Working with Carrying Angles in the Elbows

by Baxter

Woman Carrying a Child Downstairs by Rembrandt

In addition to the tendonitis I wrote about last week Elbow Pain and Yoga, another fairly common situation that I have observed in my students over the years are elbows that appear to look like knock knees do at the knee joint. What I mean by that is that the elbow joint seems to bow inward instead of making a straight line from the upper arm bone to the forearm bones. In anatomical terms this is referred to as a “carrying angle,” and sometimes as hyperextension. This could be considered just a variation on normal anatomy of the arms at the elbow joint, but ever since I started studying yoga in the mid-90s, it has been implied by many of my teachers that a carrying angle in weight bearing yoga poses could present some problems for those practitioners. I’ll get to that in a few moments. 

Interestingly, if you or I stretch our arm out in front of us, fully extending or straightening at the elbow, with our palm turned up toward the ceiling (known as supination of the forearms), and we look at the angle between the humerus and the forearm bones, it is usually not a straight line. The forearm bones angle slightly out to the side, away from the midline. But, wait! If you turn your hand down toward the floor (known as pronation of the forearms bones), you will likely notice that the upper and lower bones of the arm now appear more aligned! This is true for many yoga practitioners, but not all. And when the arms are not bearing weight, such is in many of the standing yoga poses (Warrior 2, as an example), it is really a non-issue for someone with a carrying angle. However, when we look at the elbows in one of the most common modern yoga poses, Downward-Facing Dog pose (Adho Mukha Svanasana), practitioners with a carrying angle will demonstrate this bowed-inward appearance while doing the pose. It will also show up in other straight arm yoga poses where you are bearing weight on your hands, such as Upward-Facing Dog pose (Urdhva Mukha Svanasana, Side Plank pose (Vasithasana), Plank pose, and Handstand to name some of the more obvious poses. 

I should mention that hyperextension of the elbow joint, where, instead of 180 angle between upper and lower arms in full extension of elbow, the angle is greater than that, is often present in those with a carrying angle. In hyperextension, it is often loose or lax ligaments around the joint that allow for the greater angle, but it is also influenced by the joint capsule and the shape of the bones. In both the situation of the carrying angle and hyperextension of the elbow joints, there is potentially less stability and even contact between the ends of the bones at the joint. This could increase the chances for wear and tear between the bone surfaces, as well as strain on the ligaments and tendons, and the development of pain around the elbow joint. 

A HUGE however: Because there is great variety in our skeletal structure, influenced by muscles and connective tissue, allowing the elbow joint to “lock out” into full extension where the carrying angle or the hyperextension become evident may not mean that the yoga practitioner is destined to develop arthritis or tendonitis of the elbow joint. So, it may be that only yogis who have elbow pain in the setting of a pronounced carrying angle should modify their poses to try to eliminate pain around the elbow. 

If you are interested in reading a great discussion on this topic (and to avoid re-inventing the wheel), I’d recommend you check out this post from YinYoga.com’s Bernie Clark: 

Now let’s assume that you or your yoga student is experiencing elbow pain in the weight-bearing poses mentioned above. What modifications can you try to attempt to eliminate the pain and quiet down the underlying problem that might be behind it? Here are a few ideas: 

1. Take a break from those poses for a few weeks and notice if the pain subsides or goes away completely. 
2. Do modified versions of the weight-bearing poses, like Half Downward-Facing Dog pose at the Wall, or Side Plank pose (Vasithasana) at the Wall and notice if less pressure through the elbow joint results in a decrease or absence of pain. Stick with those variations for a while before re-introducing the full arm balances. 
3. In Downward-Facing Dog pose, try to slightly bend your elbows until your arm bones will line up evenly. You might need someone to tell you where that alignment is if you can’t see it yourself. Keep in mind that you will now be relying more on your muscles, so it is going to feel like a lot more work and you may not be able to maintain the pose for as long as you did when the elbow was fully extended. Build strength gradually! 
4. For poses where the arms are parallel, like Downward- and Upward-Facing Dog pose and Handstand, try placing a looped strap just below your elbow joint towards your wrists, on the thick parts of your forearms. Make the loop just big enough that when you press your forearms outward against the loop your arm bones line up at that 180 degree angle. The strap will take on some of the muscular work you had to do in #3, and you will probably be able to stay longer in the poses. This could allow you to better sense the even alignment of the bones and find it on your own without the strap over time. Notice if the pain is gone when using the strap.
5. Also in poses where the arms are parallel, try turning your elbow creases to face each other (they are probably turning away from each other). Once your elbow creases are facing each other, try rolling your upper arm bones slightly out (external rotation) at the same time you roll your lower arm bones slightly in (internal rotation). See if these actions bring your arms into a straighter alignment.
6. Working with your shoulder joints and hand placement can also re-align your elbow joints, so it would be worth exploring what more external rotation or internal rotation of the humerus bones does to your elbow joints. Turning your hands slightly in or out (abduction or adduction at the wrist joint) could also bring the bones at the elbow into a more even alignment. But you have to make sure you don’t trade pain in one joint for that in another! 

