Yoga for the People (and Healthy Bones)!

by Shari

With the recent passing of BKS Iyengar (the teacher of my teacher, Donald Moyer) and the exponential growth of yoga inspired by Mr. Iyengar, I have been thinking a lot about health outcomes and why yoga is such a powerful self-help tool. You see, in my day job as a home health physical therapist, health outcome is measured very differently than it is in a complementary alternative health care model that yoga falls within.

My patients too often don't get better. My job in aiding their recovery often feels like I am trying to put a small Band-Aid on a gaping wound. I can’t change the situations that lead to their poor health. They suffer from the chronic life challenges of poverty. Years of poor health management, from an uncaring overworked, depersonalized, underfunded health care delivery system, and the chronic stress from living marginalized lives lead to chronic health issues. To often these patients are living in polluted urban environments, where walking is not done by choice because it is unsafe. They also are victims of poor health from years of eating processed, nutritionally void meals. The places where they live are commonly food deserts, where fresh food is unavailable without having to take public transportation via circuitous routes. Many of my patients don’t have cars. My care often feels inadequate because I can’t change their life circumstances even when they are doing all they can do to regain their health.

For example, J was in her early 80's when I met her. She was a homemaker, a long-time smoker who had remained physically inactive though very slim. She had been diagnosed with osteoporosis in her 60's and her family started a walking program with her. They also enrolled her in a senior exercise class at the near by senior center. She was pretty stabile for about 15 years and maintained independent living in her own home. But then her husband became ill, and she couldn't care for him any longer, so he was institutionalized. He died approximately one year later. After that she had a bout with pneumonia and her long history of smoking finally caught up with her; she was diagnosed with chronic obstructive pulmonary disorder and became oxygen- and steroid-dependent for respiratory management. She was also placed in an assisted living facility by her family because of frequent falls due to leg weakness. I was her home health PT. She was compliant with her exercises but wasn't really walking more than a couple of steps because of extreme fatigue. Also, she suffered from several osteoporotic fractures from "hugs" from her family. She was really upset by this because she felt like she was crumbling from the inside out. The pain from the osteoporotic fractures and the immobility from not walking and being pushed in her wheelchair by staff further eroded her overall health. She died in her sleep—with no major medical cause—several weeks after I discharged her. 

So you might be wondering, could yoga have helped J? I believe that if it had been a part of her activity regimen when she started her walking and exercise class that it would have. Yoga could have helped J with her sense of physical and emotional loss as she lost her independence and her home. Guided strength training for specific bone strengthening positions might have slowed her progressive osteoporosis. Unfortunately I will never know for certain because her care was limited by her HMO insurance company and I was only given four visits and told to "get her back onto her feet." 

In my more cynical moments I am disgusted by the public degree of privilege that American yoga seems to support. The visual images of perfect woman and occasionally men shine from the glossy covers of popular mainstream yoga magazines, with headlines urging pursuit of the “perfect yoga body” and touting delicious organic recipes, not to mention hyping over-the-counter supplements for “health” or lovely yoga fashions to enhance your practice of yoga.

So when the accolades of the wonders of yoga are constantly cited sometimes I can’t take it. But then I remember B.K.S. Iyengar and how he really did bring yoga to the people and how he did make it accessible to everyone. I also remember that yoga is more than asana—that it truly is a credo on how to live your life for the greater good.

So in this spirit of inclusivity and my own belief that the best way to deal with health challenges is through personal empowerment, I am starting a new beginner-level yoga class focusing on bone health called Yoga for Healthy Bones, both to honor J and to support my general yoga students who, as they are aging, are being diagnosed with bone loss from either osteopenia or osteoporosis. This class will provide camaraderie, creating a community of mutual support as well sharing, which the class members can engage in if they so desire. There is nothing better in self care than learning what worked or didn't for individuals with similar diagnosis. And, most importantly, this will be a venue where people can practice yoga without fear of hurting themselves.  

I am personally very impressed with the work and level of dedication that Dr. Loren Fishman has provided for his patients through his ongoing medical study on the efficacy of yoga in building bone density. This class will incorporate some of his basic principles of bone stimulation as well as focusing on many of the safe beginner level standing and seated poses for osteoporotic individuals. If you live in or are visiting the San Francisco Bay Area, come and join us on Sunday afternoons from 4:00-5:30pm at the Yoga Room in Berkeley, California (see yogaroomberkeley.com).

