Saturday Bug Report

by Nina

Pineapple and Cockroaches by
Maria Sibylla Merian

Did you happen to notice that there were three posts on Thursday, July 24, 2014? Yes, that happened. And I don't think I can fix it. Of course, it's not the worst thing in the world, but I thought you deserved a bit of an explanation. 

Only the post The Power of Svadhyaya (Self-Study), Part 2 was a new one, and this post is the one that was supposed to be published on Thursday. Enjoy!

The other two posts, Never Go to Bed Angry and Friday Q&A: When to Eat, are posts from 2011 that I updated. Normally, updating a post—which I do very frequently—does not cause it to be republished on a new date, only, well, updated in place. But I've noticed that the Blogger (the Google software I use to create and maintain this blog) has quite a number of bugs, so I assume it's just acting strangely today and hope it will recover soon. It usually does—eventually—and since it's a free product, I'm not in much of a position to complain (around here one of my mottos about my housework and cooking is "No criticizing the free help!"). 

I do think these two older posts are worth reading if you haven't already read them (which was why I was updating them). But I did feel like I should let you know that we're going to return to our normal routine of one post five days a week. 

Friday Q&A: Forward Bends and Osteoporosis

Standing Forward Bend (Uttanasana)

One of our readers left the following comment on our post Featured Sequence: Mini Sun Salutation:

I am surprised you are including a deep forward bend. Research supports avoiding forward bends in osteoporosis and osteopenia and considering there are over 54 million people with osteoporosis and many don't know they are osteoporotic it seems safer not to teach forward bends for healthy aging. I think we have a higher percentage of yoga practitioners who fit the risk profile....slight, female, white, especially if they had a restricted diet in their younger years. 

This reader is concerned about practitioners who may have osteoporosis doing deep forward bends as we showed in our Mini Sun Salutation. And, indeed, for those with OP or even undiagnosed OP (they have it but don’t know it yet) forward folds hold the potential of increasing the risk of the most common fracture in those with OP: a wedge fracture of the thoracic spine. So, if you fall into this camp, I’d recommend modifying your standing forward bends by allowing your knees to bend as much as you need to help release your pelvis over the thigh bones as you bend, and maintain a more neutral alignment of your spine as you go down. That means avoiding rounding your upper back in the area of your thoracic spine.

I have a student in one of my class in her late 60s with recently diagnosed OP, and we discussed her modifying her forward bends in just this way for poses such as Standing Forward Bend (Uttanasana) and Widespread Standing Forward Bend (Prasarita Padottansana), and she has been diligent about doing so.

Having said all that, I’d like you to keep in mind that our blog is not just for older adults who might have or be at risk for OP—or any condition for that matter. So, the Mini Sun Salutation post was really just an opportunity for us to share with you a basic common modern yoga practice that you can refer to as needed. We will try to add in a few more cautions to these sequences in the future, but you should always read our posts on yoga poses and sequences through the lens of your own personal situation, and take good care of yourself by making any modifications to the poses to better serve your needs. And if you are uncertain as to the safety or appropriateness of any YFHA recommendations, check things out with your local teachers. 

—Baxter

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The Power of Svadhyaya (Self-Study), Part 2

by Nina

Anatomical Body
India, Gujarat, 18th century

While preparing to write this post, I discovered that I had, uh, completely forgotten about some of the things I’ve written for the blog. (Hey, I’ve been writing at least one post a week—and sometimes two or three—for almost three years.) Yes, I was quite surprised to find a post about how we could use the wisdom of the Bhagavad Gita to heal from an election so divisive that even Big Bird wasn’t being nice (see Yoga Philosophy of the Day, Part 2), another about how I was using yoga philosophy to prepare for a trip to Germany that I was feeling uneasy about (see Yoga Philosophy of the Day), and a third about how we can use wisdom of yoga to change our behavior patterns (see Thinking About the Wisdom of Yoga). But it’s no surprise at all to me that I find yoga philosophy extremely valuable in my every day life. And I’ve written about that in a general overview—which I have not forgotten about—called Why You Should Study Yoga Philosophy.  

As I mentioned in my post Svadhyaya (Self-Study), Part 1, there are two different interpretations of the meaning of niyama svadhyaya (self-study). In his book The Yoga Sutras of Patajanli, Edwin Bryant says:

Svadhyaya literally means self-study, but it more commonly refers to the study of sacred texts (in a sense the two meanings overlap, since sacred texts typically teach about the self).

