Anatomy Archives - Yoga Medicine

How Does Yoga Affect the Different Systems in the Body?

Leave a Comment / Anatomy, Articles, In The Press, Internal Medicine, Resources, Tiffany Cruikshank, Yoga Medicine News / By Tiffany Cruikshank

By Tiffany Cruikshank for Yogapedia.

How does yoga affect the different systems in the body?

When we look at the research and breakdown how yoga can be helpful, we’re still really just barely touching the tip of the iceberg when we talk about being able to explain it.

The Nervous System

The effects of yoga on sympathetic and parasympathetic regulation and circulation are a big part of the effects of a yoga practice that we can explain right now. Our capacity to efficiently & effectively regulate stress and recalibrate the nervous system responses and increase blood flow. Interestingly enough a large number of pharmaceuticals target the nervous system to create their responses and yet we actually still know very little about the nervous system and the brain.

Then there’s the flip-side. The sympathetic also gets a bad rep. New research also shows that the power of stressing the system is really important to our health & longevity, with things like intermittent fasting and athletic training being examples. What’s important is that we can rise to the challenge and then smoothly transition back to a more parasympathetic dominant state. With such a diversity of movement and more introspective practices, yoga is an excellent way to train these shifts in the nervous system.

The Brain

The mind & mental health are a huge part of the effects we see from a regular yoga practice. In fact one the things that makes researching yoga so difficult is that so often prompts positive lifestyle changes from these mental shifts. A regular yoga practice changes the lens through which we see the world by creating a more nonjudgmental appreciation for what’s within & around us. It allows us moments to sit in the middle and watch the waves of our lives around us, which is a big part of its use in stress reduction.

It’s fascinating to look at the placebo studies coming out of Harvard and how we look at placebo as a negative outcome rather than the power of the mind. The importance of our perspective, our mindset, our purpose, setting an intention with practice, all these really simple things are also a big part of what’s shaping the effects of our practice. We’re learning so much more about the brain and how powerful it is in regulating so many things, including pain and our experience in the world.

The Immune System

With all the super bugs and viruses right now, the immune and lymphatic impacts of a yoga practice are precious modalities. There are so many great ways to support the immune system with yoga. Simple stress reduction, pranayama and gentle flow for lymphatic circulation; or more specific movements to target the lymph nodes. The lymph nodes intelligently congregate around the joints and rely on changes in pressure to pump lymphatic fluid through them. Movements targeted to these areas help to pump fluids through the lymph nodes and the lymph flow through the nodes is an important part of our immune function.

I love seeing how new research supports these things and the implications of how important the flow of the lymphatic fluid is to supporting the immune system. It just comes down to digging in a little deeper to understand how it all works in order to create a purposeful practice to support lymphatics.

The Connective Tissue

Connective tissue research is teaching us a lot and much of that information can be applied to a yoga practice. I believe the next wave of sports medicine will build off of this new info.

There are so many implications to support the connective tissue in yoga. We find simple things like eccentric contractions, slow flow and held passive stretches as a great way to apply a healthy stress to the connective tissues which help hydrate the connective tissue and stimulates the cells to lay down more collagen, making the tissues stronger & more resilient.

There’s some interesting research on the impacts we can have on the connective tissue and the implications in yoga. Yin yoga has some interesting applications in particular. Imagine the connective tissue right under the skin like a sponge. If you think about pulling that sponge from both ends—and they’ve done studies on this—the fluid content of the fascia goes down right away. Then as you come out, once you’ve stayed in for two minutes or longer, the fluids come back into the connective tissue, to where they were and then keep increasing beyond that for up to three hours afterwards.

There’s a whole lot more to the connective tissue, but that gives you a quick peek into one area of research. Yoga is such a big part of this and since the connective tissue is a sensory organ and a key part of our proprioception and interoception there are many more connections to how yoga can benefit the connective tissues.

Learn more in Tiffany’s episode of The Yogapedia Podcast!

What is Pain Education and How Can Yoga Help Us Understand Our Pain?

Leave a Comment / Anatomy, Articles, In The Press, Resources, Tiffany Cruikshank, Yoga Medicine News / By Tiffany Cruikshank

By Tiffany Cruikshank for Yogapedia.

What is pain education and how can yoga help us understand our pain?

There’s some interesting research out of Australia with Professor Lorimer Moseley and Professor David Butler on how pain education changes pain. I think teaching mindfulness is such an important foundation when working with pain as it allows us to peel away the filters of our past experiences as we shift to this nonjudgmental attention.

We actually don’t have pain receptors in our tissues, we have nociceptors, which are basically just sensing extreme changes in pressure, temperature & chemicals, and relaying that information back to our brain. Our brain is then filtering that against all of its past experiences, emotions and beliefs about pain or fear of pain. It’s filtering all these things and then predicting whether there is an inherent danger to the system. So ultimately the nerves are actually danger receptors, protecting us from harm to our tissues.

The interesting thing about that is that our brain is always going to air on the side of safety and protection. The feelings that we feel don’t always match up with the threat to the tissues, especially in chronic pain when the mechanical issues are long gone. For me, this is where yoga becomes such a really important tool; being able to slow down and peel away the filters of our emotional body & past experiences to sit with the experience (safely of course). Is there actually a threat or danger? Can I relax here and see if it’s still there?

Pain is in some ways our greatest teacher. If something is painful, can I go slower and allow it to shift? If I go slower and it’s still there, what is it trying to teach me? Maybe I shouldn’t be moving there. Maybe not every day. Maybe that changes tomorrow. The idea of being able to look and take away the judgment, take away the reactions, the emotional reactivity of it, and really look at this experience and remind ourselves of the fact that we all experience stress. We all suffer. We all experience pain.

Empowering our students to understand their bodies rather than be afraid of it, is really an important & empowering part of our practice.

Fear-based approaches never benefit anyone. “Don’t do this or you’re going to hurt this.” We need to empower our students to be advocates of their health and empower them to appreciate pain as a learning opportunity. To respect it by slowing down enough to listen and adapt rather than pushing through.

