Winter Ice Fear of Falling and Yoga

by Baxter

Road to Giverny in Winter by Claude Monet

Despite the fact that I have lived in California near the temperate ocean for the last 14 years, I still vividly remember the scary, slippery winter days when I lived in the Midwest in icy conditions. And I remember slipping and falling on more than one occasion. Perhaps because I was younger at the time, I avoided significant injury (except for that one ice-skating party my freshman year in college that started at midnight, when I fell while showing off and broke my arm—was there beer involved?). And as I’ve watch the national weather reports the last few weeks, I have seen icy conditions in the forecasts for a good part of the country. For many adults as they age, especially if they are not very physically active, icy conditions are enough to keep ‘em indoors for days on end, until the ice abates. Seems a shame! I wonder if there is any benefit yoga could provide to boost the confidence of those in such chilling circumstances?

As you probably have already guessed, yoga can definitely help on many levels. It can restore your confidence in your physical abilities, as you get regular with a practice geared toward the outdoor icy reality.  It can improve your strength if you have not been working your body out as of late, especially in the legs. Your standing balance can get better with targeted work in certain yoga poses. Yoga can improve your chances of getting up off the ground if you happen to go down, something we have written about in my post Transferring and Yoga Wisdom from Jane Fonda as “transfer” ability. And as many of my students have reported back after the fact, yoga can even can help you to “fall better.” Finally, if you are stressing out about falling on the ice before you even leave the house, some focused easy meditations can keep you mentally and physically relaxed as well as improving your concentration for when you step out the door and into that new, shifting reality of the winter wonderland (see Stress Eating and Healthy Eating Meditation Practice—you could use a different mantra, such as "healthy walking," for the second meditation).

Tell me more, you say! Let’s first talk about the strength, flexibility and agility that you need in icy situations. First off, you need strength and agility to feel your feet are under you and grounded to the earth, even if they might start to slip. And if you begin to slip, you’d like the strength, flexibility and agility to self-correct if possible. In modern yoga, practicing many of the basic standing poses, such as Warrior 1 and 2 (Virabradrasana 1 and 2), Triangle pose (Trikonasana), Extended Side Angle pose (Parsvakonasana), Standing Backbend, Wide-Legged Standing Forward Bend (Prasarita Padottanasana) to name a few, will allow you to start to address the strength and flexibility aspects beautifully.

Extended Side Angle Pose

Doing some simple Sun Salutations and Moon Salutations will crank up your agility skills by not only moving your body dynamically, but also making bending down to the ground and being on all fours familiar, should you still lose your balance on the ice. You could almost think of it as practice falling!

Poses with two bent knee poses, such as Powerful pose (Utkatasana) and Squat or Garland pose (Malasana), done both dynamically—in and out of it with the breath—and dropping as low as possible and holding the pose, are great poses to prepare you for a slip.  How so? Well, at the first feeling of a slip on ice, if you remember to bend your knees and not lock them, you can start to “sit down” toward the ground as opposed to tipping over like a falling tree. Sitting down is much less impactful (less injurious, perhaps) on the body than tipping over. And if you do find yourself sitting down from a slippery fall, you’ll have the strength, from having practiced these squatting shaped poses, to more quickly and successfully right yourself. In other words, you will be good at transferring down and up again. (See Featured Pose: Powerful Pose for detailed instructions on how to do the pose.)

Powerful Pose

And if you really want to advance things and improve your balance, you can start adding in one-legged yoga poses to the mix in case you slip and one foot happens to stay on the icy earth. Tree pose (Vrksasana), King Dancer (Natarajasana), Warrior 3 (Virabradrasana 3), Half Moon (Arda Chandrasana), and Standing Hand-to-Foot pose (Utthita Hasta Padangusthasana) will take you in all different directions with your legs and your spine, so again, you may feel more familiar with suddenly being in those positions in slick conditions. (See Featured Pose: Warrior 3 for three different ways to practice Warrior 3.)

Warrior 3 Pose, Easy Version

I can also assure you that my students who have fallen and lived to tell the tale (with minimal injury) reported back that they have the definite impression that their regular home practice and class attendance contributed to their ability to “fall well.” They reported that their reaction time seemed faster and that they had the ability to choose how and where to fall. And often they began to fall and “caught themselves” before actually going all the way down—save!

Now, I can hear some of you saying that this is all fine and dandy, but what I am I to do today? It’s icy out there now and I have been sitting on my butt for years. Well, there is no time like now, especially if you are not going outside today anyway, to start your new yoga home practice today. And the way things are playing out this winter, there is likely to be more ice in the weeks and months to come, so your future pay-offs will be huge by practicing one icy day at a time, beginning now. Go!

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Yoga After Heart Surgery for Stent Placement

by Baxter

Back in the late 60s and early 70s, a new surgical treatment for blocked heart blood vessels was being perfected. Known as coronary artery bypass grafting, it allowed doctors to work around the heart’s own blood vessels that supply the muscle of the heart with oxygen and nutrition when they became dangerously plugged with plaque buildup. Patients that previously would have, most likely, suffered severe or life-ending heart attacks were now being surgically repaired and at least temporarily “cured” of their heart blockages. I say temporarily because doctors like Dean Ornish, MD, noticed that many of these patients who had undergone open-heart surgery would return several years later with new blockages in their new plumbing! Most likely, this was due to the fact that they had not changed their lifestyle and dietary habits. 

As early as 1977, cardiologists started trying to treat the blockages in the heart blood vessels without having to crack the chest open, instead threading a catheter into a large blood vessel in the groin area and guiding it up to the heart and into an individual heart blood vessel. Once at the narrowing area of the blood vessel threatening the patient’s heart, a small mesh scaffold, called a “stent,” was slipped into place and gently expanded to reopen the narrowing. This stent was then left in place. 