So while one meaning of svadhyaya is to cultivate your inner witness to study your own self as I wrote about my first post earlier this week, another is to study the yoga scriptures, such as the Bhagavad Gita and The Yoga Sutras, and—if you’re feeling brave—the Vedas and Upanishads. And this type of study complements your self-study because as you read these texts, you can reflect how to use the knowledge they contain. I consulted with Ram before writing my posts on svadhyaya’s two different meanings, and he recommended asking yourself these questions about the scriptures:

• How do you use the knowledge for self-empowerment? 
• How do you use the knowledge for the betterment of society? 
• How do you grow in body and mind after reading those scriptures? 

This kind of self-study can also include more than reading just the original scriptures themselves. As Ram said:

S(s)vadhyaya =education, study, or knowledge improvement that is gained from studying not just scriptures but any book or any experience that provides deep meaning or interpretation of life (that is, thought provoking).

So svadhyaya includes any books about yoga, whether books that interpret the scriptures, such as the Edwin Bryant book I mentioned above (which I frequently turn to), books about the history of yoga, such as Georg Feuerstein’s The Yoga Tradition about ancient yoga and Yoga Body: The Origins of Modern Posture Practice by Mark Singleton about modern yoga, or modern books about yoga (plus, our blog, of course). Obviously, texts from the religions of the world will also provide you with food for thought, but you should also consider psychology books and books about human behavior. Two of the non-fiction books that have influenced me greatly include Full Catastrophe Living by Jon Kabat-Zinn and A General Theory of Love by Thomas Lewis, Fari Amini, and Richard Lannon. Even fiction that explores the human condition can contribute to your self-study (I read an interesting New York Times article For Better Social Skills, Scientists Recommend a Little Chekhov that explained how literary fiction can help you develop empathy and improve your understanding of human behavior).

It makes a lot of sense that in our studies of the self, we should turn to the wisdom of others. After all, yogis and people of other cultures worldwide have been engaged in self-study for centuries, so we can learn a tremendous amount from their experiences. As a matter of fact, the single piece of yogic wisdom that I keep returning to in my everyday life is over two thousand years old:

The wise man lets go of all

results, whether good or bad,

and is focused on the action alone.

Yoga is skill in actions.

—Bhagavad Gita

Brad and I have been talking about that quote a lot lately because he has been taking on some big challenges at work and he finds that taking this yogic approach has helped him maintain some peace of mind. (And, yes, I do remember that I include that quote that in my posts all the time!)

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Never go to bed angry

by Nina

Santa Barbara Botanical Gardens: A Detail by Joan Webster

On Tuesday I read a short little piece in the NY Times questioning the adage “Never go to bed angry” (see here). It was one of those bottom line pieces, and the bottom line was this:

“Going to sleep upset or disturbed preserves the emotion, research suggests.”

In the cited study in The Journal of Neuroscience, scientists exposed 106 men and women to images that elicited various emotions. In some cases the emotions were negative and in other cases the emotions were positive or neutral. The researchers then looked at what happened 12 hours later when the subjects were shown both new images and the previous ones, either in the morning after a night of sleep, or at the end of a full day of wakefulness. The conclusion was:

“The scientists found that staying awake blunted the emotional response to seeing the upsetting images again. But when the subjects were shown the disturbing images after a night of sleep, their response was just as strong as when they had first seen them—suggesting that sleep “protected” the emotional response.”

That doesn’t sound good, does it? Going to bed angry and waking up angry is not only an unpleasant experience for you, but it probably doesn’t enhance your relationships with the people around you. Besides, it's also not a good idea to go to bed angry if you are concerned about getting a good night's sleep. Your stress levels will be high and your sleep, if you can sleep, will be restless—maybe filled with upsetting dreams—and you won’t feel rested in the morning.

But very probably you—unlike the people in the study—can’t just put away an “upsetting image” when you are very angry. In fact, the chances are you’ll keep having one angry thought after another, and with each angry thought you’ll get another jolt of adrenaline (that’s why they call it the “fight or flight response,” people), keeping your stress levels as high as they were before.