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! 

recomended product suport by amazon

Spinal Movements: How to Keep Your Spine Safe

by Shari

We recently received this query from a reader about contraindications for spinal movements:

When are extension and flexion of the spine contraindicated. I have a patient who has issues with L5 and L6. I guess extension (backbends) would be contraindicated, correct? Also what about folks who have issues with inter vertebral discs? And what about people who have a hump in the cervical-thoracic region?

These are actually very complex questions but I will try to stay on track here. My previous post All about the Spine  gave some background on how the spine changes shape in various movements, including forward bending, back bending, twists, and side bending. Now I like to think about the spine as a train where the head on the neck is the “engine, the subsequent vertebra are the train, and the coccyx is the “caboose.”

All these separate vertebrae are connected to each other by numerous ligamentous attachments. Anterior is a long ligament that runs down the front of the vertebrae from C1-S1 and posterior is long ligament that runs down the back portion of the vertebrae. This sandwiches the vertebrae so they don’t slide forward or backward in relation to the individual top- and bottom-connecting vertebra. There are also many other types of connecting ligaments between different portions of the spine. Again, the function of all the ligaments is to keep the spine stable, and to allow coordination of movement but not too much movement at specific vertebral levels!

Anterior and Posterior Long Ligaments of the Spine

Now the interesting thing about ligaments is that they don’t have much stretch to them. In fact they don’t really stretch at all because they are stabilizing structures. What that means is that they limit movement in the spine. This is a good thing since the spine houses the spinal cord.We really don’t want to tug or pinch our spinal cord because it is the main power house that connects our brain literally to our bones and muscles and allows us to move when and how we want to.

Between each vertebra sits a cartilaginous structure called an intervertebral disc that is connected to both the top and bottom vertebra. The discs are the shock absorbers of the spine and they absorb the motion at each vertebral level.

Lumbar Vertebrae (L1-L5)

Now lets talk about what happens when there is a problem at a specific vertebral level. We can have “cranky” backs and sometimes it doesn’t take a whole lot to have your back “go out” (actually I dislike this expression because the back isn’t going anywhere so it can’t really go “out”). However, there can be areas of the spine that are more sensitive to movement. The question asks about L5 and L6 specifically. Now there aren’t a whole lot of people who actually do have an L6. Typically we only have 5 lumbar vertebrae (L1-L5), and L5 is often injured or fragile in a lot of people from different causes.

When there is a specific vertebral level that is injured, it is important to understand what the actual injury is because then you can understand how to take care of it.

There are specific spinal conditions where forward and backward bends should specifically avoided, including recent spinal surgeries, recent or acute disc injuries, or any acute injury where pain is a true warning sign not to proceed. For spinal instabilities like spondylolisthesis  back bends should be avoided, and if you have facet arthritis of the spine in lower back or neck, backbends may aggregate this kind of arthritis pain. Also, with rheumatoid arthritis and other conditions where ligaments are adversely affected, all yoga postures will need modifications to avoid over stressing ligamentous attachments.

But specific level vertebral injuries can be challenging because you can’t just stop that area from moving Movement allows the intervertebral discs to get nutrition and hydration. When the spine is prevented from moving whether from medical intervention (like surgery) or wearing a rigid brace to prevent movement, sometimes the injured area heals but due to immobility a lot of other areas of the body aren’t very happy. When there is a disc injury, allowing some flexion and extension is encouraged but the issue is the degree of motion. So what you can do is to learn how to move without causing further injury.

When I say it is important to learn how to move, what I mean is that often when people do forward- or back-bending asanas, the movement isn’t well distributed along the spine and certain areas take more of the movement in an unhealthy way. When vertebrae are stiff or there is a particular loss of motion in one area, another corresponding adjacent area will move more to correct the motion loss. This isn’t a conscious action but the body learns how to make due with what happens. So if the L5 doesn’t move well then the vertebra above it, L4, will begin to move more to compensate for the loss of movement at L5, and S1 (the top of the sacrum) will also move more than it should to also compensate. This motion loss can occur anywhere along the spine, though certain areas are more predisposed to motion changes and this is how problems develop.