All this history gets personal for both Nina and me, as we both have had loved ones undergo stent placement for coronary heart disease in the past year. In my case, my family member had just celebrated his 50th birthday, and with little prior warning or symptoms, had a sudden cardiac event at home that required CPR and electric shock to the chest by the EMTs to restart the heartbeat again. Evaluation at the hospital immediately afterwards showed one heart vessel with a blockage and a stent was put in place right away. Follow-up tests showed no permanent damage to the heart muscle from this heart attack—thank goodness!

It has been found that patients who go through “cardiac rehabilitation” programs following stent placement do better down the road than those that don’t. Cardiac rehab involves progressive aerobic activity on treadmill and stationary bikes while having the heart rhythm monitored, for 30 minutes 3 times a week for 3 weeks, then bumped up to 45minutes, 3 times a week for 3 more weeks. In my family member’s situation, he had been very physically active prior to his event, swimming and golfing regularly, and he was anxious to be able to return to those activities. If yoga had been his thing, I suspect that same desire would have been there. So, what are the recommendations about “return to activity” that could guide you as a yogi if you have to have a stent placed? The NIH has the following post-stent recommendations:

“After a stent procedure, [because of the risk of blood clots causing your open vessel to close,] your doctor will likely recommend that you take aspirin and other anticlotting medicines. Patients are told to avoid vigorous exercise and heavy lifting for a short time after the stent procedure. Your doctor will let you know when you can go back to your normal activities. … However, stents aren't a cure for atherosclerosis or its risk factors. Lifestyle changes may include changing your diet, quitting smoking, being physically active, losing weight, and reducing stress. You also should take all medicines as your doctor prescribes. Your doctor may suggest taking statins, which are medicines that lower blood cholesterol levels.”

Interestingly, there aren’t many other warnings I could find about returning to full activities, such as yoga, and no specific warnings about avoiding certain positions, including inverted yoga poses. In fact, a student of mine had his first of four stents placed for angina, or heart pain, starting at age 67 in 2000. He started doing yoga in 2003, which included regularly practicing Shoulderstand (Sarvangasana) at the wall in his new home yoga practice. He has continued to include it since then. He felt pretty certain he had discussed doing yoga with his family doctor at the time, as well as his heart doctor, and was not given any specific restrictions or warnings about yoga in general. 

I would not suggest that this means you should start a vigorous yoga practice that includes a lot a challenging inversions, but would instead suggest a gradual introduction of yoga over the course of time, just as the cardiac rehab is gradually advanced while monitoring for worrisome symptoms. And certainly engage in a conversation with your heart doctor about their views on the safety of your desired yoga program. Also, keep in mind that even a gentle yoga practice, like the one used in the Ornish Heart studies, has been shown to have powerful effects on long term heart health. So you likely have a wide range of options as to the kind of yoga practice you might restart or start for the first time if you find yourself confronted with a new diagnosis of coronary heart disease. If any of our readers have been given different advice by their docs, please write to us about it.

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How Yoga Helps with Pain

by Nina

Life Death Love Hate Pleasure Pain by Bruce Nauman*

Have you ever used your yoga practice to help with pain? If not, you might be surprised at how effective it can be. Yoga provides several pain reduction techniques. And in some cases you can even eliminate the cause of pain. For example, reducing stress could help you eliminate stress headaches and improving your musculoskeletal health could eliminate back pain. 

For acute pain, yoga provides techniques, such as breath work and relaxation, that reduce your pain. And stress management practices can also reduce the emotional suffering associated with the pain. For chronic pain, yoga is beneficial both for reducing the pain and changing your relationship to it, improving your quality of life (see Changing Your Relationship with Pain).

There are three different ways you can use yoga to reduce pain.

1. Asanas
2. Breath work
3. Relaxation

Since everyone is dealing with different conditions and has different needs and preferences, you should choose the techniques or combination of techniques that work best for you and your limitations.  

Asanas 

Even though people with chronic pain are often reluctant to move, research shows that both static and dynamic asana can reduce pain, improve physical functioning, and reduce pain medication usage for a range of conditions, including low back pain and arthritis, in people who are otherwise reluctant to move.

This is because mild to moderate exercise actually decreases physical pain. Yoga asanas release muscle tension and increase joint movement, both of which reduce the intensity of the pain. Improves your strength and physical condition, which depending on your particular condition, may help resolve the underlying condition.

The increased flow of oxygen to your brain and muscle tissues improves your energy levels and sense of wellbeing. Exercising releases endorphins the body’s natural pain relievers and improves your mood. Finally, the regular exercise can improve your sleep, which improves pain tolerance (see 5 Tips for Better Sleep for information on improving your sleep). 

For people with certain joint problems, such as arthritis, moving your joints through their range of motion and stretching your muscles can decrease the intensity of your pain or relieve your pain completely. And practicing yoga asanas mindfully improves your awareness of your physical sensations and responses to it, allowing you to improve your self care.

Research has demonstrated that even on days when you don’t feel up to moving, if you use your imagination to “exercise”— such as imagining you are doing an asana—helps prepares your body to move with greater ease and comfort when you are actually ready to move again.

Dynamic Poses. Moving in and out of gentle poses with your breath release physical tension, which can reduce pain. Reducing physical tension could also help improve your ability to breath with ease when doing breath work for pain. Examples are as Cat/Cow pose and Easy Sitting pose with a side bend. When you are ready for strength building, practicing standing poses, such as Warrior 2, dynamically will allow you to gradually regain strength.  

Static Poses. Holding gentle stretches for longer periods may allow you to release even more physical tension from the muscles than the dynamic poses. So you may find even more pain relief. And regular long holds of stretching poses can improve an joint movement over time. Examples of gentle static stretches that could help are Reclined Leg Stretch and Supported Backbend. And when you’re ready for more serious strength building, especially for your bones, working up to holds of 30 seconds in your strength building poses will help you regain even more strength.