The good news is that Baxter says it takes only about 90 seconds to clear the adrenaline released in your system by an angry thought if you switch to a more neutral topic. So to put away your anger, he recommends a structured breath practice, in which you measure your inhalations and exhalations, and count your breaths to engage your mind. If you combine this type of breath practice with a supported inversion (such as Legs Up the Wall pose) or a supported forward bend (if you find those soothing), both of which help switch your nervous system to relaxation mode, you’ll get a double dose of calm.

You could also use a guided relaxation (see here) as a way to engage your mind and relax your nervous system at the same time.

Friday Q&A: When to Eat

The Bowl of Milk by Berthe Morisot

Q: One thing that often has prevented me from having another 1/2 hr. session (at home) in the afternoon is the problem of eating. I seem to remember learning I need to wait at least 1 1/2 or 2 hrs. after I eat before doing my next asanas. Is this true? What is the shortest time one needs to wait before doing a workout - or a session (I hate calling it a workout, but hopefully you get it.) I do my a.m. yoga before breakfast - but each day is different time wise & eating with a wait period before yoga becomes a real challenge. Could you give me some suggestions?

A: I tell folks that it depends on their digestion patterns. So I will often have a light meal an hour before practice without any ill effects. Others may find it prudent to wait a little longer, so as to avoid acid reflux or discomfort in forward bending or twisting from the stomach still being full. 

—Baxter

A: So many rules! It reminds me of the one they used to have when I was a kid about how you had to wait one full hour after eating before going back into the water. Have you ever tried practicing soon after eating a snack? How did it feel? If you felt uncomfortable (or worse), then it's probably not a good idea for you. But if you felt fine, I say go for it. Personally I do it all the time, with no ill effects. And I have heard that in India for people who can't practice on an empty stomach (some people, like me, get low blood sugar), they recommend yoghurt or milk before practice. (Confession: one time my friend and I ate hot fudge sundaes just before an advanced yoga class. Then, for the first time ever, the teacher started the class with Headstand. After class, we confessed to the teacher. He was very sympathetic! He said, "Oh, you should have told me. I would started the class with a different pose.") 

—Nina

Unity Farm Journal - 4th week of July 2014

Just as running a winery isn’t all romance, art, and elegance, running a farm is not all romping with your animals, a joyful harvest, and making a profit from the fruits of your labor.

Farming is hard work year round, during the hot humid days of summer, the wet days of Spring/Fall and the chill of winter.  There’s always maintenance and always unexpected tasks.

Some of my farm related posts gloss over the details of day to day operations.  This week, I’ll give you a taste of the kinds of things that require attention.

Our 1.5 miles of trails, our mushroom operations, and manure management all depend on the Terex Front Loader, at PT-30.   Last week, it began leaking hydraulic fluid (basically 30W oil) so rapidly that the roadways are covered with oil stains and the hydraulic fluid tank level is in the red zone.   I crawled under the front loader and found that fluid was dripping from the lowest point of the protective under carriage pan - clearly a hose had come loose or an o-ring had flattened.  The Terex weights 3000 pounds and I have no way of lifting it to remove the protective plates and do an inspection.   Thus we needed to arrange a truck to take it to a service center.   I used a pressure washer to remove some of the driveway oil stains but it has not worked very well.   I'm trying a variety of detergents to loosen the oil from the asphalt, but no magic bullet thus far.

We have an eXMark Turf Tracer mower to manage our acres of pasture and fields.    Many of these areas have not been consistently trimmed in the past and under the 2 foot tall grasses were hidden rocks, logs, and other debris.    The very powerful mower uses a hydraulic power take off to turn the blades.   The debris was simply chopped up - yes the mower cut off the tops of rocks.    Although the end result of all my summer mowing has been beautiful trails and pastures, the mower blades were severely worn.   I had to lift the 550 pound mower, unbolt the blades, and sharpen them with a grinder - it’s all part of standard farm maintenance.   Now that everything is trimmed I’ve removed all rocks and debris so the blades should not be abused again.