But in situation described by the reader (issues with L5 and L6), should the student practice forward and back bends? Well, there isn’t really a simple answer. Remember, the spine needs to move. So, the answer is yes, but with careful attention to form and detail. I like to think about making the movement long and soft, not short and tight. There is always a quality of “work” in every active asana, but the key is how much work is safe? There should never be sharp point of specific pain and there should never be asymmetrical pain.

Now the last part of the question, about the hump in the cervical/thoracic region, In a previous post Kyphosis (Dowager's Hump), Baxter described several causes for this rounding of the upper back. While it is sometimes caused by a structural issue like scoliosis or osteoporosis, other times rounding of the upper back is due to long-standing postural habits and a long life of sitting at a desk working with the head in a down position. At a certain point the individual may no longer be able to correct the curvature by standing up straight. In these instances, where there is no actual medical contraindication, then gentle passive backbends are a wonderful approach to the upper back rounding.

A passive backbend over a bolster or blanket roll (lying on your back with your knees bent using a bolster or a blanket roll perpendicular to the torso) to help change the upper back curve is beneficial as long as the neck and lower back are protected so they don’t arch too aggressively. Also, learning to relax as well as stretch the diaphragm  are also helpful, which you can do with a gentle Cobra pose or  supported Upward Bow (Urdhva Dhanurasana) with a chair. Another very accessible backbend for the upper back is Supported Bridge pose (setu Bandha Sarvangasana on low blankets (one for torso and one for legs, with or without a belt tied around the legs).

Ultimately, to keep healthy, your spine needs to move daily through a full range of motion. Our daily lives limit our motion dramatically, so this is where your yoga practice plays a powerful role in spinal health. With attention to your breath, intention of non aggression in your practice, and a healthy dose of common sense we can encourage our spines to move safely in our practice. Then the key is to take these skills back into our daily lives to encourage more healthy motion.

recomended product suport by amazon

All About the Spine: Anatomy and Movements

by Shari

Recently in my classes and private sessions I have been receiving a lot of questions about the spine and exactly how it moves in different yoga poses. I thought I would do a blog post to summarize basic spinal anatomy and what the yoga practitioner needs to consider when practicing. I believe it is important for us to learn about spinal movements so we can begin to understand why one movement feels good to do while another movement either hurts or just doesn’t “go anywhere.” Many of our teachers are very skilled in the instructions they give us, but, for me, I always think that it is important to understand the why (I have never been very good about blindly following orders).

Let’s start with the anatomy of the spine. The spine is composed of separate vertebrae, which are separated into five regions of the spine. The cervical spine is the neck area and there are seven cervical vertebrae. The thoracic region is the area that begins at the level of the collarbones (clavicle) and extends all the way down to the waist. The thoracic vertebrae connect to the ribs, and there are 12 thoracic vertebrae and 12 paired ribs. The lumbar region begins at the bottom of the rib cage and extends into the pelvis. There are five lumbar vertebrae and the last vertebra sits on top of the sacrum. The sacrum consists of five vertebrae fused into a single bone (the five are initially un-fused at birth, but begin to fuse in our late teens). It is joined on each side to the pelvis and sits deep to the pelvic basin. At the bottom of the sacrum, we find the coccyx, which is composed of three vestigial vertebrae—our “tail” of bygone days.

It is important when learning about the spine to view it from multiple angles, including sideways, front facing and back facing. When you view it from these three angles, you can begin to appreciate the beauty and complexity of the spine. Some of the things that you may notice immediately when looking at pictures or, better yet, a three-dimensional model, of the human spine is that the various regions look different. The cervical vertebrae are petite and small in size, the thoracic vertebrae are bigger, with longer and more angled spinous processes, and the lumbar vertebrae are much more massive and substantial.

Also, it is apparent that the spine is not a rod but has four basic curves. The cervical region curves inward (concave), the thoracic spine curves outward (convex), the lumbar spine curves inward (concave), and the sacral region curves outward (convex). The shape of the spinal curves are important for transferring the load/weight. Maintaining those curves with weight-bearing forces keeps the spine healthy with minimal deterioration of joint surfaces. The cue that we sometimes hear in yoga class to keep our spine “straight” is a misnomer, because naturally the spine is curved! We don’t want to take the curves away but we do want to balance where the movement occurs.