Pain is a precious signal and a brilliant and intelligent system that is constantly adapting. Pain education is an interesting field that we’re still learning so much about.

Learn more in Tiffany’s episode of The Yogapedia Podcast!

The Ins and Outs of Yoga and Scoliosis

Leave a Comment / Anatomy, Articles, In The Press, Jenni Tarma, Resources, Spine, Yoga Medicine News / By Yoga Medicine®

By Sara Lindberg for Healthline.

When looking for ways to manage scoliosis, many people turn to physical activity. One form of movement that’s gained a lot of followers in the scoliosis community is yoga.

Scoliosis, which causes a sideways curve of the spine, is often associated with children and adolescents, but people of all ages have this disorder. And the spine, like the rest of our bodies, can change over time.

Physical activity, such as a regular yoga practice, is one form of treatment your doctor may recommend to help you deal with the challenges and pain that accompany scoliosis.

That said, there are some things to consider before you flow into a yoga sequence. Here are some tips and moves to get you started.

Why Yoga is Beneficial for Scoliosis

Yoga can be very helpful for those with scoliosis, particularly given the combination of flexibility and core stabilization needed to perform yoga poses properly, according to Sami Ahmed, DPT, a physical therapist at The Centers for Advanced Orthopaedics.

Stretch and Strengthen the Sides of the Body

When practicing yoga, Ahmed says parts of the body are stretched, and others are forced to contract by performing various movement patterns that require a sustained hold of a certain position. This often results in increased mobility of the thoracic spine.

Decrease Pain and Stiffness

“When looking at the spine, especially for those with scoliosis, we think about two concepts regarding its stability: form and force closure,” says Ahmed.

By strengthening the force closure, which is made up of muscles and connective tissue that keep the spine in proper alignment, Ahmed says you can often see a decrease in pain and improvement in overall function.

Physical activity, such as yoga, can help foster the maintenance of a neutral spine or improve the overall alignment.

Maintain or Improve Spinal Position

In fact, one study of 25 patients with scoliosis found that those who performed the Side Plank pose saw improvement in the primary scoliotic curve of the spine (measured as the Cobb angle).

To show improvement, participants practiced the yoga pose for 90 seconds, on an average of 6 days per week, for a little over 6 months.

Potential Benefits of Yoga for Scoliosis

stretch areas tightened by spinal curvature
strengthen weakened areas affected by the spine’s position
strengthen the core overall
pain management
improve mobility and flexibility
maintain or improve spinal position

Introducing Yoga

Know Your Scoliosis Type

If you’re interested in trying yoga to reduce pain and correct your curve, Elise Browning Miller, a senior certified Iyengar yoga teacher (CIYT) with an MA in therapeutic recreation, says you first need to understand what your pattern of scoliosis is.

“In other words, they need to picture which way their curve goes from behind and understand the rotation as well because if they don’t know their curve, they won’t understand how to do the poses to correct the curve,” she says.

Begin with Conscious Breathing

When Miller works with students who have scoliosis, she first focuses on yoga breathing with simple poses to bring the breath into the compressed areas, where breathing is compromised.

“If there is the gnawing tightness on the side or sides of the back where the scoliosis laterally and rotationally goes, then stretching that area can relieve the discomfort,” she adds.

“The approach should both involve reducing pain as well as correcting the scoliosis,” says Miller. That said, she does point out that the most important thing is to reduce the pain or discomfort and to keep the curve from getting worse, which can be done with the right approach to yoga.

Accept That Moves Can Be Different for Right and Left Sides

Jenni Tarma, a Yoga Medicine® Therapeutic Specialist, says that when using yoga to help manage scoliosis, you should remember that the distribution of tension in the surrounding tissues has become uneven due to the curvature of the spine.

“More specifically, the tissues on the concave side of the curve are shorter and tighter, whereas those on the convex side are in a continually lengthened position, and most likely weaker,” she says.

Stretch or Strengthen Where It’s Needed

Ideally, Tarma says the goal is to reestablish some balance and try to get things more symmetrical with:

targeted stretching on the concave or shortened side
strengthening on the convex or lengthened side

Skip the Pose, Any Pose

She also reminds students that since there might be significant limitations with range of motion, you should feel comfortable and empowered to skip poses that aren’t feasible or productive. It’s always important to work within your own capacity.

Give the Instructor a Heads-Up

It’s common for instructors to move around during a yoga class and make adjustments to a person’s pose.

“Hands-on adjustments in classes aren’t necessarily off the table,” says Tarma, “but I would definitely recommend making the instructor aware of the specifics before class and absolutely letting them know if you’d prefer not to be adjusted for any reason.”

Practicing Yoga with Scoliosis

As to the method of yoga, Miller prefers Iyengar because it focuses on alignment and postural awareness strengthening, as well as flexibility.

“It is a therapeutic approach, and also, mind-consciousness is key to this system (meditation in action) where you stay in the pose long enough to adjust for your scoliosis,” she adds.

Yoga Poses for Scoliosis

Yoga poses that Miller recommends for scoliosis include:

Half Forward Bend (Ardha Uttanasana)
Downward-Facing Dog (Adho Mukha Svanasna) with a belt around a door for traction to lengthen the spine
Locust Pose (Salabhasana)
Bridge Pose (Setu Bandha)
Side Plank (Vasisthasana)
Side-Reclining Leg Lift (Anantasana)
Mountain Pose (Tadasana)

Other Stretching Exercises for Scoliosis

Use Bolsters, Rollers, or Other Accessories to Stretch

Miller adds that supported back opening, such as lying over a bolster, and corrective breathing, such as lying on your side where the apex of the scoliosis curve is, can be beneficial. It opens up the breathing and corrects the curve.

Practice Your Posture

Postural awareness is also key, and Miller says she teaches it between the standing poses, such as in Mountain pose.

Try Gentle Spinal Twists and Side Bends

Simple movements like spinal rotation and side bends can also be very helpful in addressing the imbalance. However, Tarma says that due to the asymmetry, these movements will be noticeably more challenging on one side than the other.