Our new baby alpaca, Sunny, is growing up.   She’s learned how to take a dust bath, how to use the alpaca designated poop piles, and how to munch the romaine lettuce from our hoop house that we give the animals every night.    The vet called to say that her IgG measured low the day after her birth.   Like humans, Alpaca get their first antibodies from mother’s milk since they do not pass the placenta.   Sunny was a little slow to start eating, so she was delayed in getting these antibodies.  The vet recommended we monitor her temperature daily for early detection of any infection.    The normal body temperature of a baby alpaca is 101.5-102.5.   Anything greater than 103 is a fever.    Every night for the past week, Kathy and I have taken her rectal temperature.   It’s generally about 101.8, no fever.   Imagine the fun of corralling a 20 pound with the personality of a 2 year old for daily temperature taking!

Of the 3 guinea nests in the forest, one is now abandoned.   Raccoons ate the majority of the eggs and we candled the remainder to discover they were non-viable.   Mom now spends the night safely in the coop.   The other 2 nests were poorly managed - guineas are terrible parents.   I used straw to build warm, self contained incubation areas and now the guineas at least have a chance of hatching their young.    The ducks continue to incubate 9 guinea eggs that the guineas had abandoned.

One of the oyster mushroom areas finished its 3 month spawn run and my task last weekend was to remove 2000 pounds of poplar logs from the black plastic trash bags that served as incubators/humidfiers for the wood and spawn.   We now have about 10,000 pounds of poplar in production for oyster mushrooms and look forward to a major Fall harvest.

We continue to maintain the bee hives.   We spun 9 full frames of perfect summer honey (mostly clover) late one night last week by the light of a lantern.   We’ve used the hot summer days to melt bees wax in our solar melter and at this point we have 10 pounds of wax for votive candle making when then weather turns old and we focus on indoor tasks.

Although the weekend was filled with needed maintenance, there was a bit of joyful harvest.   We  picked over 100 pounds of cucumbers and are using our own cider vinegar to make sweet/hot pickles. We also picked 50 pounds of zucchini, japanese pumpkin, peas, beans, and tomatoes.   This weekend we’ll harvest the carrots, eggplant, and kale.

The next week will be more harvesting, more pickle making, more bee work, more animal care, and planning for our fall crops.    There is no rest for a farmer during the glorious weather of mid summer.

When Red Flags Should Be Raised: Yoga Snake Oil

by Jill Satterfield

Ochre and Red on Red by Mark Rothko*

As yoga grows in popularity, it also breeds abundant misconceptions and snake oil claims. The love and light aspect of many teachers and classes has gone increasingly haywire and has reached unfortunate proportions, leading many into despair and not for good reasons. After hearing so many promises of just three weeks to this or a weekend for that, anyone can think they’ve been pushed out of the human category by not responding as claimed. But when a yoga teacher says something will be a quick fix, our red flags should automatically go up because everything worthwhile takes time to be absorbed and digested.

When I was in my 20’s I was stricken with chronic pain. My gut felt like it had a burning hot knife in it that was twisting and searing all the time. I went from one doctor to another for over 13 years, endured 12 minor and two major surgeries. I also attended countless yoga classes and practiced on my own every day, often for a couple of hours.

And I was the person in class who wept into her forward-bended legs when the teacher I had at the time said this pose will heal this, and this pose will heal that, but only if we did them faithfully every day, for x amount of minutes each time. I was practicing these postures, but I was still in pain, my intestines weren’t functioning, and I was not at all well. Why were these postures not working for me? What was wrong with me? I was haunted by these questions for many years.

In hindsight, I see the error of my questions, not the error of my practice. There was nothing inherently wrong with me, but there was a lot wrong with the teacher’s pronouncements and claims. Nothing cures everyone, and yoga postures are not the be and end all, in spite of what many people enthusiastically think. Old age, sickness and death eventually befalls every one of us, and yoga poses will not change that. 

There are many styles and schools of yoga practice, which is great as we can choose what suits our body and minds the best. Even so, there isn’t just one way to practice, experience or pursue anything, and if we are told that there is, we should look for the closest exit. 

How to choose then, what to listen to, follow or engage in? The Buddha suggested that we not follow his or anyone’s advice unless we have directly experienced its sanity and truth for ourselves. I think this is a sensible rule to abide by. If you are told that any pose will fix or change something and it doesn’t, do not think it is you! And, question the source—what is the benefit in saying something is going to help everyone or that there is the only way to do something? Whoever utters these grand pronouncements needs to experience an injury or illness, or just to spend a little more time on the planet. It is humbling to be in pain, to have your body not behave or look as you would like, and as for aging, well, let’s just say it is very leveling.

