Learning to Sit On the Floor, Part 1

by Shari

We recently received a question about learning to sit on the floor without support. Because we often write about the benefits of sitting on the floor (see To Sit or Not To Sit (on the floor)?), we thought having a little guidance for people who are currently unable to sit comfortably on the floor would be useful for a large number of people. So we decided to dedicate an entire post to the topic of how you can learn to sit comfortably on the floor. But let’s begin with the question:

Q: I’m a stiff Western guy who was brought up sitting on chairs and finds it really uncomfortable to sit crossed-legged on the floor even for a few minutes. Now I find that for my wedding, which will be a Hindu ceremony, I will be expected to sit on the floor for several hours. What can I do to get in shape for this? (My normal exercise routine includes running and weight lifting—I don’t do yoga yet at this point.)

First off, may I say congratulations on your upcoming wedding. How exciting for you, and you are to be complimented in your thoughtfulness for your desire to fully participate in your wedding's rituals. I don’t know anything about Hindu wedding ceremonies except what I have read about or seen in various movies but I do know that though you will be on the floor you won’t be totally motionless. What I don’t know is exactly what type of sitting posture you will be required to do for certain lengths of time. I would encourage you to discuss this with your fiancé but let us propose that you may be in kneeling or cross-legged positions all without external back support.

For you, and everyone else who wants to work on sitting without support, it might be helpful to break down the components of unsupported sitting. Which areas need to be both flexible and strong that you can work on during the upcoming months? We also need to discuss the role of breathing in enabling you to sit unsupported.

The vertebral spine and the diaphragm are major supporting internal structures of the human body. The spine consists of four curves that when properly stacked upon each other can withstand a significant amount of gravitational force to maintain the solidity of the curves. The curves allow the spine to move as well as to maintain stillness. Nestled deep within the pelvis—which connects the vertebral spine to the lower limbs/legs—is a very important bone called the sacrum. The sacrum and the two pelvic bones (ilia) are literally the bridge that forms the base of support that we need to sit. The femurs (thigh bones) connect into the ilia at the hip joint to widen the base of support. To sit unsupported in a cross-legged fashion, we need to provide good contact of the outer heads of our femurs (thighbones) with the ground.

There is a lot of discussion among health care professionals and yogis on what ideal sitting posture is and how to obtain it. But for our discussion we need to find you a doable position. The key is that when we sit unsupported we need to position our knees lower than our hips. This is easy to see when you sit in a chair without using the backrest. To obtain this position we typically need to raise our seat height up to widen the angle between our torso and our thighs. Typical chairs for standard height individuals have us sitting with our knees level to our hips and our torso perpendicular to the chair and this is termed 90/90 sitting position. But if we widen the angle of thigh to torso ratio to 135 degrees it is easier for us to lift up and lengthen our spines.

This is where I suggest you start. Place a pillow or folded blanket on the chair seat to raise your pelvis—this will allow your knees to be lower than your hips so your pelvis can roll over the head or your femurs (thigh bones) to re-establish your lumbar curve (your lower spine). Then you can lengthen or elongate your spine. This will help you learn to sit with your spine in a lengthened position and to support this posture from the “inside out.”

To learn how to stabilize the spine from the inside out we need to learn about our diaphragm, transversus abdominus, and pelvic floor musculature, and how they all assist in spinal stabilization, especially in a seated position.

The diaphragm is the dome-shaped sheet of muscle and tendon that serves as the main muscle of respiration and plays a vital role in the breathing process as well as internal stabilization. The origins (attachments) of the diaphragm are found along the lumbar vertebrae of the spine and the inferior border of the ribs and sternum. When we inhale, the diaphragm contracts and is drawn inferiorly into the abdominal cavity until it is flat. At the same time, the external intercostal muscles between the ribs elevate the anterior rib cage like the handle of a bucket. The thoracic cavity becomes deeper and larger, drawing in air from the atmosphere. During exhalation, the rib cage drops to its resting position while the diaphragm relaxes and elevates to its dome-shaped position in the thorax. Air within the lungs is forced out of the body as the size of the thoracic cavity decreases.