Restorative Poses. These poses create deep physical relaxation for your muscles as well as for your nervous system. Relaxing your muscles at the same time you quiet your nervous system reduces both the pain and your emotional response to it.  

Breath Practices

The way you are breathing is a good barometer both of your pain and your stress. Typically your breath is fast and shallow when you’re in pain and/or stressed, while it’s slower and deeper when there is no pain or pain is milder, and you’re more relaxed. So at the very least, pay attention to your breath for clues about when you should change what you are doing (or keep on doing what you’re doing). And even the simple practice of paying attention to your breath can actually interrupt pain and stress responses. So you can use simple breath awareness for flares of acute pain or for chronic, persistent pain. See A Balm for the Soul: Practicing Simple Breath Awareness for information. 

And breath practices where you slow your breath, such as equal lengthening or lengthening the exhalation, will calm your nervous system, which may provide even more pain relief. 

Finally, using the breath observation techniques will help you identify breathing patterns that were initially a legitimate response to acute pain, but are not serving you well for chronic pain. You can then work with an expert on changing your breath patterns, which may help relieve your pain.  

Negative Emotions. Chronic pain is often associated with negative emotions, such as fear, anger, and sadness. These emotions could be the result of your pain, could be causing an increase in pain, or both. So if you’re experiencing any of these negative emotions—and it wouldn’t be surprising if you were—doing breath practices to calm your nervous system is especially worthwhile, as it may help change your mood or at least reduce some of your negative feelings.  

Relaxation 

Many studies have confirmed that relaxation practices can reduce pain and improve the quality of life for many chronic pain conditions, such as migraine headaches, back pain, and fibromyalgia. And because conscious relaxation practices take effect in a matter of minutes, turning off the stress response to pain and turning on immune, digestive, and repair and growth functions, these great first-line practices for acute flares of pain. So we highly recommend practicing conscious relaxation for both acute and chronic pain. Try out the various techniques to see which ones work best for you and your particular condition.

Focused Relaxation. All yoga stress management practices can reduce your pain, but focused relaxation may be particularly helpful. Focused relaxation, which can be practiced in a variety of restorative poses, shifts your attention from your pain to your breath or other physical sensations or to peaceful imagery. Guided relaxations, in which you follow the instructions of a recorded voice, are particularly helpful for pain because you don’t have to concentrate so hard to focus, especially for people who are new to these practices.  

Meditation. Like all yoga stress management practices, meditation can improve pain as you start to relax. But research shows that several meditation techniques (breath awareness, mantra repetition, and visualization) can actually improve your pain tolerance. This is discussed in a separate section below.

For specific recommendations, see Techniques for Managing Pain with Yoga and Changing Your Relationship with Pain.

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Why and How to Activate Your Muscles in Yoga Poses

by Nina 

Bicep Muscle

Tricep Muscle

For some time now we’ve been suggesting that you add “isometric muscle contraction” to your poses to enhance both strength building and stretching. I, myself, have been experimenting with it quite a bit in my practice, and have noticed some dramatic results. But since we’ve never really explained much about what we meant by that or how to put it into practice, I’ve decided that today I’m going to go into detail about both the benefits of this technique and the best ways to practice it so you, too, can give it a try. 

Why Do It 

Stretching. When you are stretching a particular muscle, consciously activating the agonist muscle (the opposite muscle to the one you’re stretching) will cause the muscle you are stretching to release (though reciprocal inhibition). For example, if you are stretching the your back thigh muscles (hamstrings), activating your front thigh muscles (quadriceps) will release your back thigh muscles, allowing you to increase the hamstring stretch. 

Bone Strengthening. Although a weight-bearing pose on its own will strengthen bones, if you consciously contract the muscles holding you up by firming them toward the bones, you will enhance the bone strengthening effects of the pose. For example, if you’re standing in Tree pose (Vrksasana), firming your leg muscles will enhance bone building in the standing leg. 

Muscle Strengthening. As you work in strength building poses, you can strengthen more than just the obviously active muscles by consciously contracting other muscles as you work in the pose. For example, as you hold you arms out to the sides in Warrior 2 (Virabradrasana 2), you can activate your triceps as well as your biceps to increase all-around arm strength. 

Joint Safety. For people with joint problems, such as arthritis, consciously firming the muscles that support a joint will help protect the joint from strain or wear and tear. For example, if you have knee arthritis, firming the muscles on all sides of your thighs in Extended Side Angle pose (Utthita Parsvakonasana) will help support your knees. And for people who are overly flexible and can bend easily into deep forward bends and backbends, consciously activating the muscles that are supporting you in the pose will prevent you from hanging from your joints, which can cause injury. For example, instead of passively dropping into pose where you bend backward or forward from the hips, such as Camel pose (Ustrasana) and Standing Forward Bend, (Uttanasana) you can protect your hip joints by activating your upper thigh and lower buttock muscles. 

How to Do It 

To achieve the benefits I’ve described, you should contract your muscles gently rather than strongly. Strongly contracting a muscle shortens the muscle, which seems to prevent you from moving as freely in the pose. On the other hand, gently firming a muscle toward the bone provides muscular support without interfering with movement. If you’re not used to working this way, it may take some practice. Take it in two steps (thank you, Donald!): 

1. Consciously relax the muscle, allowing it to lengthen. 
2. Gently firm the muscle toward the bone. 

Stretching. When you are stretching a particular muscle, bring your awareness to the agonist muscle (it is already contracting), which is the opposite muscle to the one you are stretching. Gently relax and then firm the agonist muscle toward the bone, and feel whether the opposite muscle stretches a bit more. For example, if you are stretching your tricep muscles (underarm muscles) with arms overhead, try gently firming your biceps toward to the bone. (I realize that which muscle is the “opposite” to the one you are stretching is not always obvious but that is an anatomy lesson for another day.)

