Friday Q&A: Yoga with a Stuffy Nose

Branches with Lichen by Melina Meza

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

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

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

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

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

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

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

—Baxter

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Yoga, Your Companion Through the Day

by Ram

Upward Bound Hands

One of the main tenets of yoga philosophy is “Yogas chitta vritii nirodhah,”which means achieving a union of the body, mind and spirit when all mental fluctuations/turbulences cease. Now, imagine waiting at the airport for nearly two hours to board an international flight. Or, you get held up in a traffic accident and the traffic has come to a standstill. Or, while negotiating over the phone with a credit card company, the customer service representative keeps you on hold. These are all situations where your emotions can flare up and yet, going by the above doctrine, you need to maintain your composure. So these situations call for supplementary yoga as a means to lighten up the situations and bring more cheer. It’s like giving a new life to the dull and routine tasks of everyday life.

Supplementary yoga can be done at the spur of the moment. It does not require a mat or other props, it does not require you to be in proper yoga attire and it does not call for a full-fledged asana sequence. In addition, if you have practiced yoga for at least six months and know the basics, supplementary yoga can really come in handy. With supplementary yoga, you have taken the power in your own hands to rein in your emotions and keep physically fit. Here are some situations based on my experience where supplementary yoga can turn life situations more interesting. You may modify the sequence or bring in your own set of poses.

Waiting in the Queue

Whether you’re at the cinema hall, airport or coffee bar, waiting in a long queue can be awful. Instead of venting it out, how about performing some standing balancing poses, forward bends or hip stretches, or a combination of all three? Yes, you may attract some curious onlookers but, hey, it’s your body and mind. So ignore the stares and move into the pose. In such situations I like to do Tree pose (Vksasana) as it is a great balancing pose and calms the mind as well. You do not need to do the full pose, just place the sole of your foot against your inner thigh (or calf) and rest your hands on your waist. Make sure your pelvis is in a neutral position and lengthen your tailbone toward the floor. Draw your gaze to the front and send a positive message for the line to move. Stay for 15 seconds, return to the standing position (Tadasana) and repeat on the opposite side for the same length of time.

If the queue is still moving slowly, you can resort to a standing forward bend position. I normally do Hand to Big Toe pose (Padangusthasana) in such situations. Just make sure that as you gently lower into the forward bend, you are not hitting the individual ahead of you. My suggestion to avoid any mishap is to allow the individual ahead of you to move, maintain the gap and finish your pose. Hold this position for 10-15 seconds. Send a positive note for the line to move, inhale, lift your torso and head back to upright position. Notice that you are now first in the line. I did this recently at the DMV office while standing in a long queue for renewing my license and it was fun!

Stuck in Slow Traffic

How many of us deal with slow traffic or stuck-in-traffic situations on a regular basis? Can we seek solace and a calm mind amidst this chaos? I like to do shoulder stretches and neck stretches (my hands are still on the wheel and feet are in their respective position on gas & brakes), and then follow it up with few rounds of Ujjayi pranayama or Victory Breath. Notice that as you direct the exhalation slowly across the back of your throat with a drawn-out “HA” sound, the vehicles in front of you have started moving faster! Repeat several times and not only will you witness prompt soothing effect in your mind, but the traffic would also have cleared. If Olympians have introduced Ujjayi into their routines, you can also do it and reach your destination safe and sound.

Cranking on the Keyboard

Whatever our occupation is, notice how our work has led us to be in front of the computer and to click away on the keyboard with constant use of the mouse. These repetitive movements of joints, fingers and wrist can lead to numerous musculoskeletal problems. Research studies show that one in eight professionals suffer from carpal tunnel syndrome (CTS) due to these repetitive movements and, among the fingers, the right thumb was revealed to be more susceptible to CTS. In the laboratory, despite bring a bench researcher, my work requires me to do a lot of computing work. So, for every 60 minutes of computing work, I do 5-10 minutes of supplemental yoga. In addition to several stretches, I love doing Upward Bound Hands (Urdhva Baddha Hastasana) as it reestablishes the full range of motion on my collar blades and shoulder blades. Check out Baxter and Nina's post Upward Bound Hands for more on this asana. The other poses I bring in are Eagle pose (Garudasana), Thumb-Big Toe pose (Padangushtasana) and Hand-to-Feet pose (Padahastasana). All these simple but powerful poses deepen the stretch and strengthen the shoulders, arms, hands and wrists, providing the perfect antidote to repetitive actions of the joints, fingers and wrist.

