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Month: December 2016

Why it’s Important to Learn Anatomy Hands-On

Karen Fabian shares her experiences at the Laboratory of Anatomical Enlightenment, and some thoughts on why it’s so powerful to learn anatomy from hands-on experience, not just books.

Human Arm and Torso of an Anatomical Model

What Can You Learn from the Body When You Look Beyond the Books

I had a chance to attend a cadaver lab training the first week of this month. I went to Phoenix to the Laboratory of Anatomical Enlightenment with yoga teacher, Tiffany Cruikshank, and many other teachers to participate in this once-in-a-lifetime experience.

Every day while I was there, I blogged because I wanted to get down in print my first impressions of the training and all that I saw. But over the past 10 days or so since I have returned, I’ve had time to let my observations sink in, but more importantly, I’ve had a chance to apply what I learned to my teaching.

Learning from Books

I would say that most people learn anatomy from books. For those that have a medical background or are in some kind of hands-on caregiver role (physical therapist, nurse, doctor, acupuncturist or massage therapist, for instance) their background might include a chance to see a cadaver.  What I found from this training was that some teachers attending had done a similar training but with a donor who had already been dissected. This was the case with me, as I’d be a physical therapy student many years ago and part of my undergraduate work included time in the cadaver lab.

The sheer impact of being involved in something like this, was my biggest takeaway. It was incredible to have the opportunity to not only see the body in its most basic form but also to be responsible for the actual dissection. Now that I’ve done both formats, I can certainly say the learning is quite different when you’re doing the dissection yourself.

Another big takeaway for me that I observed, is that everything in the body is layered. It’s so hard to isolate one muscle without noticing its proximity, shared space and similar action to other muscles. For us as yoga teachers, this has broad implications for how we answer questions from students about “what muscle does this or that” or “what can I do to stretch (fill in the blank) muscle?” For many of our students, they may think of the body in a somewhat one dimensional way. But truly, once you look deep inside, you see it from all dimensions and realize how interconnected everything is.

You Can’t See What You Don’t Know

As I’ve been teaching this past week, I’ve watched my students through a different lens. When I look at their shoulders, for instance, I see differently through the skin to the level of the muscles. I did this before, as I’d studied for years from books and even videos, but again, the appreciation is quite different when you see it in person. I once read that you “can’t see what you don’t know.”

That’s often why I start my anatomy training with a postural analysis. It is important that the teachers get used to observing someone’s body without getting bogged down with the detail. There is so much to know, with the muscles names, origins, and insertions (which they don’t know yet). This detailed knowledge comes over time but it’s always important to hone your skill using your eyes and the power of observation as one of your tools. Regardless of how much you know about anatomy, you can at least do that.

We used this ability to observe on that first day when we met the donor that our group would be working with all week. We only had our observing skills at that point because we had no medical history for the donor. As we noticed limitations in range of motion in her hip and shoulder, we noted she had scars on her hip as well. The week proceeded, and we, in fact, found a hip replacement and a completely degenerated shoulder joint to match the crepitus we heard that first day.

Anatomy and Yoga

As yoga teachers, we talk often about the shoulder joint and the impact of different poses, binding variations and arm balances on the structure of the shoulder. It’s always an interesting conversation to have with teachers as many times, teachers will suggest that moving from High to Low Push Up, let’s say, really has no impact on the shoulder. Well, we know from the study of anatomy that it’s certainly hard to say anything is absolute in every person we see, but after observing the shoulder joint before, during and after full dissection, I have grown a new appreciation for how much muscle and joint material (tendons and ligaments) surround the joint. It does give you pause when you think about improper alignment, dipping too low in Low Push Up or “resting” in all that soft tissue that surrounds this important joint.

Some recent blog posts on anatomy have suggested a gliding relationship between muscles and within muscles at the level of the fibers contained therein. This is somewhat contrary to the more common thinking that muscles stretch or lengthen. This is the somewhat typical visual of a muscle lengthening between its origin and insertion. While we didn’t see what was happening at the level of the individual muscle fibers we most certainly did see the relationship of one muscle to another and how there was quite the “glide” between them. This was very apparent when we pulled back the trapezius and underneath saw the serratus, the subscapularis and even the rhomboids. Layer upon layer, the muscles appeared and with each one, we discussed their action, origin and insertion. It was amazing.

What Next

I chronicled so much more of it in my daily blogs from the week, which you can look back and review if you wish. Overall, the experience was invaluable and I’d highly recommend it for anyone that might be interested. For future trainings with Tiffany like this one, check out the Yoga Medicine calendar. Fueled with inspiration from the training, I’ll be hosting a free webinar on shoulder anatomy this coming Wednesday at 6 pm EST. When you sign up, I’ll email you a free PDF on the shoulder. To sign up, click here.

karen-fabian-headshot

About the Author:

Karen Fabian is the founder of Bare Bones Yoga She has been teaching yoga since 2002 and has written 3 books: “Stretched,” “Key Aspects of Anatomy for Yoga Teachers” and “The Bare Bones Yoga Guide to Anatomy.” She lives and works in Boston.

The Real Reason You’ll Fail Your New Year’s Resolution

J.R. Duren from HighYa shares some insight into why people fail their New Year’s Resolutions, and how to be part of the 8% that actually succeed.

Image of a group yoga class from an article on why people have trouble sticking to their New Years Resolution

The Top Reasons Why New Year’s Resolutions Fail

It’s that time of the year – New Year’s resolution time. However, there’s a problem. All those cookies, brownies, hams, turkeys and whatever else was put before you at the holiday dinner table are now begging for you to remain within their oh-so-delicious grasp. They’re doing everything they can to foil your plans to lose weight or get in shape, two goals that made the top five New Year’s resolutions in 2015. The truth is, temptations and unexpected hurdles are quite effective in derailing our goals, so much so that only an estimated 8% of us actually follow through on our New Year’s resolutions. That’s a pretty small slice of the more than 100 million of us who make resolutions each year.