Another point to consider is that the shape of the spine will change when we move through a range of motion in our daily lives as well as in our asana practice. Whenever we sit, stand, walk, reach, lie down, and so on, we are changing spinal position. Sometimes the adjustments are small and imperceptible, and other times they are much more global. Going from sitting to standing changes the spinal curves in small degrees, while going into a deep forward bend or backbend changes the curves more dramatically. The muscles that attach to the spine are forever working to keep the spine stable in whatever position we are in.

There are four specific movements that the spine moves through. When we bend forward and curve the spine (reversing the lordosis of the cervical and lumbar region and exaggerating the curve of the thoracic region) this is called flexion. We cause spinal flexion in forward bends whether in a chair or seated on the floor. The degree of forward bend is generally limited by our leg and back flexibility. Some very common forward bends that require different degrees of flexion could be Seated Forward Bend (Paschimottanasana) and Plow pose (Halasana), which you could think of as an upside down from of Seated Forward Bend.

Why do I say there are different degrees of flexion? Well, for someone who is very tight in their legs or in their back muscles, just the act of sitting in Staff pose (Dandasana) with a lift under their pelvis is very challenging. Their natural inclination might be to sit in a rounded back or flexed spine position to start and then when they bend forward even more this becomes an unhealthy forward bend because there isn’t good distribution of the change in the spinal curve.

For the tighter student, learning to sit with their spine in neutral curves is the way to begin practice for spinal safety. The student who has a lot of flexibility in their hamstrings may have tight back muscles so when they bend forward there is no change in their spinal curves—both examples are extremes.

The key to healthy forward bends, whether in Paschimotanasana or Halasana, is for there to be “ease” in the bend.  The same principles apply to standing forward bends like Pyramid pose (Parsvottanasana). Props like chairs, bolsters, and blocks allow you to find the shape of the pose without the struggle of getting into a pose you aren’t ready for.

The opposite of flexion is extension. In extension, the curves of the cervical and lumbar region are deepened and the curve in the thoracic region is lessened. We extend our spines in classic backbends like Upward Bow pose (Urdva  Danurasana) Upward-Facing Dog pose (Urdva Mukha Svanasana), and Camel pose (Ustrasana).

Of course, our spines can also twist, as when we turn to look behind us in a car. We twist our spines in seated twists, such Bhajrajasana, or Marichyasana, and in standing poses, such as Triangle pose (Trikonasana) and  Revolved Triangle pose (Parivrtta Trikonasana). And in certain poses we combine both flexion and twisting as in Parivrtta Janu Sirsasana. Poses with both extension and twisting are less common, but one example is the One-Legged Downward-Facing Dog pose with a twist.

Finally, we can side bend, as when we reach down to pick up something like a handbag or grocery bag that is next to our foot. We side bend our spines in side-bending yoga poses, such as Gate pose (Parighasana). And in many poses we combine both side bending and twisting, such as in Triangle pose (Trikonasana) and and Revolved One-Legged Forward Bend (Parivrtta Janu Sirsanana). Generally, we don't purely side bend without some twisting or purely twist without some side bending, though the primary movement will look like side bending or rotation.

The key concept to protecting your spine in all your poses is understanding where we want to encourage the movement and how to distribute the movement so as not to cause excessive motion  at one vertebral level. Another key concept is to avoid using momentum to push through “resistance.” When we are overly aggressive in attempting to gain motion this is where injury will surely occur.

So let’s break down this concept of spinal motion a bit more. If we understand that different parts of our spine move more in certain movements, does this mean that certain asanas will affect different parts of the spine differently? Yes, absolutely! The cervical and lumbar regions are concave when the spine is at rest. When we move into a backbend, these areas become more concave in relation to the curve reversal of the thoracic region. Because the thoracic region is stabilized from the front (anteriorly) by the rib cage and from the back (posteriorly) by the long spinous process, there is relatively less curve reversal from convex to concave in this region. As we move into a forward bend, the rounding of the thoracic curve increases into more of a convex shape. The opposite occurs in the cervical and lumbar spines; they start in relative concavity and as the forward bend moves throughout the spine, their shape changes from concave to relatively convex.

