Friday Q&A: Foot Position in Pigeon Pose

Q: I'm wondering if you would please weigh in on something in one of your posts. It has to do with the position of the ankle - dorsiflexion or plantar flexion - in pigeon pose. I've always heard to dorsiflex the ankle (toes toward knee) in thread the needle and pigeon. But recently I heard that in pigeon the ankle should be in dorsiflexion only if the shin is parallel to the front edge of the mat, i.e., at a 90 angle to the knee, as it is in thread the needle, and plantar flexed (pointed, Barbie style) if the knee is bent more than 90, with the foot closer to the hip rather than the top edge of the mat. 

Do you guys have an opinion on this? I'd appreciate any insights you can offer.

Pigeon Pose Preparation with Flexed Foot
(I'd have her turn her foot onto its pinky edge so it's in a more neutral position.)

A: Great question, and like most things dealing with yoga poses and alignment issues, it depends! Remember, each person’s body is a bit different from the next, so individual variation is very important in deciding how to do poses. 

I don’t have a hard and fast rule about the front leg foot in One-Legged Pigeon pose (Ekapada Rajakapotasana 1) or Pigeon preparation (the hip stretch), but I do have one regarding the front knee in these poses. Due to the shape of the pose and the weight and force that gets placed on the front leg, especially in the forward folding version of Pigeon preparation, the pose should never create pain in your front knee joint. The front knee joint is particularly vulnerable to strain or injury in many practitioners with stiff and inflexible hip joints, which is a lot of people! When your hips are stiff and can’t move much, your knee ends up taking the extra forces and can get tweaked and injured. Because most practitioners do have some hip tightness, I typically recommend having the front knee and shin bend towards the opposite hip, so the angle between the thigh and the shin is about 45 degrees of flexion at the knee. At that angle the shinbone rolls towards the floor a bit (external rotation, for my anatomy geeks out there), which can then present a challenge to the next joint downstream, the ankle joint. When the ankle joint is dorsiflexed to 90 degrees here, it can lead to excessive supination or rolling in of the ankle joint—not so good for the ligaments of the outer ankle area. So, I find that for many practitioners, pointing the foot and ankle, known as plantar flexion, feels better and is safer for the ankle, and likely the front knee as well.

What about poses such as Reclining Thread the Needle and Pigeon preparation where the front shinbone is parallel with the short front edge of the mat? First off, almost everyone can do Thread the Needle safely, and when you dorsiflex the ankle of your top leg, notice if the knee joint feels better and more stable then when it relaxed or pointed. If it does feel better, then do that. If not, don’t! For the small percentage of practitioners who have enough flexibility in the front hip joint to do Pigeon preparation safely with the front shin bone parallel to the front short edge of the mat, you can try flexing the foot/ankle to 90 degrees with the shinbones and notice the effect on your knee joint: does it feel better and more stable or not? Let that be your guide as to the effectiveness of pointing or flexing the ankle in these poses. Also, notice how it feels when your torso is more upright versus when you forward fold your torso over your front leg. 

The theory on the benefit of dorsiflexing your front ankle to 90 degrees (as in our photo) is that may bring the knee joint into a more neutral alignment that is safer for all the soft tissue structures of the knee, such as the menisci, ligaments and tendons. But, again, remember that IT DEPENDS on the individual to see if this is true for their body or not. Good luck exploring Pigeon pose!

—Baxter

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Positive Psychology vs. Yoga Philosophy

by Ram

The Moon Over a Waterfall
by Hiroshige

Recently, I was introduced to the topic of positive psychology, a newer branch of psychology that has earned wide popularity thanks to the seminal work done by psychologists Martin Seligman and Mihaly Csikszentmihalyi (this name is tougher to say than a yoga pose in Sanskrit: the closest I can come to his name is “Me-high Sheek-sent-me-high”). 

According to Seligman and Csikszentmihalyi, the focus of general psychology is on treating abnormal behavior and mental illness. In contrast, positive psychology was established on the conviction that normal people prosper by leading a meaningful and fulfilling life. Positive psychology does not describe dysfunction and abnormal behavior; rather it is centered on determining positive human development and helping people to prosper and lead healthy, happy lives. Positive psychology describes the “good life,” and uses scientific tools, strengths and virtues to enable individuals and communities to prosper and lead a well-lived, fulfilling life.  