“The goal is to train a better range of motion and function on the weaker side. For example, if twisting to the right is more challenging, that’s the side we would focus on,” she says. You can do twists and side bends in a simple seated posture, either on the floor or in a chair.

Strengthen Your Core

That said, Tarma does point out that at least some of the work should be active, meaning you’re using the core and back muscles to execute the movement, as opposed to using your hands or arms to leverage yourself into the position. “Long-term results require more active strengthening to shift the spine into a more neutral position,” she adds.

Work Towards a Balance, Not Symmetry

And while perfect symmetry may not be attainable or even necessary, Tarma says that working toward it can help mitigate discomfort and improve overall function.

Expert Tips on Getting Started

Get private instruction. When getting started with yoga, Tarma recommends private sessions with a knowledgeable instructor before participating in public classes. “An appropriately trained instructor can help identify the convex and concave sides of the spinal curve, provide the appropriate therapeutic exercises, and provide guidance with ways to modify in public classes,” says Tarma.
Practice daily. Miller says daily practice is key, even if only for a short time. “By committing to a daily practice, you can educate and make an imprint on the body to find more symmetry from an asymmetrical body,” she says.
Avoid inversions or poses that hurt. Ahmed’s advice? It’s wise to avoid yoga positions that cause pain above a level 2 on a scale of 1 to 10. “In general, I’ve found that inversion poses tend to create the most pain due to the pressure on the thoracic spine,” he says.
Work within your flexibility and range of motion. He also recommends avoiding putting stress on your body’s flexibility levels, especially for beginners. You should also ease any expectations about how a pose should feel. “With time and practice, everyone can improve their yoga execution,” says Ahmerm

Shoulder Tension Release

Leave a Comment / Anatomy, Rachel Land, Resources, Shoulder, Yoga Medicine News / By Rachel Land

By Rachel Land for Yoga Medicine^®.

Follow along with this 4 minute shoulder release yoga sequence with Rachel Land. The Lats, or Latissimus Dorsi, are a common source of tension on the shoulder complex. When tight, they can draw our arms down and in toward the ribcage, closing off our chest and making it difficult to expand into full and effortless breathing. The same pattern can make it difficult to lift our arms comfortably overhead, both in life and in yoga poses like downward facing dog. Follow along with Rachel to release shoulder tension, open the shoulders and experience the difference between sides before moving on to complete the sequence.

Find the original video on Yoga Medicine^®’s Youtube channel.

Yoga for Shoulders: Healthy Shoulder Positioning in Common Yoga Poses

Leave a Comment / Anatomy, Rachel Land, Resources, Shoulder, Yoga Medicine News / By Rachel Land

By Rachel Land for Yoga Medicine®.

Our arms and hands are in front of the body most of the time, creating a common postural pattern where the head of the shoulder drifts forward in its socket. This pattern can impact our posture, breathing, and the weight-bearing position of the joint. In this video with Rachel Land, E-RYT 500 yoga teacher and Yoga Medicine® Therapeutic Specialist, you will learn how to activate one of the muscles on the posterior shoulder, our external rotator Infraspinatus, to help draw the head of the shoulder away from the chest back into the centre of its socket. You’ll then use that muscle activation to create central joint positioning in side plank.

Find the original video on Yoga Medicine’s Youtube channel.

Self Care in Healthcare

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By Leah Deutsch for Yoga Medicine®.

As a doctor of obstetrics and gynecology, I took a rather unconventional path to arrive at my healthcare profession. In the UK, the traditional route to a medical degree is a 5-6 year track, however, I diverged from that track with a bachelors degree in law, international travel, and serving on a child protection team before embarking on a graduate entry medical degree. Despite this meandering path, I always knew I wanted to work in obstetrics and gynecology (O&G) because it’s an incredibly diverse specialty where you need the deductive skills of a medic combined with the technical prowess of a surgeon. Add to that a thrill seeking behavior of an adrenaline junkie and you have the perfect O&G doctor!

Acclimating to Stress in the Medical Profession

Although I took time to ensure I was ready to commit to this career path, I wasn’t prepared for the magnitude of stress encountered in each day. The thing that you don’t really realize until you are thigh deep is while caring for a generally young and healthy population, anyone can become life threateningly unwell at a moment’s notice. The increasing seniority in women’s care further increases the amount of personal responsibility laid on the shoulders of an O&G doctor. When you add in the impact on personal health, such as the increased risk of breast, gastrointestinal, and prostate cancers 1 from working night shifts and a chronically understaffed system, it sometimes makes you wonder why anyone chooses this career! Don’t get me wrong — when the outcomes are positive it is one of the most rewarding and privileged jobs to have. It’s moments when you are faced with a mum or baby dying or having life-changing outcomes that accumulatively take their toll on a doctor’s mental and physical health.

A Pathway to Burnout

My own journey in O&G involved a few rather traumatic events during the first three years. In my first year, I was involved in two maternal deaths and an intrapartum still birth (babies dying prior to labor is about 3.74 in 1000, while in labor is far rarer around 0.32 in 1000). 4 Sadly, these events are arguably more common than necessary in the developed world. These are healthy women who come into the hospital but either they or their baby died from complications in labor.

During my second year of training, a baby died following a caesarean section I performed. I can still close my eyes and remember trying to hold it together, while suturing the woman’s shaking abdomen as she sobbed beneath me. The case went to the Coroner’s Court and I spent most of my third year of training waiting for my day in court. The verdict was that the medical team was not at fault, but the year of stress and worry had already taken its toll on me. By my fourth year of training, I was waking in the middle of the night, unable to sleep and dreading work. I began to experience a complete lack of connection and in some cases, resentment towards my patients. I had nothing left for the people close to me in my life. I was suffering from burnout.

PTSD within Obstetrics and Gynecology

In my field we have a 30% attrition rate. These are not young and disillusioned medical students having a change of heart, but rather professionals who could be 7-8 years into their careers that ultimately decide their livelihoods are unsustainable.