What’s even more interesting is, that every January there are literally thousands of articles and posts from casual writers, so-called “experts” and legit experts who write, at length, about why we fail and how we can succeed with our resolutions. In our opinion, it would be pretty amazing to be part of the 8% who actually succeed. But more than that, we want to see that 8% change. Wouldn’t it be fantastic if 88% of us succeeded instead of a meager 8%? Call it idealistic, but we’d like to change our success rates for New Year’s resolutions. To do that, we embarked on a three-part series on resolutions. Our trio of articles includes:

• Why we fail at our New Year’s resolutions
• What we can do to succeed with our New Year’s resolutions
• Top New Year’s Resolutions tips from psychologists, mental health professionals, and fitness experts.

Throughout this series we dig into the real reasons why we fail and how we can succeed, consulting a wide range of experts to come up with useable, powerful information. Click here to read the full article – including tips from Tiffany Cruikshank!

Medications & Yoga

Margeaux Amerine, Pharmacist and  RYT-200 graduate shares a list of some common medications that can have significance as they relate to a yoga practice.

Medications & Yoga

Medication use is a part of our client intake form, thus having general knowledge of their medications in relation to yoga is important for understanding their overall health, level of pain, as well as how these medications might affect their yoga practice.

Topics:

  • Bone and Joint Disorders
  • Cardiovascular
  • Endocrine
  • Neurologic
  • Psychiatric
  • Respiratory

Bone and Joint Disorders

Common disorders include osteoarthritis, osteoporosis, rheumatoid arthritis and gout.

1. Osteoarthritis (OA)

A common, slowly progressive disorder affecting primarily the weight bearing joints of the peripheral and axial skeleton. It is characterized by progressive deterioration and loss of articular cartilage resulting in osteophyte formation, pain, limitation of motion, deformity, and progressive disability. Inflammation may or may not be present in the affected joint.

Pharmacological Treatment: Pain relief (see neurologic section for complete list of pain relievers and their implications in relation to yoga.)

Considerations: (see neurologic section for complete list of pain relievers and their implications in relation to yoga.)

2. Osteoporosis

Characterized by low bone mass and deterioration of bone tissue leading to bone fragility and increased fracture risk.

Pharmacological Treatment:

  • Calcium
  • Vitamin D
  • Bisphosphonates: Alendronate (Fosamax) Risedronate (Actonel), Ibandronate (Boniva)
    • Bisphosphonates bind to hydroxyapatite in bone and decrease resorption by inhibiting osteoclast adherence to bone surfaces.
  • Others include but less common: Selective Estrogen Receptor Modulators (SERMs), calcitonin, estrogen and hormonal therapy, phytoestrogens, testosterone and anabolic steroids, bone formation therapy

Considerations: For patients with osteoporosis who are at risk for fractures, the aims are to prevent falls, fractures, and their complications. Developing a yoga prescription with awareness that these individuals are at increased risk for a fracture is important, however strength exercises may help prevent bone loss and decrease falls and fractures.

3. Rheumatoid Arthritis (RA)

A chronic and usually progressive inflammatory disorder of unknown etiology characterized by involving several joints, with symmetric joint involvement and systemic manifestations.

Pharmacological Treatments:

  • Disease-Modifying Antirheumatic Drug (DMARD): methotrexate, hydroxycholorquine, sulfasalazine, and leflunomide
  • Non-Steroidal Anti-Inflammatories: (see neurologic section for complete list)
  • Biologic Agents: Enbrel, Remicade, Humira
  • Corticosteroids: prednisone, methylprednisolone
    • Corticosteroids can cause severe, adverse reactions including tendon rupture and has common side effects including muscle weakness and dizziness/vertigo.

Considerations: Joint swelling, stiffness, and pain are common with RA patients. Long-term corticosteroid treatment will increase the risk for tendon rupture.

Cardiovascular Disorders: (not limited to)

Arrhythmia

Defined as loss of cardiac rhythm, especially irregularity of heartbeat.

Pharmacologic Treatment: Quinidine, Procainamide, Disopyramide, Lidocaine, Mexiletine, Tocainide, Flecainide, Propafenone, Beta-Blockers, Amiodarone, Bretylium, Dofetilide, Sotalol, Ibutilide, Verapamil, Diltiazem

Heart Failure (HF)

A clinical syndrome caused by the inability of the heart to pump sufficient blood to meet the metabolic needs of the body.

Pharmacologic Treatment:

  • ACE Inhibitors: Captopril, Enalapril, Lisinopril, Quinipril, Ramipril, Fosinopril, Trandolopril
  • Beta-Blockers: Carvedilol, Metoprolol, Bisoprolol
  • Diuretics: Hydrochlorothiazide, Metolazone, Furosemide, Bumetanide, Torsemide
  • Digoxin
  • Others: Spironolactone, ARBs (losartan, candesartan, valsartan), Nitrates, Hydralazine, Amiodarone

Hyperlipidemia

An elevation of one or more of the following: cholesterol, cholesterol esters, phospholipids, or triglycerides.

Pharmacologic Treatment:

  • Bile Acid Resins: Cholestyramine, Colestipol, Colesevelam
  • Niacin
  • HMG-COA Reductase Inhibitors (STATINS): Atorvastatin, Fluvastatin, Lovastatin, Pravastatin, Rosuvastatin, Simvastatin
    • Can cause generalized muscles aches (myalgia/myopathy) as well as the rare, but serious condition of rhabdomyolysis. Many patients experience muscle aches daily while taking these medications.
  • Fibric Acids: Gemfibrazole, Fenofibrate
  • Others: Zetia, Fish Oil Supplements

Hypertension

Persistent elevation of arterial blood pressure.

