Tiffany Cruikshank, LAc, MAOM, E-RYT for Retreat Guru‘s featured teacher series. Tiffany discusses the meeting of Eastern and Western medicine, why she loves yoga, and how Yoga Medicine came to be.
Bridging Eastern and Western healing: with Tiffany Cruikshank
Why do you practice yoga? Do you come to the practice to help heal an injury, support spinal health, or perhaps, release some stress? Maybe yoga is your spiritual practice, and the physical benefits are an afterthought. A fusion of all these things?
For Tiffany Cruikshank, founder of Yoga Medicine®, the magic of yoga — and what had her create a yoga school — is an appreciation for how yoga can support the whole person. We spoke with her about how her approach fuses Eastern and Western medicine. Learn why this might just be the future of yoga as a healing modality.
Chinese Medicine & Healing
“I think the beauty of both, yoga and Chinese medicine is looking at who this person is,” she says. “I love teaching our teachers… not, ‘here’s this pose for headaches’ or ‘here’s this pose for hypertension’, but really understanding: who is this person? And, what is it that unlocks the mystery of their health journey?
It’s not necessarily that I can just look at someone and know. It’s not a magical thing. Truly it’s not a clear-cut approach but really learning how to understand the human being, both from a physiological standpoint and an anatomical standpoint. What makes sense to me is the Chinese medicine context as well. Because for me, that’s where it starts to tie in the whole person. It starts to bring together the psychological aspects, the physical aspects, and the physiological aspects.”
What Does it Mean to be Healthy
Her experience forms the philosophical foundation for her Yoga Medicine® approach to movement and health. It’s not about creating a one-size-fits-all program, Tiffany says, but answering a broader question: what does it mean to be healthy.
“I think there is a healthy concurrent to enjoying your exercise, but there’s always the sense that we have to beat ourselves up to be healthy and I really believe to be healthy is about supporting your body’s natural capacities. Yes, we get lazy and at times have to push ourselves to get out and do something, but it doesn’t necessarily mean we have to beat ourselves up. I’m not saying there’s no place for intensive intervals and things like that, I think there’s a place for everything.
For me, [it’s about] questioning what it means to be healthy and where these ideas come from… What drives it… and how that feeds my priorities. I think the beauty of yoga is the lifestyle that it creates, the mindfulness that it creates for us to look at and examine and take ownership of our health, of our lives. And as I get older, for me it’s also just recognizing that you only have so much time in this world, you only have so much time in this life. How should we use that time? For some people that might be running, and for others that might be with their families or doing yoga.
You know, the beauty of yoga is that it can fit seamlessly into that. It can just be a few minutes of meditation, it can just be a few minutes a day, and be something that really supports everything else that you’re doing. I think that’s why it has caught on fire all around the world.”
Merging East with West
Interested in herbalism from the young age of 14, Tiffany now has a breadth of training that bridges both classical Eastern medicine, in the forms of yoga and acupuncture and oriental medicine, with Western medicine in the form of rigorous anatomy, physiology, and kinesiology. She dreamed of playing professional tennis. Because of this, sports medicine drew her interest in school. This created a foundation to be the link between the traditional practices of yoga and oriental medicine. Tiffany explains that doctors and practitioners are wanting to increase the inclusion of yoga in their work.
“I feel that a lot of the desire for doctors wanting to use it is there, they just really don’t know how to. And fair enough, the reality as a healthcare provider is if you refer your patient to go to yoga, you might get in a lot of trouble because they can end up in an Ashtanga class, they might end up in a Yin Yoga class or anything in between, all of which could be fantastic, any one of those could be the cure to all their problems – or potentially not. Because it could potentially make things worse.” And this is where Tiffany and her school are raising the bar on teacher trainings. Although she doesn’t believe yoga teachers are meant to be diagnosing students’ ailments or injuries, she does believe her students can be prepared to better interact with the medical world.
Engaging the Medical Community
“My purpose was really just to train teachers on a deeper level, to be a resource of teachers to serve the medical providers. My school, Yoga Medicine® is not a style of yoga but a school that trains teachers to think for themselves and apply the appropriate style and techniques for the individual. I really believe that there’s a place for every style of yoga out there. It’s just knowing how and when to use them and in what context it would be most helpful for people. Especially if you are talking about people who are injured or sick for whatever reason.”
If that means she can get medical professionals into her training, whether to gain perspective for themselves or to learn how to better use yoga in their practices, she’s thrilled. “For doctors, I think it’s changed a lot. Nowadays it’s not uncommon for us to see in a training of 70 people that 20 of them are healthcare providers of some sort. From surgeons to anaesthesiologists to radiologists, and obviously, there’s been physiotherapists coming into the yoga world for a while, massage therapists, but the doctors I think is a new thing, at least for me in the past few years. Surgeons and doctors who are already set up in the medical world, in hospitals, are wanting to come in and learn how to teach yoga in those facilities, which is crazy.”
Frankie Niwot for Yoga Medicine® discusses neuroplasticity, how it contributes to health, and how self care takes advantage of the power of the brain.
Neuroplasticity and Self-Care
What we practice on the mat has a huge impact on our muscles and joints, but what about our self-talk? What is the impact of a 60-minute practice on the storyline running in our heads throughout the other 23 hours of each day? Just like life, practice can be filled with preferences and opinions that cycle back into our personal critiques that we carry off the mat. We can become grounded in likes and dislikes of postures, styles, body parts and even breathing techniques. What happens when we get anchored in places that negatively affect our conversation with our own bodies or abilities?
Negative self talk can be likened to inflammation on the brain. We have the capacity to trigger or elevate our stress response in the body. Our adrenals are responsible for the production of the stress hormones, cortisol and adrenaline; but the adrenals are reacting to the mental patterns or environmental triggers. The adrenals are not acting independently, we have a huge impact on their stress or ease. Makes sense right? We can be doing all the things – have a regular practice, go to classes, teach lovely sequences – but are we checking the underlying inflammation and stress levels in our bodies? Are we stuck in patterns that are winding up our fight or flight mode, as we are trying to find some ease in the day?
Teach Lovely Sequences
That’s right, I said teach lovely sequences, because yoga teachers do not get a free pass here. As teachers, we too can be incredibly hard on ourselves as we simultaneously craft a body positive environment for our students or clients. This can especially be true for a new teacher who is trying to find a unique voice and style, which can create anxiety and stress. Students and teachers alike can focus practice on perfection way more than on ease.
The first yama is ahimsa or nonviolence, to do no harm. Practicing kindness to ourselves, our abilities, our bodies is the subtle side of ahimsa. In this mindset, we get to rewire our stress response with new language, a new foundation of support for ourselves. When we choose self care as a motivation, it transforms our practice and make room for easeful pathways in the brain.
Let’s face it, most of us didn’t find yoga because everything was awesome in our lives. We found the practice for it’s ability to change us, to change our attitudes, our focus, our ability to chill out in a stressful time. This is the beauty of neuroplasticity, the brain’s ability to form and reorganize synaptic connections in response to learning, injury, and general life experiences. We are able to adjust our response and reorganize our thoughts and reactions around fresh connections in the brain. We can change patterns and belief systems and our bodies through yoga.
A Practice to Try
#1 – Write it out.
Name your mindset and describe it. Maybe it is about a challenge, task at hand or emotional response you are experiencing.
#2 – Call out the evidence.
Mindsets and self talk are molded with the evidence we collect. We gather to prop it up, to make the mindset stronger and stronger. For example, when we have a mindset that we are connected to all living beings, we see the world through that lens. We collect the evidence in our lives to support connectivity. We may be more likely to see similarities with others, to find compassion for another person’s difficult time. Connectivity, as a mindset, changes the way we interact with the world.
#3 – Ask yourself if there is another pathway to explore or a route – a PATTERN INTERRUPT.