“Good life” according to these psychologists is about using our strengths and positive traits to produce genuine happiness and unlimited fulfillment on multiple levels that include, among others, the biological, personal, relational and institutional dimensions of life. Some of the major topics of interest in positive psychology include: happiness, optimism and helplessness, mindfulness, flow, character strengths and virtues, hope, positive thinking and resilience. Notice how these positive psychology traits resemble most of the ethical principles highlighted in the Ashtanga Yoga Philosophy by Patanjali. Similar to therapeutic yoga, positive psychology is being implemented in real-world applications in areas including therapy, self-help, stress management, and workplace issues. 

Let me now focus on one of the positive psychology traits, flow. I had an opportunity to read excerpts from the book “FLOW” by Csikszentmihalyi and what amazed me was that the flow principles described by the author in the book resonated soundly with the principles of yoga philosophy as well.  According to Csikszentmihalyi, “flow”occurs when:

1. An individual is faced with a task that has clear goals and which requires specific responses
2. When one is engaged in an activity where the challenge matches the individual’s skill, that is, when a person's skills are fully involved in overcoming a challenging task 

When the above two happen, the individual has an undivided focus and gets totally involved and forgets everything else but the activity. “Flow” may seem an effortless state but it requires a whole lot of effort initially to make that state accessible. The flow can be explained through the phenomenal compositions of musical maestros such as Bach and Beethoven, exquisite art work by Da Vinci and Picasso, or the mesmerizing sounds of the opera singers. In all of the above-mentioned examples, these respective individuals experienced “the flow,” a state of complete immersion in that specific activity. In “the flow” state, the ego falls away, time just vanishes, every new action, movement, and thought succeeds the previous one, the individual’s body, mind and intellect get completely united as a “whole,” the individual’s skills gets used to the utmost, and, at the end of all of it, the activity turns intrinsically rewarding for the individual.

Csíkszentmihályi puts forward several factors that are required to experience flow:

• Clear and challenging goals that are attainable
• Concentration and focused attention
• Activity that is intrinsically rewarding
• A loss of feeling of self-consciousness 
• A loss of time—feeling so focused on the present that you lose track of time passing
• Feeling of personal control over the situation and the outcome feeling of personal control over the situation and the outcome (without being attached to the results of your actions)
• Lack of awareness of physical needs
• Complete focus on the activity itself 

Flow experience is not restricted to any one activity and occurs in different ways for different people. Some might experience flow while engaging in a sport; others might have a similar experience while engaged in an activity such as music, reading, painting, drawing, or writing. If it’s challenging and you have the necessary skill sets to immerse in the activity completely, it can result in flow. Flow keeps an individual in a truly happy state. Csikszentmihalyi proved that the more an individual is in flow the happier he/she becomes. 

Now coming to yoga, notice how it is a perfect activity to achieve flow. Be it yama, niyama, asana, pranayama, or pratyahara, all of these require dhayana (focus) and dharana (concentration and motivation). This very nature of yoga allows an individual to match challenges to skill level. The breath work, concentration, precise alignment, the controlling power of how hard you’re pushing yourself—all of this puts an individual in a flow state. It was as though Patanjali designed the entire yoga philosophy to provide a flow experience. Every time you achieve flow in your yoga practice, you gain experience and inherently improve your skill level. Very soon, the practice takes your skill sets to a higher level and you are able to do more by challenging yourself further. You experience contentment and enjoy a sense of accomplishment. It’s a great positive spiral and it results in improved health and happiness. That is “Living Samadhi” (bliss/enlightenment) in an everyday life.

So the next time you encounter a positive psychologist, declare that you too are in “Flow” with your yoga practice. Better, read the book and “flow inwards” in your yogic life!