In twists, it is important to encourage full spinal involvement, but also to understand that the majority of the twist will occur in the cervical region, followed by the thoracic region and lastly the lumbar region. There is very limited rotation of the lumbar vertebra due to their specific structural construction. Also, please try to avoid allowing your spine to round or flex whenever doing twists. The key to healthy twists is to keep the spine long, with a good conscious control of maintaining the curves as you twist. This is often erroneously called keeping the spine “straight”, but now you know better when you hear this cue from a teacher!

When you practice, try to picture how your spine changes shape from the starting position into the position of the asana and then back to starting position. This is your experiential anatomy lesson of flexion (forward bending) and extension (backward bending), and twists. 

recomended product suport by amazon

Acute Orthopedic Injuries

by Shari

In my role as a physical therapist and yoga instructor, I see lots of clients and yoga students who have experienced both acute and chronic orthopedic injuries. In western medicine, an injury is considered acute rather than chronic when it is less than three months old from onset. In general, an acute injury is an injury that occurred as a result of a traumatic event, including:

• Muscle pulls
• Ligament sprains
• Fractures
• Dislocations
• Contusions (bruises)

Signs of an acute injury generally include one or more of the following:

• sudden, severe pain
• swelling, often with the inability to place weight on a limb
• extreme tenderness on palpation of limb or other body part
• inability to move a joint through full range of motion,
• extreme limb weakness, visible dislocation or breakage of a bone

In general, there are two types of acute injuries: an unexpected acute injury and a cumulative trauma. An unexpected acute injury is one that is sudden and immediate, for example, the result of a skiing accident or a fall. My friend Shelly Prosko, who will write a post for us in the near future, experienced an unexpected acute injury when she was Double Dutch skipping and ruptured her Achilles tendon. On the other hand, a cumulative trauma is one that has been building up for a long time, possibly due to micro-injuries to a specific, vulnerable area until a final “last straw” movement causes the injury. This was the case with my right knee medial meniscal tear, which happened during a yoga class when I was doing the same pose I had been practicing for many years.

After you experience either type of acute injury, you have a dilemma: do you seek immediate medical advice or practice the “wait and see” method? Obviously if you think you may broken a bone, have a concussion, are bleeding profusely or are in excruciating pain, you should go to the emergency room. Otherwise, if the injury seems minor, you can take a 48-hour wait and see approach. During this 48-hour assessment period, you can practice R.I.C.E first aid:

REST: The first 24-48 hours after the injury is considered a critical treatment period, and you should curtail your activities. Gradually use the injured extremity as much as you can tolerate, but try to avoid any activities that cause pain. Often using a splint, sling, or crutches is necessary to adequately rest the injured body part.

ICE:
 For the first 48 hours post injury, ice the sprain or strain 20 minutes at a time, every 3-4 hours. The ice pack can be a bag of frozen vegetables (such as peas or corn), allowing you to be able to re-use the bag. Another popular treatment method is to fill paper cups with water then freeze the cup. Use the frozen cube like an ice cream cone, peeling away paper as the ice melts. Do not ice a sprain or strain for more than 20 minutes at a time! You will not be helping heal the injury any faster, and you can cause damage to the tissues!

COMPRESS: Use compression when elevating a sprain or strain in early treatment. Using an Ace bandage, wrap the area overlapping the elastic wrap by one-half of the width of the wrap. The wrap should be snug, but should not cut off circulation to the extremity. So, if your fingers or toes become cold, blue, or tingle, re-wrap!

ELEVATE: Keep your sprain or strain elevated, higher than your heart if possible, to reduce swelling. Elevate at night by placing pillows under your arm or leg.

One of the most wonderful positions for reducing swelling (edema reduction) is Legs up the Wall pose (Viparita Karani). And you can even do this pose in bed if your bed is next to a wall and you have the agility to position yourself into the pose. If this isn’t possible, you can try using two bolsters propped up against a chair instead of a wall, especially if you have someone to place the bolsters for you. However, in acute trauma, this pose may NOT comfortable so short bouts might be more beneficial than longer periods of time.

