Friday Q A On Your Feet All Day

Q: I liked the comments on flexibility (see Flexibility and Aging).  I would love it, since you addressed the couch person or the sitting person, if you could address the person that stands all day. Is on their feet all day.

A: The area that gets tight from standing is your low back. So any type of back-bending is good for counteracting a day spent on your feet. You can do conventional backbends or even bend over the edge of your bed, a table or a counter (the way you back-bend over a yoga horse). Seated forward bends may also help relieve your low back.

Stretching your hips (external rotators) is also helpful, so try the standing twists as well as the seated Marichyasana variations. After you release your hips, you may want to work on your legs. You could try standing lunges with your arms up the wall (a modified Warrior 1 pose). Standing Padangusthasana also works well for this. Any type of calf stretch is also good. Basically, any standing pose will help counteract the static position of standing all day. So how about Triangle pose (Trikonasana), Extended Side Angle pose (Parsvakonasana), and Intense Side Stretch pose (Parsvottanasana)?

—Shari

A: Because your hips and legs get tight from standing, Baxter recommends his dynamic leg stretch and hip opener series (see Dynamic Reclined Hip Stretches). Lying on the floor as your stretch your legs and hips will relax your lower back at the same time as you encourage the blood to flow back toward your torso from your legs and feet (which is helpful if you have any swelling).

My favorite way to stretch my legs and rest my back after spending a lot of time on my feet is to practice the Reclined Leg Stretch series (Supta Padangusthasana) followed by an inverted pose, such as Shoulderstand on a chair or Legs Up the Wall pose (Viparita Karani). The inverted poses use gravity to stretch your legs (how cool is that!) at the same time they return the blood back to your torso, reducing swelling in your feet and ankles.

Because the tightness in your torso, shoulders, and neck is the similar to that created by sitting all day, the two poses Shari recommended for counteracting sitting will also be very helpful for standing (see Flexibility and Aging).

—Nina

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Friday Q A To Roar or Not To Roar Lion Pose

Q: I am a devoted Swedish yogini and also a physiotherapist, and I am following your posts with great interest. I was searching for the "roaring lion pose" but did not find any on your site. I understand that there are a lot of benefits to this yoga exercise and I am interested to know how you think about it. I am really into yoga "as medicine" and I am very devoted learning about yoga so I can inspire and help people. So what do you think about the pose? When would you apply it in a sequence? What are the contraindications?

A: Thanks for such a great question! We have not yet talked about Lion pose (Simhasana) on our blog, but your inquiry gives us the perfect opportunity to tackle this interesting and somewhat whimsical pose. I personally like this pose, but I keep in mind that it is the modern version, with its roar, that I particularly like. In its earliest form, in the first books on hatha yoga (the Hatha Yoga Pradipika and the Gheranda Samhita), the roar is not mentioned. And, unlike the two versions of the pose found in B.K.S. Iyengar’s Light on Yoga (version 1 has the ankles and shins crossed underneath the thighs and version 2 has the legs in Lotus pose, then rolling onto the tops of the knees into a backbend), the original texts are not so clear on the leg position.

To give you a bit more historical context, the author of the Hatha Yoga Pradipika considers Simhasana to be in his top four of the fifteen poses he mentions in this text. According to Richard Rosen’s Original Yoga: Rediscovering Traditional Practices of Hatha Yoga (my top pick for Christmas yoga books this year!), the Hatha Yoga Pradipika author “praises the pose by saying its honored, even worshiped by the “best yogis.”” In addition to the lack of the roar being mentioned in our two old texts, neither one mentions sticking the tongue out either. The mouth is to be open wide, and one of the books mentions tipping chin to chest in the Jalandhara Banda chin lock or Net-Bearing Bond.

Richard cites another text that may explain the absence of the tongue and roar of modern times.This text suggests:

 “the traditional pose represents a condition of alert readiness often seen in cats, in which the “lion is sitting quietly, waiting for something to happen. This is the mental attitude the mind has to adopt in order to enter deep meditative states.””