This is where we can collect and mine for different evidence to support a new groove in our brain. We get the opportunity to soften the edges of what seemed so solid and try on a new conversation. We have all experienced times of loneliness, when we may feel like the only person on the planet who gets it. And many of us have experienced a pattern interrupt when we remember our connectivity, we remember that we are in this together, we wake up to the possibility of support.
#4 – Be willing.
Letting go of the conversation that we hold so dear can sometimes feel like a white knuckled death grip. It can feel like unknown territory … because it is. It is the beginning and we have to try it out like a new outfit and it may take a while before it becomes a favorite. But everyday we can choose to be willing to try.
#5 – There is plenty.
Remind yourself that there is plenty – of time, of possibilities, of perspectives, of ways to be in relationship with yourself. The relationship we craft with ourselves, is the longest one we will ever have. There is a vast depth to our ability to care for ourselves, to let our yoga practice facilitate a wild release of what may be stagnating our potential. There is plenty of room to be kinder to ourselves and reap the benefits.
Erica Jung for Yoga Journal on how yoga helped her grieve the loss of her brother after his suicide. Learn how to use yoga to help you cope emotionally with difficult times.
This Is How My Yoga Practice Guided Me Through My Brother’s Suicide
Six months ago, I found myself sitting under an overpass in North Carolina. I looked at the still creek, bare trees, and slate-grey sky; felt the smooth, cold sand under my seat; and listened to the sound of sweetly chirping birds that somehow overpowered the steady stream of cars on the bridge overhead. The area felt surprisingly peaceful in its bare December glory. It was a slice of nature and a sanctuary.
I took a deep breath of appreciation and let a smile spread across my face as I silently said thank you to Mother Earth and to God. Thank you for letting this be the last thing he saw.
You see, this was the exact spot where my big brother hung himself.
This memory came rushing back to me after the news that Kate Spade and Anthony Bourdain had both committed suicide. And like so many, even those who haven’t had someone they’ve loved make the decision to exit this world, I find myself asking why?
Utilize Your Community
Why have suicide rates skyrocketed in the last 20 years, despite us living in a time when self-help practices are exploding? Why is this happening in an era where we’re seeing yoga set record-breaking levels of participation, and when the expansion of technology and ease of travel make it easier than ever to connect and stay connected with others?
The number of people choosing to end their own lives is growing and not slowing.
I don’t have all the answers, but I do believe that as a yoga community, we can be doing more to truly utilize yoga’s full power and true intentions—particularly when we’re faced with challenging times.
I often tell people that I believe our practice isn’t for the times that feel easy and manageable. Our practice is for when the times are the toughest, when we feel the most broken, threatened, or fearful. The teachings aren’t about how to shut out the things you don’t like; rather, they are about how to embrace those things, gain perspective from them, and expand yourself as a being by facing them.
How Yoga Guided Me Through My Brother’s Suicide
What I know now is that when you learn someone close to you has died, your mind kicks into overdrive as you try to figure out and understand what happened, and also how to handle it. There’s the immediate grieving; and then there’s everything else in your life that needs to stop or be rearranged. People to call, assets to handle. It‘s overwhelming, and can be all-consuming—if you let it take over.
Through this incredibly difficult time, my saving grace was the practice that I had done a thousand times before—the practice of learning to recognize ego and fear and tune in to my inner guide. And in that most unlikely time, my inner guide told me that all was well. My brother was OK. He was at peace. And I was able to see that just maybe, there was a gift from him in all of this.
How Yoga Helped me Cope
It was that gentle-but-steady inner guidance that brought me peace, ease, and an almost immediate connection to something greater than myself. It was almost as if my brother was sitting there with me saying, It’s all good. Stop stressing. I’m happy and free, and it’s going to be OK. Everything about that defied logic. Yet if my practice has taught me anything, it’s that this inner guide will lead me beyond what is logical, and it will never lead me astray. It was through constant and unwavering practice that I was able to listen to this voice when I needed it most, and have faith that I’d know how to move forward.
There is no separation between my life and my practice. In the weeks and months following my brother’s suicide, I was reminded of this even more. In fact, my asana practice on my mat has taken more of a back seat over the years. But my practice? My practice comes to life in every moment I live, and in every breath I take. I am my practice, and my practice is me—and that never stops. Ever. When times are the hardest, that is when I have to dig into it the deepest and trust.
Yoga Can Help You Cope, Too
If the news of these recent, high-profile suicides has you feeling down or wondering what to do—or, if the news is bringing up memories of how suicide has touched you on a deep and very personal level—here’s my advice to you: Turn to your practices. Here’s how.
Sit with your discomfort.
These days, so many of us charge hard toward what makes us feel good, and we skirt the tough stuff. In fact, I would argue that we’ve moved away from what makes yoga so powerful and transformative, and instead, we’ve stopped at the surface, opting for the things that feel more pleasant, are more marketable, and don’t push any buttons. A prime example of this is how we use social media as a platform. We are flooded with more and more professional-looking pictures and images of extreme poses captioned with Rumi quotes. Yet we seem to be losing our ability to go deeper, and have more uncomfortable conversations with each other.
Even social media yogini pioneer, Rachel Brathen, noted recently that whenever she posts a photo in a bikini with a simple quote, her likes and followers increase drastically. When she posts about tougher topics, she loses followers by the thousands. In trying to make it, we as teachers and practitioners tend to adjust to the market and do more of what works and less of what doesn’t—and in turn, the community begins to think that yoga should only be speaking about positive topics. The result? We’ve lost our ability to sit with discomfort, discuss the tough stuff, and learn that true grace often comes as a result of growing through something hard.
We live in a unique culture here in America, where admitting you need help is often a sign of weakness. The stigma can be heavy when someone seeks mental and emotional guidance. We value toughness and never needing help—which is why it‘s no wonder we struggle to let our guards down to even say something as simple as, Hey, I’m struggling. So many of us practice yoga and meditation within inches of each other, but we never extend beyond the border of our mats to say hello or introduce ourselves.
So, as practitioners who want to live our yoga, I encourage all of us to start taking small, but consistent, steps of vulnerability. Practice being the first to say hello and smile. Take a moment and share a dream or even an embarrassing story with a partner, friend, or coworker. And whatever you do, reach out to someone when you feel down or need help. Chances are, whomever you talk to has been in the same boat at some point, too.
Listen to your inner voice.
There is this voice of Wisdom that we all have within. Yoga teachers talk about it liberally, and I think it’s safe to say that we have all experienced hints of this voice. When times feel hard, it can be tempting to ignore this voice—especially when what you hear doesn’t make logical sense. But I would urge you to quiet down and make space to really listen to what it might be saying—and to work up the courage to follow what you hear. The shock of the recent high-profile suicides may be giving you a chance to raise some questions within yourself and get really honest about the answers.
Have you been hard-charging along a path where you’ve had to suppress your true self and happiness? You have an opportunity to listen to the voice telling you that—and then to take a leap toward true alignment. Don’t get me wrong: It takes serious guts to listen to that little nagging voice telling you something needs to change, and then to actually make those changes. But what if not listening to this inner guide is the only thing standing between your biggest dreams and making those dreams a reality?
If there’s one thing people associate with yoga, it’s flexible hamstrings. After all, how many of your friends refuse to attend yoga class, protesting that they can’t even touch their toes?
Many of us struggle with our hamstrings—stretch after stretch, those irksome posterior thigh muscles spring back as tense as ever. Even those with flexible hamstrings regularly complain of hamstring discomfort. And while there are plenty of hamstring stretches in yoga (forward folds, downward dog) stretching the hamstrings often fails to address the problem. So what will?
We love to simplify and separate, to see each body part in isolation. The reality, however, is not so clear-cut. Every muscle, through its surrounding fascial net, connects to the muscles beside it, below it, above it, and beneath it. Each exists as part of a complex whole, influencing and influenced by all of the structures around it as well as by those that work in opposition. So if you’ve been stretching your hamstrings to no avail, maybe it’s time to take a look at the bigger picture.