Another technique I just learned about is that if you are targeting a particular muscle, you can contract the muscle you want to stretch BEFORE you go into the pose. For example, if you want to stretch tight hamstring muscles, you could practice Locust pose (Salabasana) to contract the muscles just before practicing Standing Forward Bend (Uttanasana).

Strength Building. If you are practicing a strength-building pose, rather than contracting only the most obviously active muscle, firm all the surrounding muscles around the bone as well. For example, in Downward-Facing Dog pose (Adho Mukha Svanasana), firm all your arm muscles and shoulder muscles toward the bone. When you want to strengthen your hip area, in a standing pose, for example, you can slowly engage the muscles all around your hip joints, ensuring that this action does not pull you out of good alignment. 

Joint Safety. For joint safety, you want to emphasize strength and stability rather than promoting more flexibility. So practice as you would for increasing bone or muscle strength by firming the muscles that support your joints. For example, to protect your front knee in Warrior 2 pose, you might shorten the distance between your feet so you are not bending your front knee through such a deep range of motion, and then, when your knee is positioned over your ankle joint, focus on firming the muscles on all sides of the knee joint toward the bone. 

If you decide to experiment with any of these techniques, either in your home practice or in a class you're teaching, please let me know how it goes!

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The Importance of Yoga for Strength

by Nina

Lately as I’ve been teaching yoga for healthy aging to several older people, I’ve couldn’t help but notice how weak some of them are. For example, one woman has trouble balancing because knee problems led her to stop walking and her legs became very weak. (Even though balance requires much more than just brute strength—see Yoga and Balance: An Overview—if you don’t have the muscle tone to keep yourself upright, you’re going to be all wobbly.) Then, there’s the man who walks regularly but who is losing his upper body strength due to a white-collar job that leaves him using his body for light physical labor only on the weekends. 

Left unchecked, this kind of muscular weakness could lead to an inability to live independently because even the simplest daily activities, such as getting up out of bed, getting out of a chair, and, especially, walking up or down the stairs, require strength. (See Yoga for Strength: An Overview for information about what happens to muscular strength as you age.) And lack of ability to balance due to weakness is going to increase the risk of falling, which is a serious problem for older people (see The Importance of Preventing Falls).

In fact, even though I had originally intended to cycle between strength, flexibility, balance, and agility, I quickly realized yoga for strength should be included as part of every single yoga for healthy aging class or daily home practice. So I thought today I’d recommend a few of my favorite strengthening poses and practices. Although Baxter has written some full-length sequences for strength (see Lower Body Strength Practice, Upper Body Strength Practice, Core Strength Practice), you can don’t necessarily have to do a long practice. I feel that practicing just a few strengthening poses on a regular basis will allow you to bring about real change. What I like about the following poses is that they are simple, accessible, and safe, yet they allow you to work as hard as you wish (though longer holds or repetitions). 

And although I haven’t been focusing specifically on bone strength—I can’t tell what’s going on with people’s bone strength just from looking at them—the good news is that all these poses will strengthen bones at the same time they strengthen muscles. 

1. Warrior 2 (Virabradrasana 2) mini vinyasa, followed with a long hold of the pose. People with balance issues can practice with their backs near a wall. Provides both lower body and upper body strengthening. See Warrior 1 and Warrior 2 Mini Vinyasasas and Featured Pose: Warrior 2 (Revisited).

2. Warrior 1 (Virabradrasana 1) mini vinyasa, followed by a long hold of the pose. People with balance issues can practice with their back heel against the wall. Provides both lower body and upper body strengthening. See Warrior 1 and Warrior 2 Mini Vinyasasas.

3. Powerful pose (Utkatasana), in all its variations. I particularly like using a block between the thighs to activate the thigh muscles, which are so vital for basic movements of getting around in the world, especially getting up out of a chair or off the toilet. Provides both lower body and upper body strengthening. See Featured Pose: Powerful Pose.

4. Downward-Facing Dog pose (Adho Mukha Svanasana), in all its variations. Provides upper body strength. See Featured Pose: Downward-Facing Dog Pose.

5. Plank pose, in all its variations. Provides upper body and core strength. See Featured Pose: Plank Pose.

6. Side Plank pose (Vasithasana), in all its variations. Almost anyone can do the wall version. Provides upper body, side body, and core strength. See Featured Pose: Side Plank Pose.

7. Upward Plank pose (Purvottanasana), in all its variations. Provides upper body, back, and core strength. See Featured Pose: Upward Plank Pose.

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Interview with Dr Loren Fishman on Yoga for Osteoporosis and Other Topics

by Baxter

For those of you not familiar with the work of Dr. Fishman, he is a long-time yoga practitioner, a physician specializing in rehabilitative medicine, and someone who is endlessly curious about the power of yoga to address health issues, such as osteoporosis, osteopenia, arthritis, and scoliosis. We are fortunate he agreed to this interview today so we can learn more about his recent research on bone health.  

Baxter: Can we begin with a little background on what got you interested in osteoporosis and yoga in the first place?  

Loren: When I was in India (1972-75) I got the first part of the idea, seeing these people from a truly ancient culture who still walked hundreds, even thousands of miles. These people seemed to me to have such strong, almost metallic bones. Mr. Iyengar gave me the same impression, only more so. 

Afterwards, in medical school, when I learned about Wolff’s law, that the strength of a bone depended on the forces to which it was subjected, I put the puzzle together: Yoga, generating forces many times greater than gravity, built bones up and made them stronger. But it has to be yoga graced by great attention to alignment. Otherwise, those great forces would cause injury.  