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Unity Farm Journal - The 5th Week of May 2014

The Memorial Day weekend included shearing day on the farm.   Every year in May, we trim 15 pounds of fiber from each alpaca, removing a body size “down jacket” just in time for Summer.  The animals are transformed from teddy bears to Dr. Seuss animals.  We gently halter the animals and reassure them with ear and chin massages.   Then we lead them to a foam pad and use a soft rope to restrain their legs so that they cannot move while the sharp clippers are shaving their fiber.   We also use the opportunity to trim their teeth and nails.   In two hours, the work was done and the newly sheared animals were back in their pastures.   Here are before and after pictures which suggest that alpacas are more fiber than body.

This weekend we worked on more mushroom totems, adding 36 stacks of logs to a new mushroom area underneath the shade of a 100 foot pine tree.   We added 6 different subtypes of oyster and bagged the logs, keeping them warm and moist for a 3 month spawn run.  This Fall, we will see some fruiting.  Now that we have 144 Oyster logs in production, we should achieve commercial quantities over the next 12 months.

Now that Spring mud season has dried up a bit, we’ve begun to maintain all our trails, using the Terex front loader to haul chips.  I placed and raked a bed of poplar chips 4 inches deep and 4 feet wide over the entire 1000 foot length of the Orchard trail.  Next weekend I’ll do the 1000 foot Old Cart Path and the 1000 foot Gate Path.    The real challenge will be the 1500 foot Marsh Trail, which is bounded by a stream at both ends and the only passage is via two 12 foot bridges.   Last year I did it wheelbarrow by wheelbarrow from our composted chip pile.

The warmth of the Spring days is perfect for extracting the thick honey from the hives that did not successfully overwinter.  We used a capping fork to gently open the wax covered frames and then placed them in our hand cranked centrifuge.   Our Summer honey is mostly clover and wildflowers.   Later in the season, the nectar flows are mostly goldenrod and Japanese knotweed.   We bottled 3 gallons of dark, late season honey.   Think of the difference between early season honey and late season honey as similar to the contrast between white sugar and molasses.  The goldenrod brings a complex herbal aroma and taste to the honey, which some people find overpowering.   I enjoy it as flavoring for soy yogurt.

The hoop house is exploding with Spring vegetables.    Our meals now include large bowls of fresh salad, using a dozen types of lettuce accompanied by a mixture of fragrant, spicy greens.   The peas, beans, chart, squash, and peppers are growing fast in the heat and moisture of the raised beds in the hoop house.   We recently added misters to the beds, since keeping the soil moist in the steamy environment of the enclosed space took an hour of hand watering a day.

I was in Beijing on Saturday and hauling logs/chips on Sunday.     You can appreciate the contrast I experienced from standing in the Beijing financial district to standing in the Unity Farm orchard, 24 hours later.

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Featured Sequence: Easy Balance Practice

by Baxter

As we have talked about many times here at YFHA, balance is one of the key physical skills to cultivate as we age. As Shari said in Nina's interview with her about aging and balance:

“ …if we can’t balance, we fall and break bones or hurt ourselves in different ways. Twenty percent of all Americans have balance issues, and falls are a public health catastrophe. They send people to hospitals and may require costly surgeries and months of pain, suffering, and hard work to try to regain prior levels of functional independence. 

In addition, if we are afraid to move because we fear falling, this fear affects every aspect of our lives and starts the spiral of further decline and illness. People who fall are afraid of exercise and movement because of the anticipation of future falls. But if you don’t use your physical body the decline is unrelenting.”

The good news it that balance is a skill you can practice and improve if you do a home practice regularly. The following sequence is the first of two that I will share with you to help you on your way to better balance. If you have poor balance already or have recently taken a fall secondary to losing your balance, I recommend working close to a wall that is behind your back. That way you can easily lean back against the wall if you feel like you are losing your balance.

Easy Balance Sequence

1. Mountain Pose (Tadasana): You might say, “Hey, this is not very balancey.” But Mountain pose is the foundation of all standing pose work, so it is good place to begin. Start with Mountain pose with a block on its narrowest side between your thighs and your feet set so you feel a nice squeeze of your inner leg muscles against the block. Stand for 60-90 seconds with your legs actively squeezing the block. This will strengthen your inner thigh muscles in addition to working all of the standing muscles in your legs. Then repeat the pose without the block. When working without the block, try to feel evenly balanced on the ball and heel of the foot, the inner and outer edges of the foot.