Hamstring Anatomy and Function
Let’s start by examining the anatomy in a little more detail. Three hamstrings run down the back of each thigh: semimembranosus, semitendinosus, and biceps femoris (whose name reflects its two heads).
The semimembranosus, semitendinosus, and the long head of the biceps femoris originate on the ischial tuberosities, or sit bones, which are bony knobs at the base of each side of the pelvis, and the short head of the biceps femoris originates at the thighbone. The hamstrings then run down the back of the femur (thighbone), cross the knee joint, and insert on the lower leg bones.
If you palpate the back of one knee you’ll feel three stringy tendons. Side by side at the inner knee are the two tendons of the semimembranosus and semitendinosus (which attach to the larger lower leg bone, the tibia), and at the outer knee is the single tendon of biceps femoris (which attaches to the smaller bone, the fibula).
It’s not necessary to memorize the anatomy. But visualizing the path of these muscles helps us to better understand their function. When the hamstrings contract, they create two primary movements:
1. Hip extension
Moving the femur behind the pelvis, as we do in backbends or in a lunge. In hip extension, the hamstrings (except for the short head of the biceps femoris) assist the gluteus maximus on the back of the pelvis. Their antagonists, the muscles commonly called the hip flexors, include the iliopsoas and rectus femoris (the only quadricep muscle to cross the hip joint).
2. Knee flexion
Bending the knee to bring the tibia and fibula closer to the sit bones. In knee flexion the hamstrings are assisted by the gastrocnemius, a large superficial muscle on the back of the calf, along with some other synergists. Their antagonists in this movement are the quadriceps on the front of the thighs—the rectus femoris, vastus lateralis, vastus intermedius, and vastus medialis.
Now that you’re up to speed on the anatomy, visualize how bending the knee and extending the hip will shorten the hamstrings and how the opposite actions—flexing the hip and extending the knee—will lengthen the hamstrings. In the images above, notice also how the hamstrings connect the pelvis to the lower leg; they not only play a key role in the function of both hip and knee joints but also influence the position of the pelvis (which in turn, impacts the lower back).
As with any other muscles, the hamstrings function best when balanced between stability and mobility, when they are able to perform their roles from varied positions and under varied loads and then rest. Unfortunately for many of us, our lifestyle, postural habits, and movement patterns make it unlikely that we will balance hamstring stability and mobility without a little help.
A major challenge to hamstring health is the amount of time we spend sitting on them. This habit, relatively new in terms of human evolution, chronically shortens the hamstrings, reduces their strength, and limits circulation. Even practicing yoga isn’t necessarily a help, as most yoga practices put more emphasis on hamstring flexibility than on strength.
Any hamstring imbalance has implications broader than just localized tension in the back of the thighs. Overly short or tight hamstrings can pull the top of the pelvis backward, creating a posterior pelvic tilt; overly long or weak hamstrings can do the opposite, allowing the top of the pelvis to tip forward into an anterior pelvic tilt. Nothing occurs in isolation, so the altered position of the pelvis then changes the position of the lumbar spine and the length of the hip flexors. Anterior pelvic tilt deepens the natural lumbar curve, places additional load on the sacroiliac joints, and shortens the hip flexors. Posterior tilt flattens the lumbar curve (placing additional load on the discs between the lumbar vertebrae), and lengthens the hip flexors. Either type of pelvic tilt, if habitual, can have an impact on the lumbar spine, sacroiliac joints, and knees.
So what can we do to help the hamstrings achieve elasticity and resilience and to be able to meet the demands we place on them without strain?
1. Stretch with a neutral spine.
Yoga practices often include a number of standing and seated forward folds, but if our hamstrings are tight enough to lock us into posterior pelvic tilt, we tend to round the lower back and feel more of the stretch in the back muscles instead. There’s nothing wrong with stretching back muscles like the erector spinae, but keeping a neutral spine can help us hone in on our hamstrings. In my opinion, the most effective way to isolate a hamstring stretch is supine hand to big toe pose, or supta padangusthasana, in which the floor facilitates a relatively neutral position for the spine, allowing us to more effectively target the hamstrings.
Give it a try
Lie on your back with your knees bent and feet on the floor, with a belt, strap, or towel within reach. Draw your bent right knee into your chest, holding the knee or shin with your hands for a breath or two to release tension in your gluteus maximus.
Then hook the strap over the ball of your right foot and extend your heel toward the ceiling. You’re looking for a gentle stretch in the belly of the hamstrings (the mid back of the thigh), rather than at the sit bones or behind the knee; you may need to retain some bend in your right knee or reduce the flexion in your right foot to achieve that. If you already feel the stretch, keep your left knee bent and left foot on the floor.
If you don’t yet feel a stretch, lengthen your left leg along the floor, while trying not to arch your back or hike your right hip toward your right shoulder.
Looping a second strap around your right thigh and left foot can help you keep the pelvis neutral.
Once you’ve found a gentle hamstring stretch, stay for at least three relaxed breaths, with chest and shoulders soft, before engaging the quadriceps of your right thigh. When we contract the muscles on one side of a joint we inhibit their antagonists on the other side of the joint from contracting, so in this pose, engaging the quads creates a deeper hamstring stretch. Stay in the deeper stretch for another three to four breaths before releasing your right leg and switching sides. Repeat the stretch every day or two. You may find it especially helpful when your hamstrings are warm after exercise.
2. Vary your stretching position.
You probably will have noticed that different positions change the sensation in your hamstrings. Poses like wide-legged forward fold (prasarita padottanasana) and wide-angle seated fold (upavista konasana) favor stretching the medial hamstrings, semimembranosus and semitendinosus. Positions with the legs together—like standing forward bend(uttanasana) and intense western stretch (paschimottanasana)—emphasize the stretch on the lateral hamstring, the biceps femoris. Many students also find it beneficial to bend their knees or point their toes during hamstring stretches. So rather than just finding a stretch and moving as deeply as possible into your range of motion, varying your position may help release hamstring tension, boost circulation, and encourage lubrication between and around the hamstrings.
Give it a try
Come into supta padangusthasana, using a strap or belt to hook your right foot, once again focusing the stretch on the belly of your hamstrings. This time, stop when you feel a gentle stretch. Keep a little slack in the hamstrings so you can play with varied leg and foot positions. Then bend and straighten your right leg, flex and point your foot, or glide your right leg side to side as if sweeping the ceiling with your foot. Take four or five relaxed breaths, moving smoothly and exploring sensation in the hamstrings, before releasing your right leg and switching sides.
Use this gentle stretch every day or two at the beginning of the day (or before your yoga practice) to warm and mobilize the hamstrings, release hamstring tension, boost circulation, and encourage free movement between and around the hamstrings. You can also use it to loosen up your hamstrings at the end of a long day.
3. Relax with realistic expectations.
If you’re a fan of the “advanced” yoga poses you see on social media, you may be surprised to learn that normal range of motion for hip flexion with a straight leg is around 90 degrees (more or less a right angle between thighs and pelvis). Many yoga poses require more flexibility than this, so yoga class is not necessarily the best place to gauge whether or not you need to improve the range of motion of your hamstrings. If your lifted leg stacks directly above your hips in supta padangusthasana, for example, you may not actually need to increase your flexibility. But if, despite a healthy range of motion, your hamstrings feel stiff or tight, you may then benefit from releasing hamstring tension—relaxing them rather than stretching them.
Flowing stretches like those suggested above can help, but another key determinant of muscle tension is the nervous system. The sympathetic nervous system has many roles, one of which is to increase muscle tone, preparing us for “fight or flight.” On the other side of the equation, the parasympathetic nervous system, responsible for what is often called the “relaxation response,” releases muscle tension. So take the time to find a stretch gentle and soothing enough to relax into. Allowing the hamstrings to relax, to almost drape off the backs of the thighbones, may just release stubborn hamstring tension better than a deep stretch can.