Personalizing a yoga practice should begin with deeply listening to your body, noticing how it is feeling that particular moment or day. Turn towards your heart, ask yourself how you are feeling emotionally that day, and check in to your mind to notice its state at that time. By checking in, you automatically begin to set up a union of body, mind and heart. You begin a dialogue, and the more you listen, hear and quietly reflect and experiment, the more your wisdom will flow. Here's a short video by me that you can use to learn to check in:

All this isn’t to say that we don’t need teachers—we most definitely do. But choose your teacher wisely by trying his or her suggestions, and if they work for you, build on them by experimenting at home by yourself and conferring with your teacher when there are questions.

Fortunately, I eventually healed, beyond medical expectations. I did this by meditating deeply in my body, listening, checking in, trying things slowly, practicing over and over, not rushing or pushing or striving and by being very, very kind to myself.

Nothing is wrong with us, any of us. And we can all find beautiful, wise, and compassionate teachers and practices—especially when we walk away from those that don’t help us to feel our best.

Jill Satterfield is the founder of Vajra Yoga + Meditation, a synthesis of yoga and Buddhism that combines meditation, yoga and contemplative practices. Named “one of the 4 leading yoga and Buddhist teachers in the country” by Shambhala Sun Magazine, Jill has instigated mindful and creative educational programs for over 28 years.

She is also the founder and Director of the School for Compassionate Action: Meditation, Yoga and Educational Support for Communities in Need, a not-for-profit that trains teachers, psychologists and health care providers to integrate mind and body practices into their professions. SCA also provides classes to people in chronic pain, with illness, those suffering from PTSD, and at-risk youth. Jill teaches workshops internationally, is a faculty member of Spirit Rock Meditation Center’s Mindfulness for Yoga Training  and the Somatic Training in Marin, California, and is a guest teacher for many other training programs. To find out more about Jill, visit her website vajrayoga.com.

Patient Generated Data Goes Mainstream

Since 1999, Patientsite, the BIDMC  shared record between doctor and patient,  has enabled patients to track blood pressure, glucometer readings, activities of daily living, mood, pain etc. but few patients have used those features.

Why?  Because it requires time and energy to maintain that data.

What if data gathering was entirely passive?

Today, I own a Withings bathroom scale and Withings Pulse O2 wearable monitor.    When I get up each morning, my weight, body mass index, and fat percentage is measured by my scale and wirelessly sent to the Withings cloud where it is routed to my Microsoft HealthVault account and my iPhone Withings app.

As I go through each day, my Pulse O2 device tracks my sleep pattern, my activity level (distance and elevation), my heart rate, and my pulse ox measurement.    Using Bluetooth Low Energy (BTLE), all the data is instantly synched to my iPhone and viewable by hour, by day and by week.

There is nothing I have to do.   All of this just happens as part of my activities of daily living.

There are three factors that are combining to create a perfect storm for patient generated data to enter the mainstream

1.  The devices, standards (content, vocabulary, transport), and usability are good enough.  The total expense of acquiring/using them is cheap enough

2.  ACOs are beginning to accept the fact that home care devices such as pulse oximeters, blood pressure cuffs, electronic  scales, glucometers, and sleep monitors will be essential to care delivery between episodic visits with clinicians.

3.  It’s likely that Meaningful Use and other government programs will offer stimulus (or penalties for non-compliance) for incorporation of patient generated data into the electronic health record.

Every year I take on a personal project and do my best to roll it out in production.  In the past that has included administrative simplification, healthcare information exchange, patient/family engagement, Google Glass, mobile support for our consumer/clinician facing applications, shared care plan creation etc.

Patient generated healthcare data is the next key frontier in care coordination, population health, and clinical research.  Although Beth Israel Deaconess has invested significantly in home care, care management, and telemedicine, it has not yet made the commitment to be a leader in patient generated healthcare data.

I’ve used the pulse oximeter on Mt. Fuji to track my performance and I’ve learned that I walk an average of 20,000 steps per day during my life as a healthcare CIO and farmer.   I’ve learned that sleep pattern is instant deep sleep for an hour, punctuated by light sleep/deep sleep intervals for 30 minutes, followed by waking in 4 hours.    I’ve watched variation of my weight - weekends have more activity and less time eating, so by Sunday night I’m at the lowest point of the week.   During the weekday meetings and office time, I eat more and exercise less.    The good news is that over the course of each month, my weight peaks and troughs cancel each other.