Another spectacular pose for edema reduction is Chair Shoulderstand (see Judith Lasater's Favorite Poses), which you can do in a more passive position with your legs perpendicular or in more active position with your legs upright. The more passive pose is to rest your legs against the chair back, which requires less physical work and allows more relaxation (although this creates more of a backbend).

As you practice your R.I.C.E, keep assessing your pain levels. Sometimes the severity of an injury isn’t apparent immediately but if the pain worsens as the hours progress, this is a good indicator to seek medical care.

Ok, so your 48 hours have passed and you have religiously been practicing R.I.C.E. but you are no better, but no worse. At this point it is time to go to a medical doctor and learn as much as possible about the different possible treatments for your injury and then go through a careful decision process. And yoga can help you through all this.

In my situation with my right knee medial meniscal tear, I waited over six weeks of my own “conservative care” approach before the grim reality hit that things weren’t getting better. I didn’t follow my advice of getting medical help after 48 hours because I thought I could just heal my knee with a lot of RICE and restorative inverted poses. It did slowly get better over the six weeks but I reached a plateau in regaining movement and decreasing edema, and finally acknowledged I needed to be evaluated and diagnosed by a physician. (And frankly, I do have “white coat syndrome” and found it is easier hide my head in the sand and not acknowledge that my injury was more serious than I thought. There was no actual injury so I kept hoping it would get better. Sometimes we ALL practice avoidance!)

I then entered into the traditional medical model (see Fizzy Yoga!) and began non-surgical medical interventions. Along the way, I realized that I needed to add other C.A.M. (complementary alternative medical) approaches to my other endeavors. I realized that I needed to address all five koshas and sought out other medical practitioners that I trusted to aid me in my healing not just by addressing the physical injury but also by preparing me for the question that I had been avoiding: was I going to opt for surgical repair of my meniscal tear?

I meditated on the reason I wanted surgery and what would I gain from it. I had never in my 58 years had ANY surgical interventions, so even to contemplate surgery was a huge question for me to come to grips with. Many people told me to “just have the surgery, it is no big deal,” while others told me horror stories about failed meniscal surgeries and a NY Times article on why knee arthroscopy doesn’t work. But the surgeon who I consulted for this procedure was spectacular. He told me point blank that the decision was mine, but that I couldn’t be on the fence about it. I needed to believe it was the right choice for me. He even went as far to tell me that I could cancel in the surgical suite before anesthesia if I wanted to. His words changed the power dynamics and allowed me the space to meditate on my own fears and come to terms with them. He would do his job, but I had to do mine also.

Yoga helped me through the surgical process in many ways. Pre-op as I was waiting to be brought into the surgical suite, I was in a "comfy" type room with a recliner chair. I lay in that chair, covered myself with the blankets and practiced Ujaii breathing to calm myself. Also, I tried to clear my mind of all doubts and fears by just counting and following my breath. That practice helped immensely, and I was surprised on how low my blood pressure was when they took it before taking me into the operating suite. Just before the anesthesia was administered, I also tried to follow my breath as the lights literally went out. Post op in the recovery area again some Ujaii breathing helped to center me.

Once home, pranayama was helpful in quelling the anxiety and pain from the procedure. I didn't really start yoga asana practice till 24 hours post procedure. Starting with using my breath as I worked through my range of motion exercises and tried to be "kind” to my knee. Yoga is intimately connected to my current recovery. I really can't separate it out from my activities—everything I do now is with mindful attention to my knee and how it will respond to a new activity or asana position. Learning to GO SLOW is my current practice because when I don't, boy oh boy, does my knee balloon up! My knee is my teacher now and the rest of my body is the student—a different place to be for sure.

So, now it is two weeks post-op recovery. I have learned how to ask for help, which for me is really challenging. I have also learned that I need to still the little voice in the back of my mind that criticizes or is unhappy that I still can’t do something that I “should be able to do.” On the other hand, I’ve found it quite amazing how my knee has taught me how to experience asana differently. Yes, before I had to modify, modify, modify, but now the experience of gratitude is present. I ENJOY pranayama now and am practicing it more regularly. Also, I feel embraced by Chair Shoulderstand when I practice it. It is hard to describe but as soon as I am up in the pose I feel like I am getting a “big hug” that encompasses my entire being. The words don’t quite communicate the feeling of prana in my body!

recomended product suport by amazon