Diaphragm

Structurally, the diaphragm consists of two parts: the peripheral muscle and central tendon. The peripheral muscle is made up of many radial muscle fibers—originating on the ribs, sternum, and spine—that converge on the central tendon. The central tendon, which is a flat aponeurosis made of dense collagen fibers, acts as the tough insertion point of the muscles. When air is drawn into the lungs, the muscles in the diaphragm contract and pull the central tendon inferiorly into the abdominal cavity. This enlarges the thorax and allows air to inflate the lungs.

Due to its structural orientation, the diaphragm can be used to assist in torso stabilization for erect sitting along with contraction of the transversus abdominus muscle. The transverse abdominis muscle attaches to the thoracolumbar fascia and the deep erector back muscles between the pelvic bone and rib cage posteriorly and from the lower six rib cartilages, linea alba and the inguinal ligament anteriorly.  It extends the entire length of the anterior trunk.  Since it is the only abdominal muscle to attach to the posterior spine, it is considered the “human corset” of the trunk.

It is also helpful to work with your pelvic floor. The pelvic floor muscles create a hammock that spans the base of the pelvis from the front to the sides and to the back. Women often learn about these muscles after childbirth and are taught Kegel exercises to “strengthen” this area. You learn to engage the urogenital triangle without using the buttocks or tucking your tail to engage. In yoga mula bandha (root lock) is the “Kegel” and is taught to create strength and preserve energy of the body.

To learn how to feel the diaphragm and transversus abdominus, you can lie on the floor with your head slightly elevated and your chest opened. You can do this by folding three yoga blankets in an overlapping stepped or tiered position so the different layers of blankets support the curve of your lumbar spine, your thoraco lumbar junction and lastly your head (see Yoga Couch on gingergarner.com):

If this setup is too complex, you can try a Supported Savasana with your torso on a bolster (or folded blankets) and your head on a support. See Savasana Variations for info.

To sense the muscular actions of breathing, place your hands on the outer edges of your waist on your floating ribs. Gently firm and draw in the area just below your umbilicus and keep that area gently firm as you take a full breath in. As you inhale, notice if you can feel your lower rib angles moving out into your hands. As you exhale, continue to keep your lower belly engage as you feel your ribs return to their resting position.  Once you can do this breathing  in the reclined position, you can transition to doing it in hands and knees position and then to sitting in a chair to learn to create internal support in an upright position.

To learn where your pelvic floor is, sit on a soft but firm chair with your knees lower than your hips and gently bear down as in defecation. You should feel a slight bulging of your perineum. Then, try to lift your perineal area by tightening the muscles between your pubis and anus. You might also notice that you are drawing in your lower belly to do this, and that is okay because we often engage both our transversus abdominus and our pelvic floor muscles. Just make sure you aren’t tightening your buttocks to do this. Continue to practice this regularly while sitting in a chair until you have built up your tolerance and stamina.

Now let’s look at the more visually obvious muscles you need to work with. To sit erect for long periods of time—whether on a chair or floor—you need to have strong back muscles. These include deepest paraspinal msucles that run the entire length of your spine from head to tail, the deep spinal muscles that are longer and broader, and the more superficial larger back muscles, such as the latissimus dorsi, trapezius. A good way to begin to strengthen these muscles is by practicing simple backbends like Locust pose (Salabasana) with various arm positions and leg lifts (see Locust (Dynamic Version) for a few ideas) and Bow pose (Dhanurasana). 

You might also want to work on your back in Bridge pose variations (Setu Bandha Sarvangasana), especially working with the deep spinal stabilizers, which you can do with One-Legged Bridge or Marching-in-Place Bridge. You might want to have someone watch you when you do these positions to make sure that you can keep your spine neutral and not sag or twist. Also an all-fours position (see Hunting Dog Pose) with opposite arm and leg lifts will work the deep spinal stabilizers. Using a stick that is placed from your head to tail along your spine gives you nice feedback that you are maintaining a neutral spine. Please remember when you start doing these active training positions to use your deep abdominal/diaphragmatic /pelvic floor stabilizing breathing that was described earlier.