Give it a try
Set up in supta padangusthasana once more, this time lying down through a doorway or against the corner of a wall (or pillar, as pictured below) so that your lower leg is able to relax onto the floor and your lifted leg can lean onto the wall. Get comfortable enough to stay for a few minutes—which may mean creating space between your buttocks and the wall, bending your lifted-leg knee, or placing a cushion under your head.
Once you’re comfortable, become more aware of your breath. The breath is one of the few automatic processes that we can also deliberately control, so it plays a unique role in bridging the conscious and unconscious minds. Slow and easy breathing with a relaxed belly, perhaps lingering for an extra moment in the exhalation, offers an easy shortcut to the relaxation response. Once you’ve settled into deep, relaxed breathing, see how it feels to close your eyes and direct your focus to the subtlety of inner sensation, rather than to the outer shape you make.
Stay for two to three minutes before slowly releasing. Feel free to take a moment to relax before switching sides. Repeat this relaxing practice regularly, especially just before bed, to gradually release chronic hamstring tension.
4. Strengthen the gluteus maximus and hamstring muscles.
Remember that the gluteus maximus and hamstring muscles work together to create hip extension. One of the side effects of sitting in hip flexion for hours every day, as most of us do, is that the gluteus maximus muscles are chronically lengthened and the hamstrings chronically shortened.
Muscles work more effectively when they are able to easily contract and then relax; being stuck in one position prevents this from happening. The muscles then become almost “lazy”—more difficult to engage and less efficient when they do engage. Not only are the hamstrings trapped in a shortened position, they often wind up compensating for the “lazy” gluteus maximus. The hamstrings tend to respond to this overwork by becoming tight, tense, and irritated. Our natural response is to stretch them (as we frequently do in yoga), but as many of us have found, stretching irritated muscles can result in even more tension. On the other hand, strengthening the gluteus maximus and the hamstrings can help them to work more efficiently, reducing the tension and irritation that results from being in one position for extended periods.
In theory, we use the glutes and hamstrings every time we move a leg into extension (when we lift one leg from downward facing dog, for example), or move from hip flexion toward hip extension (as when we stand up from a forward fold or lunge). In practice, however, the body is very good at compensating for weakness and tends to instead use more dominant muscles—like the erector spinae down the back or the hip’s external rotators (the piriformis, gemelli, and obturators). This is why it can be worth isolating the gluteus maximus and hamstrings in an exercise like bridge slides.
Give it a try
You’ll need to be on a smooth, hard floor with a blanket or towel handy. Lie on your back with knees bent, right foot on the blanket and left foot on the floor. Position your feet and knees hip-width apart with your heels fairly close to your sitting bones. Press down into your feet to lift your hips and lumbar spine until your body creates a straight line from knees to shoulders. Adjust your feet if required to stack your knees directly above your ankles.
You’ll be using your gluteus maximus muscles to keep your hips lifted. Scooping your lower belly to lengthen your tailbone toward your knees should reduce the tendency to recruit your back muscles, while keeping the knees tracking at hip-width rather than letting them splay out should reduce use of the hip’s external rotators.
Come onto the heel of your right foot. Slide it away from you until your right leg is fully extended, and then use your right hamstrings to slowly drag your right heel back under your right knee again. Repeat five to eight times before slowly lowering your hips to the floor and switching sides.
If the exercise feels easy, try placing both feet on the blanket and moving both legs simultaneously.
Repeating this exercise every day or two for at least a month should help your glutes and hamstrings regain some of their natural strength.
5. Release your hip flexors and quadriceps.
Remember that the hip flexors and quadriceps on the anterior body are the antagonists for the gluteus maximus and hamstrings on the posterior body. The quads are commonly stronger than the hamstrings, yet yoga abounds with quadricep-strengthening work (think of the number of warrior and chair poses in the average class) and hamstring stretches (start with uttanasana and downward facing dog and continue down the list from there), rarely offering the reverse. Add that to hours of sitting and you quickly realize we are tipping the balance even further toward short, tight anterior muscles and weak posterior muscles. Over time, this imbalance pulls the pelvis forward, adding to tension on the hamstrings.
Working more often on gluteus maximus and hamstring strength will address one side of the equation, and regularly releasing the hip flexors and quads will address the other. It can be particularly helpful to choose a pose you can relax into for a longer period of time, allowing time for stubborn hip flexor and quad tension to gently dissolve; my favorite is the yin yoga pose half saddle.
Give it a try
Take a seat. Roll to your left hip, bend the right knee, and draw the right heel close to the right outer hip. Point the toes and rest the top of the foot on the floor, padding it with a small towel or an extra fold of your mat if required to feel more comfortable. Lean back on your hands, lifting your hips slightly so you can lengthen your sacrum toward the back of your knees; this slight posterior pelvic tilt is vital to lengthen all of the quadriceps and the psoas. If you already feel a stretch at the front of your right hip and thigh, make yourself comfortable enough to stay for a while, taking a comfortable position for the left leg.
Otherwise, recline back onto a bolster, stacked blankets or cushions, or the floor until you feel comfortable. If you feel pressure in your right knee, roll more of your weight onto your left hip; if you feel any pressure in your low back, create more posterior pelvic tilt (you may need to sit your hips on a half-sized block or firmly folded blanket to do so).
Position your left leg wherever it feels the most comfortable; rolling your bent left knee open (as pictured above) will soften the stretch down the right thigh, while pressing your left foot into the floor and pointing your knee toward the ceiling (as pictured below) will deepen the stretch.
Once you’ve found your ideal position, stay and breathe smoothly for three minutes or more. Repeat the stretch two to three times a week.
6. Balance your hamstrings and calf muscles.
Returning to our anatomical big picture, we’ve looked at the hamstrings’ synergists in hip extension, the gluteus maximus muscles, as well as their antagonists, the hip flexors and quadriceps. If we’ve examined these possibilities without creating happy hamstrings, it makes sense to also check in with the muscle that assists the hamstrings in knee flexion—the gastrocnemius.
The two heads of this superficial calf muscle attach on either side of the femur and run down the calf to form (along with the soleus, the deeper calf muscle) the Achilles tendon and then insert on the heel. We lengthen this muscle by straightening the knee and plantar flexing the foot (moving the top of the foot toward the front of the shin). This is why gastrocnemius tension can be one cause of heel lift in downward facing dog. If that sounds familiar, your gastroc may be tight enough to alter the natural relationship between the knee flexors, making it worth investing some time in calf stretches.
Give it a try
Place a rolled blanket or rolled-up mat parallel to a wall, about arms’ length away. Place one or both of your hands on the wall for support, and then stand with the balls of your feet on the rolled prop, letting your heels hang heavy so that gravity gradually draws them toward the floor. Keep your legs straight to focus the stretch on your gastrocs (rather than bending your knees, which would target your soleus muscles instead).
If this feels easy, play with recreating the same propped heel hang in downward facing dog or under the back foot in warrior I. Stay for at least three to five steady breaths, allowing the weight of your heels to gradually create length in your calf muscles. Repeat this stretch every day or two to see if rebalancing your knee flexors helps you release hamstring tension.
7. Restore healthy circulation.
In addition to being strong and flexible, healthy muscles are also well nourished by blood flow and free of fluid stagnation. Sitting on the hamstrings for hours every day can reduce their circulation. Reducing the time we spend in a sitting position, taking regular breaks from sitting, stretching in varied positions, relaxing chronic muscle tension by tapping into the parasympathetic nervous system and working on hamstring strength can all, in their own ways, encourage healthy circulation. Another potentially helpful tool is myofascial release—using targeted pressure to release muscle and fascia tension and encourage fluid exchange.
Give it a try
You’ll need two tennis balls or rubber massage balls. Sit with your legs stretched out in a narrow V shape in front of you. If that’s not comfortable, sit on a chair with a firm seat. Place one massage ball under each thigh, an inch or two away from your sit bones.