Professor Pauline Slade from the University of Liverpool has done extensive research into the burnout of healthcare workers. 2 In her 2019 study forthcoming in the British Medical Journal, Professor Slade identified that 1 in 10 O&G doctors suffer from clinical symptoms of PTSD and 1 in 5 from subclinical symptoms. 3 When I first heard that statistic, I needed a moment to let it sink in. I felt a mix of utter sadness that such an incredible percentage of my colleagues are suffering and also experiencing a feeling of inevitability; somehow I was unsurprised given my own experience. I realized this was not ‘feeling a bit stressed’ — this is PTSD!

A Path to Yoga

I first discovered yoga in 2001, though it was not a significant part of my life at that juncture. During medical school yoga grew in prominence as a handy relief from academic stress; but like many, my initial focus was largely on the physical practice. There was no one light bulb moment for me, but a gradual understanding of the deeper self-connection I gained by stepping on the mat. I slowly immersed myself further, not really knowing why but realizing it served to replenish my depleted self.

As I embarked on my career in O&G and began to experience these early symptoms of burnout, I found myself turning more frequently to my yoga practice. It was a kind of lifeline, a moment where I could focus inwards to who I was away from my role as a caregiver and doctor. Eventually, yoga permitted me to cultivate a stillness and a connection to being present for the first time. It didn’t remove the environment I had to work in, but it did create a kind of pause button. It enabled me to see what was important and I started to notice that I was able to curate these moments of presence away from the mat too. I found myself using pranayama and mindfulness techniques while caring for women in labor and I slowly rediscovered a passion in caring for these patients. Incredibly, I found that I began to feel less drained and even more energized with feelings of positivity from being able to connect with my patients when I took a more holistic approach to their care.

Yoga as a Tool for Lifelong Learning

In 2014, I decided to embark on a yoga teacher training due to the inspiration from what I saw yoga was bringing to both my patients and myself. Always the scientist, I felt compelled to understand what was going on at a deeper level with my practice. This was to be something purely for my own personal growth and development, but it ended up shifting my entire perspective. On my return, from a 3-week intensive training, I took steps to negotiate a reduction in my hours at the hospital, meaning I had one day a week, which was reserved entirely for yoga.

Subsequent trainings over the past five years in prenatal yoga, pranayama, and meditation have led to a continued and hopefully life long enquiry in to my practice, widening my focus to include these more subtle benefits alongside my physical yoga practice. By teaching prenatal yoga, I have gained a great personal reward in bringing these tools to women in my community which supplements their care in a very different way than in my role as a doctor.

East Meets West – Addressing the Issues

Historically, the culture fostered by the medical profession has embraced almost a militant-like detachment. Admittedly, this mental functionality serves a valid purpose in the heat of an emergency; however, it does medical professionals a disservice when processing these very real and often traumatic experiences that can manifest into burnout and high attrition rates. In recent years, there has been a gradual movement to support the wellbeing of healthcare workers and a recognition that this antiquated ‘tough it out’ mentality needs to be reworked.

The fact that yoga encompasses moving, breathing, and ‘being’ in a mindful way means to me that yoga is accessible to so many regardless of physical capacities. The use of yoga’s mindfulness tools that activate the parasympathetic nervous system and ease the mind-body disconnect can potentially provide a cheap and accessible source of healing.

Doctors are beginning to advocate for a fundamental change in how we support each other. This is reinforced by research confirming what as health care professionals we already experientially know. A 2018 randomized controlled trial showed a significant reduction in depression, anxiety, and perceived stress scores (63%, 58%, 40% respectively) in workers practicing mindfulness based techniques. 5 These scores were maintained in 3 and 6 months follow ups.

My own personal experience echoes these findings and I know anecdotally that many others feel the same. It is an exciting area of change and I passionately believe that by acknowledging the relevance of this ancient practice in treating modern day symptomatology, we could create a more resilient and compassionate medical workforce. As a society there needs to be more of a discussion in remedying a culture responsible for decades of damage and a shift to caring for the care takers.

References

1. IARC Monographs Vol 124 group. Carcinogenicity of night shift work. Lancet Oncol 2019; 20: 1058–59.
2. A programme for the prevention of post-traumatic stress disorder in midwifery (POPPY): indications of effectiveness from a feasibility study Slade, P, Sheen, KS, Collinge, S, Butters, J and Spiby, H (2018) A programme for the prevention of post-traumatic stress disorder in midwifery (POPPY): indications of effectiveness from a feasibility study. European Journal of Psychotraumatology, 9. ISSN 2000-8198
3. The implications of traumatic work-related perinatal experiences for obstetricians and gynaecologists: findings from the INDIGO study. Paper presented to World Congress of Obstetricians and Gynaecologists June 2019 Professor Pauline Slade, Institute of Health and Life Sciences, University of Liverpool
4. Healthcare Quality Improvement Partnership (2018) MBRRACE-UK Perinatal Mortality Surveillance Report 2018. Available from: https://www.hqip.org.uk/resource/mbrrace-uk-perinatal-mortality-surveillancereport-2018
5. The Effects of an Online Mindfulness Intervention on Perceived Stress, Depression and Anxiety in a Non-clinical Sample: A Randomised Waitlist Control Trial, D Querstret, M Cropley, C Fife-Schaw INTERNATIONAL JOURNAL OF BEHAVIORAL MEDICINE 23, S54-S55

Understanding How Physical Changes That Accumulate With Age Impact The Practice Needs Of Older Students

Leave a Comment / Anatomy, Articles, Healthcare Providers, In The Press, Resources, Spine, Yoga Medicine News / By Yoga Medicine Ad

By Ashley Bouzis for Yoga Medicine®.

“A human being would certainly not grow to be 70 or 80 years old if this longevity had no meaning for the species to which he belongs. The afternoon of human life must also have a significance of its own and cannot be merely a pitiful appendage to life’s morning.” — Carl Jung

According to the US Census Bureau, the number of Americans ages 65 and older is projected to nearly double from 52 million in 2018 to 95 million by 2060. With this, the 65-and-older age group’s share of the total population will rise from 16% to 23%. 1 We can anticipate this shift in population demographics will be reflected on the mats of yoga students. In fact, the 2016 Yoga in America Study reports that nearly 40% of practicing yogis are over the age of 50. 2 These older individuals are more likely to have previous injuries, mobility restrictions and alterations in neuromuscular function than their younger counterparts.