There may be other suggestions that some of our readers have tried for elbow pain attributed to carrying angles or hyperextension of the elbow. What have you found beneficial? And have any of you lived with this variation of anatomy without developing any problems? Let us know you experiences and thoughts on angles at the elbow!

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Caregivers: The True Karma Yogis (Rerun)

by Ram

Last Leaves by Melina Meza

You could be a sister, brother, parent, relative, friend, or neighbor who provides care and assistance to a recipient without receiving any payment for such services. You are a true karma yogi. Karma Yoga, as we know, is a path of yoga that allows for an individual to carry out his/her duties selflessly as a service without looking to reap any benefits from such service. Such individuals have the opportunity to directly experience the inner joy and wellbeing that selfless service brings. These individuals are also known as caregivers since they provide a wide variety of selfless services to a recipient, including assisting with daily tasks like personal care, providing meals, helping the recipient with their daily physical activities, administering medications, meeting with healthcare providers, daily supervision and activity, coordinating treatment regimens, management of the recipient’s medical care and health insurance, etc.

The following subset of statistics mentioned below and drawn from the National Alliance for Caregiving speaks volumes of the caregivers’ true act of karma yoga:

• More than 65 million people (representing about 1/5 of the U.S. population) are caregivers providing care for a chronically ill, disabled or aged family member or friend during any given year and spending an average of 20 hours per week providing care for the recipient. Approximately 66% of caregivers are women. More than 37% have children or grandchildren under 18 years living with them.
• The value of the free services caregivers provide for older adults is estimated to be $375 billion a year.
• Twenty hours per week is the average number of hours family caregivers spend caring for their loved ones while 13% of family caregivers are providing 40 hours of care a week or more.
• Thirty-six percent of family caregivers care for a parent and 7 out of 10 caregivers are caring for loved ones over 50 years old.

On the disturbing side are the statistics drawn from the same National Alliance regarding the impact of care-giving on a caregiver’s health that is a serious cause for concern:

• Women caregivers are 2.5 times more likely than non-caregivers to live in poverty and five times more likely to receive Supplemental Security Income (SSI).
• Forty-seven percent of working caregivers indicate that an increase in care-giving expenses has caused them to use up all or most of their savings.
• Nearly 25% of caregivers caring for 5 years or more report their health is fair or poor. 20% of employed female caregivers over 50 years old report symptoms of depression compared to 8% of their non-caregiving peers. 40-70% of family caregivers have clinically significant symptoms of depression. 1 in 10 caregivers report that care-giving has caused their physical health to deteriorate.
• Sixty-three percent of caregivers report having poorer eating habits than non-caregivers.
• Family caregivers experiencing extreme stress have been shown to age prematurely. The level of stress can take as much as 10 years off a family caregiver's life.

Thus, while care-giving may be rewarding mentally, spiritually and emotionally, for a majority of caregivers it is undoubtedly stressful. Caregivers were found to have a 15% lower level of immune response and a 23% higher level of stress hormones compared to non-caregivers, suggesting that the stress encountered by primary caregivers greatly impacts their health and ability to recover from any illness. The stress associated with caring for persons with chronic degenerative diseases has been shown to drastically reduce caregivers' immune system thus increasing their chances of developing a chronic illness themselves.

There are several strategies that caregivers can use to reduce the effects of this added stress. One such strategy that is receiving a lot of attention is yoga and meditation. While yoga has been shown to help people with a multitude of health problems, several recent studies indicate that yoga could help the caregivers as well. Research studies involving caregivers (see here and here) have shown that yoga and meditation can help lower depression, reduce fear, worry and anxiety, improve cognitive functioning, decrease overall stress and slow down cellular aging associated with stress among caregivers. A majority of caregivers find the yoga and meditation strategy useful and report improvements in physical and emotional status.

As a researcher working to understand the mechanisms of Alzheimer’s disease, I am saddened to hear that a majority of the Alzheimer's caregivers experience high levels of stress. Caring for a person with Alzheimer’s disease is an extremely difficult task and can become overwhelming, especially when the disease is at its late stage where the patient has completely lost memory and other cognitive functions. Performing basic activities of daily living becomes difficult to manage for the Alzheimer's patient and the caregiver. Each day brings new challenges for the caregivers as they try to manage care with the patient’s new patterns of behavior. This puts the caregivers at a greater risk for developing depression and other chronic illness unless they seek remedial measures.

A recent study on caregivers of Alzheimer’s patients confirms the therapeutic benefits of yoga and meditation. For the study, researchers recruited a total of 46 caregivers of Alzheimer’s disease to participate in a stress-reduction program for a 2-month period and randomly placed them in one of two groups. 25 volunteer caregivers were assigned to receive a yoga and meditation program and the other group of 21 served as a control group and did not receive any specific treatment.