Either relax your legs or roll them gently side to side, leaning onto your hands or the back of the chair if that’s more comfortable for you. Stay a couple of deep breaths before moving the balls an inch or two farther down your legs, repeating the process until the balls are about two-thirds of the way to your knees. As the balls move down the backs of your legs, you can lean slightly forward to add weight, while focusing on allowing your legs to rest heavily on the balls rather than trying to find a stretch.
After two or three minutes remove the balls. Lie on your back, and see if you can feel any change in your hamstrings. Repeat this practice two to three times a week, stopping if you feel any pain or irritation. See if the extra stimulation helps your hamstrings to feel better.
Hamstring flexibility is commonly associated with yoga practice, but it isn’t the pathway to long-term hamstring health. It’s only when we see the hamstrings as part of a bigger picture that we are able to help them work in balance with all the muscles surrounding and opposing them.
Erica Yeary for Yoga Medicine® shares some key information on what the erector spinae is, what it does, and how to treat it.
5 Steps to Release The Erector Spinae & Balance Organ Function
The more time I spend studying the anatomy of the human body, the more I am fascinated I am. Both the function of individual systems and how the systems are intricately interconnected are astounding. To dive into both, we are going to look specifically at the function of the erector spinae muscles, how they connect with other systems in Traditional Chinese Medicine, and how to use myofascial release (MFR) techniques to address issues throughout the body.
First, let’s get to know the function of the erector spinae muscles. The erector spinae is a group of muscles that extend on each side of the spinal column from the skull to the thoracolumbar fascia in the pelvic region. The three muscles, from medial to lateral, are the spinalis, logissimus, and iliocostalis. These are powerful, movement-oriented muscles that create bilateral extension of the spine and unilateral rotation and/or lateral flexion. Without the strength of the erectors, we would not be able to stand up straight. While strength in this muscle is imperative, many people can have overly tight erector spinae muscles and present with lower cross syndrome, which is a condition where the lumbar spine is overly curved with an anterior pelvic tilt and hyperlordosis. As a result, many people could benefit from utilizing MFR techniques on this group of muscles. But what if you feel along the sides of your spine and the muscles don’t feel tight or tender? You could still benefit from MFR because of the interconnected communication between these muscles and other systems of the body. Much like our physical hips are related to our “emotional junk drawer”, the erector muscles are more than just physical movers of the spine. Specific points along the erectors are direct links to major systems of the body, as explained in Traditional Chinese Medicine. The following steps explain how to use tennis balls or MFR balls to not only release the muscles themselves, but also aid in the function of specific internal organs. As a general rule of thumb, stay at each step between 30 seconds and 2 minutes for the full effects to settle in.
Place two balls that are touching at the center of your mat. Lay down on your back on top of the balls so that they are on either side of the spine (not on top of the spine itself) at the level of the top of your shoulder blade or T1. The knees can be bent or straight. If the intensity is too much, place a blanket on top of the balls and then lay on top of the blanket. Feel free to move the arms in a manner that is appropriate for you, which could include giving yourself a hug or just letting the arms fall to the sides. This location is known as the UB11 acu-point and it relates to the lungs by spreading and descending Lung Qi in Traditional Chinese Medicine. Stimulating this location can help with coughing or an inability to connect with your breath.
Roll the balls down the back until they are at the level of the bottom of the shoulder blade at T7 on either side of the spine. Relax the shoulders down on the ground. Stimulating this location, known as UB17, can invigorate the blood to aid in any blood or cardiovascular related conditions because it is the converging point of blood.
Roll the balls down just a little further to T9. If you wear a bra, this is about the level of the horizontal bra strap across the back. Continue to let the entire body be heavy down on the ground with the balls on either side of the spine. This location would be particularly important to address if you consume alcohol on a regular basis because UB18 acu-point is related to the liver and gallbladder.
Remain on your back as you roll the balls further down the spine to the base of the ribcage at T11 and T12. This is slightly below the level of the belly button. Continue to breathe deeply and relax the muscles in contact with the balls. For increased intensity, you may bring the knees in toward the chest slowly. Known as the UB20 acu-point, stimulating this location can help with bloating, diarrhea, vomiting, and any spleen conditions because it is related to the spleen and stomach.
The final MFR location is at start of the lumbar curve of the spine at L2. Make sure the balls are still touching and on either side of the spine. This location, the UB23, is known to strengthen and balance the kidneys. After 30 seconds to 2 minutes, remove the balls and lay flat on the ground to reflect on any changes you feel.
Quick Tips for MFR
Always look for an area that you can calmly breathe and relax in without pain, sharp and/or shooting sensations. Avoid nerves, bones (in this instance, especially the spine!), visible swelling or bruising, and broken skin. Always consult healthcare provider first as this is not meant to replace medical care.
Michelle Dickey for Yoga Medicine® on what the interstitium is, what it does, how it can affect your yoga practice, and how to keep it healthy.
The Interstitium: Breaking Down the Mystery
What is all this talk about our “new human organ”? Did scientists really NOT know about an entire organ in the body? You might have heard that a new human organ has been discovered. On March 28, 2018, scientists named the new organ the “Interstitium”. Upon first reading this, my instant reaction was to wonder how scientists could possibly discover a new organ. We’re all aware of our heart, lungs, stomach, kidneys, etc. being organs, so how is it that one got overlooked?
In 2017, I was lucky enough to take part in Yoga Medicine’s cadaver lab where we dissected untreated cadavers. Untreated means that the body is not preserved with formaldehyde nor had the body been previously deconstructed. Throughout this dissection, Master Dissector Todd Garcia would name the various tissues that we were handling and moving through. This included all the organs. Not once in this dissection, did the trainer stop and hold up anything and say “this is a thing without a name,” and then move on. So, it baffled me when I saw the headline about discovering a new organ. Especially because my hands had been in a cadaver, learning about all the different components within the human body.
What is it?
The newly discovered interstitium is defined as “a contiguous fluid-filled space existing between the skin and the body organs, including muscles and the circulatory system.”  That means that this organ covers the whole body from head to toe and is underneath our skin but before our body organs. Our skin isn’t that thick; it’s about the thickness of a few pieces of paper. Somehow this new organ lies under that single piece of paper before the muscles? That seems pretty crazy.
Now it becomes a little easier to see why this organ was hiding from us for so long. With the more common organs such as the heart and lungs, etc, we have a large mass of body tissue that is palpable. These more common organs are able to be seen right away within the body as they have their own individual texture and feel to them that differentiates them from the other body tissue surrounding them.
Where is it?
But this interstitium, it’s the king of hide-and-seek. In a cadaver, peel off the skin, first layer of adipose, and fascia, and you’re left looking at, what appears to be, the beginning of the silvery layer of deep fascia that covers the muscles. At least that’s what was previously thought.
In the video link below , you can watch as Fascial Researcher Gil Hedley dissects various parts of the body and finds in each area that between the skin and the muscles and organs of the body, there is this layer that is extremely difficult to see unless you know to look for it. Watch as Gil Hedley expertly dissects through this “fuzzy layer” or “perifascia” and shows that this isn’t just a slimy goop of boogers hanging out on top of things, but it’s a very fine layer of collagen and elastin that has rebound properties and tensity.
This tiny, tiny layer of fuzz, is so thin it’s transparent. This is the “new” organ that is finally coming out into the open. The layer is tricky though because when exposed to the elements, it hardens and turns brown and doesn’t seem to be of any true importance. This hardened layer was thought to be a densely-packed stack of connective tissue, lacking moisture. It wasn’t until a team of researchers, using a new in vivo microscope technique called confocal laser endomicroscopy, discovered this layer while investigating a patient’s bile duct for cancer. They found that within this fuzzy layer are microscopic subcompartments of interstitial fluid (aka lymph fluid) that wrap around the entire body and connect into the lymphatic system. The lymphatic system connection that the interstitium has could be a key player in cancer metastasis .
Just like the other organs in our body, there are ways to keep this newly defined interstitium healthy and strong so it can continue to act as a shock absorber (because of the rebound properties) and help protect you from damage.