Baxter: We have written about your early work on osteoporosis in a pilot study done in 2009, but I know you have done a more recent study with exciting results. Can you tell us about that research and how our audience of yoga practitioners and yoga teachers might use what you have discovered?

Loren: After the pilot study was successful, I made a DVD and gave it away to 1000 people from every part of the world to use for our next study. It took eight years to get all the data we needed to complete this second study. We published this 1000 patient study (241 actually compliant) as Twelve-Minute Daily Yoga Regimen Reverses Osteoporotic Bone Loss, Lu, Yi-Hsueh; Rosner, Bernard; Chang, Gregory; Fishman, Loren M. Topics in Geriatric Rehabilitation April/June 2016 - Volume 32 - Issue 2 - p 81–87.  

Baxter: Can you tell us about the safety and accessibility of your bone strength protocols?

Loren: Safety? We asked everybody in the 1000-patient study to get X-rays before and after the two years they practiced using the DVD. About one quarter of them actually did. Results: No fractures, no significant advance of arthritis. No yoga-related fractures reported by anyone in the study. In fact no serious injuries of any kind were seen or reported in over 100,000 hours of people doing this yoga daily. Over 80% of them had osteoporosis or osteopenia when we started. In the final analysis, the spine and hip improved significantly, (p =.02 and.01), and the femur improved more than it does in people using the most popular medicines (p = .0002). 

When we saw that the yoga in the DVD actually worked, we put it up here on YouTube and sell the DVD through PayPal on the website sciatica.org. 

Baxter: Are there any unanswered questions you still have regarding the use of yoga for osteoporosis? 

Loren: Yes. How do you convince the doctors? The study got written up in the New York Times, and the one on scoliosis in the Wall Street Journal, but the medical community remained largely unpersuaded. We are now working on another study that we call a dose-response study, in which we have participants see a yoga teacher who is trained in our yoga every two weeks to see what “dose” of yoga the participants are giving themselves. Then we’ll see what happens to their DEXA scans in two years. I suspect not only does it work, but is synergic with the various medicines, yielding an effect that is greater than just adding the two effects together. But that’s just a suspicion. In a few years or so we’ll see if there’s a relation between how much you put into your yoga and how much stronger your bones become. 

Baxter: What is next for you? Any upcoming or ongoing studies? And can our readers participate in some way?

Loren: Yes, we’re now doing another certification training in osteoporosis, and certified teachers can give classes, report data, and participate in our newest dose-response study. We also have one coming up on lower back pain. After all, back pain is the biggest medical reason people seek out yoga. Here yoga appears synergic with medicine. These courses are analogous to “post graduate work” after becoming a yoga therapist. They have online and workshop components.

We’ve just gotten another study accepted by “Muscle and Nerve” on botulinum toxin for piriformis syndrome. And we just submitted a study in which yoga is more effective for scoliosis than any conservative method ever published, and unlike surgery, innocuous and just about free. We have patients from age 8 to the late 80’s. Then we’re working with Carnegie Mellon’s computer people on a new, objective way to analyze the facial expression of pain, to give a more objective way to understand pain. Do people realize that probably one third of medicine is based on pain, and yet all we have to rate it is the puerile one-dimension 1-to-10 scale?  

Baxter: I understand you have started offering trainings in your way of addressing osteoporosis. What are these trainings like and where can our readers learn more about them?

Loren: The up-and-coming trainings are in North Carolina, at an Appalachian mountain retreat called Art of Living near Boone, starting May 31, and another in San Francisco in mid-July. That San Francisco training is almost full, but the one in Boone is pretty open. They are 40-hour teachings, 20 hours online at artoflivingretreatcenter.org.

We have also developed alternative sets of poses for osteoporosis to ward off the inevitable ennui of doing the same poses day in day out, and also to strengthen the bones of the wrist, the fourth most probably fracture site (as I said earlier, we have put the first group—the group we’ve already proven to work—online for free at YouTube and offer DVDs on the website sciatica.org). And we give workshops, such as the one at Art of Living in North Carolina and online training to teach yoga teachers to train people to do these poses at their proper level. We feel this is an effective, innocuous, and quite valuable skill for yoga teachers to acquire.

Baxter: Is there anything else you’d like to say to our readers?  

Loren: Yes, there’s a recent controversy about how long should a yoga class be, based on an article in the Atlantic Monthly. In this era of Dog Yoga and Pizza Yoga I think people can get on the wrong track. Like anything else, the length of a class depends on whom you’re teaching and what you’re teaching them. The length isn’t important in itself. How long does a word have to be to keep its meaning? One should measure progress not by distance traveled, but by proximity to goal.  

Baxter: Sage advice, and thank you for all of this important and relevant information. We look forward to hearing more of the results of your studies in the future!  

Loren Fishman, MD is Medical Director of Manhattan Physical Medicine and Rehabilitation in New York City, author of eight books and author or editor of more than 70 academic articles. He is a world-recognized pioneer in the treatment of piriformis syndrome and rotator cuff tear and an expert in curing back pain. "A Thomas Edison of yoga therapy,” according to Pulitzer-Prize winning author William Broad, Dr. Fishman has done peer-reviewed clinical research on yoga and osteoporosis, scoliosis, and rotator cuff tear. He has integrated yoga into his medical practice for decades. Dr. Fishman received a degree in philosophy from Oxford University. Then he studied yoga in India with BKS Iyengar.

Dr. Fishman is Associate Research Editor of Topics in Geriatric Rehabilitation, on the staff at Columbia College of Physicians and Surgeons, and a past president of the New York Society of Physical Medicine and Rehabilitation. 