In Light on Yoga, Iyengar shares a colorful myth regarding Vishnu helping out a devotee being tortured by a demon by appearing as a creature half lion on the upper half and man on the lower half. This modern teacher claims the benefits of the pose to include curing foul breath and cleaning the tongue. With regular continued practice, speech becomes clearer, so he recommends it for stammerers. It is also supposed to help master the three bandhas, even though they are not described as being activated in his instructions. However, he is pictured with his head tipped in Jalandhara Bandha in the book.

I tend to include the pose in a sequence if I am using a theme that it would work nicely with, such as finding one’s voice or working with power or anger or some such focus. I also include it in practices where sound is being utilized. I usually sequence the pose in the middle of a practice.  Or, I will put it at the start of group of sitting poses that could be placed near the end of a full practice.

As far as contraindications, they would be mostly regarding keeping the knees, ankles and feet safe as you try the first and second variations from Light on Yoga, especially the second, which utilizes Lotus (Padmasana—quite a challenge for most adult’s knees. As an alternative to both legs options, you can do the pose in Vajrasana legs, with the shins under the thighs without crossing the ankles. A blanket is always a welcome addition for comfort under the shins. 

Be sure to read more in both Original Yoga and Light on Yoga. And have fun cattin’ around!

—Baxter

Friday Q A Helping a Student with a Hip Replacement

Hip Joint from Behind

Q: I am a relatively new yoga instructor that teaches Gentle Hatha to (mostly) seniors.  Recently, a gentleman came in with bilat hip replacements from 10 and 12 years previous. He rides his bike and is in pretty good shape for a gent in his 60's. His hips were replaced by a posterior approach. How cautious do I need to be with this man? Do we modify mostly in the early days after the operation? Of course, I've modified the asanas to his ability and told him to not push it to the extreme. So is it fresh post op that we worry mostly about or for decades following? Thanks!

A: This is a great question and I am glad you asked it. In most cases, the hip replacement should outlast an individual’s lifespan. The literature states that total hip replacements typically last from 15-to-20 years after the initial surgery, but in some instances they can last over 30 years. But this is neither a guarantee nor assurance, for the simple reason that life is unpredictable.  Many factors affect the future of a hip replacement, such as accidents, fractures, late infections, and deterioration in overall health. Also, how well you take care of yourself down the road is something the surgeon cannot control. The longevity of a hip replacement thus depends on many factors, including the following:

• Surgeon skill in implanting the components
• Known history or track record of the implants
• How well you take care of yourself and your health
• Understanding and respecting the limitations of a prosthetic lifestyle
• Your activity level and body weight
• Avoiding high impact or extreme sports

Medical literature states that the most common reasons for individuals needing subsequent hip replacement surgery include:

• Loosening of the implant. 
• Dislocation of the implant
• Infection, such as staph infections either around the time of surgery or later through the introduction of the bacteria into the blood stream.

It is believed that the most common reason why hip replacements fail is because the weight-bearing surface wears out and the prosthesis begins to loosen. So, what is hip replacement loosening? When a hip replacement is placed into the body, it is either press-fit into the bone or cemented into position. Either way, it is fit tightly into the bone of the thigh (femur) and pelvis so that the implant cannot move. Hip replacement loosening occurs over time, and can cause problems with the normal function of the hip replacement prosthesis. When implants loosen, the hip replacement can begin to move small amounts. This can be caused by the shaft of the prosthesis becoming loose in the hollow of the thighbone or due to thinning of the bone around the implant.

Loosening of the joint can occur at any time, but it normally occurs 10-15 years after the original surgery was performed. Signs that the joint has become loose include pain and feeling that the joint is unstable and that there is increased loss of hip mobility. Another operation (revision surgery) may be necessary, although this cannot be performed on all patients.

Both physicians and patients are very concerned about the problem of hip replacement loosening because a hip replacement revision surgery (replacement of a joint replacement) is a much more difficult operation and hip replacement revisions are often not as successful as the first operation. After revision operations, patients tend to recover less overall motion of the joint. Also, the longevity of the implant decreases with each revision. Therefore, physicians tend to avoid joint replacement surgery until absolutely necessary, and try to get as much mileage out of each replacement as possible.