Sitting for Too Long

Our bodies were not designed to be immobile—look back to our hunter-gatherer ancestors and you will understand the need to be more active. (For more I this, check my sequel to follow soon.) Sitting for long hours at work, at a desk, in the car, on the bus or in front of the TV not only adversely affects the neck, shoulders, back, hamstrings but in the process we are also inviting health risks to our lifestyle, including heart attacks, joint problems, spinal issues and cancers. Furthermore, sitting for long periods reduces longevity and increases the risk of an early death. (For more on the risks associated with sitting for long periods, check my article The Dangers of Being Sedentary.)

These days my work requires for me to sit at the office desk for several hours so I bring in my supplemental yoga at work, too. Half Dog Pose at the Wall is an excellent pose that only requires a wall. It provides a good forward bend of the pelvis over the thighbones without curving the lower back. I even do the pose with the hands resting on a desktop or on the seat of my office chair. I also do some standing leg stretches that Baxter and Nina explained in the post Standing Leg Stretches, which provide the same hip opening and leg stretching benefits that one receives from many of the standing poses. I end up doing some shoulder stretches as well, which you can find described in the post Standing Shoulder Stretches.

All the above mentioned poses are good antidotes for hip and leg tightness and for tightness in the lower back. The poses provide an allover stretch, opening your shoulders and stretching your arms, back, hips and legs. Notice how supplemental yoga poses take up less space and you can do them in any location, anywhere there is a wall, chair, desk, ledge or window sill? People around may give you the stare but we yogis don't care, correct?

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Building Unity Farm - Planning for Spring

In the past 18 days, we've had 9 snow days.   The small silver nub in the center of this picture is a yardstick placed in the snow on the patio.

The squirrels can walk up to the bird feeder.    It's time to have a heart to heart with the groundhog who suggested 6 more weeks of this.

For the first time, this week, I cannot split wood because the logs are buried too deep.    Mulch and manure are similarly inaccessible.    The snow banks are as high as the roof of the hoop house, so watering vegetables took an hour of concerted shoveling to find the door.    I carved a moat around the beehives to give them ventilation space amidst the snow drifts.  The Cooper's Hawks are sitting in the trees hoping some rodent finds a path to the surface of the snow.

The snow drifts around the paddocks are now 7 feet high and I've used the Terex front loader to keep the barnyard clear.   However, the trails into the forest and mushroom growing areas are just too deep to access.

With outdoor tasks limited, it's time to plan for Spring.   Here are a few of the action plans

1.  Woodlot management
Last year I split 10 cords of wood by hand.   Although it's great exercise, the wear and tear on joints is high while swinging a 10 pound maul against a 50 pound chunk of solid oak.    It's time for a wood splitter.    As soon as the snow melts, I'll revise the wood processing area to include a storage area for unsplit logs - about 20 cords of oak, black birch, ash, maple, and cedar.   In the center, I'll configure a wood splitter and work table using products from Super Split, a flywheel driven rather than hydraulic approach to wood splitting.    The split wood storage area will hold 10 cords - enough for current burning and aging for next year.   With all that great wood, I'll have to think about creative ways to have fires year round beyond fireplaces and the patio fire pit.    A stone pizza oven or Goemonburo comes to mind, but those are projects for another year.

2.  Seed catalogs
The seed catalogs have arrived and we're selecting the greens, squashes, root vegetables, garlic and onions we'll grow in the 2014 season.   The next week will have temperatures in the 40's so the hoop house will start to be a very productive place.

3.  Bee management
We're rebuilding our hives, moving them to a dry, sheltered, south facing location, and planting bee friendly crops around them.   Our first winter with bees seems to have been successful.   7 of our 8 hives are vigorous and healthy.

4.  Mushroom farm expansion
Now that I have the Terex front loader, I can move logs around the property much more easily.  Before the last snow, I cut a road to a grove of pine trees, the perfect shade for another mushroom growing area.   By Summer, we'll have nearly 500 logs in production, spread in 3 forested area accessible via forest roads covered with wood chips.    When the snow melts I'll also use the Terex to spread a new layer of wood chips on our mile of trails.

5.  Bottling hard cider and mead
The fermentations of Fall are now complete and we're ready to bottle - as soon as we can reach the cider house and use the bottling equipment in the heat of a 50 degree day.    At the moment, we have 60 liters to bottle and I look forward to tasting the hard work of last year's harvest.