2. Mountain Pose with Arms Overhead and Heels Lifted (Urdhva Hastasana): Starting in Mountain pose, bring your arms slowly out to the sides and up until your arms are overhead alongside your ears.

To make it more of a balance pose, try coming up onto to the balls of your feet, lifting your heels just a few inches off the floor. Try to stay as even side-to-side on the balls of your feet as you can for a few seconds, and then lower your arms and heels back to the earth. Repeat one or two more times, focusing on getting steadier each time. If you are feeling particularly off balance, try facing the wall with your feet just a few inches from the wall and rest your fingertips on the wall overhead as you lift you heels.

3. Hunting Dog Pose: Come down to hands and knees, trying to keep your body very steady going into the pose. Follow the instructions at Featured Pose: Hunting Dog Pose. If you feel too wobbly in the pose, keep the toes of your straight leg lightly on the floor. Stay for at least 30 seconds, but work up to 90 seconds gradually over time. As you come out of the pose, try to keep your body very steady. 

4. Warrior 1 Pose (Virbradhrasana 1): This post Featured Pose: Warrior 1 will give you the basic idea of how to do Warrior 1, but for this practice, pay close attention to the transitions into and out of the pose, making them as smooth and stable as possible. 

5. Triangle Pose (Utthita Trikonasana): As I had you do in our Lower Body Strength Sequence, you may want to start by coming in and out Triangle pose dynamically a few times. This can really challenge your balance, so feel free to set up with your mat parallel to and up against a wall, and look toward your front hand has you go in and out of the pose, not up at the ceiling. Start with your legs apart and feet aligned as usual for Triangle pose. Inhale your arms parallel with the floor, and then exhale into Triangle pose. Inhale back up with your arms out to sides, and then exhale your arms down to your sides. Repeat six times. Then hold full Triangle for six breaths, and work on increasing your time in the pose. Repeat on second side, with the dynamic sequence as a warm up for the full static hold.

6. Tree Pose (Vkrsasana), Easy Version: If your balance is wobbly, stand with the wall just behind your back. Start in Mountain Pose with your feet a bit closer together than usual. Shift your weight onto your left leg and bend your right knee a bit, coming onto the big toe of your right foot. Swing your right knee out to the right about 45 degrees. Then slide your right foot up against the inside of your left ankle, placing your right heel just above your left ankle bone but keeping your right big toe on the ground. Press your right heel firmly into your left ankle. See if you can then take your arms out to your sides parallel with the floor. Keep your gaze relaxed and on the horizon in front of you. If you are still feeling steady, try taking your arms overhead as in Arms Overhead pose. Whichever version you do, keep your legs steady and still, and try to stay for six breaths or so, gradually working your way up to 60-90 second holds. Repeat on second side. 

For those already experienced with practicing the full version of Tree pose, feel free to do any version of the pose that you’re comfortable with. 

7. Warrior 3 Pose (Virabadhrasana 3), Easy Version: Start at the wall, coming into Half Downward-Facing Dog Pose at the Wall, as described here. As your press your hands into the wall, lift your left leg up behind you as close to parallel to the floor as you can manage while still keeping your hips relatively square. While you’re in the pose, try to lighten the touch of your finger on the wall, as you continue to keep your hips square with the floor beneath you, your bottom foot squarely on the floor, and your lifted leg strongly reaching back behind you. Try to stay for six breaths or so, gradually working up to 60-90 second holds. Repeat on second side. See Featured Pose: Warrior 3 (Wall Version) for detailed instructions on this pose.

For those already experienced with practicing the full version of Warrior 3, feel free to do any version of the pose that you’re comfortable with. 

8. Standing Forward Bend (Uttanasana): Come back into Mountain pose and savor having both feet back on the ground! Place your hands on your hips and, on an exhalation, begin to bend forward from your hip joints. When your pelvis won’t rotate over your upper leg bones any more, allow your spine to round gently into a full forward bend, as you release your arms toward the floor. If your hands easily make it to the floor, great. But if they fall shy of the floor, don’t force them down; instead place your hands on opposite elbows. Feel free to bend your knees a little bit if your lower back or hips feel strain or pain. Stay for 30-60 seconds. 