The program lasted two months, with the yoga and meditation sessions lasting 1 hour and 15 minutes (25 minutes yoga, 25 minutes pranayama and 25 minutes mindfulness meditation), three times per week. The participants had to attend one live training session per week, whereas the other two weekly sessions were performed at home with the aid of a DVD. The levels of stress, anxiety, depression, and morning salivary cortisol of the participants were measured before and after the intervention. At the end of the two-month program, the group that received the yoga, meditation and pranayama training had significantly lower levels of depressive symptoms and greater improvement in mental health and cognitive functioning, compared to the control group. The intervention group also exhibited a statistically significant reduction in the stress and anxiety scores, thus indicating that yoga and meditation type of intervention is very useful in reducing stress in caregivers directly involved with patient care tasks.

It is believed that the beneficial effects of yoga and mediation are due to a reduction in sympathetic activity with a concomitant increase in parasympathetic activity. These changes result in increases in GABA, serotonin and melatonin concentrations and a reduction in the levels of adrenalin and noradrenalin, all of which result in improvements of mood, reduction in body temperature, reduction in stress and anxiety, and greater improvement in mental health. The study also draws attention to the close relation between mental and physical health by documenting the mechanistic links at the cellular level. While there are many psychosocial interventions that enhance mental health for caregivers, the yoga and meditation intervention seems attractive as a simple therapeutic practice that could be distributed and applied for use in clinical practice not only for patients but for caregivers as well.

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Friday Q&A: Trauma Resurfacing, Crying in Class

We recently received this comment on Ram’s post about trauma (see Post-Traumatic Stress Disorder: Yoga to the Rescue).

Q: This is a very important topic. I have always been pretty surprised that my yoga teachers (many of whom are simply excellent) seem oblivious to the trauma students bring into their studios. I was mistreated as a
 child and when I began a yoga practice, I was unprepared for how yoga resurfaced issues that I had long thought were put to rest. But there I was -- breaking out into tears in bridge pose in the middle of class for no apparent reason. I could not find anything (or anyone, though I was not exactly willing to shout my needs from the mountaintop) that could help me understand what was happening. My teacher at the time was sympathetic, but stumped. I have since learned from friends who were sexually assaulted that yoga kicked issues up for them, too. It took me a while to understand somatic memory and to find ways to use yoga as a source of healing. I wish I could have found some help with that since I was so new to yoga and did not really have a sense of how to proceed. Is there any effort to make this part of most training programs? Are there guides or reading materials for us to learn from? Often, when I go into a new class, I count the students and do a rough estimate of the survivors of child abuse and sexual assault (knowing the stats and assuming a random sample of the US population is present). The number is never zero. 

A: I’m so sorry to hear about the difficulties that you, our commenter, have experienced, both in terms of the original abuse and then later having the experiences resurface in your yoga class. And I’m very glad your teacher was sympathetic and that—eventually—you found ways to use yoga as a source of healing. But one thing for you to realize is that it is quite common for yoga students to cry during class (especially during backbends) for any number of reasons. So while you suspected that you were crying due to traumas resurfacing during practice, a yoga teacher could not possibly know that from your tears alone (see Baxter’s comments below about crying during class). And unless you are studying with a yoga teacher who is also a trained therapist or has taken a special training program to work with students recovering from trauma, it is actually not appropriate for an ordinary yoga teacher to try to help you with these issues.

In my training, in fact, I was specifically instructed not to try to comfort or take care a crying student. This may sound harsh but the reasoning is that, first, you can’t know why the student is crying and, second, you do not have the training to be counseling a student about emotional issues because you are not a therapist. (This is equivalent to the yoga teacher’s situation with students who have physical problems. Because we are not doctors, we should not be diagnosing and treating medical conditions in our students, but should refer them to experts for help.) At most, we were told, we could offer a more comforting yoga pose to do.

For example, once while I was assisting Rodney Yee in a backbend workshop (backbends are known for triggering tears) a student began to cry. He told me to quietly offer the student a bolster and ask her whether she wanted to set up in Supported Child’s Pose, which she did. And that seemed to help calm her. So, in general, as a teacher who is not specially trained to help students who have survived trauma or abuse, I’d say that if you start crying in a yoga pose and you feel comfortable enough to continue on, you could just allow yourself to cry. But if you do not want to continue in the pose, you should come out and take a pose that feels more comfortable to you, possibly a pose where your front body is protected (the opposite of a backbend) whether that is Supported Child’s pose, a Supported Forward Bend, or even Crocodile Pose (Makrasana) where you lie on the floor on your belly. If these types of poses don’t offer comfort, perhaps try a simple seated pose or any other pose your intuition tells you will work for—whatever feels best. And if you were to come to me after class and share with me the reason for your crying, I would recommend that you see a therapist or an expert on trauma for advice.