Following, we explore some of the changes that occur in the pelvis, spine, joint capsule and neurologic function throughout the lifespan and I outline some tips and tricks to keep in mind when working with older yogis to assist in creating a safe practice that honors their needs.

The Pelvis and Lumbar Spine

In older populations, we often find shortened, high-tone hip flexors, particularly in individuals who spend a significant amount of time in a hip-flexed seated position. With this hypertonicity and shortening of hip flexors, the pelvis is pulled into a tipped forward position and the lumbar portion of the spine assumes a hyperlordotic (swayback) curve. This orientation of the pelvis allows a fair amount of mobility but is not structurally ideal as it increases risk of disc rupture and pinching of neurovascular bundles as they exit the spinal column. Additionally, it may contribute to low back pain as the surrounding musculature attempts to bring the spine into alignment.

A posteriorly tilted pelvis (which can also be brought on by prolonged sitting) is generally accompanied by gluteal muscle clenching and/or abdominal gripping; compensatory changes that take over as the body attempts to accommodate for the center of gravity shift caused by the posterior tilt. To get a sense of what this feels like, stand and squeeze your glutes together as if trying to bring your pubic bone forward and up. At the same time, turn on your abdominals as though trying to bring your anterior lower ribs in contact with your anterior superior iliac spine (ASIS). Now try to move around. You’re pretty locked in, right? Imagine trying to do a sun salutation from that position! Not only does this position limit mobility, it can also result in pinching or compression of the sacroiliac (SI) joints; another known contributor to low back pain.

So, if we don’t want our pelvis tipping too far anteriorly or too far posteriorly, where on earth is it supposed to be? I’m guessing you’ve heard of the “neutral pelvis,” right? Well, that’s what we are aiming for, but with a few tweaks!

When finding “neutral pelvis,” many of us have been taught to cue students to direct the ASIS toward the front of the room or bring the pubic bone slightly up. The challenge with this cue is it doesn’t accommodate for the fact that each person has an individually specific pelvic angle that allows their spine and pelvis to align in a way that maximizes stability and shock absorption. For this reason, the cueing described above will create the correct position for some students, but place others outside of the most “functional” range of their pelvis.

I find the most accessible way to find a “functional” rather than “neutral” pelvis is to instruct students to bend their knees slightly and gently bounce up and down, taking note of where the pelvis naturally wants to lie. The slight bouncing relaxes the tightened hip and gluteal musculature helping to allow the pelvis to fall into its functional position. The sensation we want students to find is that which allows an equal balance of support on all sides of the low spine without feeling excessively elongated or pinched in any one area. Once students feel they’ve found this position, invite them to slowly back out of the knee bend towards a straight leg position while maintaining the pelvic angle. As they straighten their legs, they should find their core naturally activates. Many students will find their center of gravity shifts slightly backward so the hips line up more directly over the ankles – the start of a great Tadasana (Mountain Pose). While assuming this position, I find it useful to remind students to not allow the glutes to take over and to only straighten the legs as far as they are able without letting the pelvis fall out of the established functional position. Keeping a micro-bend at the knee often helps with this.

The Mid Spine

Next, let’s turn our eyes to structures further above the pelvis, notably the changes that accumulate in the mid and upper back as we age.

Over the course of a lifetime, the human body experiences an overall reduction in bone mass. In the spine, this results in a decline of mechanical strength and collapse of the anterior and central portions of the vertebra. As these changes accumulate, one may experience pain, loss of height, and loss of the normal curve of the thoracic spine resulting in a hump or kyphosis. These changes occur alongside weakening of the structural integrity of intervertebral discs, which provide cushioning between the vertebral bodies. When the structural integrity of the disc is compromised, disk rupture and herniation become more likely. Rupture or herniation of disc structures may compress motor and sensory nerves as they enter/exit the spinal canal. If structures are compressed enough, radicular (shooting) pain or decreased muscle strength may develop.

Because much of the reduction in bone mass (mechanical support) is beyond our control, we need to look to other ways of supporting the spine as we age. The primary muscles of support for the spine are those of the deep back and core. Assisting students in building awareness and activation of these muscle groups helps protect the integrity of the spine through muscular support as mechanical support declines.

In addition to standard reclined core activation exercises, moving the body through leaning exercises while standing can help students develop the muscle awareness necessary to keep the core active as they move. To do this, I start with functional pelvic position as above and then ask students to gently and slowly lean forward, to the side, and slightly back while being mindful to keep the core active and the glutes relaxed. Many students will find a tendency, particularly as they lean backward, to almost “crunch” which brings the pelvis and chest forward in an effort to offset the center of gravity. The goal is to avoid these types of compensatory movements by only leaning as far as one can while maintaining the normal curvatures of the spine.

Bhujangasana (cobra) in a chair can also be used to activate and strengthen the upper back muscles. From a seated position, invite students to place their hands behind their head or use a strap if bringing the hands together is uncomfortable. Keeping the pelvis and neck in neutral range, ask students to look upwards on the wall towards the ceiling while maintaining the focus on moving from the thoracic spine as opposed to the lumbar or cervical spine. To incorporate more opening of the chest, students may place their hands behind them on the chair or out to the side in a wing-like position. If adopting these variations, it is important not to arch the neck too far backward. Keeping a subtle tuck of the chin can help offset this tendency.

Changes to Range of Motion

Studies show that our bodies experience a decrease in range of motion of multiple joints as we age. 3 While the exact mechanism of this decline remains poorly understood, the leading theory is that with age, the connective tissues responsible for joint stability (tendons, ligaments, and the fibrous joint capsule) undergo naturally occurring declines in compliance leading to restriction of mobility. In addition to the loss of tissue compliance, decreased range of motion (ROM) is exacerbated by reductions in bone mass, painful arthritic changes, alterations in muscle strength and injuries that accumulate over a lifetime.