9. Boat Pose (Paripurna Navasana): Sit on the floor with your knees bent and your feet on the floor in front of you. Hold onto the backs of your knees and rock back to balance on your buttocks with your feet just off the floor. See how long you can stay before your front thighs begin to tire. If Version 1 is easy, try Version 2, bringing your shins parallel to the floor and holding there. If Version 2 is easy, try Version 3, letting go of your knees and stretching your arms forward. Finally, if Version 3 isn’t challenging enough, try Version 4, straightening your knees so your upper and lower body forms a “V” shape. Start with six breaths and work up from there.

10. Reclining Twist (Jathara Parivartanasana): Lie on your back, with your knees bent and your feet on the floor. Keeping your knees bent, bring your legs and feet close together, and stretch your arms on the floor out to your sides in a T position. Now let both knees drop easily to your right, as close to the ground as they will go. Allow your head to turn gently to the left. Rest in this position for a minute or so, noticing any tension or fear that might have crept into your body from the challenge of your balancing poses. As you exhale, imagine releasing as much of that emotion and feeling as you can. Come back to center and repeat on the second side.

11. Relaxation Pose (Savasana): Focus today on feeling the security, stability, and safety of your entire body resting on the floor. Use any props that would make your body more comfortable (see Corpse Pose Variations). Ideally, set a timer for 10 minutes, and let your mind stay focused on the gentle flow of your relaxed inhalation and exhalation, and enjoy your relaxation pose! 

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Early reaction to the Electronic Health Record Incentive NPRM

Last week, I posted the Notice of Proposed Rulemaking from CMS that offers flexibility to Meaningful Use attestation in 2014 .

Since then, I’ve received hundreds of emails about it from my fellow CIOs across the country.   Here’s a summary:

1.  To clarify, the NPRM offers flexibility for hospitals to attest to Stage 1 criteria for 2014 from July 1 to September 30.   However, it offers no flexibility for 2015 which begins October 1, 2014.    This means that hospitals which are struggling with Transition of Care summary exchange, Electronic Medication Admission Records (EMAR), and Patient Portals such that their implementations cannot be ready by July 1, must be fully ready by October 1, since 2015 requires a full year reporting period for attestation.     Thus, the NPRM as written really only provides a 90 day delay from July 1 to October 1.   It’s too little, too late for hospitals to achieve the business transformation, cultural changes, and workflow redesign needed.  

The solution - either relax the Transition of Care summary exchange requirements, EMAR requirements, and Patient Portal usage requirements or make the 2015 reporting period any 90 days in 2015 to enable more time for implementation.

2.   Even if a hospital has installed 2014 Edition software and can send Transition of Care summaries, most community-based physicians cannot receive them.   Also, few communities have provider directories which enable discovery of Direct addresses to send to those physicians with receiving capabilities.   Although the Transition of Care summary exchange requirement of Meaningful Use Stage 2 is a very noble policy goal, it requires an ecosystem of components that is not yet present in the US.   The same is true with the transmit component of the patient view/download/transmit capability - there are few places that can receive patient transmissions.

The solution - offer a hardship exemption if the hospital or physician office can send Transition of Care summaries, but there is no one to receive them or community provider directory infrastructure is lacking.

3.  Using Stage 1 criteria is helpful in that the Transition of Care summary exchange, EMAR, and Patient Portal criteria are relaxed, but does it require the use of Stage 1 Clinical Quality Measures?   2014 Edition software (or third party services providing quality measure computation) no longer support Stage 1 quality measures, so it is unlikely that Stage 1 quality measures can be submitted.

The solution - Stage 1 attestation with 2014 Edition software should allow 2014 quality measures.

Note:  My colleagues at CMS have clarified this issue.  "In the EHR Incentive Program, pre and post this NPRM, the clinical quality measures are not linked to the Stage of MU but to the year (CY or FY).  All participants using 2014 CEHRT, are reporting 2014 quality measures. It is ONLY if they use the 2011 CEHRT that they need to report the old CQMs. In other words, CQMs are already tied to the year of CEHRT in use, not to the stage of MU and that would not change under the proposal in the NPRM. "

The NPRM is a good first step.   It needs to be further revised to shorten the reporting period for 2015, enable the evolution of community infrastructure for Transition of Care summary exchange, and recognize that historical quality measures can no longer be computed.