Supported Child's Pose

A Supported Forward Bend

Crocodile Pose

Because none of our staff members here at Yoga for Healthy Aging have expertise in that area, we won’t be responding to your comment with specific advice about the issues you raised. However, fortunately for all of us, there are some therapists and experts who do use yoga and meditation to help patients who are survivors of sexual abuse and other forms of trauma. One that was recommended to me by a reliable source (thank you, Jarvis Chen!) is Bessel van der Kolk, MD, founder of the Trauma Center at the Justice Resource Institute in Brookline, MA. Here is an interview with him www.traumacenter.org. 

This quote from that interview is particularly relevant for us: 

“Yoga teachers need to be aware that material will come up during class and they need to be prepared at all times to help people to calm down their bodies, by working with the breath and quieting poses. Teachers should create a safe space in the class, keep the focus on the breath and the flow of the asanas. It is best to refrain from excessive talking, explaining or preaching during the class—the job of the Yoga teacher is to help people to feel safe in every aspect of their self-experience.”

Some of van der Kolk’s associates have actually written a book on the topic Overcoming Trauma Through Yoga by David Emerson and Elizabeth Hopper, PhD. And David Emerson, director of yoga services at the Trauma Center, has a forthcoming book called Trauma-Sensitive Yoga in Therapy (see www.traumasensitiveyoga.com).

I noticed that  Emerson will be teaching a workshop on this topic in October 2014 at Kripalu (see http://kripalu.org/program/view/TSYT-142) and that the Trauma Center provides Trauma-Sensitive Yoga Teacher Training (contact demerson@traumacenter.org).

So that’s a few resources to get you—and anyone else who is concerned about this issue—started.

Now here’s something more from Baxter about how a yoga teacher should handle the general situation of a student crying in class. 

—Nina 

A: I clearly remember, during my teacher training days, the first time one of my fellow students began to cry in class. I mean, really cry loudly. I was simultaneously confused (was she in pain?) and worried about her (should I console her?). Her crying began during a restorative pose—something like Child’s pose—and it ultimately lasted a minute or two. The teacher did not directly address the crying, which was also quite curious. After class, the student shared with some of us that she was actively processing some long-standing grief and that we might expect more of such crying in the future. She had discussed it with the teacher previously, and so they had an understanding of what was happening. These crying episodes went on intermittently for months afterwards.

I also recall the first time I experienced tears during practice, also while doing Child’s pose (Balasana) in my home practice. I don’t recall the thought or feeling that preceded the tears rolling, but they sure came out. There was some sadness associated with the act of crying, but also a kind of liberation of emotion that felt quite good.

In my classes, I will occasionally notice someone crying, usually during the cool down period of class or in Savasana. But I have also seen this happen at the start of class during sitting meditation, too. If the tears are quiet, I usually observe as unobtrusively as I can, what is happening, and rarely feel the need to directly check in with the student. These are almost always regular students of mine, so I have experience working with them already and feel pretty confident that they will check in with me later if necessary. But, like Nina, I tend to focus on maintaining the practice space for all of the students and not intruding on the crying episode.

On rare occasion, if there is louder crying, as quietly as I can, I will approach the student and ask if they need anything from me. I try not to pacify or console, or imply that I know what they are going through, but continue to cultivate a safe environment for them to experience their full practice. In fact, there is no way for me to know exactly what the student is experiencing in that moment, and in some ways, it is not really my business.

As yoga teachers, we are not trained to address the emotional health of our students, as psychologists are. If a student were to approach me with questions about how to deal with difficult emotions, I would refer them to a trained therapist who can appropriately work with them. At the same time, I also can acknowledge to myself that their ongoing yoga practice may help support any work they may choose to do around emotional well-being. But ultimately, it is important to know and acknowledge the limits of my expertise as a yoga instructor and to convey that in a kind and clear way.

—Baxter

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Daydreaming: A Vacation for Your Brain

by Nina

by Melina Meza

I get some of my best ideas when I’m sweeping the kitchen floor, weeding the garden, waking up in the morning, and practicing yoga. Sometimes I won’t even realize that I’ve been mulling over a problem in the back of my mind when, like a gas bubble in the La Brea Tar Pits, an idea suddenly burbles up into my conscious mind.

Which reminds me—I recently saw Brad’s report cards from grammar school, and this super accomplished scientist, who has a Ph.D. in biochemistry from MIT, didn’t do very well during his early years. In fact he spent so much time daydreaming during one class that his teachers wrote, “Brad lives in another world.” At least in his case, we know that not paying attention didn’t seem to hurt his intellectual development one bit. 