Spring will be here on March 20.    We're ready to begin another productive season on the farm.

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Yoga for People with Disabilities: Interview with JoAnn Lyons

by Nina

I've known about JoAnn Lyon's wonderful yoga classes for people with disabilities since she started them here in the San Francisco Bay Area, over a decade ago. And Baxter is one of the yoga teachers who has assisted JoAnn in her classes at the Cerebral Palsy Center. So we're both great admirers of her work. Recently I learned that JoAnn is making an effort to train more yoga teachers to do this work, so I thought it would be a good time to try to help her reach a broader audience. And what better way than to interview her about her important work on our blog so she can tell you about it in her own words! I sincerely hope you readers will help spread the news about JoAnn's work and her teacher trainings, and maybe even invite her to your studio to teach a workshop. (See her bio at the end of this post to find her contact information.)

Nina: How long have you been teaching yoga for people with disabilities and how did you get started? 

JoAnn: In 1996 I moved to Oakland to attend a year-long teacher training at the Piedmont Yoga Studio with Rodney Yee.  It was the first year Rodney taught an advanced training and, during that year, he offered our class an opportunity to try teaching classes at the Cerebral Palsy Center.  I volunteered and found it to be challenging and rewarding. 

In 2002 Piedmont Yoga Studio opened its doors on a new, accessible studio and I began teaching two classes a week there and have continued since then. The Cerebral Palsy Center now offers five weekly yoga classes and there are still two public classes at Piedmont Yoga.

It quickly became clear to me that more than one teacher was needed for a class and Rodney allowed me to teach workshops in the advanced training program at PYS on teaching yoga to people with disabilities. From these classes many teachers are now teaching yoga to people with disabilities in private settings, at the Cerebral Palsy Center, Piedmont Yoga, Clausen House and other venues not only in the Bay Area, but also across the United States.

Nina: Why do you believe that yoga is so valuable for this population? 

JoAnn: Many students with disabilities are hesitant at first to believe that these classes will work for them. Creating a safe space where they can explore the possibilities of moving their bodies in asana—sometimes with the help of assistants—take a conscious, deep breath, and be still for a few minutes, resting in restorative yoga poses that promote healing and relief from a stressful life, bring our students back on a regular basis. We’ve also found that these classes create a strong sense of community. 

Nina: Which particular practices and/or poses do you particularly recommend for this group? 

JoAnn: In my workshops I always stress that teachers must teach the student, not the pose. Especially with this population, one must take into consideration the ability of the student but be aware of the student’s disability. Almost any disability you can name may manifest in myriad ways. I’ve known quadriplegics who can stand and ones who could not move any part of their body except their eyes. I’ve had students with MS (Multiple Sclerosis) who can walk and ones who are in wheelchairs, perhaps permanently and perhaps not. And I’ve had people with PPS (Post Polio Syndrome) who are exhausted and some who are not. 

So, what I recommend is working with the student who is in front of you. If your student has some yoga experience, you can work from that knowledge. But if your student has never practiced yoga before, you need to start as you would any intro to yoga classes and carefully lead the student through easy movements, teaching them alignment, stretching and strengthening as needed, reminding them to breathe frequently and slowly building up to poses they can do. 

Obviously, if a student is paraplegic or quadriplegic, they will not be able to stand to do poses, however, that does not mean they cannot do standing poses in some other way—seated, on a chair or on the floor, lying down and using the wall as their “floor”—or maybe a pose is just not one that student should even attempt. Props are tantamount to a successful class for people with disabilities. I have students with CP (Cerebral Palsy) and paraplegia who do Headstand on a head-stander. Blocks of varying size can raise the floor to a level where a student is able to reach it.  Straps help hold body parts that don’t stay put on their own, and wall ropes and a large exercise ball allow most to safely experience the elongation of the spine in Downward-Facing Dog. Figure out what you want a student to get from a pose, honestly assess what they can do and cannot do, keeping in mind what they probably should not do (commonly called “contraindications”), and then work with your student toward the appropriate parts of that pose for them.

Nina: You are starting to train other teachers now to work with people with disabilities. Where can they study with you? 