Next let’s look at flexibility of your spine. Begin with passive backbends that are nice and easy, such as lying over a bolster to arch your spine into a reverse “C” curve. Keep it gentle—don’t be too aggressive in increasing your arch. More is definitely NOT better. Work with nice deep belly breaths here, not your stabilizing breathing pattern. Cobra pose (Bhujangasana) is also a good way to build spinal flexibility as well as a gentle Cat/Cow pose.

Now it’s time to turn to the lower body and learn to stretch our hips, buttocks, and legs. Thread the Needle/Figure Four pose (Sucirandhrasana) will help you begin to stretch your tight outer hip muscles. Happy Baby Pose (Ananda Balasana) will also help begin to stretch your gluteal muscles and tight lower back fascia. You can practice version one of Reclined Leg Stretch (Supta Padangusthana), but you may find that a sustained single leg stretch through a doorway with one leg up the doorway and the other leg straight on the floor through the doorway is a nice way to hold a hamstring stretch for a longer time period without your hands getting tired gripping a strap. Different poses to stretch your hip rotators such as seated Cow-Face pose (Gomukasana) or Pigeon pose (Kaptosana) preparation are also helpful. To stretch your rhomboids (mid-back muscles), consider adding upper back stretches, such as Garudasana (Eagle pose) arms, to your seated poses.

Finally, we need to move to standing. Begin at the beginning with Mountain pose (Tadasana). You need to learn to stand erect first before you can sit erect.

From here, learning to do Half Downward-Facing Dog pose at the Wall begins to teach you how to integrate your arms, legs and torso.

Then we do have to move onto standing poses! I think by this time you may realize that it would be helpful for you to join a beginner yoga class and to learn to do a home practice. When you find a class that you like, I would recommend privately talking with the teacher and perhaps meeting with him or her to help you devise a doable home practice to target all the areas that you need to stretch and strengthen. With patience, perseverance and a sense of humor you will accomplish your goal! 

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Friday A: The Three-Part Breath

Ladder by Melina Meza

Q: I was taught the way to breathe is through the belly to the chest and ending in the sternum area.  I saw a video from Leslie Kaminoff where he stated he does it the opposite way meaning sternum to belly. So, what does yoga teach us? Does it matter?

A: I’ll start right off with the assertion that from my perspective there is no one right way of breathing. And from my exposure to different styles of yoga and different modern lineages of yoga, I have often encountered conflicting recommendations on how to imagine the breath is moving in the body or how it is filling the lungs. But, as our reader points out, one of the more commonly taught ways of imagining, experiencing or encouraging the breath to come in on the inhalation is often called the three-part breath. In this variation, you imagine that you are filling your belly area with breath first (reflected in the belly gently expanding before any other part of the body or chest changes shape), followed by your lower chest, and lastly your upper chest. As an example, if you decided to do this over the course of a three-second inhalation, you could divide the filling or shape change of each area of your belly and chest into one-second increments. Remember you are not actually breathing into your belly, as your breath only goes into your lungs, which are located inside your ribcage! We suggest to our students that the breath is going into the belly during a full, relaxed breath because of the change in shape that takes place in that area of the body, when the breathing muscle—the respiratory diaphragm that separates the chest and abdomen—contracts and pushes down on the abdominal contents, leading to the outward bulge of the belly.

The exhalation is then sometimes said to exit in the opposite direction, from your upper chest first, your lower chest next, and your belly last. When performed in a relaxed, deep way, this breath is said to shift your nervous system to the Relaxation Response (Rest and Digest), slow your heart rate and lower your blood pressure, to name three typical benefits. But everyone experiences the breath differently, so not everyone will have those results, especially when first learning to breath differently. When I travelled to India in 2005, I was taught the style of breathing that our reader describes in his question, just the opposite of the more common three-part breath I just described. It is the same one Leslie Kaminoff describes in video that our reader mentioned. In this version of the three-part breath, you first invite your inhale into your upper chest, then your lower chest, and finally your belly. You then move your exhalation out of your belly first—with the assistance of the abdominal muscles contracting—then your lower chest and finally your upper chest. 