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Organ Prolapse and Yoga

by Shelly Prosko

Iris in the Rain by Melina Meza

Recently the blog received a question from a yoga teacher asking about the role of yoga to both reduce the likelihood of prolapse in her students (most of whom are middle aged mothers of at least one child), and to serve as a therapy to those who have had the surgery and are looking to improve the situation. She also wanted to know if there any poses or actions that could potentially damage this area.

There is certainly a role that yoga can play in the management of reproductive organ prolapse, but there are also some poses, movements and breathing methods that could potentially exacerbate the condition. For our readers who may not be familiar with what a reproductive “organ prolapse” means, Wikipedia defines the term prolapse as “to fall out of place.” There can be different kinds of prolapses. The bladder, intestines, bowel, uterus or vaginal walls can “fall” or collapse downwards. A prolapse of one of these organs results when there is too much intra-abdominal pressure in the abdominal and pelvic cavities, causing a downward force that the pelvic floor muscles (PFM’s) and surrounding connective tissue are unable to support. The organs can even fall down through the vaginal opening.

It is beyond the scope of this post to outline the causes of a prolapse. But it is important to clarify the common misconception that prolapses are caused by weak PFM’s. Yes, if the PFM’s are weak, they won’t be able to hold or support the downward force of these organs, leading to an increase risk of a prolapse when the intra-abdominal pressure rises. However, there are other connective tissue structures like fascia and ligaments that help hold all of our pelvic organs in their respective space and place. You can imagine if these structures are damaged during childbirth, or if one of these organs is removed, as in a hysterectomy, that it will change the support system in the entire cavity. This is important to understand because it will dictate how you address the prolapse with yoga or other exercises.

To answer our reader's questions, we need to look at some yoga poses that might help improve support within and surrounding the pelvic and abdominal cavities without increasing an unfavourable amount of pressure, and then look at ones that might cause an unwanted increase in the intra-abdominal pressure, potentially worsening the prolapse.

Let’s first take a look at what poses or activities to avoid (or consider re-evaluating) in your practice:

1. Poses that tend to unfavourably increase the intra-abdominal pressure (IAP) are some of the intense core poses such as Boat (navasana), Four-Limbed Staff pose (Chaturanga Dandasana), Plank pose (on elbows or hands) or variations of these poses.
2. Uddiyana Bandha forcibly and considerably increases the IAP and can exacerbate prolapse.
3. Depending on the severity of the prolapse, forward bending poses with the legs abducted (wide apart), may induce an increased downward pressure in the pelvic cavity that the PFM’s cannot support, such as Garland pose (Malasana), Wide-Legged Forward bend (Prasarita Padottanasana), Extended Child’s Pose (big toes are touching, heels and knees are wide apart, and arms extending forward).
4. Power or flow yoga transitions where there is jumping. Repeated jumping consistently increases the downward force. 
5. Breath Holding. If ANY yoga pose is too challenging for you or causes you to strain and hold your breath, then this can cause an increase in the intra-abdominal pressure, worsening your prolapse. Proper breathing during any yoga practice or other activity is always important for pelvic health and overall health of many systems of your body!
6. Avoid Kapal Bhati Pranayama (vigorous abdominal contractions during breath method).
7. Avoid activities such as heavy lifting or “pushing” (as in constipation). Lifestyle choices (forcing yourself to take several trips to unload groceries) and nutritional changes (increase bowel motility and softening) may be helpful.

Here are some poses or activities that may help manage or reduce symptoms in your practice:

1. Slightly elevate hips during Legs up the Wall pose (Viparita Karani), Supported Bridge pose (Setu Bandha Sarvangasana), Reclined Cobbler’s pose (Supta Baddha Konasana), Supported Shoulderstand (Salamba Sarvangasana).
2. Focus on awareness of the pelvic diaphragmatic breath or Reverse Kegel. Many people experiencing a prolapse assume that their PFM’s are loose and need to be tightened.  However, Jocelyn Unger, a PT pelvic health specialist at the University of Arizona Health Network agrees that the majority of women she treats that have weak and ineffective PFM’s, but also that they demonstrate tight PFM’s.  For this reason, she, along with many of the leading pelvic health specialists, recommend focusing first and foremost on the RELAXATION and release of the PFM’s before learning to engage and activate. See Urinary Incontinence for info on the pelvic diaphragmatic breath method or Reverse Kegel.
3. Breathe. It is important to ensure you are breathing effectively and not holding your breath in all your yoga poses, and in all your activities of daily living. Breath holding can increase strain and pressure against the pelvic floor. However, you must be even more mindful of effective breathing strategies in standing poses; because the force of gravity pulls downwards, the position of standing may be a somewhat precarious position if the prolapse is moderate to severe.
4. Mountain pose (Tadasana) and modified Powerful pose pose (Utkatasana) with a block between the thighs, ensuring proper postural alignment.  Alignment of the spine and pelvis can influence the position of the abdominal and pelvic organs and also influence the effectiveness of the PFM’s ability to contract. Ensuring you have a natural low back curve with a neutral pelvic alignment in your standing poses is important. An assessment from your physical therapist can help you determine where your optimal lumbo-pelvic position should be. Modify the Powerful pose simply by not squatting down as far so that there is no extra unwanted downward pressure.
5. Pranayama (breathing methods) that are meant to calm the nervous system would be beneficial for addressing anxiety that sometimes causes you to hold tension in the pelvic area. Nadi Shodana (alternate nostril breathing), Abdominal-Diaphragmatic breathing (Belly Breath) and Bee’s breath (Bhramari) may be useful.