JoAnn: I am offering a workshop in Oakland on March 14, 15 & 16, 2014 (see piedmontyogacommunity.org for further info or to register). To begin, I teach a class at the Cerebral Palsy Center to some of my regular students there for the participants to observe. My students at the CP Center are very generous in allowing this class of potential teachers to observe their class because they understand that I am training teachers who may one day teach classes for others with disabilities and they want to help. The last class will be at Piedmont Yoga Studio and we will be working with some of my students with disabilities who attend my public classes.  Most of these students have been studying with me for several years and really enjoy helping and teaching about their yoga practice as well as their disability. In some cases I also offer a private apprenticeship.

Nina: Is there anything else you’d like to add? 

JoAnn: I love teaching classes for people with disabilities. The challenges are great at times, but this is such a rewarding experience. I want more people with disabilities to have the opportunity to take a yoga class anytime they want and that can only happen if more yoga studios are willing to accommodate this population and more teachers are willing to see this as a possibility.

One of the biggest challenges is funding these types of classes. Cost of the classes I teach at Piedmont Yoga Studio is based on a sliding scale; no student is turned away because of lack of funds. Many of our students pay the scheduled price, some more if they are able, and some pay nothing or what they feel they can afford that day. The reality of this is that even if every student paid the full price for classes, by the time a teacher, assistant and rent are paid, what is taken in will not cover those costs completely. We yoga teachers are like everyone else; we have bills to pay and need to be fairly compensated for the work we do. In response to this, we work with a small non-profit, Piedmont Yoga Community, whose mission statement is to serve the community by making yoga accessible to people with challenges. Piedmont Yoga Community relies heavily on grants as well as donations, workshops and events held during the year (see piedmontyogacommunity.org).

JoAnn Lyons began her study of yoga over 40 years ago in Indianapolis, Indiana and began teaching yoga in 1991 in Vero Beach, Florida. In 1996 she moved to Oakland, California to participate in the first Advanced Studies Program at the Piedmont Yoga Studio with Rodney Yee.  JoAnn also holds an Advanced Relax & Renew Trainer Certificate, from Judith Lasater, and is one of a select group of Senior Teachers assisting Judith. She credits her current teachers Donald Moyer and Judith Lasater with helping her put herself back together again from a very old injury that left her dealing with chronic pain for several years.

Since 1996, she has been sharing her love of yoga in classes for people with special needs and disabilities. Her teaching is grounded in her observation and knowledge of the body, and her intuitive awareness of both the needs and potential of her students. JoAnn offers workshops and apprenticeships on teaching yoga to people with disabilities as well as private sessions. You can reach her at joannlyonsyoga@aol.com.

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The February HIT Standards Committee

The February HIT Standards Committee focused on development of the 2014 standards workplan, refinements to meaningful use stage 3 attestation/certification processes, and recommendations for standards to capture patient generated healthcare data.

Jon Perlin led the workplan discussion. Over the next 30-60 days, ONC will reflect on short term and long term policy goals, which will guide Federal Advisory Committee plan development.  We'll use the new strategic guidance to revise the structure of our workgroups/task forces/power teams with a special emphasis on the need for the Policy and Standards Committees to coordinate their work.   Standards Committee members discussed the need to address short term standards gaps while also thinking about medium term strategies (FHIR/REST) and long term aspirational goals (APIs, detailed clinical models).    All also agreed that now is the perfect time to pause and reflect on our progress to date, adjusting our trajectory if necessary.   We look forward to ONC guidance at our March/April meetings.

Next, we heard from Jodi Daniel and Doug Fridsma with an ONC update that covered 4 topics - a framework for thinking about a Learning healthcare system, HITPC letters of transmittal for feedback on specific standards, a Meaningful Use stage 3 review process, and the ONC 2015 Edition Certification NPRM.   A task force will be created to review the Meaningful Use Workgroup recommendations adding standards and implementation feedback such as maturity/applicability of standards and implementation difficulty.    The 2015 Edition of Certification will be voluntary and provides ONC a regulatory mechanism to polish the 2014 Edition based on industry feedback.   We're all optimistic that the 2015 Edition will reduce burden on all stakeholders.

Finally, we reviewed the recommendations for patient generated data and device data transmission to EHRs.   Commenters expressed concern about the balance between innovation at a time when the industry is evolving rapidly and providing highly constrained standards guidance to enhance interoperability.   We agreed that fully integrated shared patient/provider record systems do not need standards as they share a common database.    The Implementation Workgroup will survey the market to identify those classes of applications that would benefit from standards to enhance patient/provider communications across heterogeneous platforms.    We also agreed that devices are evolving rapidly and we should focus on the EHR's capability to receive data from devices/middleware using existing standards such as Direct and CCDA which are already part of Meaningful Use Stage 2

All agreed that the arrival of a new national coordinator brings positive change, new momentum, and a sense of optimism.