Which reminds me: I heard Daniel Levintin, a neuroscientist and author of The Organized Mind, being interviewed on KQED radio (listen here) the other night and he said that daydreaming was a “reset button” for the mind that is overwhelmed with information, and that this state of mind was the mental state in which we’re most creative. So maybe the reason I get my best ideas when I’m doing some simple tasks (I’ll get to yoga in a minute), is that I’m getting a chance to daydream. In his NY Times article Hit the Reset Button in Your Brain, Levintin describes daydreaming:

“This brain state, marked by the flow of connections among disparate ideas and thoughts, is responsible for our moments of greatest creativity and insight, when we’re able to solve problems that previously seemed unsolvable. You might be going for a walk or grocery shopping or doing something that doesn’t require sustained attention and suddenly — boom — the answer to a problem that had been vexing you suddenly appears. This is the mind-wandering mode, making connections among things that we didn’t previously see as connected.”

He says that our brains have two dominant modes of attention: the task-positive network and the task-negative network. The task-positive network is active when you’re “actively engaged in a task, focused on it, and undistracted.” The task-negative network is active when your mind is “wandering” or daydreaming. Together, he says, “these two networks operate like a seesaw in the brain—when one is active, the other is not.” To fully absorb the information we’ve been exposed to, we need to spend some time in both modes. (This sounds very similar to the two modes of the autonomic nervous system: Fight or Flight and Rest and Digest, don’t you think?) 

We don’t get much time for daydreaming these days, what with all the multitasking we’re doing throughout the day and all the information we’re constantly being asked to absorb. In his interview, Levintin pointed out that multitasking isn’t really multitasking; it’s just switching very frequently and quickly between one task and another. That’s kind of overwhelming in and of itself. He also wrote, “According to a 2011 study, on a typical day, we take in the equivalent of about 174 newspapers’ worth of information, five times as much as we did in 1986.” So it makes sense that our brains, much like our nervous systems, would need a rest once in while.

Which reminds me: when I first starting practicing yoga in Boston and then later in Cambridge, England, my teachers always taught us a guided Savasana at the end of class. It was only when I moved to the West Coast of the US that I had teachers who told me to lie down in Savasana and then just quit talking and left me to it. That always puzzled me. Weren’t we supposed to have a focus for our minds as we lay there to guide us into a state of relaxation? Why were the teachers just leaving us to “rest” on our own? After all, just this week, I republished a post about Savasana in which I said that one of the things that made Savasana a pose was having a focus for your mind, and not just lying there spacing out. Having the focus for your mind is certainly what’s needed to invoke the Relaxation Response to put you in Rest and Digest mode. But what if your nervous system is in fine shape but your poor brain needs a bit of a vacation? Maybe lying in Savanasa and daydreaming for about 10 minutes could be just what you need? Were my West Coast yoga teachers on to something?

As for my own daydreaming while I do yoga, it’s probably happening while I’m doing restorative poses and long supported inverted poses, because sometimes I just relax physically without a specific mental focus. Oh, okay, sometimes my mind wanders a bit when I’m doing more active poses as well, especially ones I’ve been practicing at home for many years, even though I do try to keep my mind focused on my physical sensations. But until I heard Levintin talking about daydreaming, I had no idea that my wandering mind during my yoga practice was actually providing me with some important benefits! 

How about you? Does your brain ever feel overwhelmed by your work? Or what you’re learning in school? Or all the information that you’re bombarded with on a daily basis? If so, consider adding some daydreaming to your yoga practice. You could do it in any form of Savasana (see Savasana (Corpse Pose) Variations). Or, you could also do it while you’re practicing restorative yoga poses (see Restorative Yoga: An Introduction and Mini Restorative Practice), as these poses relax you physically while your mind is free to wander.

Which reminds me: Ram cautions that not all daydreaming is productive or helpful, and he recommends “controlled daydreaming.” That sounds like an oxymoron to me, but I assume he means that if you notice your mind drifting into violent or aggressive fantasies, or negative dramas of any sort, you could gently move your mind away from those thoughts and onto something less stressful.

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Fluid Intelligence and Yoga

by Ram

From "The Path to Holistic Health" by B.K.S. Iyengar

The Hatha Yoga Pradipika was written centuries ago and in the course of time produced several yoga masters and teachers, yet it took Tirumalai Krishnamacharya and B.K.S. Iyengar to bring innovation to the practice of yoga, including developing new poses and adding the use of various props. 

Similarly, it took the ingenuity of Robert Jarvik to design and implant the first artificial heart. And also, had those Harvard college kids, led by Mark Zuckerberg, not been interested in digitizing their assignment notes, we may never have seen Facebook. Examples of such innovative and ingenious incidents abound and reflect a specific type of intelligence. 

What is intelligence? Is it getting a very high score on the ACT or SAT? Is it having the ability to solve complex math equations? Or does being able to create a complex software program make you intelligent? In reality, intelligence is a little bit of all of these and more. As intelligence began to be better understood by cognitive psychologists, it became clear that many distinct sub-types of intelligence exist. Psychologists are of the opinion that intelligence comes in many forms and is comprised of a variety of cognitive skills and abilities. In broad terms, intelligence comprises two sub-components: 

Crystallized intelligence. This is the ability to make use of acquired information or knowledge. Crystallized intelligence involves knowledge that comes from prior learning and past experiences. People who possess high levels of crystallized intelligence are people who remember facts and retain a wealth of knowledge on specific topic(s). Examples of crystallized intelligence include vocabulary exams and geography or spelling bees. This type of intelligence is based upon facts and rooted in experiences. It is generally long-lasting and improves with rote learning.