Pharmacologic Treatment:

  • Diuretics: Chlorthalidone, Hydrochlorothiazide, Metolazone, Bumetanide, Furosemide, Torsemide, Amiloride, Triamterene, Spironolactone
  • Beta-Blockers: Atenolol, Betaxolol, Bisoprolol, Metoprolol, Nadolol, Propranolol, Carvedilol, Labetolol
  • ACE Inhibitors (angiotensin-converting enzyme inhibitors): Benazapril, Captopril, Enalapril, Fosinopril, Lisinopril, Moexipril, Perindopril, Quinapril, Ramipril
  • ARBs (angiotensin II receptor blockers): Candesartan, Irbesartan, Losartan, Omesartan, Telmisartan, Valsartan
  • Calcium Channel Blockers: Amlodipine, Felodipine, Nifedipine, Diltiazem, Verapamil
  • Others: Alpha-Blockers, central alpha2-agonists, adrenergic inhibitors, and vasodilators

Anticoagulation

blood-thinners (anti-coagulants and antiplatelets) These medications are often used in but not limited to, cardiac patients to prevent clot formation when indicated by a specific condition.

Pharmacologic Treatment:

  • Apixaban (Eliquis)
  • Dabigatran (Pradaxa)
  • Edoxaban (Savaysa)
  • Rivaroxaban (Xarelto)
  • Warfarin (Coumadin)

Considerations: Can increase a patient’s risk for bleeding and bruising. Special care should be taken in a client on Warfarin as the blood thinning effects can cause major or fatal bleeding. Reducing the risk of falls and excessive bruising should be considered when creating a yoga prescription or general yoga practice.

General Considerations for Cardiovascular Disorders:

These patients without exception need to be cleared from a medical professional before beginning any exercise regimen. Regular aerobic exercise has been shown to improve outcomes in patients with hypertension and hyperlipidemia. These disease states come with various, but not limited to, symptoms including, shortness of breath, fatigue, dizziness, palpitations, chest pain, syncope, confusion, cough, and exercise intolerance. Most medications listed to treat these conditions also come with the same adverse side effects that are similar to the symptoms they are treating. Again, it cannot be stressed enough that these patients must be cleared for physical activity before beginning yoga.

Endocrine Disorders:

Diabetes Mellitus (DM)

Group of metabolic disorders characterized by hyperglycemia and abnormalities in carbohydrate, fat, and protein metabolism. It results from defects in insulin secretion, insulin sensitivity, or both. Chronic microvascular, macrovascular, and neuropathic complications may ensue.

Pharmacologic Treatment:

  • Insulin: Humalog, Novolog, Apidra, Humulin R, Novolin R, Humulin N, Novolin N, Lanuts, Levemir
  • GLP-1 Receptor Agonists: Tanzium, Trulicity, Byetta, Bydureon, Victoza
  • Amylin Analogue: Symlin
  • Sulfonylureas: Glipizide, Glyburide, Glimiperide
  • Biguanide: Metformin
  • Meglitinides: Prandin, Starlix
  • Thiazolidinediones: Pioglitazone, Rosiglitazone
  • DPP-4 Inhibitors: Januvia, Onglyza, Tradjenta, Nesina
  • SGLT2 Inhibitors: Invokana, Fargixa
  • Alpha-glucoside Inhibitors: Acarbose, Miglitol
  • Bile Acid Sequestrants: Welchol

Considerations: Low blood sugar or hypoglycemia is the primary side effect with most of these treatment options. Low blood sugar can lead to fatigue, dizziness, fainting. Most patients benefit from increased physical activity. Aerobic exercise can improve insulin resistance and glycemic control and may reduce cardiovascular risk factors, contribute to weight loss or maintenance, and improve wellbeing. Exercise should be started slowly in previously sedentary patients. Older patients and those with cardiovascular conditions should receive approval from medical professional before beginning exercise.

Neurologic Disorders:

Pain

an unpleasant, subjective sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage.

  • Types:
    • Nociceptive (acute) pain is either somatic (arising from skin, bone, joint, muscle, or connective tissue) or visceral (arising from internal organs such as the large intestine or pancreas).
    • Neuropathic (chronic) pain is sustained by abnormal processing of sensory input by the peripheral or central nervous system. There are a large number of neuropathic pain syndromes that are often difficult to treat (e.g. low back pain, diabetic neuropathy, post herpetic neuralgia, cancer-related pain, spinal cord injury).

Pharmacologic Treatment:

Opioid Pain Medication

Often used to treat chronic, severe pain. These medications bind to various opioid receptors, producing analgesia (pain-relief) and sedation. In general, these medications can cause sedation, dizziness, nausea, vomiting, constipation, physical dependence, tolerance, and respiratory depression.

Considerations: The effects of the opioid analgesics are relatively selective, at normal therapeutic concentrations, these agents do not affect other sensory modalities, such as sensitivity to touch, sight, or hearing, however, as the dose increases, so do the undesirable side effects. Patients in severe pain may receive very high doses of opioids with no unwanted side effects, but as the pain subsides, they may not tolerate even very low doses.

Frequently, when opioids are administered, pain is not eliminated, but its unpleasantness is decreased. Special care should be taken with these as pain perception may be modified. In treatment of acute pain or injury, exercise should be stopped completely. Yoga should only be started after approval from a medical profession. In treatment of chronic pain and long-term opioid use, extreme caution should be used with these clients. Collaboration with the primary care physical, specialist, or physical therapist is important with these individuals.

  • Codeine
  • Codeine/Acetaminophen (Tylenol #3, Tylenol #4)
  • Fentanyl (Duragesic, Actiq) -most common form in out-patient use: patch
  • Hydrocodone (Zohydro ER)
  • Hydrocodone/Acetaminophen (Vicodin, Lortab, Lorcet, Norco)
  • Hydromorphone (Dilaudid)
  • Meperidine (Demorol)
  • Methadone (Dolophine, Methadose)
  • Morphine (Avinza, Kadian, MS Contin) – Immediate and Extended-Release
  • Oxycodone (OxyContin, Roxicodone) – Immediate and Extended-Release
  • Oxycodone/Acetaminophen (Percocet, Endocet, Roxicet)

Tramadol (Ultram)

 Non-opioid pain reliever, often used to treat acute or chronic moderate pain. Produces an analgesic effect by binding to mu opioid receptors and weakly inhibits norepinephrine/serotonin reuptake.

