Friday Q&A: Ostepenia of the Spine and Headstand

Q: I am 63 years old and have osteopenia of the spine. What are your thoughts of headstand for those of us with osteopenia of the spine? I have taken yoga for several years. My teachers are wonderful and all are Iyengar certified as senior teachers. I have not yet shared with them my recent diagnosis. I appreciate your thoughts on this question.

A: As a general rule, I’d say don’t do it. As we have written about before, the spine is the number one sight for fractures secondary to osteoporosis and osteopenia means your spinal bones are already thinning. And although the thoracic spine is the most common area for wedge fractures to show up in OP, lumbar and cervical fractures happen, too. The human cervical spine—as you probably already realize—is not structured to bear weight on the head, no matter how much you might love Headstands and Shoulderstands (also not a good idea if you have osteopenia of the spine) or what your teachers might like to believe. The cervical region of the spine has the shortest vertebrae and the thinnest discs of anywhere in the spine, because it is evolved only to have to bear the weight of your head, not your body resting down on your head.

I also recommend sharing your diagnosis with your teacher. Now. If your teachers are not particularly concerned about the possible negative effects of Headstand on your spine, you might seek out a new teacher. This does not mean that you cannot do certain inverted postures. Legs Up the Wall is generally safe as an alternative, and if you can get up and down by pivoting mostly at the hip joints to use a “Headstander” (a special prop that allows a variation of Headstand where the head dangles toward the floor but does not rest on the floor) to go upside down, you could give that a try. But do remember that you need be careful about forward folding and it’s potential negative impact on the thoracic and lumbar spine with OP. 

As senior Iyengar teacher Ramadan Patel once said during a workshop on Shoulderstand when someone was bemoaning the fact they might not be able to do the pose again, “Nobody ever attained enlightenment doing Shoulderstand! It is not big deal. Let it go.” It was helpful to actually hear that back when I was able to do Shoulderstand and Headstand without a second thought. These days, I myself skip Headstand to keep my delicate cervical spine happier.

—Baxter

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Keeping Your Hips Happy and Healthy

by Shari

After reading Women's Flexibility is a Liability in Yoga by William Broad and responding with Is Women's Flexibility a Liability in Yoga? Shari's Response to William Broad and Differences Between Male and Female Pelvic Structures I thought some general advice about how to keep your hips healthy and happy would be helpful for both women and men alike.

I suggest you start by finding your hips and assessing your mobility. I often ask my students to begin by locating their hip joints. They are not on the outside of your pelvis but the spot where when you lift your legs up when you are climbing stairs, you feel the muscle moving under your fingers. This is the head of your femur (thigh bone).

Hip Joint Located Behind Inguinal Ligament

Next, test your own amount of leg external and internal rotation. Lie on the floor in Savasana (Corpse pose), with your feet slightly apart. Then, moving from your hips while keeping your legs straight, turn your legs out so your feet turn away from each other. This is external rotation.  As you do this motion, make sure you are doing the movement from your hips not from your lower leg/knee. Observe how far you can turn your legs out, and whether both sides are the same. Next, moving from your hips while keeping your legs straight, turn your legs in so your feet are turning toward each other. This is internal rotation. Again, as you do this exercise, make sure the movement originates from your hips not from your lower leg/knee. Observe how far you can turn your legs in, and whether both sides are the same.

Once you can sense how much actual hip rotation you actually have (and whether you are the same on both sides), you can begin to assess your own foot placements for standing poses. Start by exploring your particular hip alignment in wide-legged, side-facing standing poses, such as Warrior 2 or Triangle pose. See whether it is easier to feel your hip position if you step into your standing pose from Mountain pose (Tadasana) by stepping back with your left leg and keeping your right leg stable, rather than stepping the right leg forward and the left leg back (the traditional Iyengar yoga cue). Then, as you take your stance in the pose, first try keeping your front heel in line with your back middle arch and notice how your back leg internal rotation feels. If you find that in order to do this alignment you have to reposition your lower leg moving from your knee to correct this alignment, try a wider front heel to back heel stance and see if this feels like less tension in your knees and back hip.

I remind my students to not square the pelvis (see Squarer's Beware) but to allow the front pelvis to be in the same plane as the front knee and the back knee to be in the same plane as the back pelvis. In these types of poses, your front leg will be in external rotation relative to your back leg, which is in internal rotation. While working with your hips, don’t forget your knee positioning—to protect your knees, please align your knee with the middle of your ankle joint and generally in line with your second toe. All these joints should be lined up. Proper alignment that is optimum for you may take some experimentation, so if in you’re doubt, use a mirror to help you check exactly which direction your knees and hips are facing.