One editorial comment - at some point we need to recognize that layering fixes on top of existing Meaningful Use regulation, some of which was written by CMS and some of which was written by ONC creates too much complexity.   I have direct access to the authors of the regulations and email them on a daily basis.   It’s getting to the point that even the authors cannot answer questions about the regulations because there are too many layers.  I realize that we are reaching the end of the stimulus dollars, but as we head into Stage 3, I wonder if we can radically simplify the program, focusing on a few key policy goals such as interoperability, eliminating most of the existing certification requirements, and giving very clear direction to hospitals and professionals as to what must be done when.

If I were king for a day, I would consolidate the Meaningful Use program into the “Merit-based Incentive Payment System” as I wrote about in this post, offering incentives for those who achieve stretch goals, without penalties for those who do not.    In my mind, Meaningful Use has achieved its goals of accelerating EHR adoption and  fundamentally changing attitudes about the need for healthcare automation.   At this point, we should learn from the challenges to achieve Meaningful Use Stage 2, provide a short term fix (revised as above), and then use Meaningful Use Stage 3 as an opportunity to simplify the program.

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An N of One and an N of All: Personalized Medicine and Personalized Yoga

by Brad

Patterns in Nature by Melina Meza

A couple months ago I attended a conference in Seattle sponsored by US HUPO (Human Proteome Organization) called “From Genes to Function.” Afterward, while I was mulling over the talks, I was reminded of some earlier posts I’ve written where I discussed studies that were “under powered,” that is, they didn’t have enough subjects and controls to come to any firm, or statistically validated, conclusions. These included the papers that looked at reduced IL-6 levels (an inflammatory cytokine) or the effect on telomere length (the ends of DNA sequence that correlate with age) in practioners of yoga (see Science, Aging and Yoga).  In another post, I discussed the issue of the “N of one (N = 1),” a reference to anecdotal cases or one’s own experience. I have often felt that we should not be overly tough on the lack of data on some aspects of our behavior before embarking on changes, as the bar for scientific proof is often simply too high—and the likelihood of someone carrying out the rigorous study needed to obtain a higher level of confidence is not likely to happen any time soon.

So, it was interesting to be reminded of two important trends taking place in the health sciences these days: the “N of one” and the “N of all.”  Both of these concepts came up in the talk by Leroy Hood, CEO of the Institute of Systems Biology, a major leader in the field of integrated “omics” technologies in medicine, i.e., genomics, proteomics, etc.  His point was that with new technologies becoming cheaper, we could envision a situation in the very near future of routine genomic sequencing and other data intensive methods to follow one’s own health (the N of one) as well as this data being integrated with thousands of patients for a virtual cloud of data (the N of all).  The N of one concept was reiterated in a fascinating talk from Michael Snyder of Stanford in which he discussed a project where such efforts are being carried out longitudinally to monitor precise changes in one’s microbiome and other parameters.  This idea stemmed in part from his own self-diagnosis of type 2 diabetes from information he was collecting on himself (talk about personalized medicine!). It is now expanding into larger, but still relatively small cohort of 50 pre-diabetics, to identify genes and other factors that contribute to type 2 diabetes. This project is already underway and will likely be expanded to include several thousand subjects if successful. Such technology innovations would allow you to have vast information about your own DNA, blood and microbiome status from which to make more informed health decisions.

Obviously the N of all concept is related to the N of one, but refers to an even larger amount of medical data that is now becoming available to researchers, as these data from thousands, if not millions, of people become available. Access to such a trove of information would allow scientists to identify genes for rare diseases, as well as to better pinpoint behaviors that are linked to diabetes or Alzheimer’s, for example. These data would also allow individuals to make better-informed decisions about what drugs they should or should not be taking, as well as what behavioral modifications would be best for their personalized health. As this idea really gets traction, maybe we will be able to better assess how the practice of yoga affects our health (and contributes to healthy aging), both from a personalized view  (N of 1) as well as that gleaned from thousands of people (N of all). Until then, using your subjective experience along with input from your yoga teachers and colleagues to evaluate which yoga practices are beneficial to you is a perfectly valid way to make decisions about what and how to practice.