When I was first guided into this breath, I immediately recognized that it was the opposite of what I had been taught back home. But I was curious to try it and see what it felt like. My instructors at the Krishnamacharya Yoga Mandiram claimed this breath reflected the spinal movements that more naturally occur with inhaling (slight backbend of the spine) and exhaling (slight forward rounding of the spine), and stated that it would lead to a deeper, longer, fuller lung capacity. I have worked with both styles of breath over the ensuing years, and I can say for certain that one is not necessarily “better” than the other. 

Sometimes teachers of one method or the other will claim that the breath style reflects the movement of prana or internal energy in the body. Some sources state that prana moves upwards towards the head on inhalation, and moves downward on the exhalation, so therefore the first style of three-part breath reflects and supports that. Other teachers have suggested that there are energetic benefits to drawing the prana downward on the inhalation and releasing it upwards on the exhalation; and that inhaling downward towards the belly flips the digestive flame downward toward the lowest part of the belly, where the ancient Hatha yogis felt we stored all kinds of waste and toxins we needed to burn up. 

As I shared this potential difference of opinion with my friend and very experienced yoga teacher Susi Amendola, she promptly suggested the following:

“There is no one right way to breathe. There is just the ability to observe our habits and adapt if you discover that you are limited in your breathing capacity. Why are you reluctant to do a particular method of breathing: does it hurt, is it just weird and unfamiliar, or are you wed to a particular technique because you feel it is the “right way” to breath? These first two aspects are more interesting ways of assessing your breath than deciding which is the right way to do it.” 

I was reminded of the response of some of my fellow students back in India after we were first introduced to the second version of the three-part breath. Several said they would refuse to try the second version again because it was not the way they learned in their tradition, and it was therefore not something they were interested in learning.

So, when you are learning new pranayama techniques, consider giving it a try and notice how it makes your feel and how that jives with the purported benefits of the technique. If you are really struggling with either form of three-part breath, ask your teacher for guidance. Lastly, pick your teacher’s brain to see what other tidbits of wisdom about the breath you can learn.  Also, keep in mind that there can be an accumulated benefit of doing the breathing techniques regularly for a while, just as there is when doing your yoga asana home practice each day.  So add in a regular pranayama practice to your home yoga practice if you have not done so already!

—Baxter

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Hyperextension of the Knees and Yoga

by Nina

Hyperextending!

Typically it’s not me who writes about anatomical aspects of the asana practice. After all, we’ve got both Baxter, an MD who teaches anatomy to yoga teachers and Shari, a physical therapist who teaches anatomy to yoga teachers, on our staff. But after reading Baxter’s post about the standing leg and knee in Warrior 3 pose (Vrbradrasana 3), I decided to write about hyperextension in the knee joints in general because, you see, I have it myself. And I have been working with it in one way or another for about fifteen years (after it was pointed out to me by a couple of my teachers). I decided that since I had a lot of knowledge about it, it would be good to get it down in writing. 

As Baxter said in his post, hyperextension of the knee joint means that your knee joint has a slightly greater range of motion in extension than the average person’s does. In other words, in people with hyperextension of the knees, when the knee is straight, instead of the femur bone on top and the shinbones on bottom forming one straight line, your knee joint bows slightly backwards. I’d like to add to what Baxter said by observing that when your knees are hyperextended, your kneecaps don’t face straightforward; instead, they turn in slightly, with the inner edges pressing back more than the outer edges (making you look a bit knock kneed). Also, with hyperextended knees, you tend to bear more weight on your heels than on the balls of your feet and your thighs press back so they are not aligned directly over your shins. All this unevenness in your legs, knees and feet is the reason there is concern about hyperextension, with concern that it could lead to uneven wear and tear on the cushioning cartilage of your knee joint, which could result in dysfunction and pain down the road. 

Rather than simply avoiding poses where you tend to hyperextend your knees, I believe that by observing the unevenness in your legs, knees and feet, and making adjustments, you can bring your legs, knees and feet into a healthier alignment. And in this post, I’m going to share with you how I do that myself.