For the next year I’ll be exploring patient generated data, both in devices I use myself, and in the creation of novel applications that enable such data to be incorporated in ACO and clinician workflow without creating data overload for any stakeholder.

I’ll document all my lessons learned along the journey.

Featured Sequence: Inverted Heart Health Practice

by Baxter

Last week, I shared with you a dynamic sequence for Cardiovascular Health. This week, I’d like to focus on the inverted yoga poses that can have some beneficial effects on overall heart health. Inverted poses come in different shapes and sizes; some are full inversions, such as supported Legs Up the Wall pose (Viparita Karani), while others are partial inversions, such as Downward-Facing Dog pose, in which your body is inverted from your hips to your head but your legs are in their normal relationship to gravity.

Inversions can have several immediate and long-term influences on your heart and circulatory system. If an inversion is physically challenging or held for a long time with lots of muscular effort involved, such as a three-minute Downward-Facing Dog pose, this can have a stimulating effect on your heart, increasing the heart’s workload and essentially exercising the heart muscle more than when it is resting. Inversions can also assist in the return of the blood in the veins back to your heart. The veins rely on the back pressure of blood coming out of the capillaries (which may not be particularly strong), the muscle tone in the walls of the veins (which is much less then an arteries), and one-way valves inside the veins that encourage blood to move toward the heart and not backflow towards the gravity-dependent parts of your legs and arms. As we get older, some of those valves fail and stop working properly, which can result in varicose veins. Regular exercises, such as yoga and even walking, help somewhat by contracting and relaxing the skeletal muscles of the extremities to create a kind of pumping action on your veins to keep the blood moving in the right direction. Inversions put your body in a position to take advantage of gravity to assist in venous return to your heart—you flip upside down and gravity pulls the blood back toward your heart and head!

Inversions can also have a quieting effect on your nervous system, encouraging a shift from Fight or Flight mode to Rest and Digest mode. This feeds back to your cardiovascular system, allowing it to quiet and rest by lowering your blood pressure, slowing your heart rate and promoting good variability in your heart rhythm moment by moment. This quieting effect occurs when inversions are done with less effort and held for longer periods of time, such as Legs Up the Wall pose practiced for 5-10 minutes. We have written about the baroreceptors in the neck and heart before, so if you want to bone up on how inversions affect the heart system, check out Why You Should Love Your Baroreceptors. As I am pretty sure I have said before, your heart muscle needs both exercise and rest, so a good combination of effort and relaxation in your practice will give your heart a more balanced experience.  

If you have a new diagnosis of high blood pressure, especially if it is not yet under good control, or already have developed some form of heart disease, this practice is likely not for you. Having said that, there are exceptions to this caution, in particular if you are working with an experienced teacher who knows your health history and can guide you into inversions gradually. 

And for additional ideas on supported inversions, check out Nina’s post from a while back: All About Supported Inversions.

Inverted Heart Health Practice:

1. Reclined Leg Stretch 1 (Supta Padangusthasana 1): Although we often think of this pose for opening your hips and hamstrings, it is a partial inversion, so I thought it a good place to start today! We will stick to version 1 only today, as it involves keeping the top leg more vertical. 

Lying on your back, bring your right knee into your chest and place the strap around the arch of your right foot. Extend your leg towards vertical (getting vertical depends on your unique muscle and joint challenges). Push out along the line of your leg bones towards your heels, and pull back towards your hip via the strap. Gradually work your towards 90 seconds in the pose. Repeat on the other side. 

See Featured Pose: Reclined Leg Stretch Sequence for more information.

2. Standing Forward Bend (Uttanasana): This pose opens your back buttock muscles and hamstrings, as well as the back calf muscles, but it is also a partial inversion from your hips to your head. From Mountain pose (Tadasana), you might warm up for full Standing Forward Bend by inhaling your arms overhead, exhaling into Standing Forward Bend (maybe keeping your knees a bit bent the first few times), inhaling up to Arms Overhead pose (Urdva Hastanana), and exhaling back to Mountain pose. Then, when you have warmed up a bit, on an exhalation, come into a full forward bend and stay for up to 90 seconds. If you are super tight, keep a slight bend in your knees. If your hands don’t easily come to the floor, place them on blocks or have a chair seat in front of you and rest your forearms on the chair seat. If you have osteoporosis, you may want to skip this inversion. Come up on an inhalation.