In about 1 in 20 cases, the hip joint can come out of its socket. This is most likely to occur in the first few months after surgery when the hip is still healing. But, unfortunately some people’s hips will dislocate very distant to the original hip replacement. My advice here is that a hip doesn’t typically dislocate without warning signs. Pain that increases as an activity is continued is the most prevalent symptom.

So how cautious should you be with your student? The surgical hips will have a certain degree of motion that is limited by their soft tissue, hip capsule, how the prosthesis sits in the acetabulum, and so on. Start by checking your student’s range of motion while he is lying in a supine position. Test all the movements of the hip (hip up toward chest with knee bent, same knee position but bring it out to side for abduction, and turn the hip out in abduction for external rotation by bringing the bent knee up toward the armpit. Then look at his hip mobility while standing: hip flexion, abduction, external rotation and extension. You should also see if he tolerates adduction by having him sit on a chair and cross one leg over the other. If he can't do this, then any pose that has internal rotation must be modified significantly. You should have your student do this for both hips to get a sense of how it feels to his hip and see if there is any pinching or grabbing. Then you can modify the asanas accordingly.

If you ask a surgeon if his patient has any precautions after three months post op, he will generally say no, but he will modify his statement telling the patient to “use your own judgment.” So do we continue with precautions forever? Well, that is an area of disagreement. I err on the side of moderation saying, “If it makes you anxious or causes pain, discomfort, pulling, or pinching, please stop.” A student can have the potential of dislocation forever if they are not mindful on how they move and move repeatedly into discomfort. And remember the combined positions of flexion, abduction and internal rotation are the holy triad. If your student can tolerate the movements separately then you can find his limits and slowly challenge his hips, but both you and he must be aware of how the hip feels. NO PAIN should be elicited from asana and that means soreness after class or the next day. Learning how to ask how a movement feels is tricky because not everyone will say something hurts, so this includes learning which words your student uses to describe sensation changes.

So for your student, keep making sure that he observes his body’s limits and doesn’t push beyond his current activity. And congratulate him for coming to your class and investing in his continued health!

—Shari

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Friday Q A Yoga Teacher Stroke Survivor

Q: I am a yoga instructor and a stroke survivor as well. I know, I know, a yoga instructor AND a stroke survivor. Fancy that! I have a compromised left shoulder and it's getting much worse. Have had it for 6 years. This is the problem: my right side of my body is also compromised but in a different way. It's just less. Little shoulders and most of all hands. It's just less. Imagine what my yoga classes are like, little demonstration. My questions. How long would a person be totally on foot before I would have to do little thing alone? How long would I teach yoga class? When is too much complications you say above is more serious? Anything else you can think of. Also, the article Yoga and Shoulder Joint Replacements was truly wonderful.

A: I am not exactly sure I understand your question but my initial response is you should teach as long as you have students who will come. But maybe your question is more about mobility and how long will you be able to walk "on your feet" and if you can't walk, can you still teach? Again, as long as you have eyes and a heart and can use your language to convey intention, then you can teach, as long as you have the endurance. With all chronic disabilities, and especially strokes, fatigue is a big factor. Sometimes the struggle to do all the little things of life are overwhelming and then there is no more energy left for other things. If your situation is such that fatigue is a factor, can you have an assistant that you train to do the physical adjustments for your  students and perhaps the physical demonstration? Your expertise is why people come. I personally don't feel that a teacher has to demonstrate. My teacher, Donald Moyer, doesn't demonstrate much, and if he needs something modeled he chooses a student that he can use to convey the concept he is teaching for that class.

I think chronic illness makes you more adaptable because you can't do things the old way, and have to create new ways. So it might be an interesting teaching tool for you to teach your students what your body feels like to teach compassion. Acceptance is a big deal with acute illness as well as with chronic illness. Learning to accept changing body images as not “limitations” but variations is a powerful lesson.

Also, the complications referred to in the post Yoga and Shoulder Joint Replacements were for the post-operative period. In a shoulder joint replacement, they are reattaching tendons and repositioning muscles to do other jobs.This is why I said that trying to work too vigorously too quickly following the post-operative protocol can lead to serious complications in the success of the surgery. But you are alluding to pain from a stroke, as well as increasing dysfunction on the other side. This is very common because when one arm can't do, the other arm does more and overuse develops. Being referred for a total shoulder replacement is not common as there aren't a lot of docs who do them and do them well. Dysfunction from a stroke with loss of motion is not the same thing. I recommend that if you have access to health care, you see a physical therapist or occupational therapist who specializes in the upper extremity (this includes the shoulder, elbow and hand) to get a holistic view of your  movement and movement patterns. From there you can be more specific in your questions of your physical mobility and continuation of teaching yoga.