First I’ll recommend that you test yourself to see if you have hyperextension rather than knock knees, and then I’ll describe a few techniques for correcting your alignment, both as you move into and out of poses and while you are practicing them.

Testing Yourself

1. Start by standing in front of a mirror in Mountain pose (Tadasana), with your feet together (yes, together). Now look at your knees. Are they turning slightly in toward each other and coming closer together than the rest of your legs? This could be either a result of hyperextension or knock knees.

2. Next, bend both knees by moving your shins forward and shift some of your weight from your heels to the balls of your feet. Then straighten your knees by lifting from your thighs, while keeping some of your weight in the balls of your feet.

3. Look at your knees again. Are they now facing straightforward with more space between them? If so, you have corrected your hyperextended knees. If there is no change, you may have knock knees. But try the adjustment once more just in case.

Moving into Straight Leg Poses

The technique you just used to correct your hyperextended knees in Mountain pose test is one that you can use as you move into any straight-legged standing pose. For example, if you are moving into Warrior 3 (Vrbradrasana 3) or Half Moon Pose (Arda Chandrasana), where you bend your knee first and then straighten it, you will bend your knee by moving your shin forward and shifting some weight onto the ball of your foot. Then, as you straighten your leg to come in the pose, you would lift from your thigh to straighten your knee as you keep some weight in the ball of your foot. (As you come out of the pose, use the same techniques to bend and then straighten your knee.)

Warrior 3

For poses such as Triangle pose (Trikonasana) and Pyramid pose (Parsvottanasana) where you normally move into the pose with a straight leg, you can try changing the way you move into the pose, as it is the front knee in these poses that you tend to hyperextend. Using Triangle as an example, you would take the foot position for the pose and raise your arms out the sides. Then, bend your knee by moving your shin and shift some weight onto the ball of your foot. Next, as you come into Triangle pose, lift from your thigh to straighten your knee as you keep some weight in the ball of your foot. Does it feel different to you?

Triangle Pose

Working in Straight Leg Poses

When you’re already in a pose, you can make adjustments to bring your legs into healthier alignment. 

First, in any pose with a straight leg, even balancing poses such as Tree pose (Vrksasana), you can slightly bend your knee and then straighten it again using the technique I described above. One week I tested this technique with every single standing pose in Light on Yoga, and found benefits in almost every single pose. In many poses, such as Dancer’s pose (Natarjasana), this adjustment brought me deeper into the pose!

Second, without bending your knee, you can try softening your front thigh muscles (quadriceps) and allow your thighbone (femur) to move slightly forward so it aligned more directly over your shinbone and more weight moves onto the ball of your foot. This will bring your leg into a straighter alignment. I just learn this one recently, and it works well in Half Moon pose (Arda Chandrasana).

Working in Seated Poses

In seated poses with one or more straight legs, including forward bends and twists, people with hyperextension of the knees tend to press the knee of their straight leg down toward the floor when their foot is fully flexed (vertical), hyperextending the knee. So, instead of flexing your foot in these poses, try pushing the ball of your foot a bit past your heel (without pointing your toes). I call this the “Barbie foot,” as it looks like the doll’s feet without her high heels on, and I’ve noticed Iyengar uses this foot position. The result is that your knee no longer hyperextends and—additional bonus!—your hamstrings soften a bit because pressing your front foot forward loosens the tug on the calf muscle, which then loosens the tug on the hamstrings, allowing you to come more deeply into forward bends. 

Moving into Bent Leg Poses

Remember that people who hyperextend tend to have knees that turn in slightly. So in weight-bearing poses with bent knees such as Warrior 1 and 2 (Vrbradrasana 1 and 2) or Extended Side Angle pose (Utthita Parsvakonasana), it’s a good idea to try to ensure that you’re bearing the weight evenly on your bent knee. Use the same technique of entering the pose by bending from your shin and moving some weight onto the ball of your foot. And, as you bend, pay attention to your inner back knee, deepening it as much as your outer back knee. This will help align your kneecap directly over your second and third toes and distribute your weight more evenly.