3. Widespread Standing Forward Bend (Prasarita Padottanasana): Starting in Mountain Pose, step your feet wide apart, somewhere between 3 and 4 feet, depending on your build. Keeping your feet parallel, bring your hands to your hips, and on an exhalation, tip forward and down from your hip joints. Bring your fingertips to the floor, in line with your shoulders, and lengthen your spine. Then, if you can, bend your elbows and walk your hands back so they are in line with your toes and shoulder-width apart. (If you are very tight in the hips and hamstrings and can’t touch the floor, support your hands on blocks.) Release your head and neck so that, if possible, the crown of your head points down toward the floor or rests lightly on it.

The supported version of this pose, where you rest your head on a chair, a block, or the floor, can be more quieting to the heart and nervous system, so try that if your flexibility allows.

The more support you use, the more quieting the pose, the less support and longer you hold the pose the stimulating the pose: you get to decide how you want to practice each pose in the sequence.If you have osteoporosis, exercise the same caution described above for Standing Forward Bend. 

4. Downward-Facing Dog Pose (Adho Muka Svanasana): Come down to hands and knees, turn your toes under and lift up into Downward-Facing Dog pose. If you are feeling tight, take the first couple of breaths to move into the pose releasing tension and preparing to hold the pose in a quieter way. Once you become more still in the pose, you again will need to decide whether to stay for a shorter or longer period of time. 

The supported variation of Downward-Facing Dog pose that Nina shows in her post All About Supported Inverted Poses can be more quieting for your nervous system, and by extension, your heart. But I find you have to be very mindful to rest your head lightly on the support and not push it down like an extra hand. And you will likely need to use a higher prop than Nina.

Our post on Downward-Facing Dog Pose Variations can give you ideas for other versions of this popular modern pose to keep your sequence interesting! After you come down, you might spend a minute or so in Child’s Pose before moving onto the next poses that involve a bit of back bending. 

5. Active and Supported Bridge Pose (Setu Bandha): Come into Constructive Rest position (on your back with knees bent and heels about four inches from your hips), and establish the normal, slightly arched shape of your lumbar spine. Then lift your hips straight up as you push down into your feet, like an elevator going up a few floors, maintaining the neutral arch of the lower back. Once in Bridge pose, bring some focus to your arms. Press the upper back of your upper arms (right where your arms meets your shoulders) firmly down into the floor while actively lifting the lower tip of your breast bone up to the sky. 

In the full, active Bridge Pose, you are essentially inverted from your knees to your head. Stay for 15-30 seconds. To come down, lower your hips straight down, like an elevator returning to the lobby floor. Rest for a moment and consider repeating one more time. Then, come up again and place a block under your hips at the height that feels best for you. Since you will be allowing your pelvis to rest on the block, this version of bridge in much more restorative in quality, so you could easily hang out in for a while, possibly for several minutes. 

Another alternative is one of Nina’s favorites, Supported Bridge pose with Straight Legs. 

Use caution in Bridge pose if you have any neck issues, especially arthritis or disc disease in the neck.

6. Legs Up the Wall (Vipariti Karani): See Featured Pose: Legs Up the Wall Pose for instructions. If your body permits it, try to use one or two blankets under your pelvis, or, even more effective, a bolster. This will support more of your body in the inverted position. If you set yourself up well, this pose is usually easy to hang out in for anywhere from 5-20 minutes.

For those with more advanced practices, you could consider substituting Shoulderstand, either chair version (see Chair Shoulderstand) or full version. 

7. Corpse Pose (Savasana) of your choice: See Corpse Pose Variations for options. I will sometimes end my practice with Legs Up the Wall pose, but there is something to be said for doing the inversion-neutral Corpse Pose, where you are neither upright or upside down. So take 5 to 10 minutes to rest or ready yourself for what follows in your day. I’d recommend bringing your attention to the heart area of your chest as you also keep some of your awareness on the easy flow of your breath.