Continue this exploration in all your wide-legged standing poses, such as Extended Side Angle pose and Warrior 1. Try not to force rotation by causing your pelvis to move more than is comfortable over your stable legs. And don’t be afraid to line up your front heel with your back heel if that gives you more a sense of freedom in your hip joints! Turning one joint surface too much in relationship to another (the femur turning in the cup of the acetabula) will put stress and strain on the hip joint capsule and the ligaments that keep the hip within the socket of the acetabula.

 Some rules of thumb for standing poses:

1. Any pain in the groin or knees need to be respected. Please back out of the position.
2. Pay attention to pain in any body part, especially when doing single leg positions (balancing poses) and try to modify to avoid reproducing the pain. It is really important to learn how to use your muscles (which need to contract on both sides of the joints ) and bones to support your weight rather than depending on the ligamentous structures inside the joints to provide stability. Pain can come from compressing the pain sensitive structures inside joints (ligaments, tendons and capsules) or from moving beyond the joints limits of mobility (see Range of Motion: Yoga's Got it Covered).
3. Try to avoid overly stretching the front of your thighs close to your hip crease in your back leg in poses like Warrior 1, Triangle pose, etc. And for lunges, avoid going into your end range with your back leg and “hanging out” there. 

Now on to seated poses! Whether you are sitting in a straight leg position like Staff pose (Dandasana) or in a bent leg position like Seated Crossed Legs (Sukasana), Cobbler’s pose (Baddha Konasana) or Lotus/Half Lotus, it is really important to sit with your knees below your hips. If you have limitations in your hip external rotation, you definitely need to sit on a prop (folded blankets or bolster). And if you can’t lift your pelvis up over the front of your hip joints (this will look like a slumped position), again pleased sit on a prop to allow some space so you can lengthen up and bring your spine back into its natural neutral curves.

Sitting on a Prop

Remember the spine has curves for a reason—they serve as a means to distribute weight through the spine along the vertebral bodies. If you sit in a reversed or slumped position, you change the weight-bearing forces onto the facet joints and the soft tissue structures of the back (muscles and ligaments and discs). When you sit with your bones providing the support, you will tire less and breath better!

Finally, in bent leg positions, you may need to support your outer legs to prevent the sensation of hip pain. You can place folded blankets or blocks under your knees to keep your legs from hanging in space.

Sitting in Hero pose (Virasana) is a different hip position—internal rotation. Depending on the degree of internal rotation that you have, it may or may not be possible for you to sit with your knees together. In this case, try sitting on a higher support so your pelvis can be over the heads of your femurs (thigh bones) not behind them, and allow your knees to separate but not roll out. Align your thighs with your hip joints. Try palpating your hips in Hero pose and experiment to see if changing how close together your knees are helps to make the pose more comfortable. Reclined Hero pose (Supta Virasana) is also a different hip position because internal rotation is now superimposed with a backbend and if your hips can’t move into internal rotation, then your lumbar spine and sacrum will try to compensate for the lack of movement which can also cause pain and discomfort. This is especially the case for women because our sacroiliac joints may not lock down in weight bearing in this backbend so there can be an uneven distribution of weight in the back bend position. Learning how to prop for both Hero pose and Reclined Hero pose is really important, and you may need a teacher to help you with these alignment issues.

The bony structure and joint orientation of your hips in the acetabulum of the pelvis are variables that cannot be changed. Bones can only move in certain ways due to form and function. We may try to compensate for our immobility by excessively overusing our soft tissue ligaments and joint capsules to try to gain flexibility that we lack. Or, we may inadvertently try to make our hips move beyond their anatomical possibilities by the sports that we do or the yoga that we practice because we think the goal is more flexibility. This certainly can cause excessive wear and tear of the hip joint leading to cartilage deterioration and arthritis. So the issue really is our perception of what a pose is supposed to look like. How a pose feels is very individualistic, and it is not good to struggle with a pose that always causes pain. Sometimes for some of us certain poses aren’t attainable in the classical sense, but I believe that if we can recreate the feel of the pose we can get the benefits. For example, Dancer’s pose (Natarajasana) is a challenging balancing backbend in which you raise one bent leg behind you and reach overhead with one bent arm to hold the toes of your raised foot. However, modifying this pose by reaching your straight arm back to hold your foot instead of up overhead will allow you to recreate the beauty and concentration of the classical pose.