Extend Side Angle Pose

As you come out of the pose, use the same technique to straighten your leg as I described above, lifting from your thigh while keeping some weight on the ball of your foot. 

Thanks, Donald!

Whew! That’s it for now. I’d like to end by saying that I learned almost all of this from my teacher Donald Moyer, both while I was training with him to become a yoga teacher and in his ongoing classes. I'm very grateful for all that and more....

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Unity Farm Journal - 4th week of June 2014

Last weekend, we had two days of clear, warm weather, perfect for harvesting vegetables, inoculating mushrooms, and caring for bees.

We received 40 pounds of mushroom spawn from our supplier, Field and Forest, and we created two new mushroom areas - 4 raised beds of compost with Agaricus (almond mushroom) and 12 new stacks of logs with Oysters.    The Golden Oysters are beginning to fruit in the warm humidity of summer afternoons.

Eating on the farm can be as simple as taking a basket to the hoop house and gathering a potpourri of delectable vegetables.    Sunday’s brunch was a bowl of fresh strawberries, handfuls of snap peas and tender zucchini pancakes.

We’re at the height of nectar production on the 15 acres of the farm and our 12 bee hives are storing away honey at a rapid clip.   At this point, we’ve done our best to gives the bees their best chance to build up brood and food stores for the winter ahead (yes, Christmas is 6 months from now).   When nectar flows stop in July, all the food reserves until next Spring will have been stored.    Here’s what the bee yard looks like as of this morning.    Plants like borage, chamomile, and clethra line the bee yard, while salt marsh hay keeps the weeds to a minimum.

This weekend includes many animal care tasks, updating immunizations, ensuring that our pregnant alpaca are healthy for their upcoming late July deliveries, and moving the keets (baby guinea fowl) that were hatched by the ducks to the coop.     On a farm, you never know what each day will bring, so I look forward to the 12 hours a day of joyful work that awaits.

Ashtanga Yoga: Following the Eight-Fold Path

by Ram

Eucalyptus by Melina Meza

Misconception 1: Yoga means The Mat & Asanas.

Reality: This is a common misconception. In reality, yoga is one of the six schools of Hindu philosophy that describes: 1) our true nature, 2) our goal/purpose in life, and 3) the means to achieve the goal. Thanks to Swami Vivekananda, yoga came to the West in 1893 and found a very receptive audience. Yoga philosophy has its origin in the Vedic texts that address health and health practices. If ayurveda is the healing aspect, yoga is the spiritual/practical side of the Vedic teachings.  Together they emphasize a complete approach to the well being of the body, the mind, and the spirit. In fact their close relationship has even led to some scholars arguing that Patanjali, considered by many to be the father of yoga, and Charaka, often considered as the father of ayurveda, may have in fact been one and the same person known in Vedic India by different names during his travels to spread the teachings of these ancient sciences.

The underlying principle of the yoga philosophy is the fostering of the wellbeing of an individual at the level of body and mind, and helping an individual re-connect to his/her true nature through direct and personal experience (pratyeksha in sanskrit). Thus, yoga prepares the body and mind of the individual for eventual liberation and enlightenment.  

Misconception 2: Yoga Philosophy deals with different asanas or postures to achieve union of the mind and body. 

Reality: In today’s world, yoga is often thought of as “asanas only,” something like a stretching tool to keep the body limber and agile. People are drawn to yoga as a way to keep fit even though the idea behind the physical practice of yoga is to help the mind to become clear or pure and develop deeper mind-body awareness. A clear mind is not affected by stress and produces a healthy body, thus creating a greater connection with one's own pure, essential nature. Yoga philosophy describes achieving mind-body awareness through the four-fold path, namely: 

1. Karma Yoga: The yoga of selfless-action. Any individual can achieve mind-body awareness and ultimately attain enlightenment by practicing self-less service (seva), without expectations for service provided. As a result, the practitioner’s heart and mind become pure, the ego is subdued and the light of divinity shines through them.
2. Bhakti Yoga:  The yoga of devotion. Any individual can achieve mind-body awareness and ultimately attain enlightenment by chanting devotional hymns and engaging in devotional ceremonies.
3. Jnana Yoga: The yoga of knowledge. Through study, inquiry, reflection, and awareness, a practitioner’s consciousness is able to pierce through the illusory world, achieve mind-body awareness and ultimately attain enlightenment. 
4. Raja Yoga: The Royal Path of Yoga or the Yoga of Practice, a philosophy of mind-body awareness that was outlined by Patanjali. One reaches enlightenment by practicing the eight-fold path of self-realization.