How to Keep It Healthy
Taking part in a yoga class works many different areas of the body from the cardiovascular system to the muscular system and everything in between. To focus in on the interstitium during your practice, pay attention to longer holds of poses and work into a gentle “bounce and recoil” within these holds.
For example if you’re in low lunge, pretend your back leg is a rubber band and deepen your stretch to your body’s most comfortable depth and then let your body rebound naturally to the natural lunge stance. Try not to control the rebound but let the body’s natural elasticity bring you back to the starting pose – thus working the elastic properties of the interstitium.
2. Myofascial Release Techniques (MFR):
MFR is a great way to work the interstitium as well as multiple fascial lines throughout the body. As an example, while standing, take a tennis ball or lacrosse ball and place it underneath the middle of your foot. Then, roll the ball from the base of the heel to the toes in a straight line. Next move the ball to the outer side of your same foot and repeat rolling in a straight line from heel to toes.
Move the ball to the inner side of the foot and repeat once more from heel to toes. After you’ve rolled the middle, outer, and inner sides of the foot, go back to a spot that felt it needed more work, place the ball under that spot and set your heel down. Wrap and unwrap your toes around the ball. Repeat on as many spots as needed then switch and repeat on other foot. This can be done throughout the entire body in a variety of ways and will reduce and eliminate restrictions.
Drinking water will help keep the moisture and elastic properties of your fascia, including the interstitium. Try to get at least eight – 8 oz. glasses of water each day to help keep your body and interstitium at peak function.
Jessica Rasmussen-Williams for Yoga Medicine® shares two routines to strengthen and stretch your shoulders. Use these routines to increase mobility and range of motion.
Stretch, Strengthen & Stabilize Your Way Back into Mobility
Remember the days when hanging from a jungle gym, climbing trees and throwing a ball came as easy as reaching for your keyboard to check your email, picking up your phone to make a phone call or check in on social media? In early childhood, our joints are at their maximum mobility and over time we build strength through exploration and curiosity. For example, we slowly built the stability for load bearing on the shoulder joints through “tummy time”, learning to crawl and eventually the power to pull ourselves upright to resemble the humans around us. From there, we moved to jungle gyms, trees and fields for ball throwing. Without thought, we launched ourselves across the monkey bars, reached for the next branch to pull ourselves further up the trees and played catch with our friends for hours without waking up injured or sore.
During our early teenage years, playground antics, tree climbing and ball throwing gave way to sitting at a desk in middle school without an option for the ever popular recess. Our physical priorities changed even more as we moved into high school and for some, made our way through college. As adults, many of us have unintentionally lost some of our physical curiosity and exploration as new priorities entered the game: computers and cell phones.
Posture & Lifestyle
While we begin to spend more hours of the day occupied with these computers and phones, our daily range of motion (ROM) that we practice begins to adapt to a new formation. It’s easy to get caught up in the eye catching information that these devices are putting in front of us these days. If we aren’t mindful, we can easily lose sight of the fact that we begin to round our shoulders and upper back as our head moves forward and drops to observe the luminous screen. Our posture takes the hit from this decreased ROM as the muscles in the front of the shoulder and chest tighten and the back of the shoulder and upper back strain and weaken. One day, we find ourselves feeling a bit rusty or even injured when we step back in time and attempt something outside of our new norm.
Joint Structure: A Brief Overview
The shoulder is made up of two joints, the glenohumeral and acromioclavical (AC) joints. While they are both a synovial joint, meaning that they have a joint capsule and secrete synovial fluid for lubrication, the two move in a completely different manner. The glenohumeral joint is a ball and socket joint which allows for movement of the humeral head in all directions in an ideally healthy ROM and stability. The AC joint is a gliding joint which offers up very small gliding movements and allows for the movement of the scapula on the back of the rib cage.
While the structure of the two joints differ significantly, the stabilization of both is equally important. The level of efficiency in the structure of the shoulder as a whole is negatively impacted when only one joint is stabilized. There are 2 types of stability that come into action here, passive and active.
Passive and Active Stability
Passive stability is where we are unable to energetically control the cartilage, capsule, ligaments and bone structure. Our skeletal structure and unique history of both healthy and injured joints limits our individual range of motion (ROM).
Active stability is where our mindful movement enters the playing field with muscles stretching and strengthening to keep the integrity of the joint and surrounding areas. We are able to control our destiny in preventing injuries along with wear and tear on the joint if we are able to find a balance in tension. The optimal joint positioning will make a world of difference in prevention, but how do we get there? Unless there is a genetic disposition to degeneration or abnormal bone structure, the answer is tensegrity.
Stedman’s Medical Dictionary for Health Professions and Nursing defines tensegrity as a concept of muscular-skeletal relationships based on the work of architect Buckminster Fuller. The concept refers to the forces of tension (provided by muscles, tendons, ligaments, and fascia) pulling on the structure (bones and joints) that help keep the body both stable and efficient in mass and movement.
The tensegrity system is responsible for managing tension and compression in the body. In the case of the shoulder, the basics of this concept suggest the integrity of the tension determines the stability of the joints. If there is a weakness on one side of the system, there will be increased tension distributed to other areas of the structure. To find those areas of weakness, first look for the tension. For example, notice your own posture. If the shoulders and upper back are rounded forward, the tension will likely lie in the pectoral muscles and internal rotators, resulting a weakness or straining in the external rotators, scapular stabilizers and erectors.
To combat this common postural limitation, we will take a look at a few ways to stretch the areas of tension, strengthen the areas of weakness and find the stability necessary to restore healthy function in the shoulder. In other words, we are looking for a community effect in the body.
Roll up a portion of your yoga mat so it is about 3-4 inches thick. Find a comfortable place to lay down on the rolled part of the mat along the length of the spine with the back of the hips on the floor and the head resting on the roll.
Bend the knees so the soles of your feet are on the floor a little further than hip distance apart.
Then let the knees fall together to touch, or place a block between the thighs as a resting place for the legs.
Take the arms out in a T position with the palms facing up for a few rounds of breath.
If this feels like too much already, remove the mat and come flat on your back. Regardless of which option you have chosen for yourself, bend the elbows into a goal post shape with the palms facing the ceiling. Stay here for a few breaths to check in with how the body responds to this shape.
Feel the broadening of the rib cage with each inhale as that expansion stretches the pec major and minor in the front of the chest.
Find a heaviness across the front of the chest and outer edges of the shoulders with each exhale as you soften and allow the back of the rib cage and arms to get heavier on the roll and floor.
If you would like a little more, keeping the elbows at the 90 degree angle and start to glide the arms overhead until the fingers touch.
If at any point the arms raise up off of the floor, simply glide the arms back toward your starting point until the entire arm comes back in contact with the floor. Once you’re there, come back to the breath to expand on your inhale and settle into the heaviness of the exhale.
Find your way to tabletop on your mat with the wrist crease directly below the head of the shoulder, a micro-bend in the elbows (to avoid a hyperextension in the joint), knees directly below the hips and gaze at the floor. From here we will work to strengthen the scapular stabilizers along the side of the rib cage (serratus anterior) and in between the shoulder blades themselves (rhomboids).
First, on your exhale, press firmly into the mat as you lift the chest away from the floor.
Maintain length in the spine without rounding in the upper back by pressing forward through the crown of the head and occipital bone at the base of the skull. Find the shoulder blades wrapping themselves to the outer edge of the ribcage and imagine pressing the hands slightly forward and toward one another while keeping the shoulder head hugging into the socket of the joint itself. The hands themselves won’t actually move with this action, although, the head of the humorous will stabilize into the joint. Hold this position for three breaths.
On your next inhale, keep the same position in the arm, lower the chest and squeeze the shoulder blades back behind you.
Shoulder heads are softening away from the ears and hugging into the joint. Again, look for the length along midline by hugging the belly away from the floor to keep from extending the spine. Hold here for three breaths to check in with how that feels.