One last thought: This scenario may seem like a dystopian future to many of you, as there are clear issues of privacy and how much information we really want to know about ourselves or others to know about us. Not surprisingly, these issues are being hotly debated among scientists, medical ethicists, and policy makers—and we should be participating in this discussion as well. There are already some pretty serious guidelines in place to insure privacy and remove personal identifiers from much of this data, but things are changing rapidly. The explosion of medical and behavioral information about ourselves and others will almost certainly happen as the technology become cheaper and more widely available. It will be very interesting to see how this plays out—and whether the rewards of personalized medicine will lead us to better ways to manage our health.

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Cultivating Healthy Posture with a Simple Restorative Pose (Rerun)

by Timothy

Poor posture is a common problem that people of any age can have but it is one that tends to worsen over time. Particularly common is the rounding of the upper back into a C-shaped curve, aka Slumpasana. People often hold their heads several inches forward of the body’s plumb line, which can lead to neck and upper back discomfort, among other problems. I’m just back from teaching workshops on therapeutic yoga at Kripalu and the Himalayan Institute and several of the people I worked with—some despite years of yoga practice—still had this postural habit. So I thought today I’d share with you a simple technique that in a number of cases has proved helpful for improving posture.

You might not think poor posture would be a factor is serious health problems, and we certainly weren’t taught much about it in medical school. But if you read medical textbooks and search out relevant studies, you will see that poor posture can contribute such problems as carpal tunnel syndrome, osteoporotic fractures, and even heart disease and depression. From a yogic perspective, this combination of slumping posture and the less-than-ideal breathing that accompanies it is also believed to contribute to anxiety, insomnia, digestive difficulties, etc.

When your back rounds, your lower ribs compress the top of the abdomen so it’s not possible to fully move your diaphragm, the major muscle of breathing, and take a full breath. As a result, people take shallow breaths, primarily bringing air into the upper parts of the lungs. Such a breathing pattern is not as efficient in bringing oxygen into the body, and more importantly for many health concerns, is agitating to the nervous system. I won’t go into the physiology here, but suffice it to say that I have repeatedly seen that improving your posture in a way that allows you to take slower, deeper breaths can lead to an improvement in overall health and well-being.

When you’ve had a long-term habit of slouching, however, it may not just be as simple as remembering to sit up straight or to pull you shoulders back when standing. Long-term slouching leads to shortening of muscles in the front of the upper body, as well as of the fascia, the connective tissue that surrounds and interpenetrates the muscles, and which can limit movement. It’s said that longer holds of poses are necessary to help lengthen the fascia, and while people differ on what the ideal holding time is, I believe staying in a pose for a few minutes may be ideal. That’s hard to do in most regular asana, particularly the backbends, which open up the back. The pose described below is a supported backbend, which like a regular backbend helps correct the postural problem, but because it’s restorative, it’s easy to stay long enough to have the desired effect on the fascia.

To do the pose, you’ll need one blanket and something to place under your head. Take a standard folded yoga blanket and unfold it once, so that you’ve got a long rectangle. Roll the blanket from the longer edge into a thin cylinder. Place the cylinder sideways on your mat a couple of feet from the head of the mat, sit in front of the blanket, and lie back so that rounded edge comes to your mid-thoracic spine.

Thoracic Spine, the portion of your spine to which your ribs attach—
between your cervical spine (neck) and lumbar spine

You can play with the placement, maybe a little higher or lower to get the region of your upper back that seems the most stubborn. Most people, particularly those who tend to slouch, need a pillow or folded blanket under the back of their heads, so that the chin can be more or less at the level of the forehead or slightly lower.

Once you’ve got your props in place, come to a supine Mountain pose with your back on the blanket roll, your head on the head support, and the tops of your shoulders on floor between the head support and the blanket roll. Now, take your arms out to your sides in a T-position, externally rotating your upper arms so your palms face the ceiling, which will help counteract the tendency of most slouchers to internally rotate them. Engage your leg muscles and lightly flex your feet. After  you’ve established your alignment, let go of all effort and lie back into this restorative backbend and let the blanket do all the work. Your only job is to remain mindful, trying to breathe slowly and deeply for the next several minutes. Titrate the time you stay to your comfort levels and schedule. For most people, I’d recommend starting with a minute or so then working up to 5-15 minutes a day. The longer you hold it (as long as you remain comfortable), and the more regularly you do it, the better the results!