While impaired range of motion in any joint will contribute to pain and functional impairment, mobility of the hip and ankle joints warrant specific attention as they contribute most significantly to back pain, gait (walking) abnormalities, and risk of falling.

Kapotasana (Pigeon) and Virabhadrasana I (Warrior I) are both wonderful poses to address mobility of the hip. As floor work may not be accessible for all elderly students, both poses can easily be adapted to a chair.

In seated Warrior I, students are asked to sit sideways in a chair with the seat supporting one thigh and the same side buttock. The leg to the outer part of the chair is then slid around to the back and the leg straightened as much as is comfortable. Because the chair supports the weight in this pose, more focus is directed to the stretch of the hip flexor as opposed to building strength in the lower limbs. If one wants to play with building strength from this position, simply engage the muscles required to lift the thigh away from the chair.

For seated Pigeon, one ankle is placed on the opposite knee to achieve lengthening of the external rotators of the hip. If more intensity is desired, students may lean forward, taking note to lean from the pelvis and to avoid rounding the lower back.

Working on ankle mobility is also easily accessible from the seated position. Controlled articular rotation exercises (CARs) offer a way to increase both range of motion and strength of the muscles responsible for ankle dorsiflexion (the motion that clears the foot over the ground during walking) and plantar flexion (necessary for the push off phase of walking).

To perform an ankle CAR from a seated position, ask students to extend one leg until the back of the heel rests on the ground. From this position, slowly move the foot into maximum plantar flexion, then slowly rotate the foot in a circle reaching to the end of the available range in all planes. The benefit of this type of movement is that it moves the joint through its “usable” range of motion under muscular and neurological control which enhances length, strength and control as opposed to utilizing passive stretching which only lengthens tissues. CARs can be used for nearly every joint in the body. There are a number of online resources illustrating how to apply CARs movement to various joints.

Proprioception

Another known change with age is a decline in a sensory function known as proprioception (the joint-position sense we use for balance and knowing where our body parts are in space). Declines in this sense contribute significantly to fall risk. While many of the treatments proven to improve proprioception are outside of the scope of a yoga practice, “active movement training with visual input” is a technique that can be applied on the mat and has been found to be one of the most effective ways to train and improve proprioception. 4

To engage in active movement training, students are asked to identify a target on the ground or wall and to use their visual input to guide a given body part to touch the target. For example, you might ask students to start from a standing position with arms at their sides and identify a small, distinct area on the floor, maybe a crack or an area of unevenness in the texture. Once the area is identified, you invite them to reach an identified body part (i.e. the heel) to touch the area and then bring the heel back to its previous position. For students with visual impairments, the instructor can provide verbal feedback to assist in reaching the target. When utilizing targets on the floor, it is best to start with flat targets (i.e. a mark or piece of tape on the floor) and utilize elevated targets (i.e. a block) only if the student has adequate strength and balance.

The Mind and Soul

In late adulthood and beyond, individuals often define their lives by what they are contributing to the world and what legacy they will leave behind. Psychoanalyst Erik Erikson referred to the final stages of life as characterized by generativity versus stagnation and ego integrity versus despair.

During the mid-stages of late life (approximately age 40-65), individuals may find themselves reflecting on their sense of “needed-ness.” Relevant questions may include: Am I contributing enough? To whom do I matter? How can I improve the state of the world? If one does not perceive that they will leave a legacy in line with their values, they may feel a loss of inertia and purpose. Encouragement to reflect on the legacy one would like to leave and ponder ways of building that legacy can be welcome class themes for students at this stage.

Beyond the age of 65, individuals often begin to contemplate the mark they will leave on the world at the time of their death. Relevant questions at this time include: Did I do enough? Have I acted in ways that reflect my values? What regrets do I have? At this stage, it is quite normal to experience a sense of regret and despair over prior actions. In order to peacefully conclude this, it is helpful for individuals to accept that there are aspects of their life they find regrettable and also aspects they find pride and peace in. Acceptance of this dialectic may help individuals develop the “sense of coherence and wholeness” 5 that comes from the “acceptance of one’s one and only life cycle as something that had to be.” 6 At this stage, students may benefit from themes surrounding the acceptance and tolerance of emotions such as regret, an opportunity to reflect on what parts of their legacy bring them a sense of satisfaction and encouragement to resolve any relationship rifts they feel able to.

Conclusion

As teachers, we are given the opportunity to work with students of all demographics, including those whose bodies have seen them through the morning of life, into the afternoon and beyond. Understanding the changes that occur as the body and mind move through these stages allows us to create a safe, effective and respectful practice for yogis of advanced age.

REFERENCES
1) Projected Age Groups and Sex Composition of the Population: Main Projections Series for the United States, 2017-2060. U.S. Census Bureau, Population Division: Washington, DC.
2) Ipsos. (2016). “2016 Yoga In America Study.” Oct 7-16, 2015. Retrieved from: https://www.yogaalliance.org/Portals/0/2016%20Yoga%20in%20America%20Study%20RESULTS.pdf
3) Stathokostas, L., McDonald, M. W., Little, R. and Paterson, D.H. (2013). Flexibility of older adults aged 55–86 years and the influence of physical activity. Journal of Aging Research, 2013, 743843.
4) Aman, J.E., Elangovan, N., Yeh, I., Konczak, J. (2014). The Effectiveness of proprioceptive training for improving motor function: a systematic review. Frontiers In Human Neuroscience, 8(1075).
5) Erikson, E. (1982). The life cycle completed. New York, NY, US: W W Norton & Co.
6) Erikson, E. H. (1950). Childhood and society. New York, NY, US: W W Norton & Co.

Self Myofascial Release Practices for Better Backbends

Anatomy, Articles, Hip, In The Press, Myofascial Release, Rachel Land, Resources, Shoulder, Spine, Yoga Medicine News / By Yoga Medicine Ad

Senior Yoga Medicine® teacher Rachel Land shares a simple sequence that can unlock common areas of resistance and make your backbends feel better.