Fluid intelligence. This is the ability to be innovative or ingenious  It allows you to quickly adapt to and solve problems, even in an unfamiliar situation. Fluid intelligence is the ability to reason, think and apply. In order for someone to have fluid intelligence, they must be able to reason and think conceptually, as well as achieve problem solving skills. Although abstract thinking and problem solving skills are achieved during a person's education, learning, and experiences, fluid intelligence is an innate ability that is independent of those things. Having an open mind and high level of awareness are key aspects of fluid intelligence abilities. On the yoga mat, fluid intelligence is all about ingenious methods of modifying a pose to reap the same benefits and avoiding any pains, distress or risks. 

Fluid intelligence and crystallized intelligence are both components of general intelligence and yet are distinct in their respective aspects. Two people with the same IQ may exhibit similar crystallized intelligence but dissimilar fluid intelligence. While both types of intelligence increase throughout childhood and adolescence, the general belief is that crystallized intelligence continues to grow throughout adulthood and then begins to decline after age 65. Nevertheless, as we age and accumulate new knowledge and understanding, crystallized intelligence becomes stronger. In contrast, fluid intelligence and the ability to reason and think conceptually begin to decline around age 40.

Now you may ask what do these concepts have to do with yoga? Well, results from a recent study investigating the relation between age and fluid intelligence in middle-aged yoga and meditation practitioners, and matched controls indicated that fluid intelligence declined much slower in yoga practitioners and meditators combined, than in controls. Furthermore, mindfulness meditation was positively correlated with fluid intelligence. The study Fluid intelligence and brain functional organization in aging yoga and meditation practitioners involved 47 physically and mentally healthy participants (16 yoga practitioners, 16 meditation practitioners, and 15 controls), who were recruited after matching for age, gender, education, race, and handedness. Age-related decline in fluid intelligence and normal functional brain network properties in these participants were investigated. Fluid intelligence was tested using a variety of cognitive skills. Functional networks were also measured by the resilience displayed by neurons to actual lesions in the brain’s cortical areas or by simulating such attacks. The apparent rate of age-related decline in fluid intelligence was found to be lower in yoga practitioners and meditators combined as compared to controls. Furthermore, resting state functional neurons of yoga practitioners and meditators combined were more resilient to damage than those of controls. Interestingly, mindfulness meditation alone was effective in blocking the age-associated decline in fluid intelligence as well as increasing the neural network resilience.

The results of this study may also explain previous studies that indicated that older meditators have better attention performance than non-meditators. Both meditation and yoga requires the quality of mindfulness that in turn triggers functional neural network integration and improve fluid intelligence. The results are extremely relevant and important as they have a potential practical implication with a rapidly aging world population and increasing life expectancies. So if you wish to have a non-medicated, non-prescription-based method to strengthen your neural network and improve your fluid intelligence, unroll your mat and start your practice of yoga and meditation today!

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Elbow Pain and Yoga

by Baxter

As I was preparing for an upcoming workshop on Yoga for Elbows and Wrists, I decided to look back at our blog posts and see what we had shared with you over the last three years about elbows. To my surprise, there was not one dedicated post on the elbows (my sincere apologies to all the elbows out there!). It’s a bit surprising on both a professional and person level. Professionally, it is not uncommon for my students to complain about one of their elbows being sore or painful. And, personally, I have had intermittent bouts of elbow soreness over the years, most often associated with sudden increases in my violin playing. If I am at a music jam and playing for several hours (without enough regular practice time), I will often have right elbow soreness the next day that can persist for up to a week. Why the right one? It is my bowing arm and therefore the side that is repetitively flexing and extending at the elbow joint over and over as I play. On those occasions, I find myself modifying my yoga practice to address the soreness and limitations, both to keep the yoga from worsening my symptoms and to choose poses I think could speed my recovery.

The elbow joint is often referred to as a “hinge joint,” much like a door hinge that allows two movements, swinging open and closed, or, in the case of the elbow, flexing and extending. However, this is a bit simplistic, as just beyond the place where the upper arm bone, the humerus, and the lower arm bones, the ulna and the radius, meet to form the elbow joint is another important joint that adds a few more movements into the mix. This is the connection between the two forearm bones themselves. The top part of the radius and ulna abut one another in such a way that the forearm bones can roll over one another, which ultimately allow the palm of the hand to spin up and down, as in the action of giving and receiving some “skin.” To the untrained eye, this seems like “rotation” of the wrist joint, but in actuality, it starts at the elbow joint and has the fancy names of supination and pronation. And, like the knee joint, the elbow joint also has ligaments on the inner and outer aspect of the joint to keep the upper and lower arm bones from bowing in and out. Cartilage coats the bony ends of the elbow joint bones to keep them flowing smoothly over one another as we move the arm around.