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Yoga and Your Sinuses

by Baxter

Magnolia Blossoms by Melina Meza

Over the years I have heard a lot of talk about yoga and the sinuses. For example, one of my first teachers claimed there was an old sadhu practice for addressing congestion in one of side of your sinuses (you have sinus cavities behind your forehead bones, your cheek bones and deep behind your nose itself) where you make a fist and jam it high in the opposite side armpit and clamp your arm down around it for a few minutes. The congested side is supposed to open up promptly. There is even a crutch that is apparently used for such purposes in India. My own experiments on this technique are inconclusive!

A quick check of Timothy’s list of 75 health conditions that yoga helps does have one reference to a study looking at yoga for sinusitis inflammation of the sinus cavities that can be caused by bacteria or virus, as well as allergens, Efficacy of daily hypertonic saline nasal irrigation among patients with sinusitis: a randomized controlled trial. Interestingly enough, the study is not looking at what most of us would think of as modern yoga practice via postures, but a practice of using the neti pot to irrigate the sinuses with warm water, a practice that falls into the category of shat-karma or “six acts” of Hatha Yoga, and is actually a preparatory practice called jala-neti, in which water with a bit of salt dissolved in it is sniffed up the nose.

First let me say that I was pleased to see that the study was published in the Journal of Family Practice, one I have subscribed to over the years - way to go, Family Docs! But what did this study find? They had the experimental group irrigate their sinuses daily for six months, and here is what they discovered:

“Daily hypertonic saline nasal irrigation improves sinus-related quality of life, decreases symptoms, and decreases medication use in patients with frequent sinusitis. Primary care physicians can feel comfortable recommending this therapy.”

Sweet! A little further digging on PubMed brought up this study done in India in 1991 that looked at posture’s effect on nostril dominance, that is, which nostril is more open at any moment. If you check yourself throughout the day to see which nostril is more open, you will note that it changes every few hours. The author noted that if you started out lying on your back and your left nostril was more open and the right one more congested, by lying on your left side, within in a four to eleven minutes, the right side will become more open and the left side will become more congested. The author postulated that this was “a reflex effect due to the pressure stimuli to the lower lateral side of the body particularly around the shoulder region and effect was mediated through the sympathetic innervation to mucosal venous sinuses of the nostrils.”

This could play out in our yoga asana practice in side lying poses like Vishnu’s Couch (Anantasana) or even side bending poses like Triangle (Trikonasana) or Gate (Parighasana). But you’d have to be in them for at least four minutes to start to see the effect! This lead me to another study done in India with that crutch I mentioned at the beginning of the post, and lo and behold, it took about 17 minutes to get the same effect that lying on your side did. Which would you rather try?

If we get back to the idea of yoga asana and related tools for sinuses and, in particular, sinusitis, which can be an actual infection of the sinuses, there are lots of recommendations online. However, inversions are mentioned in several of these, and my experience is that students with sinus congestion from the common cold or sinus infections often have a significant increase in pressure and headache symptoms as well as worsening of breathing in the forward bend or inversion, often forcing them out of these positions. So for acute sinus symptoms, you may want to hold off on these groups of poses.

According to long-time Iyengar teacher Dean Lerner in an Ask the Expert post for Yoga Journal, inversions again play high on the list of recommended poses, especially Shoulderstand and Plow pose. In addition to the possible worsening effect on acute sinus symptoms, you really need to be a fairly experienced practitioner to do these poses safely. He does postulate that the inverted poses increase the blood flow to the sinuses and this has a flushing effect. However, the blood stays in the blood vessels and does not actually move out into the sinus cavities themselves, so this theory is seriously flawed. And remember, this is just theory, and has not been formally studied.