Consideration: Although this medication is a non-opioid pain reliever, pain perception may be modified.

Acetaminophen* (Tylenol)

Non-opioid pain reliever often used to treat acute mild to moderate pain. Produces an analgesic effect by weakly inhibiting COX-1 and COX-2 (cyclooxygenase) receptors. *These medication is available over-the-counter or OTC, meaning without a prescription.

Non-Steroidal Anti-Inflammatory Drugs (NSAIDS)

Often used to treat acute and chronic mild to moderate pain with inflammation. The medications inhibit cyclooxygenase; reduce prostaglandin, and thromboxane synthesis.

Considerations: There can be increased risk for bleeding when taking these medications. These medications play an important role in acute injury by helping to decrease the ‘inflammation cycle’ by, with the exceptions of acetaminophen, preventing formation of prostaglandins produced in the response to noxious stimuli, thereby decreasing the number of pain impulses receive by the CNS. In terms of acute injury or pain, yoga should be stopped or limited and only after approval from a medical profession. You will also see chronic use of these medications for their anti-inflammatory pain relieving properties, but also come with the increase risk for developing a GI (gastrointestinal) bleed. All NSAIDs have some analgesic effects, but there is high interpatient variability in therapeutic response to NSAIDs.

  • Aspirin* (Bayer, Bufferin, Ecotrin, Exedrin)
  • Celecoxib (Celebrex)
  • Diclofenac potassium (Cataflam)
  • Diclofenac sodium (Voltaren, Voltaren XR)
  • Diclofenac sodium with misoprostal (Arthrotec)
  • Diflunisal (Dolobid)
  • Etodolac (Lodine, Lodine XL)
  • Flurbiprofen (Ansaid)
  • Ibuprofen (Advil, Motrin, Motrin IB)
  • Indomethacin (Indocin, Indocin SR)
  • Ketoprofen
  • Ketorolac (Toradol) – used to treat acute, severe pain only
  • Magnesium salicylate* (Bayer Select, Doan’s Pills)
  • Meloxicam (Mobic)
  • Nabumetone (Relafen)
  • Naproxen (Naprosyn)
  • Naproxen Sodium* (Aleve)
  • Oxaprozin (Daypro)
  • Piroxicam (Feldine)
  • Sodium Salicylate (various generics)
  • Sulindac (Clinoril)

Chronic neuropathy (nerve pain)

These medications work by activating or blocking various neurotransmitters and receptors on the brain. Historically, many of these medications were indicated for other uses, but with time have been given secondary indications for the treatment of neuropathy.

Considerations: These medications, specifically, do not work on the same receptors as opioids. The patient will feel decreased pain, however pain perception is not modified.

  • Amitriptyline (Elavil) – Depression, migraine
  • Duloxetine (Cymbalta) – Depression/anxiety, fibromyalgia, and chronic muscle or bone pain
  • Gabapentin (Neurontin) – Seizures
  • Nortriptyline (Pamelor) – Depression
  • Pregabalin (Lyrica) – Fibromyalgia, seizures

Muscle relaxants

Often used to treat acute or chronic muscle spasms. Exact mechanism of action is unknown for many of these medications; all are centrally-acting muscle relaxants; some work on neurotransmitters in the brain resulting in sedation and alteration in pain perception, reduced spasticity, depression of central nervous system activity, as well as inhibiting monosynaptic and polysynaptic spinal reflexes.

Considerations: These medications are often used in treatment of acute injury or pain; hence all physical activity should be stopped. Chronic use of muscle relaxants is not common as acute use, and is typically seen, but not limited to, patients who have neurologic disorders such as multiple sclerosis and chronic pain due to injury; in these client’s collaboration with a primary care physician, specialist, or physical therapist is key.

  • Baclofen
  • Chlorzoxazone (Lorzone, Parafon Forte)
  • Carisoprodol (Soma)
  • Cyclobenzaprine (Flexeril, Amrix)
  • Diazepam (Valium)
  • Metaxalone (Skelaxin)
  • Methocarbamol (Robaxin)
  • Tizanidine (Zanaflex)

Topical Pain Relievers

Often used in acute or chronic mild to moderate pain. These medications are applied topically to the area of pain.

  • OTC: products containing menthol, camphor, salicylates, capsaicin. (Icy-Hot, Biofreeze, Bengay, Blue-Emu, Capzasin etc…) – these should really only be for acute, short-term use.
  • Lidocaine: these products contain lidocaine, which is a numbing agent.
  • Lidoderm Patches: prescription only – Ointment, gels, cream: some are OTC others are prescription depending on strength.
  • Diclofenac Gel (Voltaren) – Anti-inflammatory gel applied directly to painful joint. May be preferred method of chronic NSAID therapy as it decreases risk for GI bleed.
  • Diclofenac Patch (Flector) – Anti-inflammatory patch applied directly to painful area.

General considerations for Neuropathic Disorders:

This information is not here for you to diagnose your client’s level of pain, but to rather understand their general pain level, duration of pain treatment, and to provide insight into their general health. In my practice, I see patients on acute and chronic pain medications everyday. In general, many patients on chronic pain medication are able to perform daily functions while taking these medications. This does not go without saying that any type of opioid intake can cause pain perception modification, respiratory depression and death in not only acute but also chronic use and any person under the care of a physician should be cleared for physical activity. Most importantly this information can provide you more insight into understanding pain in our clients. Pain itself is perceptive; one person’s level 10 pain might be another person’s level Listening and being aware are the best tools you can use.

Psychiatric Disorders

 Anxiety disorders

A constellation of disorders in which anxiety and associated symptoms are irrational or experienced at a level of severity that impair functioning.