Backbends have undeniable benefits. In a world where most of us sit in cars or at computers for hours each day, poses that create spine and hip extension help to balance out the biomechanical patterns created by sitting.

However, the benefits of backbends are not always accessible. We all differ in our bone structure, our proportions, and the consistency of our soft tissue. Because our range of motion in any given pose is unique, the deep backbends enjoyable to some of us are not achievable for all. In fact, chronic tightness in the front body (the very tension backbends seek to alleviate) can prevent us from being able to comfortably find our range in backbends; instead of creating the desired feeling of space, backbends may do the opposite—cause compression or claustrophobia, and take our breath away.

That’s where self myofascial release (SMFR) can come in handy. It is one of my favorite tools for unlocking habitual areas of tension, and it’s perfect for people who struggle to find freedom in backbends.

A Sequence to Make Backbends Feel Better

The key areas for focus in this SMFR sequence are:

The hip flexors

Rectus femoris, tensor fascia latae (TFL), iliacus, and psoas. When chronically short and tight, these muscles draw the pelvis into anterior tilt, in which the front of the pelvis tips forward and thus deepens the curve in the lumbar spine. When we backbend in anterior pelvic tilt we come to the end of our range in the lumbar spine more quickly. Instead of giving the hip flexors a much-needed stretch, we can end up feeling pressure or compression in the low back—especially when gravity deepens the backbend, as it does in upward facing dog (urdhva mukha svanasana) and camel pose (ustrasana). Releasing our hip flexors to reduce anterior pelvic tilt may allow us to explore our range of motion without crowding the low back.

The rectus abdominis

This familiar abdominal muscle draws the base of the sternum toward the front of the pelvis. While subtle engagement can provide helpful support in backbending poses, excessive tension there can leave us feeling constricted and unable to find free range of motion or easy breathing. A tight rectus abdominis isn’t an issue for everyone, but it can be for athletes and those who unconsciously brace the belly or hold it in.

Muscles that limit arm and shoulder movement

The pectoralis major and latissimus dorsi in particular. The pectoralis major is our main chest muscle, while the latissimus connects the inner upper arm with the low back. Sitting doesn’t just influence the hips and spine; the arm and chest muscles also tend to get short and tight when we chronically slump forward with our arms in front of our body. This can be a limiting factor in backbends, most of which involve the arms as well as the hips and spine.

Backbends that require the arms to move behind the body into extension, such as bow pose (dhanurasana), require the pecs to lengthen. The deepest backbends—including wheel, or upward bow pose (urdhva dhanurasana), and the overhead bind in dancer pose(natarajasana)—take the arms into overhead flexion, which requires elasticity in both pecs and lats. So relaxing chronic tension in these muscles can make backbends feel significantly freer, increasing the mobility of the arms and reducing the required range from the spine.

The upper portion of the gluteus maximus.

The lower portion of gluteus maximus is a hip extensor, which makes it a huge help in backbends, but the upper portion assists hip external rotation. When our glutes fire strongly both movements tend to occur (which is why the knees tend to flare wide in backbends). Hip external rotation in backbends is not problematic for some, but in others it can crowd or compress the sacrum (the triangular bone at the base of the spine that joins the two halves of the pelvis). Releasing the upper portion of gluteus maximus might just help us find more hip extension without feeling the glutes grip or clench around the sacrum.

This SMFR sequence will help you unlock some of these common areas of resistance, creating space for you to feel freer and easier in your unique range of motion. You will need two same-size massage or tennis balls (shown below are the Recovery Rounds by RAD and Yoga Medicine® and a yoga block.

Before you try the sequence, practice a backbend you usually experience as limited. That will give you a baseline for comparison after myofascial release.

Note: Self myofascial release on the abdomen is not recommended during pregnancy. If you are pregnant, either skip these locations (iliacus, psoas, and rectus abdominis) entirely or seek advice from your healthcare provider.

Rectus Femoris

The sequence begins with the hip flexors. To work on the right rectus femoris, set up on all fours with a massage ball on the floor in front of your right kneecap. Slide your left knee forward and toward the left side of your mat, and then lean onto your forearms so that your right lower thigh sits on top of the massage ball. Tuck your right toes under and use that leverage to move your leg forward and backward, rolling up and down the bottom third of your right thigh until you find an area that feels tense or tender. Then either rock side to side across the muscle fibers or bend and straighten your right knee to pin the superficial fascia in place while the deeper layers glide with that movement.

Spend 10 to 15 seconds on whichever option feels the most helpful, and then rest on that spot for 5 to 10 seconds, encouraging your right thigh to soften as much as possible. Now inch your body down your mat until the massage ball is roughly halfway between your right kneecap and hip crease. Roll up and down the middle of your thigh until you find a tender area to work with, and then rock from side to side or bend and straighten your knee for up to 30 seconds before moving on to the right TFL.

Tensor Fascia Latae

To investigate the right TFL, remain in the same position but place the massage ball roughly an inch below and an inch to the right of your right frontal hip bone (so that it is between the front and side of your pelvis). Remain still or rock gently side to side for 15 to 20 seconds.

Then remove the massage ball and lie down on your belly with your left knee still bent out to the side.

Iliacus

For the right iliacus, place your massage ball just inside your right frontal hip point or ASIS so that the edge of the ball is almost touching the inner surface of that bony ridge.

Make your head and neck comfortable (perhaps by resting your head on stacked hands or turning it to one side). Take a few slow breaths, deliberately relaxing your lower belly with each exhalation and allowing the massage ball to melt in.

Once you feel your abdomen relax, either remain as you are for 10 to 15 seconds or bend your right knee to 90 degrees and rock your lower leg from side to side like a windshield wiper.

For the final 5 to 10 seconds, release your right leg back to the mat and feel the massage ball sinking in toward the inner rim of your pelvis.

To move on, remove the ball and slide your left leg down beside your right leg. Take a few breaths lying prone, and see if you can feel a difference between your right and left sides. Then press back up to hands and knees to repeat the sequence on your left side.