On the other hand, I found more reasonable recommendations on the Indian Mirror website. The sequence is worth trying because it is unlikely to aggravate sinus pressure and pain while still moving your spine and head into potentially beneficial positions of gentle forward bends, backbends from a prone position, side bends and mild inversions. The sequence features Mountain pose (Tadasana), Seated Forward Bend (Paschimottanasana), Camel pose (Ustrasana), Triangle pose (Trikonasana), Downward-Facing Dog pose (Adho Mukha Svanasana), and Cobra pose (Bhujangasana), and, in an additional section, Knees to Chest pose (Pavanmuktasana, which I usually call Apanasana), Raised Stretched-Out Foot pose (Urdhva Prasarita Padasana), Lion pose (Simhasana), Bow pose (Dhanurasana) and Savasana. And, for breath work, the Bellows Breath known as a Bastrika. If I were to modify this sequence, I’d recommend the following:

1. Bending the knees in Paschimottanasana to make it easy on the back
2. Skip Camel due to its more advanced requirements
3. Monitor Downward-Facing Dog to make sure it does not worsen my symptoms
4. Repeat Cobra if Bow pose feels to much for the back
5. Elevate the spine and head for easier breathing in the supine position, Savasana

More importantly, I’d remind us all that yoga has been studied and found to have a positive effect on the immune system, and, ultimately, if the immune system is functioning at its peak, we are going to have the best chance of influencing the course and re-occurrences of sinus problems. That means establishing a regular home practice that is well balanced, and includes pranayama practices such as alternate nostril breath, nadi shodhana, as well as seated meditation in addition to our beloved asanas. From there, if the concept intrigues you, I’d recommend experimenting with gentle inversions like Downward-Facing Dog and Standing Forward Bend. Or try out the poses recommended by the Indian Mirror above if that grouping seems appealing to you. And rest and do restorative practices when you are acutely sick and save the more physical practices for your recovery time. Since we don’t have any formal studies on these tools of yoga and sinuses yet, you are effectively investigating the practices to find what works best for you. Let us know what you discover!

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Friday Q&A: Chronic Fatigue Syndrome, Part 2

Road by Melina Meza

Q: I find that there are not many yoga teachers with an awareness of yoga practice specifically for Chronic Fatigue Syndrome (CFS). I was diagnosed with CFS 6 months ago and am doing graded exercise therapy, which includes walking. I would love to practice yoga every day, but am lost as to where to begin. Any help would be much appreciated!

A: We received this follow-up inquiry recently from one our readers following an earlier post I did on CFS. Just so everyone out there reading this is on the same page, start by checking out my Nov 5th blog post Chronic Fatigue Syndrome and Yoga.

Now I’ll recap by giving you the Mayo Clinic’s LINK list of CFS symptoms:

“Chronic fatigue syndrome has eight official symptoms, plus the central symptom that gives the condition its name:

•    Fatigue
•    Loss of memory or concentration
•    Sore throat
•    Enlarged lymph nodes in your neck or armpits
•    Unexplained muscle pain
•    Pain that moves from one joint to another without swelling or redness
•    Headache of a new type, pattern or severity
•    Unrefreshing sleep
•    Extreme exhaustion lasting more than 24 hours after physical or mental exercise

And to meet the diagnostic criteria of chronic fatigue syndrome, you must have unexplained, persistent fatigue for six months or more, along with at least four of the above signs and symptoms”

Next, I’ll recap what the folks at the Mayo Clinic have to say about CFS, and explain how I think yoga fits in (in italics):

1. CFS is a condition that does not improve with rest, so gentle yoga movements could help. 
2. Even though the cause is not known, it is theorized that stress may play a role, and yoga is great at reducing the effects of stress.
3. Because the fatigue may worsen with physical or mental activity, a yoga practice for CFS should have several types of practices to take into account the variability of symptoms from day to day.  More on this in a moment!

In addition, I recommend that you read the posts we have done here at YFHA on yoga for pain, yoga for insomnia, and yoga for headaches to get some additional ideas on how to address those symptoms of CFS.

Because our reader mentioned that she has been prescribed “graded exercise therapy,” meaning that the type and intensity of her exercise is slowly and gradually increased, usually in response to how she would be doing from day to day, I would add that such an approach would also have practices that could step things back and down if flares occur. This day-by-day approach to things like walking could be extended to yoga practices as well. And although I mentioned some of these ideas back on Chronic Fatigue Syndrome and Yoga, I am presenting them in a slightly different way today.

On a day when mental fatigue is an issue, longer supported restorative poses would be a good choice, with the easiest of mental focuses, such as simply following your inhales and exhales. A supported Savasana with a recorded yoga nidra might also be appropriate on these days. Remember, conscious relaxation for 10 minutes or for longer times, as in yoga nidra, can provide a different kind of “rest” than typical sleep or napping, which could be beneficial for both physical and mental fatigue.