For healthy aging, I believe that struggle may not always be the best way to go; instead, learning to be less aggressive and more adaptive is a best way to approach asana. Mental focus and alertness with concentration on using the breath to create asana is more satisfying than trying to force oneself into contortions that may not be possible for one’s innate physical structure. This is how we balance and protect ourselves from injury during the physical asana practice.

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Falling for Yoga Myths: Yawning and Sighing and the Nervous System

by Nina

Heart and Lungs

I hope you realize by now that there are a lot of myths out there in the yoga world, such as that yoga nidra is an ancient practice or that Sun Salutations have been practiced for thousands of years. So here at Yoga for Healthy Aging, we try to do a bit of fact checking before we go ahead and write about a subject, whether it is medical, scientific, or historical. And when I edit a post, I try to confirm anything that looks a bit, well, suspect. But once in a while, I’m less than meticulous, and that can result in an error or two. After I read what Baxter wrote about the relationship between the breath and the nervous system in his post How Your Breath Affects Your Nervous System, I asked him to take a look at a related post I wrote some time ago called Your Key to Your Nervous System: Your Breath because I was concerned that perhaps my original post had errors in it. Although at the time I had been writing about what I was convinced were facts, Baxter confirmed that some of the information in my post about yawning and the affect of the breath on the nervous system, which I had learned from a yoga teacher, was actually incorrect. Baxter identified this misinformation as a yoga myth—ideas that seems to get perpetuated, despite the fact there is no proof of their validity.

So this post today is an update to my original post, with Baxter’s comments/corrections on my original statements. Well, it’s a journey for us, too, right?

YOGA MYTH: Nina wrote, “Have you ever wondered why you tend to yawn when you’re sleepy? Well, a yawn is a great big inhalation. And because your heart rate tends to speed up on your inhalation, that yawn in the middle of that boring lecture or business meeting is little message to your nervous system: wake up! On the other hand, when you are upset about something, you tend to sigh. That sigh—try one!—is an extra long exhalation. Because your heart rate tends to slow on your exhalation, that sigh while you are feeling emotional turmoil or are just stuck in traffic is a little message to your nervous system: take it easy, buddy, slow down a bit.”

BAXTER’S CORRECTION: Here’s what I found…and it does not seem to confirm your suggestions that it is the heart rate effects that are driving the yawn or sigh. There are four theories about why we yawn, none proven or much studied:

• Physiologic theory: Our bodies induce yawning to draw in more oxygen or remove a buildup of carbon dioxide. At least one studied seems to have disproved this theory.
• Evolutionary theory: Some think that yawning began with our ancestors, who used yawning to show their teeth and intimidate others. An offshoot of this theory is the idea that yawning developed from early man as a signal for us to change activities.
• Boredom theory: Although we do tend to yawn when bored or tired, this theory doesn't explain why Olympic athletes yawn right before they compete in their event or why dogs tend to yawn just before they attack. It's doubtful either is bored.
• Brain-Cooling theory: a more recent proposal is that since people yawn more in situations where their brains are likely to be warmer—tested by having some subjects breathe through their noses or press hot or cold packs to their foreheads—it's a way to cool down their brains. Cool brains think more clearly.

Why do we sigh? As it turns out, sighs do seem to work like the brain’s reboot button for regular breathing. According to a 2010 study Take a deep breath: The relief effect of spontaneous and instructed sighs, during mental stress, the volunteers’ breathing became more and more irregular as participants increasingly relied on deliberate breath control, at which point, a sigh occurred, causing automatic regular respiration to kick in again. Furthermore, muscle tension steadily built up before a spontaneous sigh and decreased afterward, supporting the idea that sighing helps release tension.

YOGA MYTH: Nina wrote, “It turns out that by intentionally taking in more oxygen (either by speeding up your breath or by lengthening your inhalation) you can stimulate your nervous system and that by taking in less oxygen (by slowing your breath or lengthening your exhalation), you can calm yourself down. It’s that simple.