Misconception 3: Ashtanga Yoga is a style of yoga founded by Pattabhi Jois.

Reality: While the above is true, the actual term “Ashtanga Yoga” (ashta=eight, anga= limbs) refers to the eight-fold path/eight rungs/limbs/steps of yoga as described in the Raja Yoga section of the yoga philosophy.  Its practice helps us to discriminate between ignorance and awareness and truth from illusion, which is the means for liberation or enlightenment. In the Sadhana Pada of the Yoga Sutras by Patanjali we are introduced to the concept of Ashtanga Yoga. Verse 2.28-2-29 declares:

yoga anga anusthanad ashuddhi kshaye jnana diptih a viveka khyateh
yama niyama asana pranayama pratyahara dharana dhyana samadhi ashtau angani

Through the practice of the different limbs, or steps to Yoga, whereby impurities are eliminated, there arises an illumination that culminates in discriminative wisdom, or enlightenment. The eight rungs, limbs, or steps of Yoga are the codes of self-regulation or restraint (yamas), observances or practices of self-training (niyamas), postures (asana), expansion of breath and prana (pranayama), withdrawal of the senses (pratyahara), concentration (dharana), meditation (dhyana), and perfected concentration (samadhi).

In future posts, I'll discuss each of these eight limbs individually. Until then, you can use the search function on our blog to find posts from our archives on some of these topics, including the yamas, pranayama, meditation and so on.

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Interoperability in Real Life

On Monday afternoon my wife was speaking with my 82 year old father-in-law, when he began speaking in word salad - not slurring his words, but clearly speaking words that made no sense.   He had no numbness or weakness, no confusion, and no change in consciousness.  After 5 minutes all symptoms resolved.

My wife called me and after hearing the history, I knew he was having a transient ischemic attack (TIA).   Given that he was stable, I recommended that we coordinate an immediate hospitalization at a site suggested by his primary care physician (PCP) rather than take an ambulance to a random nearby location.     My wife called his PCP and was given a choice of two hospitals - one with IT systems I control and one with IT systems I do not.   She drove him to the hospital that offered care coordination via interoperable IT systems.

My father-in-law has records at 3 locations - an academic medical center (home built EHR), a community hospital (Meditech), and a multi-speciality practice group affiliated with but not owned by BIDMC (Epic).

Upon arrival at the Emergency Department, he had a blood pressure of 180/90.   The physician asked - what is his baseline blood pressure and has it varied over the past 6 months?   The physician clicked on the external records link we’ve placed in Meditech and he immediately viewed my father-in-law’s blood pressures in his PCP's Epic system.

He then asked about recently specialty care.  One click later, all this information appeared from the academic medical center.

His care was materially different because his continuous lifetime record - inpatient, outpatient and emergency department - was available without going to a separate portal or  adopting a new workflow.

Over 24 hours, he received an echocardiogram, EKG, carotid ultrasound, and MRI.   All were essentially normal and he was started on aspirin and will followup with a neurologist recommended by his PCP.  Upon discharge, he was given a meaningful use care summary and a transition of care document was sent electronically back to his PCP.

Interoperability becomes much more real when you watch your own family members experience it.    As I’ve said before, the end of paper records and data silos will happen in our lifetimes.  This will not be a problem we pass along to our children!