Once you have practiced pelvic diaphragmatic breath awareness and learned to release the PFM’s, then you may be ready to start a gentle engagement of the pelvic floor muscles AS YOU EXHALE. Lie on your back with your knees bent and feet flat on the mat, or sit upright in a comfortable position. As you inhale, allow your belly to naturally move out. As you exhale, very gently draw your lower belly inwards, keeping your spine and pelvis neutral.  Inhale and relax, allowing your belly to soften. During the next exhalation, you can try to add a gentle lifting sensation of the pelvic floor. This is an extremely subtle movement, but is the beginning of learning how to incorporate gentle core activation movements, which may be part of your overall prolapse yoga program. I recommend seeking a health care professional who can help you accurately activate these muscles before you start engaging them in your yoga practice, as research shows they often are not engaged properly in group settings.

It is important to understand that these poses do not treat a prolapse. There are a variety of causes, severities and treatment options for different prolapses, so it is wise to follow advice from your health care practitioner as to which treatment approach is best suited for you and your specific case.

Finally, our reader asked about using yoga to prevent organ prolapse for her students. It is inaccurate for me to say these exercises will help prevent a prolapse, because there are truly so many different factors that contribute to prolapse, some of which we can’t control. Therefore, it would be almost impossible to pinpoint the cause that may be unique to each of your students. However, if you take into consideration some of the above tips and recommendations, this may help reduce some of the risk factors. I would strongly encourage ALL women to visit a Physical Therapist who specializes in pelvic health PT at any stage in life, so their alignment and pelvic floor health can be individually assessed, and a home program unique to their needs can be implemented.

A visit to your pelvic health specialist does not need to be only when a dysfunction arises! As a yoga teacher, it would be helpful if you could find a pelvic health PT in your area that you can team up with to discuss individual home yoga programs for your students with these prolapse concerns. The PT could assess each woman and then communicate with you what areas need to be addressed for optimal pelvic health. This would be a great preventative and health creation approach. Pelvic health PT’s are found in these online directories across Canada and the USA. 

Disclaimer: This article is not meant to diagnose, treat or act as medical advice. Please consult your health care provider for clearance and guidance before following or participating in these activities. 

Shelly Prosko is a Physical Therapist, Yoga Therapist and a Certified Pilates Instructor. She received her Physical Therapy degree at the University of Saskatchewan, Canada in 1998, her Yoga Therapist training through Professional Yoga Therapy Studies in North Carolina and her Pilates certification through Professional Health and Fitness Institute in Maryland. 

Since 1998, Shelly has been integrating yoga principles and methods into her physical therapy treatments. She has treated a wide variety of musculoskeletal, neurological and cardiorespiratory conditions while working in private orthopaedic clinics and long term care facilities across Canada and the United States.


Currently, Shelly resides in Sylvan Lake, AB and travels across Canada and the United States offering specialty Physio-Yoga Therapy workshops, classes, private sessions, lecturing at University and College programs as adjunct faculty of Professional Yoga Therapy Studies, teaching at YTT’s and actively promoting the integration of medical therapeutic yoga into our current healthcare system. She believes that bridging the gap between Western and Eastern healthcare philosophies is essential in order to achieve optimal health. Her treatments are individually based and are a unique blend of both approaches.

Please visit www.physioyoga.ca for more information about Shelly’s mission and services, and to read a variety of testimonials of how PYT has profoundly influenced many people’s lives.

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For A Good Experience In Yoga Aylmer Is The Way To Go

By Florine Meadows

The discipline of yoga has its roots in the present day country of India. It was exercised for mental, spiritual, and physical benefits. The time of origin is not very clear, but it is placed at around the 5th and 6th centuries BCE by most scholars who have researched it. Today, its influence has a worldwide reach, with people exercising it differently for various reasons. Whenever one needs a good session in yoga Aylmer should be the first destination to think about.

The introduction of the discipline to Western countries happened around late nineteenth and early twentieth centuries. By around the 80s, Western countries were practicing it majorly as a physical exercise. In India, yoga is not all about physical exercise alone. It goes much deeper into the spiritual realm as a meditative tool. It is done to achieve five major goals, according to its originators.

The translation of the word yoga into the English language means union. Proper practicing of this discipline is supposed to achieve an integration of mind and body. The principles of awakening, integrity, and reflection are the ones upon which change through yoga is facilitated. Transformation and vision are the core values of the whole practice. Many styles exist today with some being relatively new than others. Major styles are Hatha, asana, yin, and, iyengar among others.

According to arguments forwarded by enthusiasts, the discipline can be used in the prevention, relieving, and treatment of various health problems. However, attempts to establish the effectiveness in serving as a complementary intervention for cancer, heart problem, and asthma among others strategy ended up with mixed and inconclusive results. A study that specifically focused on effectiveness to the relief of symptoms and other problems caused by cancer concluded that it was not effective.

Regardless of what research says, most of the studies done to determine the effectiveness of this practice have always taken the form of preliminary studies. Some took the form of clinical trials of low methodological quality including poor randomization, bias, inadequate blinding, and small samples. The aforementioned problems coupled with several others have led to unfair negative perception of this practice in conventional medicine.

Cancer patients in Canada who have used it for a long time have reported to have experienced mental and musculoskeletal health. A reduction in the severity of asthma has also been reported. This discipline is great at improving anxiety and mood when compared to metabolic exercises like walking. Brain GABA levels are also improved among regular participants.

Breathing, meditation, and exercise are the core areas if focus for Hatha, which renders it useful for people with heart problems. Doing it well reduces high blood pressure, improves cardiac rehabilitation, and betters signs of heart failure. When used together with conventional medicine to manage certain health conditions, better results can be achieved.

There are facilities that offer the service where one can sign in, but it can be practiced at home too. There is a fee for attending classes and maintaining membership. Most facilities teach more than one style to achieve different results.

About the Author:

Read more about To Learn About Yoga Aylmer Should Be The Location To Prioritize.