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Aging Muscles, Bones and Joints

Adam and Eve by Lucas Cranach the Elder

Q: You all have been writing a lot about muscles and bones lately. I was wondering, how exactly does aging affect our musculo-skeletal system? And how can we influence the aging process with yoga and our lifestyle choices?

A: The process of aging affects our musculo-skeletal system in several particular ways. As I have written about previously, as muscles age, especially after about the age of 50, we start to lose muscle mass in a process called sarcopenia (see Strength and Aging). Sarcopenia is considered a normal part of the aging process, one that can lead to visibly smaller skeletal muscles—the ones that move our body and limbs around—which are then also going to be weaker. It is usually a slow, gradual process, but unchecked could lead to a point in a person’s life when the weakness could negatively impact his or her daily activities. According to an article Aging changes in the bones – muscles – joints from the National Institutes of Health: 

“Changes in the muscle tissue, combined with normal aging changes in the nervous system, cause muscles to have less tone and ability to contract. Muscles may become rigid with age and may lose tone, even with regular exercise.”

The body’s soft tissues tend to mostly made of water, and as we age, we also gradually experience a decrease in the amount of water in the muscles and the connective tissues (fascia and tensions) that surround the muscles and attach them to the bones, as well as the ligaments that connect bones to bones. As these changes occur, these structures become more brittle, less resilient and more likely to suffer injury, such as, strains and sprains. And because these structures don’t have a very good blood supply to start with, repair and recovery is typically slow, and slower as we get older. Other important soft tissue structures, such as the intervertebral discs between the vertebrae bones of the spine, and cushions, such as the meniscus in the knees and the labrum in the hip and shoulder joints, also suffer the same changes and the same potential for injury and degeneration. 

The skeleton, which is made up of over 200 bones, also undergoes changes as we age. Most commonly, the joint surfaces between the mobile joints can suffer wear and tear over a lifetime of use. The connective tissue barrier known as cartilage that coats the ends of each bone to make it slippery and cushioned can gradually thin out and leave the underlying bone exposed and sensitive to inflammation. This is commonly referred to as osteoarthritis (see Yoga for Osteoarthritis), an extremely common aging-related problem that can actually start at about any age, especially in those who use their bodies intensely for sports and work activities. 

Finally, the bones can begin to thin and lose density as we age, making them more vulnerable to fractures, which can then be slower to heal due to the abnormally thin bones. Thinning of the bones (osteoporosis) is extremely common in women over 65, with up to 50% developing it, and surprisingly common in men as well over 65, at 25% incidence. The bones of the thoracic spine (your mid spine) are at greatest risk for fracture, followed by the wrist bones and the femur bone (thigh bone) of the hip joint. Fractures from osteoporosis can lead to ongoing chronic pain, physical disability and, particularly with hip fractures, premature death. 

These factors and others, such the connection between the muscles and the neurologic system, can also lead to changes in posture and balance, which can also increase the chances of injury over time. An increase in general stiffness and pain can also arise with combinations of the above changes. 

On a brighter note, it has been noted in aging athletes, specifically long distance runners and cyclists, who maintain good cardio-vascular and respiratory function may see improved endurance in their sports compared to when they were younger! Here is a case where long term participation in physical activity pays off in improved function, not decline. This speaks directly to what we can do with regards to our lifestyle choices that can positively influence these changes of aging: stay active!  Regular exercise, modified to accommodate body changes such as arthritic joints or thinning bones, can help to slow, stall and even reverse many of these conditions. And for our purposes here, yoga can be an ideal standalone practice for some conditions, such as sarcopenia, and great in combination with other health practices for others, such as with osteoporosis or arthritis (which might also require medications and mineral supplements, for example). Eating a healthy diet and drinking adequate amounts of water to fuel and hydrate the body, and by extension these parts of the musculo-skeletal system, is another wise choice. 

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