Pharmacologic Treatment:

  • Benzodiazepines: Alprazolam (Xanax), Clonazepam (Klonopin), Diazepam (Valium), Lorazepam (Ativan), Temezapam (Restoril), Triazolam (Halcion)

Considerations: Can increase risk for falls (especially in the elderly), dizziness, fatigue, impaired coordination, and drowsiness. Due to their sedative effects, extreme caution should be used if a patient is taking one of these medications while doing yoga. Treatment with these medications can be acute, or during a period of heightened anxiety or panic, as many of them have a short duration of action, or can be used chronically as daily therapy to treat some psychiatric disorders, seizure disorders or as a muscle relaxant. Having knowledge of your clients intake and frequency can help determine the appropriateness and safety related concerns in associated with a yoga practice. Collaboration with a client’s primary care physician, counselor or therapist can help to determine appropriateness and safety related concerns.

  • Antidepressants: escitalpram, imipramine, paroxetine, venlafaxine
  • Azapirones: buspirone
  • Diphenylmethane: hydroxyzine

Major Depressive Disorder

Characterized by one or more major depressive episodes without a history of manic, mixed, or hypomanic episodes.

Pharmacologic Treatment:

  • Selective Seratonin Reuptake Inhibitors (SSRI): Citalopram, Escitalopram, Fluoxetine, Fluvoxamine, Paroxetine, Sertraline
  • Serotonin/Norepinephrine Reuptake Inhibitors: Venlafaxine, Duloxetine, Desvenlafaxine (Pristiq), Levomilnacipran (Fetzima)
  • Aminoketones: Buproprion
  • Triazolopyridine: Nefazodone, Trazodone
  • Tricyclic Antidepressants: amitriptyline, Clomiprimine, Doxepin, Imiprimine, Despiramine, Nortripyline,
  • Monoamine Oxidase Inhibitors: Phenelzine, Tranylcypomine
  • 5-HT1A Receptor Antagonist: Vilazodone (Viibryd)
  • 5-HT3 Receptor Antagonist: Vortioxetine (Brintellix)
  • Noradrenergic Antagonists: Mirtazipine

Considerations: Most medications to treat these condition come with corresponding side effects to include, but not limited to, dizziness, fatigue, headache, impaired coordination, drowsiness, anxiety, sedation, insomnia, orthostatic hypotension; this should be taken into consideration when designing a yoga practice. Counseling, stress management, cognitive therapy, meditation, supportive therapy, and exercise can be powerful tools and should be used collaboration with other care providers such as counselors, therapists, or medical professional; this includes the treatment of other psychiatric disorders such as Alzheimer’s and Schizophrenia.

Respiratory Disorders: (not limited to)

Asthma

A chronic inflammatory disorder of the airways in which many cells and cellular elements play a role. Episodes of wheezing, breathlessness, chest tightness, and coughing.

Chronic Obstructive Pulmonary Disease

Progressive airflow limitation that is not fully reversible. Airflow limitation is usually both progressive and associate with an abnormal inflammatory response of the lugs to noxious particles or gasses. The most common conditions comprising COPD are chronic bronchitis and emphysema.

Pharmacologic Treatment:

  • Inhaled Beta-agonists: Albuterol, Formoterol, Salmeterol, Levalbuterol
  • Anticholinergics: Ipratropium, Tiotropium
  • Oral Corticosteroids: Prednisone, Methylprednisolone, Prednisone
    • Corticosteroids can cause severe, adverse reactions including tendon rupture and has common side effects including muscle weakness and dizziness/vertigo.
  • Inhaled Corticosteroids: Beclomethasone, Budesonide, Flunisolide, Fluticasone, Mometasone, Triamcinolone
  • Others: Theophyline, Cromolyn, Accolate, Montelukast

Considerations: A medical professional should clear clients with these conditions before beginning an exercise regimen. In contrast to oral corticosteroid therapy where unwanted side effects like tendon rupture, muscle weakness and dizziness are a concern, inhaled corticosteroids have less systemic absorption. Beta-agonists can have unwanted side effects to include wheezing, chest tightness, trouble breathing, nervousness, tremor, chest pain, palpitations, nausea, or dizziness. Due to the nature of these conditions and associated side effects, collaboration with a medical professional is important for the safety of the individual.

General considerations on Respiratory Disorders:

This information is not meant for you to diagnose or plan treatment for your client, but to better understand and aid you and your client in developing a safe yoga practice. It cannot be stressed enough that these common medical conditions, but not limited to, come with increased risk when patients partake in physical activity, thus making sure they care cleared by their physician for physical activity and collaboration with their care providers is crucial for their safety, as well as your own.

This information is not all-inclusive and if you have any questions regarding medications related to yoga, please feel free to email me at mcschoofs@gmail.com.

Sources:

Wells, Barbara G., Joseph T. DiPiro, Terry L. Schwinghammer, and Cindy W. Hamilton. Pharmacotherapy Handbook. Sixth ed. New York: McGraw-Hill Medical Pub. Division, 2006. Print.

Break Free From a Monotonous Yoga Routine

Expert Tips: Break Free From a Monotonous Yoga Routine

Yoga casts its charm over us with all its flexible and tranquil poses. Especially in the beginning, during our honeymoon phase with yoga,  we live in this haze of yogic enchantment. However, as it often happens, time comes as a spoiler, we learn to master the simple asanas and finally the head and handstands, the enchantment diminishes and yoga becomes a monotonous routine. This is especially true for many yogis who practice the art at home.

As our yoga regime becomes more and more a part of our predictable routine, sooner or later we may find our practice dwindling. Why? The clear culprit for this lack of motivation is boredom!!!

The human mind craves creativity – repetitive routines make yoga teachers shirk their practice and push students to drop their memberships. This lack of interest and concentration also increases risk of injuries.

So, how can we get out of this rut and continue with our healthy routine without feeling apathetic? To help you find your answers, Yoga With Sapna brings to you valuable expert advice from renowned yogis from around the world. These yogis have “been there, done that” and come out victorious in their struggles.