Like many of the other joints of the body, the elbow is subject to wear-and-tear arthritis, problems that arise from injury, repetitive stress on the ligaments and tendons near the joint, and unusual skeletal variations. The most common source of elbow soreness and pain in my students by far is of the repetitive stress variety, so I’d like to focus on those for the rest of this blog. And, of the many possible causes of such repetitive stress, working at the computer is way at the top of the list. As a family doc, when my patients came in with elbow soreness and pain at the outer edge of the elbow, I’d diagnose them with “tennis elbow” and if the pain was on the inner elbow, it would be tagged as “golfer’s elbow,” even if they did not play tennis or golf! The underlying problem was really the repetitive action, whatever its source, leading to a chronic inflammation of the tendons in those areas that is called “tendonitis.” And this is probably what I was kicking up in my own elbows when playing my fiddle. The areas involved are often tender to touch and also painful when you flex or extend your elbow, or even when you flex and extend your wrist (which could be confusing, eh?).

Addressing Elbow Pain with Yoga

An initial approach to addressing this kind of elbow pain would be to avoid the repetitive movement that precipitates it, even if certain yoga poses might normally require such a movement. This means you have to be willing to improvise and change the appearance of poses as needed to keep the joint relatively quiet. 

Non-weight bearing poses for the arms are a good idea initially, so as to reduce the additional pressure and demands on the elbow joint that poses such as Downward-Facing Dog pose (Adho Mukha Svanasana) and Upward-Facing Down Dog (Urdva Mukha Svanasana) bring into the elbow. Choosing to focus on poses where your elbows are fully straight and extended, such as Warrior 1 and 2 (Virbradrasana 1 and 2), Triangle pose (Trikonasana) and Extended Side Angle pose (Uttitha Parsvokanasa), is a great starting place, and also has the added benefit of moving your shoulder joints through a pretty full range of motion, which could have positive effects on your elbows. 

Eventually exploring poses that bring your elbow joints into play with weight bearing on the joints should be done mindfully. You want to try and maintain the full movement of the elbow joint without worsening the pain. Start with Eagle pose arms (Garudasana), and if that feels OK, advance to Cow-Faced pose (Gomukasana) arms, which adds more deep bend to the joint. See Standing Shoulder Stretches. 

Eagle Pose Arms

Cow-Face Pose Arms

I also find that Wrist Flossing  can be beneficial for the elbows as well as the wrists, so take that for a test spin, too!

When your joints are beginning to improve, gradually add in more challenge for your elbow joints by taking a bit of weight onto them, such as in Half Downward-Facing Dog pose at the wall. 

If Half Downward-Facing Dog pose feels good, advance to full Downward-Facing Dog. When you start working on all fours, such as in Cat/Cow pose or Hunting Dog pose, play with the even press of your hands into the floor, evenly between the heels and balls of your hands and evenly between the pinky and thumb sides of your hands. This can often give you important feedback on how the placement of your hands relates to the even work of the elbow joints.

Use caution with the poses that super load the below joint, such as Pushup pose (Chaturanga Dandasana), and arm balances, such as Heron and Crow poses or Handstand. You might want to wait until your elbows are pain free for a while before learning these or adding them back into your practice. 

Finally, as I mentioned before, there are many other elbow issues that can cause pain and soreness. Some will benefit from the above recommendations as well, whereas others may need different approaches. I hope to share more about the elbows in the coming weeks, and if you have specific curiosities about elbows, please send me a comment!

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Savasana (Corpse Pose), Rerun

by Nina

Of all the hundreds (or thousands?) of yoga poses, there is a single pose that has been called the best antidote to the stresses of western civilization. And anyone can do the pose, regardless of age, physical condition, or yoga experience, because all it requires is the ability to lie down and be still. This is Savasana (Corpse pose). And while Savasana is often taught as the last pose in yoga class, you can do it on its own, at any time you need. All that’s required is a firm surface to lie on and 10 to 20 minutes, and you’ve got a surprisingly effective anti-stress medicine that has absolutely no side effects and if you become addicted, well, that’s a good thing.

Now you may be wondering, how can just lying down on your bedroom floor trigger the relaxation response? And how is this position that you take all the time in bed, on the grass under a blue sky, or on the warm sand of a beach qualify as a yoga pose?

Savasana triggers the relaxation response (see here) because you bring your attention to your body and your mind while you lie on the floor instead of just daydreaming or spacing out. And it qualifies as a yoga pose, because to practice Savasana properly, you:

• align your body
• remain still
• use a mental focus
• maintain your awareness as you come out of the pose

Here are details about these four aspects of Savasana:

Alignment. The first thing to do when you lie down in Savasana is to arrange your body—and that means every single part of you, including your arms, your legs, your torso and even your head—in a neutral position. This neutral position ensures you’re as comfortable as possible so you can relax completely without physical distractions (like having your legs go to sleep or getting a crick in your neck).