Yoga for Every Body An Interview with Janet Wieneke Rerun

by Nina

September Photo from 
the Yoga for the Larger Woman Calendar

“Around the same time, the thought hit me that I had been dragging this body around for all these past 50 years instead of really living in it. It came to me that I had not claimed this body, not moved into this body. I was renting it, but I didn’t live there. I didn’t want to live there—in the “undesirable” section of town.
 
“That began to change though when I realized no amount of wishing, bargaining or promising will change the fact that this is my body and that it benefits me greatly to “step up” and partner with my abilities, instead of wishing that things were different.” — Janet W

I was so moved by this quote from Janet Wieneke from the Yoga for the Larger Woman Calendar that Baxter mentioned in his post Healthy Eating and the Digestive System that I decided I just had to interview her. For I believe it’s so important for everyone to understand that anyone, of any age or body type—small or large, flexible or stiff, strong or weak—can not only do yoga, but will all benefit tremendously from it. Now, let's hear what Janet has to say!

Nina: What was your life like—and your relationship with your body—before you started doing yoga?

Janet: For the first 40 years or so of my life I didn’t think too much about my body. In fact I made an effort to avoid seeing or connecting with it. I had a lot of aches and pains but figured it was my own fault for being so fat for so long. I did get some exercise—I did Volkswalks for a while, did jazzercise for a few years, swam laps at the local pool and even joined a gym a few times. None of it was something I was really enthused about but did it because I knew I needed to keep moving.

My diet then was probably better than people would assume. I usually tried to “shop around the edges” at the supermarket and visit farmers’ markets and avoid heavily processed foods. I had a few food sensitivities at that time (citrus primarily, whole wheat) but nothing to difficult to deal with.

Then, in my early 40’s I started having more GI problems. I tried all sorts of OTC drugs to deal with the pain/gas and nausea but nothing really made it better. I had my gall bladder removed as that was assumed to be the problem. After that things got worse and my diet options narrowed considerably. I spent a couple of years trying to force my body to accept and process what I wanted to eat. My body fought back by upping the intensity and frequency of the gut “attacks.” It was a continual battle. It got to the point that I realized if this was going to be the rest of my life, it didn’t want it.

Nina: How did you get started with yoga, and how did it change you?

Janet: I got started in yoga when I realized I really didn’t have an exercise plan that I wanted to do. There were lots of things I could or should do, and I did, on occasion. I enjoyed taking the occasional class through our local community college, and one day when I was leafing through the booklet I saw “Yoga for the Larger Woman” advertised. I thought, “Wow, I’d have half a chance!” I was in a book group that met at the same time though, so I just shelved the idea away. The next term I looked again to see if perhaps they had changed the time. They hadn’t. I decided to back out of the book group and give yoga a try. I really didn’t think I’d like it that much as I’ve never been very flexible.

The first few times were a struggle. I was so ashamed of bending over in front of others, exposing my extra-large ass to the masses. I cringed inwardly anytime it was suggested.  Then Vilma started doing the “Sellwood salute,” which is basically Downward Dog at the bar, where we would envision “beauuutiful tail feathers” that we would proudly display in a waving motion. It cracked me up every time. Gradually as I quit forming opinions of myself that I could fob off onto other people, I looked around and noticed I didn’t stand out so much in class. Sure most of the women were smaller than me but a few were larger, and—big picture—it really didn’t matter. Within a few months I noticed I was having far less back pain and even my gut “attacks” were less frequent.  I started to really pay attention and noticed other things, like how great a stretch felt from the inside out or which muscles activated when I raised my leg. I started to consider my body and excess flesh with more awareness and less judgment. During this time I was also doing some counseling and the two modalities together brought to light how I was “caring” for myself, and I began to question if what I was doing was actually working for me or if I was just existing on habitual thoughts and habits.

Eventually I realized the more time I spent on my matt, the more attached I felt to this body, in a positive way. I started to care about what I was eating and was more willing to accept the responsibility of my actions. This last year I began seeing a naturopath who put me on a regime of nutritional supplements and I continue to feel better. Today I still struggle with eating what my body needs/tolerates over what I want to eat, but I feel my yoga practice gives me support in making better choices.

Nina: A couple of our readers wanted me to ask if you’d seen any improvements in your balance and flexibility.

Janet: I have noticed a slight improvement in flexibility, nothing dramatic—my nose will never meet my knee cap. But after the first year of yoga though I headed out to do a good spring clean up in the yard and reached down for something and literally smashed my fingers on the ground. I remember how surprised I was as the year before that never would have happened! My balance may be slightly better as well. I’m certainly more confident on my feet but whether that is a balance thing or just general alignment I can’t say for certain.

Nina: Is there anything else you'd like to tell our readers?

Janet: I’ve always been more of a thinking person than a feeling person. Now after having a fairly regular practice for a few years, it’s almost as if a third way of being has come into play. It is more of an intuitive way of being. It’s something I cannot fully explain with words or isolate within my body. It’s almost a middle ground—a balance? When I can operate from this level, my stress level decreases, I make better choices from everything between what I eat to how I show up for others and it is far easier to live in this body. I wish I had “discovered” yoga long ago.

The years I’ve spent wishing I looked different, acted different, was different—all a waste of time but apparently held the lesson/s I needed to learn. I never felt that yoga was available to me, a fat person. Yoga was the domain of the lithe and “enlightened.” While I think that is still the predominant thought, I KNOW yoga is available to anyone willing to let go of their “cerebral” inner voice and listen to the wisdom of their own body. It’s a tough sell, especially if you’re fat, but it is so worth the effort.

Janet Wieneke is a native Portlander, works in health care as a dosimetrist, and is the personal servant to two animals (one cat and one dog). Her favorite pastimes are fused glass, yoga, photography and being out in nature. She studies yoga with Vilma Zaleskaite at The Yoga Project in Portland, Oregon,  and she is “Miss September” in the Yoga for the Woman Calendar, which you can purchase here. 

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