BAXTER’S CORRECTION: It is actually likely not that simple, as the effect I described in my post How Your Breath Affects Your Nervous System really more clearly explains what happens: the inhale speeds up the heart rate (not because of O2 levels) and the exhale slows it down (not due to O2 levels, but due to the nerve input from breath cycle to heart). As the heart rate slows more over the course of five minutes of 1:2 ratio breathing, for instance, the slower heart rate is monitored by the brain and leads to even further turning on of the parasympathetic Rest and Digest response. And, in fact, carbon dioxide levels in the blood stream have a much greater influence on the rate of breathing than O2 levels, and are monitored much more closely by the brain moment by moment and lead to adjustments in the ANS tone of whether sympathetic or parasympathetic nerves are stimulated. The importance of “getting more oxygen” in is a myth that has been propagated for a long time by yoga teachers in this country. For further information, see Leslie Kaminoff’s article What Yoga Therapists Should Know About the Anatomy of Breathing.

CONCLUSION: Well, we're all learning this stuff together. Even Baxter went ahead and did a bunch of new research. And, sigh, at least I was right about sighing.

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How Your Breath Affects Your Nervous System

by Baxter

When I read the posts of my fellow YFHA bloggers, I often learn new perspectives that might differ from my own as well as new information that I was previously unaware of. Reading the posts also highlights occasions where I could have been clearer or given better information on a particular topic. As an example, I have written about breath techniques and their effect on the autonomic nervous system, as did Timothy in his awesome follow-up post on the buzzing bee breath, Bhramari Pranayama with Mudras. And we often mention that extending or lengthening the exhalation triggers the parasympathetic nervous system, the Rest and Digest part of our nervous system’s balancing program. This made me realize that I could add a bit more detail to explain how that actually happens.

It turns out the Autonomic Nervous System (ANS) that connects brain to body is a two-way street. If I am anxious and nervous or stressed out by events in my life or simply the thoughts about those events, my brain, via the nerves of the ANS, will likely turn on the Sympathetic part of that system (the Fight or Flight response), which could result in faster heart and breathing rates, and increases in blood pressure, to mention just two of the most obvious physiological changes.

But the cool thing is that the lungs and heart can feed back to the brain and essentially convince the brain that things are calm and peaceful, even when there are still stressful circumstances. One neat way this happens involves the relationship of the heart and lungs and the nerves between them. In each round of breath, during your inhalation, your heart gets stimulated to beat a little faster. Then during the exhalation that follows, your heart gets told to slow down a tad. The overall effect is very little change in the heart rate from minute to minute. But when you make one part of the breath cycle, either the inhale or the exhale, longer than the other, and you do this for several minutes, the accumulated effect is that you will either slow the heart rate down or speed it up from where you started. When you make the inhales longer than the exhales, for example, by using a two-second inhale and a one-second exhale, and you keep this up for several minutes, the heart rate will go a bit faster. This will send a feedback message to the brain that things need to activate more in the brain and body for whatever work there is to be done, stimulating the Sympathetic portion of the ANS.

With the very useful Bhramari breath Timothy expanded on Bhramari Breath with Mudras, we do the opposite. As we hum during the exhalation, the exhales get longer relative to the inhales, as when we do a 1:2 ratio breath practice without the humming. This new respiratory cycle begins to slow down the heart rate, sending a message to the brain that everything is more peaceful and calm than five minutes ago, allowing the brain to support this shift further by activating the Parasympathetic portion of the ANS (the Rest and Digest or Relaxation response) that goes back from brain to body.

Research has shown that the vagus nerve as well as certain chemical neurotransmitters account for these effects of breath patterns on heart rate and subsequently on shifting the balance between the Sympathetic and Parasympathetic parts of the ANS. Keep in mind that the ANS is trying to keep all background systems in balance and responding appropriately to ever-changing circumstances of our day.

I’m providing this information for those of you who want to go a bit deeper in your understanding of how breath patterns affect the nervous system balance and either excite the system or quiet it. Our conscious choice of breathing differently can shift us to a more desirable part of the ANS, either by stimulating the active Sympathetic branch or the quieting Parasympathetic branch.  Most of us need more of the latter, but not always!

For a little more background on how the Respiratory system influences the Cardiac system, which in turn influences the Autonomic Nervous System, see The human respiratory gate as well as Effects of yoga on the autonomic nervous system, gamma-aminobutyric-acid, and allostasis in epilepsy, depression, and post-traumatic stress disorder.

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Pre-Thanksgiving Giving Thanks

by Baxter

Lanterns by Melina Meza

So, it’s one day from the annual gathering of families and friends that we in the USA call Thanksgiving, and it occurs to me that I haven’t yet thanked the staff here at Yoga for Healthy Aging, all of whom do their work for you as a labor of love.