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The Standing Leg and Knee in Warrior 3 Pose

by Baxter

A funny thing happened a few weeks back as I watched my teacher trainees teaching one another: I saw things happening in their bodies that I miss when I am  the one teaching. That is the benefit of sometimes just watching what’s happening around you! And the most interesting thing I noticed was what happened to the standing leg and knee when one of them was teaching Warrior 3 to the others. I am fond of Warrior 3, and often also frustrated by it, too. It requires balance, strength and flexibility in different parts of your body. Your standing leg hamstring has to be flexible enough to straighten at the knee while your pelvis, top leg and torso all tip over it. Your back body muscles have to be strong enough to keep your top leg, torso and sometimes arms all in one long line parallel with the floor resisting the pull of gravity. Your shoulders have to be flexible enough to take the arms overhead for the full expression of the pose. And those are just the most obvious things going on!

What I saw that day relates to the alignment of the standing leg knee joint and is most relevant to you practitioners out there who know you are prone to hyperextension of the knee joint. Hyperextension of the knee joint means that your knee joint has a slightly greater range of motion in extension than the average person does. In other words, in people with hyperextension of the knees, when the knee is straight, instead of the femur bone on top and the shinbones on bottom forming one straight line, your knee joint bows slightly backwards.

Nina Hyperextending Her Knees

There is some controversy as to whether this is a problem in the long run. On the one hand, it likely allows those of you out there with this kind of knee joint the ability to do many of the more challenging yoga poses where the legs are straight. God knows I could use a bit of that openness in Standing Forward Bend (Uttanasana)! But there is some concern that it could lead to uneven strain on the supporting structures of the knee and could also lead to uneven wear and tear on the cushioning cartilage of your knee joint, both of which could result in dysfunction and pain down the road. So, it may be worthwhile to minimize hyperextension in the knees when possible!

What I noticed that fortunate day was the following: When the students did the Warrior 3 variation in which the legs and torso are parallel with the floor and the arms are out to the sides of the body at a 45 degree angle, the standing leg was very vertical and I did not observe much hyperextension in the 8 or 9 students who normally exhibit this tendency in some of their standing poses.

But the moment they shifted to the “full” pose, where the arms are brought forward along side the ears, am amazing thing happened: everyone’s center of gravity shifted a bit forward in the body, and the body appeared to slide back a few inches in space.

And in that moment, all my hyperextenders hyperextended in that bottom knee in unison!!! It was silent, but visually exploded into my awareness! I was stunned, but it was confirmed when they did the pose on the second side. What’s a newly enlightened (at least in this case of Warrior 3) teacher to do? Share the news with you all, of course. I have been teaching the pose in the last two weeks, and I am continuing to see this pattern of vulnerability in the knees of my students who have extra flexibility. 

You may be asking yourself what to do with this new information? If you are a stiff practitioner like me, you won’t need to do anything with it personally, unless you teach. Then I’d suggest you confirm this observation for yourself in some of your students. But if you have flexible knees yourself, you might observe your Warrior 3 from a side view in a mirror or have a trusted friend or teacher watch you in each Warrior 3 variation and see what happens in your knees.

If you do note a significant increase in hyperextension in the full pose, you might skip it (doing only the version with arms out to the side) or do it less frequently. Alternatively, check with your yoga teacher to see if he or she has techniques that you can use the bring your standing leg in full Warrior 3 into a healthier alignment. If so, try using those techniques to adjust the alignment of your standing leg in Warrior 3 both in class and when you practice at home. After all, this is a modern yoga pose, and in my book that means you can modify and adapt it to suit your unique needs. I hope this information is useful in the ever-changing exploration of your yoga practice.

Cautions: If you have low back pain, you may have to drop your lifted leg a bit lower or bend your back knee to reduce the weight stress this pose puts on your lower back (even a micro-bend to the lifted leg can be helpful). If you have arthritis of the neck, you may want to avoid lifting your head to face forward. As always, use common sense. It if hurts to do the pose, come out and ask your teacher for some feedback about what you’ve been doing. If balancing is a big problem and you’re just getting frustrated, return to the wall version.

If you’re having a lot of trouble and want to work your way gradually into the pose, you can do the pose at an angle instead of parallel. For more tips, see Nina’s post Taking on a Yoga Challenge. For additional instructions, read our entire post on Warrior 3 Variations.

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