Lie down on your back on a firm surface, with your spine in its healthy, natural curves. If your head isn’t comfortable resting flat on the floor, place a folded blanket or firm pillow underneath it (but keep your shoulders touching the floor). Make sure you are dressed warmly; if necessary cover yourself with a blanket.

Place your legs eight to ten inches apart, turn your arms out so your palms face up and your hands are six to eight inches from the body, and position your head perfectly between your two shoulders, with your eyes about equal distance from the ceiling. None of us are completely symmetrical, but you can adjust your body so it’s as symmetrical as possible and the weight is even on both sides of your body. Now your alignment is close to what medical books call “anatomical neutral,” the position your body naturally assumes when no muscles are being activated. And when you are in this neutral position, you can begin to relax your body completely.

When your body is entirely supported by the floor, you no longer need to contract your muscles to hold yourself upright (or partly upright). You can simply let your body to completely drop with the force of gravity, so all your muscles can soften and melt, releasing their hold. 

For those of you who find you can’t lie comfortably in the classic position, don’t worry. You can use props to make yourself more comfortable (for example, if you are having back problems, you can rest your calves on the seat of a chair) and you can even lie in a different position (for example, if you are pregnant, you can lie on your side or if you’re anxious you can lie on your belly). I’ll describe these alternate versions in a future post (see Savasana (Corpse Pose) Variations).

Stillness. After positioning your body so you're aligned as symmetrically as possible, make a commitment to remain still. When your body becomes motionless, external stimulation is reduced to a minimum, allowing your nervous system to cool down and your mind to quiet. Normally when you rest on your bed or couch, you shift around unconsciously, fidgeting or wiggling around to find a more comfortable position. You probably even change from one position to another when you’re sleeping (if you’ve ever shared a bed with someone else, you know what we mean). In Savasana, keeping your body still allows you to relax completely because there is no need to contract of any muscles at all except those needed to breathe. In fact, we’re so used to contracting our muscles, even when resting, it may take some time for you to let go completely.

After you have stilled your body, you’ll continue to receive messages from your ears, nose, tongue, skin, and eyes. Even in a quiet room, there’s still a lot to hear, smell, taste, and feel, and you’ll continue to perceive the light (or lack of it) in the room even with your eyes closed. All these sensory impressions send stimulating messages to your brain. So after quieting your body, consciously relax your sense organs, letting your tongue rest on the floor of your mouth, allowing your eyes to soften back toward your skull and gazing with closed eyes under your cheekbones, and withdraw your awareness from the rest of your senses. With the withdrawal of your senses, your physical relaxation will increase.

Focus for the Mind. If your thoughts are busying while you're in Savasana—whether you're trying to decide if you should watch Law and Order to CSI: Miami tonight or considering something more momentous—you won't be able to relax completely or trigger the relaxation response. So after you've aligned and quieted your body, turn your awareness inward. Typically the focus for your mind in Savasana is your breath, the gradual relaxation of specific parts of your body (sometimes called a body scan), or a peaceful image (for example, you might imagine your mind is the surface of a lake whose ripples are slowly subsiding). Rather than simply letting your thoughts wander as they would if you were lying on the grass in your backyard, intentionally keep your mind focused on your object of choice. When you notice your attention wandering, gently return it to that object. For example, if your breath is your focus for your practice, continue to watch your breath for the entire practice, and each time you notice your mind wandering, gently bring it back to your breath again.

Maintaining a mental focus is how you stay alert in the pose, allowing you to reap the benefits of conscious relaxation, rather than simply falling asleep. It helps you stay aware in the pose by keeping your mind anchored in your body, rather than drifting off into fantasy. And it helps you stay present in the pose by keeping your thoughts in the moment, rather than dwelling in the past or racing into the future. 

When you abide in the present moment you naturally become more aware of your own thoughts. As an impartial witness to your own experience, observe each thought as it passes through your mind without becoming involved in any of the storylines. Alert and aware, serene and detached, watch your thoughts—what’s on TV, should I cook ratatouille or paella, did I remember to feed the goldfish—as they come and go, come and go. There will be time for all that later. Then, like a pond that has been stirred up with a stick, allow your mind to settle down gradually until the waters are serene and clear.

Coming Out. Stay in the pose for at least 10 minutes (it takes 7 or 8 minutes to trigger the relaxation response). When you are ready to come out, take a couple of deep soft breaths, then slowly bend your knees and place the soles of your feet on the ground. Next, slowly turn over onto your right side and rest there for a couple of breaths. Then slowly use your hands to push yourself up to a seated position, allowing your head to release downward until you are completely upright. Finally, when you are seated upright, slowly lift your head. (And, yes, do it all slowly.)

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