I am so grateful for the staff of YFHA! We have grown in the past two-plus years to an impressive eight people who regularly contribute to the posts that you read each week. In addition to the original crew of Nina, Brad and me, Shari Ser, PT, Timothy McCall, MD and Ram Rao, PhD regularly write posts with unique perspectives that have enriched our offerings greatly. So a big thanks to this trio of insightful and talented yogis and writers!

Bridget Frederick, our copy editor, has been going over our posts regularly with a fine-tooth comb, which those in the biz know is essential for coherent and understandable writing. She also makes it possible for Nina to take occasional time off by doing behind the scenes blog maintenance work. Invaluable! Melina Meza has generously offered to share her beautiful photos with us, and they have started to adorn many of our weekly posts. Other photographers have contributed photographs as well, including Philip Amdal, Joan Webster, and Michele Macartney-Filgate. Thanks, team—you make this adventure of love a Walton’s Family style one!

Maybe as importantly, THANK ALL OF YOU OUT THERE who read us regularly—you are a huge inspiration for the posts you read here each week! You’re now part of the YFHA family, too.

Happy and Healthy Thanksgiving to all our readers!

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Memory Loss—Meditation to the Rescue

by Ram

Yellow Leaves by Melina Meza

Alzheimer's disease (AD) is an irreversible, progressive neuro-degenerative disease that is characterized by severe memory loss, unusual behavior, personality changes and a decline in thinking abilities. Death of neurons in key parts of the brain harms memory, thinking, and behavior. Neuronal death in the hippocampus area of the brain triggers short-term memory failure, and often the person's ability to do familiar tasks begins to decline as well. Alzheimer's disease also attacks areas of the cerebral cortex responsible for functions such as language and reasoning. Thus AD patients gradually lose language skills and judgment. Personality changes, emotional outbursts and disturbing behavior, such as wandering and agitation, appear and can happen more and more often as the disease runs its course. People with AD eventually require comprehensive care, so the disease presents a considerable problem in patient management. It is believed that therapeutic intervention that could postpone the onset or progression of Alzheimer’s disease would dramatically reduce the number of cases over the next 50 years.

While mutated genes may contribute to the development of Alzheimer's, scientific evidence shows that genes are neither necessary nor sufficient to cause the disease. Environmental as well as life-style practices may also contribute to the disease progression. There is growing evidence that an epidemic of AD may be around the corner and people are rightly concerned, since it threatens to spike in prevalence as the population steadily ages. The significant growth in the population over age 85 that is estimated to occur between 2010 and 2030 (from 5 million to 9 million) suggests a substantial increase in the number of people with Alzheimer's. AD affects over 5 million Americans--there is neither a cure, nor treatment to halt the progression of symptoms. The drugs currently available to treat the disease address only its symptoms and with very limited effectiveness.

Most of us can avoid the mind ravaging effects of AD by making healthy changes in lifestyle, remaining active, achieving ideal weight, reducing stress, and in some cases, supplementing with a diet, vitamins, herbs and/or nutraceuticals that are recommended to you by a physician or licensed practitioner. The brain, like muscles in the body, requires exercise to remain strong in function. Stimulation of the brain increases the branching of brain cells that support cognitive function, and these beneficial effects can be seen in people of all ages. Thus, it is important to pursue intellectually challenging activity throughout life. Maintaining mental agility and learning new tasks as we age is will also contribute to our own well-being and independence. This was clearly articulated by Baxter in his post The Importance of Independence and Nina in her post What is Healthy Aging, Anyway? as they defined healthy aging.

Meanwhile here’s some good news for us yogis with regard to AD. A new pilot study led by researchers at Beth Israel Deaconess Medical Center suggests that the brain changes associated with meditation and stress reduction may play an important role in slowing the progression of age-related cognitive disorders including Alzheimer's disease. The authors of a new research article demonstrated that stress reduction through meditation also improves cognitive reserve.

Approximately 50 percent of people diagnosed with mild cognitive impairment—the intermediate stage between the expected declines of normal aging and the more serious cognitive deterioration associated with dementia—may develop dementia within five years. Additionally, as people with mild cognitive impairment age, there's a high correlation between perceived stress and AD. The authors wished to know if meditation reversed this process. They evaluated adults between the ages of 55 and 90 and included 14 adults diagnosed with mild cognitive impairment in the study. All participants were randomized to two groups: one group that participated in Mindfulness-Based Stress Reduction (MBSR) using meditation and yoga, and a second control group that received normal care. The study group met for two hours each week for eight weeks. They also participated in a day-long mindfulness retreat and were encouraged to continue their home-practice for 15 to 30 minutes per day. All participants underwent a functional MRI (fMRI) before the onset of the study and then again after eight weeks to determine if there were any changes in the structures of the brain or in brain activity.