Yoga Medicine’s senior yoga teacher, Amanda Bonfiglio Cunningham says:

“According to the forest bathing organization, Shinrin Yoku in L.A., being among the trees offers both physical and mental health benefits. From lowered stress levels to an increase in mindfulness, fervent believers are boasting rave results. So if your practice feels monotonous, take it on a date! In this active form of meditation, tune in to nature’s ability to awaken your senses. Allow the breeze to cool your skin and the birds to be your music, let mother nature reignite your passion for the practice.”

Check out Yoga With Sapna’s full list of expert tips here

Mindfulness: The New Years Resolution You Should Keep

Lindsay Tigar from Bustle shares some tips on how to fulfill your New Years Resolution by learning to practice mindfulness and self-reflection.

Mindfulness Bustle Article

How To Practice Mindfulness Into The New Year, Because It All Starts With Reflection

You can see it there, nagging at you in the very tail end of your calendar, reminding you that yep, another year has come and gone. So much happens in the 12 months or the 365 days or the 525,600 minutes that pass with time, and it can be overwhelming to think about how fast it flies. Most people use the New Year as a time to push an imaginary reset button, preparing them for a transformation, an opportunity, the drive to change something in their lives. But what experts are saying might be the better approach? Not having goals or a resolution, but instead, adopting a mindful approach to the New Year.

“The New Year is a good time to reflect back because it marks both the end of one chapter and the start of a new one. Moments like these offer a chance for ritual and ceremony, something lacking in the chaos of the stressful modern life. Marking the end of the year with reflection helps us be more intentional with our choices, and ensure that life doesn’t just pass us by,” psychology and life coach, Rebecca West tells Bustle.

If you’ve been meaning to check ‘Be more mindful’ off your mental to-do list for, like, ever and haven’t made time to make it a priority, let the New Year be your opportunity. Here, experts share the most mindful ways to enter the next span of your life with a sense of contentment, happiness and that ever-lusted after, zen.

Click here to read the full article which includes tips from senior Yoga Medicine teacher, Amanda Bonfiglio Cunningham. Visit the Yoga Medicine team page to learn more about Amanda and our teaching staff.

Yoga Journal – Free Your Side Body: A Flow for Your Fascia

By Allison Candelaria.

Do you practice yoga regularly but still feel “stuck” in certain spots? Senior Yoga Medicine teacher Allison Candelaria created this muscle-and fascia-freeing flow to tune up the lateral sides of your body.

With much of the body’s natural movement being forward, the side body tends to get overlooked in our daily lives. We rarely bend to the left or to the right. As a result, the tissues of the side body can end up tight and/or weak from top to bottom. Poor postural habits don’t help. Slouching can create so much tension in the upper body that lifting the arms fully overhead becomes impossible and stretching from side to side causes discomfort.

Let’s take a look at how the individual muscles are affected. The triceps rarely get a good release and can sometimes be the limiting factor in yoga poses with arms overhead. The latissimus dorsi muscle, which plays the important role of connecting the lower body to the arms, tends to adhere to surrounding tissues. Melting tension in this very large muscle can free up more range of motion. The quadratus lumborum (QL), our lateral lumbar spine stabilizer, often tight from sitting or standing, can shorten and decrease the distance between the ribs and the pelvis. Creating a nice release in the QL can make us feel taller and more pliable.

Standing, sitting and repetitive forward movements have a huge impact on the lower body. The gluteus medius on the side of the hip, for example, is prone to becoming tight from all of our natural forward movement, which can interfere with our ability to stabilize the pelvis. We can use our yoga practice to stretch the front and back of the hip to reduce tension in the iliotibial band that runs down the side of the leg (think poses like Reclined Figure Four and Gomukasana with a Side Bend). But with myofascial release, the goal is to release it from the quadriceps muscles, allowing them to move independently of one another. Finally, the lower leg can hold a lot of tension from the stress of holding us upright. The extensors of the foot can get bound up with the flexors, including the calves, so these areas are also worthy of some relief.

By focusing on releasing the fascia, this flow will tackle these common areas of tension—one at a time—then retrain the muscles to lengthen, strengthen and fire more efficiently. Since the tissues are all connected via the fascial system, working on any part of this lateral line of muscles will affect the rest of the chain. Not only can this flow reduce pain and increase range of motion, but with a consistent practice we can teach our muscles how to move more efficiently. Post-myofascial release, we will test our range of motion to see the instant results of the work. I recommend using this sequence as needed (daily for more limitation or few times a week for less) and holding each trigger point area for 30–60 seconds.

Click here to see Allison’s 12 Poses for the Fascia of Your Side Body

3 Moves to Correct Hip Hypermobility

Alice Louise Blunden of YogaMedicine shares some crucial information about the popularity of “hip-openers,” a quick lesson on hip anatomy, and three poses to help correct hypermobility and build stability in your hip joint.

3 yoga poses to correct joint hypermobility and promote hip stability

Not ALL Hips Need Opening: 3 Moves for Hip Stability

When yogis talk hips, it’s generally about opening them. But your hips CAN be too open. If you fall into the hypermobile camp, learn how to balance strength and flexibility to protect your hips.
Dedicating time during our physical yoga practice to opening the hips can be nourishing, therapeutic—and downright addictive for many of us. (How about that feel-good release in Pigeon Pose?) Let’s consider, though, whether we always need to push for more flexibility in this region of the body or if it may be more helpful for some people to build strength.

Do Your Hips Really Need Opening?

Hip strength is necessary in day-to-day life. Whether we are walking in the park, running for the bus, or cycling to work, the hip joint takes the brunt of the body’s weight and enables all of these fundamental actions. In short: Stable hips are a good thing—they carry our bodies throughout the day. Of course if you are an athlete, runner, or someone simply born with especially tight hips, hip-opening poses are helpful in maintaining a healthy range of motion and balance between strength and flexibility. If you’re on the other end of the spectrum, though, and are naturally quite open in the hips or after years of practicing hip-opening poses now have very open hips, consider whether it’s still helpful to continue increasing the range of motion in this region of your body.