When increased pain is occurring, gentle yoga practices or restorative practices that don’t aggravate or increase the pain levels while they are being done could keep the body moving and active. The more intense the pain, the more likely restorative poses with a meditation on breath or mantra—so as to remove the “thinking about pain” from the actual experience of pain—should be employed.

As fatigue lessens, you would then start to gradually modify your daily asana practice to slowly and deliberately challenge your endurance, strength and flexibility. If the next day results in more fatigue, you would downgrade your practice to meet the symptoms that are there that day. If all is well, I’d do a few days at a given level of increase in intensity before the next advance of challenge.

Even though the Mayo Clinic only recommends yoga for addressing pain in CFS, as I mentioned above, I think a regular “graded” yoga practice can address many of the symptoms of CFS. And although the research to date is almost non-existent, I hope that the trend towards more research on Yoga and Health will produce more studies to bear out Yoga’s benefit for CFS.

Research Resource: Dr. Timothy McCall lists this study A controlled study of the effect of a mindfulness-based stress reduction technique in women with multiple chemical sensitivity, chronic fatigue syndrome, and fibromyalgia in his 75 Conditions that yoga helps. 

—Baxter

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Interview with Anna Guest-Jelley of Curvy Yoga

by Nina

I’m excited to welcome a special guest today here on the blog, yoga teacher, author and activist Anna Guest-Jelley of Curvy Yoga. I’ve been admiring her from afar for some time now because of her work as a champion for women’s empowerment and body acceptance. Recently I finally got up the courage to approach her. And guess what? She was as warm and welcoming as I imagined her to be, and she agreed to let me interview her so you can find out more about her mission and her work.

Nina: Tell us a bit about yourself and how you got started with yoga.

Anna: Hi, everyone! I’m excited to be here because I love this blog!

Chronic migraines brought me to the mat a little over 15 years ago. I was desperate for anything to help, and several people recommended yoga.

At the time, I was also completely disconnected from my body. I hated it and wanted it to change – less pain, less weight. I eventually tried over 65 diets before yoga helped me realize that body acceptance is a much better and happier way to live life (even though body acceptance is the last thing I was expecting, or even wanting, from yoga at first!).

Nina: Why did you start Curvy Yoga?

Anna: I started Curvy Yoga because for about the first 8+ years of my practice, I always thought something was wrong with my body during asana. Since my teachers never talked about how to adapt poses for bigger bodies, and I almost never saw any other bigger-bodied students in class, I assumed (incorrectly, thank goodness!) that the problem was me.

Over time, though, as I began my journey towards body acceptance, I had the thought: “Hey, maybe the problem isn’t my body! Maybe the problem is there’s just not enough information about how to adapt yoga for curvy folks.”

Once I realized that, indeed, the latter was the case, I set out to see what I could do about changing that.

Nina: Which yoga practices and/or yoga poses do you think are especially helpful for body acceptance?

Anna: I believe that the way yoga can move people towards body acceptance is by helping them (re)connect with their bodies. So many of us are disconnected for various reasons, and it’s quite hard to accept, much less love, something that you can’t feel or connect with. 

For me, once I began to be able to feel what was going on in my body physically during asana, I was then able to slowly extrapolate that to noticing my breath, my mental and emotional states, etc. It was only from that place of embodiment that I began to be able to know and meet my body’s needs from a place of love, not misplaced, unhealthy and (in my case) disordered approaches to weight, eating and exercise.


I see the whole path of yoga as one of body acceptance because of how each of the limbs teaches us to connect with our body and self in a holistic way.

Nina: Do you have anything else you’d like to tell our readers?

Anna: I’ll just add that for anyone reading this, student or teacher, that making yoga accessible for people of all shapes and sizes doesn’t have to be complicated. Whether through pose modifications, props, sequencing, body positive theming, or some combination, it’s all very doable.

Yoga has a profound ability to connect us with our bodies and empower us when it comes from a place of acceptance, not shame that a body is not this or that seemingly ideal way. You never have to change your body for yoga! 

Anna Guest-Jelley is the founder of Curvy Yoga, a training and inspiration portal offering classes, workshops, teacher trainings, retreats, a virtual studio and lots of love and support to people of every size, age and ability. She is also the author of Permission to Curve: Inspiring Poses for Curvy Yogis & Their Teachers and the co-editor of Yoga and Body Image: 25 Personal Stories About Beauty, Bravery and Loving Your Body (forthcoming Fall 2014, Llewelleyn). Visit Curvy Yoga online at CurvyYoga.com.

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