I hope this helps. Please let me know what happens!

—Shari

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Friday Q A Future Topics

by Nina

Stalactites or Stalagmites?
I Can Never Remember by Brad Gibson

No reader questions came up this week on the blog, so today I'll ask you all a question.

Q: What topics would you like us to cover in the coming months? You can ask brief questions for the Q&A, suggest topics for longer pieces, or recommend experts to be interviewed or perhaps write posts as guest bloggers. You can leave your answers as comments on this post (or any other post), send email to Baxter at baxterbell@mac.co, or message us on Facebook at Yoga for Healthy Aging.

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Friday Q A Questions

Q: You have questions and answers on your blog almost every Friday. My question is about the questions: where do the questions that you answer on your blog come from?

A: The questions come from you, our readers! We answer questions that we receive in person, via email (send them to baxterbell@mac.com) or through comments left on individual blog posts. Some of our reader's questions get answered on a Friday Q&A post, but others trigger full-length posts on the particular topic.

Okay, fine, I admit it, not all the questions come from our readers. I made up the question for today because it's time for another round of questions and/or concerns, and I thought that some of our newer readers might not realize they can ask us any questions they like.

So speak up, everyone! Do you have any specific questions you'd like us to answer? Or, do you have any requests for general topics for us to address? We love hearing from you.

—Nina

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Friday Q A Yoga with a Stuffy Nose

Branches with Lichen by Melina Meza

No sooner had I put out my post today on Yoga and Your Sinuses, when one of my students sent this question to me:

Q: Can you comment on whether one should make any changes to their practice if they can't breathe through the nostrils, and have to practice as a mouth breather? This has happened to me at least twice this year...

A: This is likely a universal dilemma for anyone who has been practicing yoga for a while! After all, the average person has between two to four upper respiratory infections a year, not to mention the millions of Americans who suffer from seasonal allergies that can leave the nose congested as well as runny. So, in all likelihood, this is going to happen to you this year if you practice yoga. As I mentioned in my post Yoga and Your Sinuses, the only study done on yoga-related practices to treat sinus congestion used nasal irrigation or neti pot, to cleanse the nose. I know this is not about changing your practice on those days when your nose is congested, but I personally do find the neti pot technique helpful if I wake up congested, and a good prelude to my asana practice.

As for modifying or changing your practices on congested days, it will depend a bit on how your nose and sinuses respond to certain yoga poses or positions. As I also mentioned in my post this week, many of my students report that any poses that look like an inversion tend to increase the pressure and discomfort in the nasal and sinus passages and make breathing more difficult through the nose. So the first modification I’d make if that happens to you is bring those poses up so your hips, belly, chest and head are parallel or higher relative to the floor. For example, instead of Downward-Facing, use the wall for Half Dog Pose at the Wall.

Instead of full standing forward bend, only tip half way down to Half Standing Forward Bend (Ardha Uttanasana). You may decide to skip more challenging inversions, like Headstand, Shoulderstand, Handstand and such, and substitute a standing or seated pose to your liking that day. And elevating your head and chest a bit for Relaxation pose (Savasana) or doing a side lying version could be a great option for the end of class.

You could also could try Side-Reclining Leg Lift/Vishnu’s Couch pose (Anantasana), but skip the leg up in the air, and hang out for four to ten minutes (if only one side of your nose is blocked, lying on the opposite side, of course) and see if the research I referenced this week works for you.

And then there’s the problem of doing alternate nostril pranayama practices in class if they come up on your congested day. I’d probably skip them and do some three-part breathing as a generally beneficial alternative, or do a simple seated meditation on your mouth breathing while your fellow students are doing their Nadi Shodhana practice. Fortunately for most of us, our common colds are short lived, and you will be back to your full practice in a week or so. I hope these common sense options serve you well in the meantime.

—Baxter

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