I am ‘blessed’ with naturally open hips. I never shied away from postures that required an increased range of motion in this region of the body when I first started yoga. I’m the person who could actually fall asleep with my legs wrapped behind my head in Yoginandrasana. But was it therapeutic? I certainly looked like an advanced yogi in these postures. But, unfortunately, my lack of knowledge and understanding of the hip joint meant that I could have been doing more damage to my body than good.

Understanding the Hip Joint

The hip joint is a ball and socket joint composed of two bones. The femur sits in the acetabulum, which is part of the pelvis. Covering the bones of the hip is the articular cartilage. The articular cartilage is important for providing a cushion and a smooth surface when the bones move on one another. Surrounding the acetabulum is additional cartilage called the labrum, which forms a lip around the cup-shaped bone to provide additional stability in the joint.

While it is helpful to understand the anatomy of the hip, what may be more even important (if a bit frightening) is knowing that one of the deepest layers of the joint, the cartilage, does not have any nerve endings. This means you may not be aware of any damage to the cartilage until it is too late. Although cartilage doesn’t have nerve endings, the surrounding muscles, tendons, and ligaments do. This is why yoga can be helpful for tuning into the body to find a balance between strength and flexibility. This is crucial for the health of the muscles and the integrity of the joints. By listening to our bodies with this sense of mindfulness we can begin to notice our strengths and weaknesses. This will enable us to develop a nourishing practice that our bodies truly need.

Click here to see Alice’s 3 Moves for Hip Stability

Yoga for Mind & Body – Benefits of Yoga Interview

Amanda Bonfiglio Cunningham - native society

Which Way is Life? Podcast episode 17.

Which Way is Life? offers podcasts designed to help busy, overworked, stressed out people find their way to a more balanced, healthier, inspired life. Bill Klaproth interviews trendsetting doctors, fitness professionals, life coaches, and more to learn about transformational discovery and positive change.

In this episode, you’ll hear from Yoga Medicine instructor Amanda Bonfiglio Cunningham. Click here to listen to the episode and learn Amanda’s suggestions on the physical and mental benefits of yoga, how to find the right yoga studio for you, and the one thing you can do to improve your life today.

amandabyogavirasana

Amanda is a teacher, philanthropist, wife, dog mama and business owner. Amanda has been practicing and teaching yoga for a combined 15 years. Click here to learn more about Amanda and the Yoga Medicine team.

Best Meditations of 2016: Save These for a Stressful Day

The benefit of the holidays’ timing as the year’s punctuation mark is that they happen to coincide with all of these best-of-the-year roundups. So check out our roundup of the best meditations of 2016.

Just when you have the greatest need for meditation and the least amount of time to actually meditate—much less track down a specific technique you want to try—we have conveniently aggregated the best brain-boosting, mind-settling, and self-illuminating practices we published this year. Happy holidays!

tiffany-cruikshanks-meditation-for-healthy-weight-loss
Tiffany Cruikshank meditating. Check out the best meditations of 2016 to help with holiday stress.

Visit Yoga Journal’s full list here or click here to go straight to Tiffany’s Meditation for Healthy Weight Loss.

Native Society feature: Valerie Knopik

Yoga Medicine is proud to share a feature on one of our assistant teachers, Valerie Knopik, by Native Society. Native Society connects aspiration readers with inspirational content, and we couldn’t agree more that Amanda is a motivational resource on our team! We hope you enjoy reading this article.

Bethany_O_Photography_-_www.bethanyo.com-3321_349x254 Valerie Knopik, PhD, is the Director of Research for Yoga Medicine, a Senior Research Scientist & Professor of Psychiatry and Human Behavior at Brown University, and a yoga teacher in Providence, Rhode Island. Formally trained in classical ballet, as well as a former runner, Valerie has always been a believer in staying active but yoga is the perfect marriage of her work in mental health & her love of movement & anatomy. With a PhD in Psychology, Valerie is extremely active in mental health research, focusing on how our internal biology and our external physical environment (including yoga, mindfulness, and meditation) can interact to positively change our mental health landscape.

Valerie’s sincere hope is that, while the physical asana practice might be the introduction to yoga (as it was for her), her students can utilize the asanas as a tool to find cohesion of body, mind, and spirit in order to experience fullness & purpose in their lives. Valerie lives with her husband and their two children (and a big, lovable Great Dane named Justice) in Rhode Island.

What do you do best?

If I had to pick one phrase to capture what I do best, it would be the following: I inspire others to pursue and achieve their true potential.  I wear multiple professional hats – one as an academic researcher/scientist mentoring postdoctoral fellows and junior faculty at Brown University, one as a Yoga Medicine trained teacher holding space and guiding students every week, (as of a few months ago) yet another as the Director of Research for Yoga Medicine.

While these professional hats used to feel very separate and distinct from one another, I find that now, more than ever, my experiences in these various domains are mutually informative.  I truly believe that this gives me an advantage and allows me to carve out a very specific niche.  What I do best boils down to this simple action, informed by all aspects of my life – inspire others to pursue and achieve their true potential, provide them with the tools to dig deep, start from within, and achieve their goals.

What makes you the best?

I am so passionate about my new role as Director of Research for Yoga Medicine because it allows me to draw on every modality of my experience to date. Working alongside Tiffany Cruikshank and the Yoga Medicine team, I am building a research program focused on the application of yoga, meditation, and mindfulness to improve health and the human condition.  Our vision is to educate and empower our global communities to use yoga therapeutically based on a deeper understanding through purposeful and well-designed research.

Through this effort, I have the honor of mentoring and training our Yoga Medicine community of teachers in the nuances of conducting research and to deliver purpose-driven yoga, meditation and mindfulness instruction as a way to robustly examine its effects on various health outcomes. In my view, this continues the push, already started by Yoga Medicine, to raise the bar on what it means to be yoga teacher. Education. Experience. Results.

valerie-knopik-3I teach, mentor, and speak from a genuine and authentic place. That is, I use my own personal journey and experiences – both struggles and successes — to connect with others and inform my work. I know that not everyone is going to appreciate that and that is okay; but, in working from that authentic place, I have built a community that encourages all to bring their unique gifts to the table and to shine brightly.  Moreover, I think that passion and authenticity actually shows – i.e., that it is evident to those around me and they can, in turn, find a safe refuge to learn and grow in that space that I have helped to create.