Finally, when you are ready, start to move on your breath.
Exhale to press into the palms, lift the chest away from the floor. Inhale to lower the chest, squeeze the shoulder blades back behind you. Move back and forth on your breath through 10 rounds of each. When you’ve completed those 10 rounds, make your way back to child’s pose to rest with the arms extended overhead. Repeat 3 times and see where you feel strong and even where you feel a bit of weakness.
To ramp up the intensity, feel free to walk the knees back to a modified plank or come into full plank.
This will increase the load of weight bearing in the shoulder. If you find that you are straining or losing the ability to be stable, simply back off by staying in table top until you find the strength to move to the next level. There is strengthening to be found in all options, you may just need to increase or decrease the number of repetitions to find the right combination that works for you on that particular day.
Now that you have a couple of tools for stretching and strengthening, work to consistently incorporate them into your personal practice. Pairing these simple, yet powerful exercises with a mindfulness of your posture and time spent with your computer will bring you the stability you need along with an increased accessibility to your natural mobility that makes way for movement without injury.
 Stedman, Thomas Lathrop (2012), Stedman’s Medical Dictionary for Health Professions and Nursing 7th Edition, New York, NY: Stegman
Dr. Ryland Stucke for Yoga Medicine® shares some advice for any yogis who will be undergoing surgery or those who are already recovering from surgery.
A Surgeon’s Advice to Yogis Facing an Operation or Recovering from Surgery
On average, every person will undergo six surgical procedures during their lifetime, and the need for surgery is on the rise . If you’re facing an operation, or recently had one, you probably have many questions about what you should or shouldn’t do, and when you can return to your usual yoga routine. Common sense goes a long way, and your surgeon can give you specific information. However, with some basic information, you can speed your recovery and reduce complications.
We all know about the idea of rehabilitation after surgery, but prehabilitation is preparing your body to better handle a major trauma, like surgery. New research has demonstrated that patients can, and SHOULD, actively participate in their recovery starting before they have their operation. Prehabilitation (prehab) helps avoid deconditioning and can lead to better outcomes and a faster recovery [2,3]! The key is thirty minutes of moderate intensity exercise every day to the point that you break a sweat. Your asana practice is a great way to combat the upcoming effects of surgery and lying in bed as you recover. Gentle twists and upper back openers are excellent poses to incorporate.
Beyond the physical benefits of a prehab routine, practices lik meditation and pranayama before surgery will help you cope with the extra mental stress of surgery. Hospitalized patients experience an interruption in their usual routines including boredom, sleeplessness, pain, and frequent interruptions from medical staff. Meditation and pranayama help ease these stressors, and enhance the parasympathetic nervous system which aids in recovery. If you don’t have an active mediation practice, explore it before your operation. Mediation apps also can be helpful. You can also try a simple mantra based meditation using a phrase such as, “Balance and strength” or “I am whole”. Practicing chandra bheda (left sided nostril breathing) can help to counter the inflammation and heat produced by surgery. Additionally, nodi shodhana (alternate nostril breathing) is a great way to balance the body after a major stress.
No single diet plan has been shown to be the best, but a well-balanced diet with good sources of vitamins and minerals matters. Vegetarian and even vegan diets are safe around the time of surgery, but make sure to have adequate protein which is the fuel for rebuilding tissues after surgery. No matter what you eat, a well-balanced diet featuring healthy foods should be the focus.
Additionally, if you smoke, quit right now. Smoking significantly increases complications and impairs wound healing; quitting has huge positive benefits for recovery. Cut back on alcohol consumption, which can suppress the immune system. Instead, try drinking fresh vegetable juices or smoothies for additional micronutrients and an immunity boost.
Surgery Recovery After the Operation
Time to get moving! Regular activity after surgery is important. This helps strengthen the immune system, minimize complications, and speed recovery. Most surgeons will ask you to take a small walk the same day of your operation. You can start with meditation, pranayama, and gentle restorative poses in your hospital bed right away. Even simple movements such as circular movements of the ankle, arm, and neck will improve blood flow and jump-start the healing process. Listen to your body and gradually increase your level of activity as tolerated.
No surgeon can entirely erase the pain, so know that coping with some pain is part of the healing process.
Depending on the surgery you have, you may have a specific rehab routine prescribed to you. However, many operations don’t come with a handbook of rehabilitation exercises. If you are having abdominal surgery with a traditional open incision, you’ll want to be especially careful. No deep twisting, large backbends, or focused core work for at least 4 weeks. If you have laparoscopic or robotic surgery, you may be able to restart your full practice sooner but talk to your surgeon.
If you have joint or orthopedic surgery, your rehabilitation plan and exercises should be prescribed. Make sure you get clearance from your surgeon before you go back to a group class, especially if it’s a more strenuous style. Your yoga teacher is also a great resource for ideas about safe poses and modifications for specific sequences. You might consider putting your yoga teacher and doctor in touch to consult each other on your surgery and a safe exercise plan.
General Rules to Follow
If it hurts, don’t do it (a little soreness is OK, pain is not).
You’ll have some ups and downs, but should generally keep improving after surgery. If you’re not improving overall, this could be the first sign that something is wrong which means you should talk to your surgeon.
Don’t over exert yourself, but don’t be a slug. Now is NOT a good time to binge-watch Netflix. If you can’t do anything else, walking is great after an operation.
Nutrition matters…. a lot. Eating nutritious foods helps your body heal and improves your immune system as your body recovers.
Everyone’s recovery is different, and every form of activity or exercise has its own risks. Listen to your body and respect the healing process. Personalized advice from yoga instructors or medical professionals is a great way to ensure you’re on the right path. Always consult your surgeon if you have concerns about your recovery.
Lee PHU,GawandeAA. The number of surgical procedures in an American lifetime in 3 states. J Am Coll Surg. 2008;358:S75
GillisC, LiC, LeeL, et al. Prehabilitation versus rehabilitation: a randomized control trial in patients undergoing colorectal resection for cancer. Anesthesiology. 2014;358:937-47
Barberan-GarciaA,Ubré M,RocaJ, et al. Personalised prehabilitation in high-risk patients undergoing elective major abdominal surgery: a randomised blinded controlled trial. Annals of Surgery. 2017; [epub ahead of print].
Christina Heiser for A Sweat Life shares some safety tips for those looking to explore hot yoga for the first time.
How to Practice Hot Yoga Safely
You probably have plenty of yoga classes under your belt. After all, yoga has a ton of health benefits including increasing your flexibility and boosting your mood, so it’s a great type of exercise to do regularly.
Now, hot yoga studios are popping up in cities across the country, offering a steamy take on a classic. The theory is that the heat—a room will be anywhere from the 80-105 degree range depending on what practice of yoga you take—allows your muscles to open up more so that you get a deeper workout.
But that heat can do a number on you, so it’s important to follow a few basic guidelines. Top yoga instructors share their best tips for surviving hot yoga.
Ease your way into hot yoga.
Skip flow or power flow classes if you’re a hot yoga first-timer, as these classes may be too intense for beginners, says yoga instructor Vanessa Barthelmes. Instead, try Yin yoga in a heated room. “This allows your flexibility to increase and you can wind down from a hard day,” says Barthelmes.
Megan Kearney, Yoga Medicine® instructor, says that if you’re over 40, consider establishing a regular yoga practice before moving into a heated room. She also says anyone can benefit from giving themselves a couple of weeks to build to the heat. “Start by attending classes that are warm and build to the hotter classes,” says Kearney.
Make water a priority before, during, and after class.
It’s super-important to drink water before, during, and after a hot yoga class.
“Hydrate before class, because if you’re not hydrated, it makes a huge difference,” says Kendra Thomas, yoga instructor at NEO U in New York City. Barthelmes suggests bringing a large water bottle with you and keeping it near your side you can sip whenever needed. “You don’t want to practice with a belly full of water so simply take it as you need,” she says.
