limb weakness, visible dislocation or breakage of a bone

In general, there are two types of acute injuries: an unexpected acute injury and a cumulative trauma. An unexpected acute injury is one that is sudden and immediate, for example, the result of a skiing accident or a fall. My friend Shelly Prosko, who will write a post for us in the near future, experienced an unexpected acute injury when she was Double Dutch skipping and ruptured her Achilles tendon. On the other hand, a cumulative trauma is one that has been building up for a long time, possibly due to micro-injuries to a specific, vulnerable area until a final “last straw” movement causes the injury. This was the case with my right knee medial meniscal tear, which happened during a yoga class when I was doing the same pose I had been practicing for many years.

After you experience either type of acute injury, you have a dilemma: do you seek immediate medical advice or practice the “wait and see” method? Obviously if you think you may broken a bone, have a concussion, are bleeding profusely or are in excruciating pain, you should go to the emergency room. Otherwise, if the injury seems minor, you can take a 48-hour wait and see approach. During this 48-hour assessment period, you can practice R.I.C.E first aid:

REST: The first 24-48 hours after the injury is considered a critical treatment period, and you should curtail your activities. Gradually use the injured extremity as much as you can tolerate, but try to avoid any activities that cause pain. Often using a splint, sling, or crutches is necessary to adequately rest the injured body part.

ICE:
 For the first 48 hours post injury, ice the sprain or strain 20 minutes at a time, every 3-4 hours. The ice pack can be a bag of frozen vegetables (such as peas or corn), allowing you to be able to re-use the bag. Another popular treatment method is to fill paper cups with water then freeze the cup. Use the frozen cube like an ice cream cone, peeling away paper as the ice melts. Do not ice a sprain or strain for more than 20 minutes at a time! You will not be helping heal the injury any faster, and you can cause damage to the tissues!

COMPRESS: Use compression when elevating a sprain or strain in early treatment. Using an Ace bandage, wrap the area overlapping the elastic wrap by one-half of the width of the wrap. The wrap should be snug, but should not cut off circulation to the extremity. So, if your fingers or toes become cold, blue, or tingle, re-wrap!

ELEVATE: Keep your sprain or strain elevated, higher than your heart if possible, to reduce swelling. Elevate at night by placing pillows under your arm or leg.

One of the most wonderful positions for reducing swelling (edema reduction) is Legs up the Wall pose (Viparita Karani). And you can even do this pose in bed if your bed is next to a wall and you have the agility to position yourself into the pose. If this isn’t possible, you can try using two bolsters propped up against a chair instead of a wall, especially if you have someone to place the bolsters for you. However, in acute trauma, this pose may NOT comfortable so short bouts might be more beneficial than longer periods of time.

Another spectacular pose for edema reduction is Chair Shoulderstand (see Judith Lasater's Favorite Poses), which you can do in a more passive position with your legs perpendicular or in more active position with your legs upright. The more passive pose is to rest your legs against the chair back, which requires less physical work and allows more relaxation (although this creates more of a backbend).

As you practice your R.I.C.E, keep assessing your pain levels. Sometimes the severity of an injury isn’t apparent immediately but if the pain worsens as the hours progress, this is a good indicator to seek medical care.

Ok, so your 48 hours have passed and you have religiously been practicing R.I.C.E. but you are no better, but no worse. At this point it is time to go to a medical doctor and learn as much as possible about the different possible treatments for your injury and then go through a careful decision process. And yoga can help you through all this.

In my situation with my right knee medial meniscal tear, I waited over six weeks of my own “conservative care” approach before the grim reality hit that things weren’t getting better. I didn’t follow my advice of getting medical help after 48 hours because I thought I could just heal my knee with a lot of RICE and restorative inverted poses. It did slowly get better over the six weeks but I reached a plateau in regaining movement and decreasing edema, and finally acknowledged I needed to be evaluated and diagnosed by a physician. (And frankly, I do have “white coat syndrome” and found it is easier hide my head in the sand and not acknowledge that my injury was more serious than I thought. There was no actual injury so I kept hoping it would get better. Sometimes we ALL practice avoidance!)

I then entered into the traditional medical model (see Fizzy Yoga!) and began non-surgical medical interventions. Along the way, I realized that I needed to add other C.A.M. (complementary alternative medical) approaches to my other endeavors. I realized that I needed to address all five koshas and sought out other medical practitioners that I trusted to aid me in my healing not just by addressing the physical injury but also by preparing me for the question that I had been avoiding: was I going to opt for surgical repair of my meniscal tear?

I meditated on the reason I wanted surgery and what would I gain from it. I had never in my 58 years had ANY surgical interventions, so even to contemplate surgery was a huge question for me to come to grips with. Many people told me to “just have the surgery, it is no big deal,” while others told me horror stories about failed meniscal surgeries and a NY Times article on why knee arthroscopy doesn’t work. But the surgeon who I consulted for this procedure was spectacular. He told me point blank that the decision was mine, but that I couldn’t be on the fence about it. I needed to believe it was the right choice for me. He even went as far to tell me that I could cancel in the surgical suite before anesthesia if I wanted to. His words changed the power dynamics and allowed me the space to meditate on my own fears and come to terms with them. He would do his job, but I had to do mine also.

Yoga helped me through the surgical process in many ways. Pre-op as I was waiting to be brought into the surgical suite, I was in a "comfy" type room with a recliner chair. I lay in that chair, covered myself with the blankets and practiced Ujaii breathing to calm myself. Also, I tried to clear my mind of all doubts and fears by just counting and following my breath. That practice helped immensely, and I was surprised on how low my blood pressure was when they took it before taking me into the operating suite. Just before the anesthesia was administered, I also tried to follow my breath as the lights literally went out. Post op in the recovery area again some Ujaii breathing helped to center me.

Once home, pranayama was helpful in quelling the anxiety and pain from the procedure. I didn't really start yoga asana practice till 24 hours post procedure. Starting with using my breath as I worked through my range of motion exercises and tried to be "kind” to my knee. Yoga is intimately connected to my current recovery. I really can't separate it out from my activities—everything I do now is with mindful attention to my knee and how it will respond to a new activity or asana position. Learning to GO SLOW is my current practice because when I don't, boy oh boy, does my knee balloon up! My knee is my teacher now and the rest of my body is the student—a different place to be for sure.

So, now it is two weeks post-op recovery. I have learned how to ask for help, which for me is really challenging. I have also learned that I need to still the little voice in the back of my mind that criticizes or is unhappy that I still can’t do something that I “should be able to do.” On the other hand, I’ve found it quite amazing how my knee has taught me how to experience asana differently. Yes, before I had to modify, modify, modify, but now the experience of gratitude is present. I ENJOY pranayama now and am practicing it more regularly. Also, I feel embraced by Chair Shoulderstand when I practice it. It is hard to describe but as soon as I am up in the pose I feel like I am getting a “big hug” that encompasses my entire being. The words don’t quite communicate the feeling of prana in my body!

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