What are your aspirations?

In many ways, my personal and business goals are intertwined.

PERSONAL: To love fiercely (family and friends), to support unconditionally, to be passionate about what I do for a living, to be better at creating balance in my own life, to stay grounded through life’s challenges, and to be someone people want to be around. Ultimately, I want to make a difference in people’s lives.

BUSINESS: To continue to find ways to combine my two loves/careers – scientific research and yoga – in a way that is meaningful and balanced. To continue to be an outstanding mentor and teacher in all domains of my professional life. To continue to learn and grow by working and training with my own mentors.

Biggest Success?

I feel very fortunate to have worked incredibly hard and to say that I’ve been blessed with many successes.  My academic career has had a trajectory that I am very proud of and my path in yoga has, of late, blossomed into more than I could have imagined one year ago.  The joining of the two – research and yoga – via my role as Director of Research at Yoga Medicine, is something I dreamed of and something that I proud to say that I am diligently working toward.

However, I remain steadfast in saying that my family is my biggest success.  My two children and my marriage are the most important work that I do. They are my biggest supporters and cheerleaders and I would not be where I am today without them. They have shaped who I am and my work ethic (and, let’s be honest, having two children has honed my ability to juggle multiple jobs and projects!).

Most Challenging Moment?

There are three incredibly challenging moments that have shaped who I am – (1) the death of my mother when I was 12 years old; (2) the death of my 16-year-old niece; and (3) a 6-month separation from my husband.

When I was 12, my mom died of cancer…

She was sick on and off for about 3 years before she passed.  Having to navigate those waters as a child – well, I can’t say that I did it very well.  I did the best that I could and my dad and siblings did the best they could.  But how do you survive that grief and that loss? I am still dealing with the aftermath of really having never completely processed many aspects of her death.

I still wrestle with feelings of guilt that I didn’t go into her hospital room one last time before she died and the constant wondering of whether or not she would be proud of the person that I have become. But, losing her gave me such gifts…a relationship with my dad that is like no other and the fierce desire to be the best mom I could be (and you can bet that I celebrated inside myself when my children, one by one, turned 12 because I have officially had more time with them than I had with my mom) – and for these gifts, I am so incredibly grateful.

Four years ago, my 16-year-old niece, Leanna, fell ill with a rare viral infection of the heart, myocarditis…

From the time she fell ill (with what seemed like the flu) to the time that she passed, was a little over one month.  ONE MONTH.  One month of touch and go.  Of my brother and his wife living in the Ronald MacDonald house at the hospital.  Of ups and downs and gut-wrenching decisions. One month of our family, in various combinations, rallying in that hospital waiting room. It still feels surreal. I wish every day that she was still here with us. Yet, what I take away from this is the lesson in how one person can affect others…how one person can profoundly change another’s perspective on life…and to remember to enjoy each and every moment because I’ll never get another moment quite like it.

My 6-month separation from my husband and our decision to make it work…

Five years ago, my husband and I were separated.  I will not go into the details but suffice it to say that we lost track of each other.  After 11+ years of marriage, we lost each other, plain and simple. During that separation, there were times when I was sure we were going to get a divorce and times when I wondered how our children were going to handle things.  I hate that we went through that period. But, I’m so incredibly grateful at the same time.

Why?  Because we found each other again. In all of our flaws and our individual differences, we made the joint decision to try to make it work. That period in my life taught me how much effort a successful marriage (or any relationship, really) requires.  It is not something to just sit back and watch.  You need to be an active participant.  You can’t check out.  Not for one moment. It also taught me who was truly in my support network.  I still can’t believe it, but I lost people who I thought were good solid friends when my husband and I decided to move forward with our marriage.  For whatever reason, they couldn’t understand it or chose not to.  It taught me who was in my tribe…and those people who stood by me (and by us). I love those people fiercely and always will.

Motto?

Sparkle it up and let your light shine! AND, of late, “If you limit your choices to what seems possible or reasonable, you disconnect yourself from what you really want. And all that is left is compromise.” – Robert Fritz

valerie-knopik-1

Favorite People/Role Models?

Walter Knopik, My dad, for showing me what it means to be a beautiful person, inside and out, and for teaching me the value of hard work.

Chris Knopik and Steve Knopik, my brothers, and my sister, Barbara Baker for setting the bar and being supportive every step of the way.

Kristi Garner, My dearest and oldest friend, for everything.

Scott Kiekbusch, My husband, and our children, Violet and Ronin, for holding me accountable every day and for teaching me how to love deeply and unconditionally.

Tiffany Cruikshank, My mentor, for pushing me to be the yoga teacher than I am today, for encouraging me to grow and find my niche, and for giving me the opportunity to join my love of research and my love of yoga in a way that empowers others.

My trainees and students, for trusting me and for teaching me.  I’ve learned so much from each and every one of them.

Favorite Places/Destinations?

Ah, here’s the short list:

Secret Beach (Kauai)

Australia

Punta Monterrey Beach Resort, Mexico

Siesta Key Beach, Florida

Birch Restaurant, Providence, RI

Favorite Products/Objects?

Manduka Eko yoga mat

Rad Roller myofascial release balls

Meditate Your Weight, by Tiffany Cruikshank

The Great Work of Your Life, by Stephen Cope

My trusted meditation pillow

Any drawing or project created by my children

Current Passions?

Yoga, science, research, the beach, the ocean, food, dark chocolate, music, cooking, wine, reading for pleasure (not work), downtime, relaxing at home, Sunday afternoons with no obligations, movies, massages, my family – translation???  Anything that fuels me and makes me feel alive!

Visit the online article here.

Click here to learn more about the Yoga Medicine team.

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