After class, Thomas recommends replenishing with electrolytes (which you can find in coconut water) to avoid dehydration and muscle cramps.
Wear the right clothes.
Sure, you want to look cute during hot yoga, but be strategic about what you wear to get the most out of your workout. “Cotton clothing is one of the most breathable fabrics but it can soak in water, making your core body temperature rise,” says Kearney. “Avoid cotton-spandex blends and opt for wearing breathable lightweight clothing, like polyester or nylon or poly-cotton blend. That wicks the moisture away from the skin to help it dry and stay cool.”
Bring a towel.
With all that sweating you’ll be doing in hot yoga, it’s really easy to start slipping and sliding all over your mat when you’re in downward dog. “Bring a towel or something, such as an extra layer of clothing, you can wipe your hands on if you start to slip from sweat,” says Gordon. “Also, try to avoid wearing lotion as you might find it extra challenging to find stability if your hands are sliding around your mat.”
Cool yourself down by breathing.
Breathing is a huge component of yoga—and it’s particularly important when you’re practicing in a heated room. “If the heat feels overwhelming, practice cooling ‘sitali’ breath,” says Victoria Gordon, yoga instructor at New York Health & Racquet Club. To do this, curl your tongue into a “U” shape and inhale through your curled tongue. Then, exhale through your nose. If you can’t roll your tongue, inhale through pursed lips (like you’re sipping through a straw) instead.
Don’t go past your limits.
You may think you’re impressing your instructor by going hard, but that’s not the way to do it. “Hot yoga give an inflated sense of flexibility,” says Alia Sebben, founder of Amana Yoga and Gaiam Yoga Studio instructor. “It’s easy to get injured by going to your edge. Less is more. Have a solid baseline for your level of intensity for the postures before a heated class.”
There’s nothing wrong with taking breaks during a hot yoga class. “It is pretty common to feel a little lightheaded when you are new to hot yoga,” says Kami Price, yoga instructor and head trainer for IdealShape. “Make sure that you are breathing, especially when you are moving from bent over positions to standing positions. If at anytime you feel like it’s a little too much, take rest in child’s pose.”
Kearney adds that you can apply a cold rag to your neck or pressure points. But if you start to feel nauseous or confused, lie down or leave the room, she says.
If at first you don’t succeed, try again.
Your first hot yoga class may be difficult—but you’ll get better at it the more you do it. “Don’t quit after your first class,” says Price. “It usually takes your body a few classes to acclimate to the temperature and humidity. Focus on taking it one class at a time, and progress not perfection, so that you can eventually experience all of the benefits that come from hot yoga.”
Skip hot yoga if you have certain health issues.
Hot yoga isn’t for everyone. “If you easily get dizzy, dehydrated, or fatigued and/or are prone to heat stroke, hot yoga may not be for you,” says Kearney. “Anyone who suffers from pain in muscles or joints, osteoarthritis or rheumatoid arthritis should also avoid these classes. And lastly, anyone who suffers from high or low blood pressure or heart disease should also avoid hot yoga.”
Abbie Stutzer for Organic Authority discusses how yoga can be used to heal trauma for survivors. Learn some tips to make the process easier, and get started.
How Trauma Can Impact Your Yoga Practice
Yoga can strengthen a person’s body and calm their mind. However, the whole yoga practice—going to class, interacting with a teacher—can cause stress if a student has experienced trauma.
We reached out to a handful of yoga and medical professionals and asked them to explain how yoga is beneficial for many trauma survivors and detail how some survivors approach their yoga practice.
How Yoga Helps Heal Trauma
Yoga can serve as a healing tool for people who have experienced trauma. In general, a yoga practice teaches people how to remain present, slow down their breath, and become acquainted with their bodies, Diane Malaspina, PhD., Yoga Medicine® instructor, and psychologist says.
So, a yoga practice can help stimulate the part of a human’s nervous system that is related to calming, soothing, and healing the body, brain, and mind. “Through yoga, we learn skills that can help us regain a sense of ownership over our body and experience,” Malaspina explains.
In 2014, a study demonstrated that yoga is a useful adjunctive treatment for PTSD, Dr. Srini Pillay, Harvard trained practicing psychiatrist, adds. Basically, yoga can help survivors tolerate physical and sensory experiences associated with fear and helplessness. Yoga also can help survivors become more emotionally aware and manage their emotions more effectively.
Yoga for Trauma Survivors
Pillay says that trauma survivors may appreciate trauma-informed or trauma-sensitive yoga, or kundalini yoga. “Trauma-sensitive yoga utilizes a series of postures and breathing aimed at strengthening self-connection after a traumatic event,” Pillay explains. “[It] removes strongly suggestive language, deemphasizes posture intensity, and eliminates hands-on assists from the teacher.”
Pillay adds that trauma-sensitive yoga places emphasis on feeling. “Typically, the yoga focuses on four themes: experiencing the present moment, making choices, taking effective action, and creating rhythms.”
“Debriefing may not actually be helpful,” Pillay adds; “focusing on resilience is key.
Brigitte Gordon, doctor of nursing practice (DNP), board-certified psychiatric nurse practitioner, and past yoga teacher and practitioner, adds that the “best” type of yoga is different for everyone.
“Some individuals want to sweat, work hard, and not have to think,” Gordon says. “For them, an Ashtanga, vinyasa, Iyengar, or Bikram class may be best. For those who desire a slower, softer more gentle class (if they’re feeling vulnerable) may benefit from a yin or restorative class.”
Finding the Right Teacher
Ideally, a trauma survivor should work with a yoga teacher who is sensitive to their needs, Dr. Christopher Willard, licensed psychotherapist, educational consultant, and author, says. Survivors also could benefit from working with a teacher who is versed in adapting practices, poses, and classes for people with PTSD.
Willard adds that there are many therapists who have experience with trauma and yoga; many therapists are also yoga instructors. “These [people] can be a great resource, so ask your therapist if they teach or have recommendations,” Willard says.
“An instructor that offers modifications to poses and the option to take a break as needed can create a supportive environment,” Malaspina reiterates. “Providing the option to decline hands-on adjustments and using language that invites students to explore sensation as an inquiry into the body and mind is also supportive.”
Some survivors gain comfort by coming to class early. This allows the student to familiarize their self with the studio, bathroom, and exits. Arriving early also allows the student to place their mat in a place that makes them feel comfortable.
“If triggered during class, some students will feel good going into child’s pose or using mindful grounding techniques, such as focusing on what you see, hear, feel, and smell,” Gordon says. “Focusing on your senses can be greatly grounding.”
Be Aware of Triggers
If possible, a trauma survivor should become aware of the postures and poses that may feel triggering. For example, some students may feel stress when opening or closing their eyes. Also, breath-work and visualization could feel challenging.“The idea with yoga and therapy is always to move at your own speed,” Willard explains, “not pushing yourself out of your safety zone.”
Trauma survivors also could benefit from finding a class that allows students to discretely tell a teacher they don’t want hands-on adjustments. “Studios are now offering smooth stones that a student can place on the corner of their mat to let the teacher know they don’t want touch,” Gordon says.
Gordon adds that a studio with an inclusive website that shows pictures of students and teachers who “look like them” (size, shape, ethnicity, etc.) can induce calm.
Also, remember that what may trigger someone else may empower another person. “Don’t get into comparing yourself,” Willard adds. “Go easy, check in with yourself, and your teacher and therapist as you go.”
If you start crying or feel emotion arising after class, allow your emotion to release. “Holding the emotion in creates more tension in the body and mind,” Malaspina explains. “Crying stimulates the cranial nerves which soothe the emotional center in our brain.”
Malaspina adds that it’s also common for students to cry during a yoga class. After class, if you still feel raw or filled with tension, take slow deep breaths. “Emphasize lengthening the exhale, which soothes the nervous system,” Malaspina says.
And if your feelings are overwhelming, reach out to a mental health professional for additional support.
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