Psoas

After you have worked on the left rectus femoris, TFL, and iliacus, move on to our primary hip flexor—the psoas. Lie on your belly with your two massage balls an inch apart just below your navel.

Make your head and neck comfortable and allow your belly to expand and push the balls out as you inhale; then soften to allow the balls to sink in as you exhale.

Either stay as you are or tuck your toes and lift your knees to lean more weight onto the massage balls. Breathe here for another 15 to 20 seconds, and then remove the balls and take a few relaxing breaths.

Rectus Abdominis

Next, work on the rectus abdominis, the primary trunk flexor. Remain prone with your head and neck in a comfortable position.

Move the massage balls higher until they are side by side, pressing into the soft tissue below the base of your sternum in between your ribs (not into the bones themselves). Use the rhythm of your breath to encourage your muscles to relax so that the massage balls melt into your upper abdomen.

Either stay prone or prop yourself up on your forearms, using your body weight to pin the muscles in place as you lengthen them. Stay another 15 to 20 seconds in your chosen position, and then remove the balls and breathe deeply for a moment or two. Take the opportunity to notice how you feel so far.

Pectoralis Major

Now shift focus to the chest and shoulders, starting with the pectoralis major, the large (and often tight) superficial chest muscle. From your prone position place your block on its lowest height under your right shoulder and place one massage ball on top of it. Then adjust your props so that the massage ball nestles into the hollow below your outer right collarbone (just inside the head of your shoulder).

Put your right arm in a cactus position and relax as much as you can so that the weight of your arm and shoulder creates pressure on the massage ball. Relax your head and neck, resting your forehead or temple on the back of your left hand or the floor.

Stay for 20 to 30 seconds, breathing slowly and fully into your chest. If you’d like more sensation, reach your right arm forward and back, using your body weight to pin the muscle in place as you lengthen it. When done, remove your props and take a couple of breaths with your arms down by your sides to see if the right and left shoulders feel any different. Then repeat the process on the left side of your chest.

Latissimus Dorsi

When you are ready to move on to the latissimus dorsi, press up to all fours, and then sit upright. Take your left thumb to your right armpit, and catch the thick strap of muscle at the back of your armpit between your left thumb and fingers. That is the target area: the top of the right latissimus dorsi as the muscle fibers gather to insert onto the inner right upper arm.

Lie down on your back with knees bent and feet on the floor, supporting your head on your block. Use your left hand to hold one massage ball against the target area on the upper right latissimus as you take your right arm out wide. Once the weight of your body pins the ball in place, you can release your left hand and start to roll toward your right, using your body weight to create the desired intensity of sensation: The more you roll toward your right, the more intense the sensation.

If you feel enough sensation, remain still for 20 to 30 seconds, breathing freely. If you want more sensation, slide your right arm along the floor toward the top of your mat—using body weight to pin the latissimus in place as you lengthen the muscle—and then slide it back toward the side of your mat. Repeat the arm movement two or three more times before resting still for a final breath.

When you are finished, remove the ball and roll onto your back. Stretch both arms overhead to see if you feel a contrast between the right and left sides before repeating the process for your left latissimus.

Gluteus Maximus

Finish the sequence by releasing the upper fibers of the gluteus maximus. Lie on your back, bend your knees, and place your feet on the floor. Lift your hips high enough to pin both massage balls beneath you on either side of the pelvis about an inch below the top rim and an inch wide of the sacroiliac joints.

Slowly rock your knees from side to side, feeling the weight shift from one massage ball to the other. If that feels helpful, stay with that gentle movement for 15 to 20 seconds.

If you’d like more sensation, prop yourself up on your forearms to roll your body an inch or two toward the top of your mat and back again, gliding the massage balls up and down either side of the upper half of your sacrum to release any tension there.

For the final 5 to 10 seconds find a position in which you can remain still and soften the skin over your buttocks. Then remove the massage balls and take a breath or two lying flat on your back. See if you can feel a sense of softness or spaciousness around your sacrum.

Now that the sequence is complete, repeat your chosen backbend, paying particular attention to the areas you have worked on. Aim to lengthen the front of the thighs, hips, and torso, and open the chest and side ribs, while softening the tight grip the glutes might have on the sacrum. Notice how it feels to breathe in this position before moving out of the pose.

Remember that the benefits of backbends stem not from the depth we achieve, but from their capacity to balance life’s tendency to compress the front of the body. Range of motion differs for each of us, but releasing the areas that stop us from finding our mobility can turn feared or dreaded backbends into poses we can all enjoy.

Video/Photo credit: Kyle Rebar

The Mind and Body in Balance

Anatomy, Articles, Healthcare Providers, In The Press, Tiffany Cruikshank, Yoga Medicine News / By Yoga Medicine Ad

Lisa Cypers Kamen interviews Tiffany Cruikshank for Harvesting Happiness Talk Radio Podcast.

In this week’s episode, you will learn about using your own energy for self-regulation, balancing mind and body through breathwork, medicinal benefits of yoga, and harnessing the power of your own mind to reach your potential.

Click here to listen to the Harvesting Happiness Talk Radio Podcast with Tiffany.

On and Off Your Mat Yoga Podcast Interview

Anatomy, Articles, In The Press, Tiffany Cruikshank, Yoga Medicine News / By Yoga Medicine Ad

Erika Belanger interviews Tiffany Cruikshank for On and Off Your Mat Podcast.

A note from Erika:

“For our 31st episode, I sat down with Tiffany Cruickshank. I met Tiffany at Yoga Journal Live Event in SF. I took some of her Yoga Medicine workshops over a few years and I absolutely loved her approach to the body, her attention to the anatomy, physiology and biomechanics. Since then I’ve been following her online and dreaming of doing her trainings. I’m in awe with all the work she does as a yoga teacher, teacher trainer, author, and activist, so I was very excited to sit down with her and chat about it all.”

Click here to listen to the On and Off Your Mat Podcast with Tiffany.

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