The results of MRI imaging showed that the group that engaged in MBSR had significantly improved functional connectivity in the hippocampal areas of the brain that is responsible for emotions, learning and memory. Furthermore, those who practiced MBSR experienced less degeneration of the hippocampus. In addition, the data also suggested a trend toward improvement for measures of cognition and well-being.

What a cheap but effective method to reduce hippocampal degeneration and improve functional connectivity in the same areas of the brain that is affected by Alzheimer's disease! Meditation and yoga are some of the simplest intervention modalities with very little downside that may provide real promise for AD individuals that have very few treatment options. In addition to beneficial changes in the brain, yoga and meditation will stimulate the three aspects of healthy aging namely: decreased morbidity, independence and mental equilibrium (equanimity). Indeed, a very good deal!!

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Bhramari Pranayama with Mudras

by Timothy

Recently in a post (Pranayama for Everyone), I wrote about the "buzzing bee breath," Bhramari. I taught a simplified version so that people could get used to it, and feel this practice's almost immediately palpable soothing effects. A reader wrote in with a question about the mudra (in this case meaning a hand position) often taught as part of the practice. So today, I'll teach two more advanced versions of Bhramari, in which the hands are used to deepen the effects.

The fifth limb of the eight-limbed path of yoga as taught by Patanjali is pratyahara, which I like to translate as "turning of the senses inward." Most of us living in the modern world lead lives of nearly constant sensory overload. Phones ring and buzz, TVs blare in the background, and even gas pumps impose video commercials on us. It's hard to escape the visual and aural onslaught. A beautiful antidote is Bhramari, particularly when it's taught with Shanmuki mudra.

Shanmuki mudra is designed to close the gates of perception: the ears, eyes, nose and mouth. It noticeably heightens the power of Bhrmari to internalize the awareness, and you'll notice that the buzzing sounds louder. But before we try the full mudra, let's begin with a modified version.

Bhramari with Modified Shanmuki Mudra

Sit in a comfortable seated position, with the spine upright but relaxed. Place the pad of each index finger on its respective ear, on the tragus, the skin-covered tab of cartilage near the front of the ear, just above the earlobe.

Using gentle pressure, use the tragus to block sound from entering the ear. Try a few rounds of Bhramari, making a medium-pitched buzzing sound on each exhalation. Compare the effects when you occlude the ear and when you lift the fingers.

Bhramari with Full Shanmuki Mudra

In full Shanmuki mudra, instead of the index fingers, use the tips of the thumbs to push down the tragus. The index fingers exert mild pressure on the upper, inner eyelid. Be careful not to press too hard. You want the pressure to feel soothing to the eyes. The middle fingers are placed on either side of the nose, above the nostril and below the nasal bone. You'll know you're in the right place, when gentle pressure on the fingers slightly occludes the passage of air through each nostril. The ring and pinky fingers are placed on either side of the midline just above and below the lips, respectively.

Once you've successfully got the mudra in place, try anywhere from one to five minutes of Bhramari, then lower the hands. You may want to continue to sit in meditation for a few minutes after you finish.

Therapeutic Benefits

Bhramari very quickly shifts the autonomic nervous to parasympathetic dominance. The practice can be useful for anyone with a stress-related condition, and particularly when demands and sensory input make you feel overwhelmed. It may be especially useful conditions like anxiety and insomnia, and even autoimmune conditions.

If you're using Bhramari to reduce symptoms of a cold or sinus infection, either skip Shanmuki mudra entirely or only use the modified version above. Ditto if you feel claustrophobic with the mudra.

While high blood pressure can have multiple causes, many cases of so-called "essential hypertension" (which make up the vast majority of cases), are characterized by heightened activation of the stress response. Thus the regular, ideally daily, practice of Bhramari and other calming yoga techniques may be very effective both at keeping your blood pressure down, and helping reduce it if it's high.

Note from Nina: For more about the yogic approach to high blood pressure, please check out Timothy's upcoming webinar on Yoga U, at an online educational resource. It will be held on two consecutive Saturdays at 12:30 eastern and 9:30 pacific time, starting November 30, 2013. Click this link for more information.

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