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Raising the Bar for Teachers – Bare Bones Yoga Podcast Interview

Karen Fabian interviews Tiffany Cruikshank for Bare Bones Yoga Podcast.

In this interview, Tiffany gives us a glimpse into her beginnings as a teacher many years ago, how she began her work as a yoga teacher and how she developed her brand, Yoga Medicine, into the powerhouse it is today, with over 7,000 teachers around the world trained in her methods and part of her teaching network.

Click here to listen to the podcast on Bare Bones Yoga’s website.

Why Weak Hip Flexors Can Be A Pain In The Butt

Gry Bech-Hanssen discusses the benefits that strong and functional hip flexors could have on your backside and range of motion.

How Yoga Changes Your Brain

Emmy Lymn discusses how yoga can provide benefits beyond just the physical, and how it can additionally leave a positive impact on the brain.

Cadaver Lab Dissection – Anatomy Education or Learning Empathy?

Emily D’Alterio discusses her experience from Yoga Medicine’s Cadaver Dissection Lab.

Arm Balance Recovery

Senior Yoga Medicine teacher, Rachel Land, shares with Yoga International a feel-good self-massage sequence that you can use to relieve upper body soreness.

How Anxiety Affects Weight—And How to Manage It

Diane Malaspina, a Yoga Medicine® E-RYT 500 instructor and Therapeutic Specialist, mentions how a yoga practice can help alleviate anxiety and improve your overall health.

By Melissa Rudy for SharkPeople.

Got a headache or a fever? Over-the-counter meds will usually do the trick. Nursing a running injury? Some combination of rest, ice, compression or elevation (and good old-fashioned patience) will likely have you back on track before too long. Indeed, most physical symptoms, although uncomfortable and inconvenient, are pretty straightforward to spot and treat.

The mental and emotional ones, like anxiety, are a little trickier.

According to the Anxiety and Depression Association of America (ADAA), anxiety affects 40 million adults in the United States, making it the country’s most common mental disorder. Cheryl Carmin, Ph.D., professor of clinical psychology at The Ohio State University College of Medicine, describes anxiety as a “fight or flight” response to what a person perceives as a dangerous situation. “This response activates the hypothalamic-pituitary-adrenal (HPA) axis, which causes an adrenaline reaction,” she explains.

Depending on the strength of that reaction, symptoms could include an increased heart and respiration rate, upset stomach, shaking, sweating, dizziness, headache or even a panic attack. Others may not have as dramatic of a response, and instead may worry excessively, notes Dr. Carmin. “While worry may not involve panic-like symptoms, its chronic nature can similarly take a physical toll on people, as they are in a state of high alert for long periods,” she says.

Common Triggers of Anxiety

There are many different types of anxiety with a myriad of triggers, from genetics to personal trauma to brain chemistry. Although there are effective treatments available, nearly 60 percent of people suffer through anxiety without seeking care.

“The causes or triggers for anxiety are very individualized,” Dr. Carmin notes. “Some people focus on physical symptoms as an indication that there is something medically or psychologically amiss. Other people fear what people may think of them, or believe that others will negatively evaluate them. Many people have specific phobias—such as fear of heights, freeway driving, enclosed spaces, certain animals or insects [or] blood—and being in the presence of anything they fear is a trigger.”

The Anxiety/Weight Loss Connection

For many people, the struggle or inability to lose weight can be a major source of anxiety. But on the other hand, if someone already has anxiety, that could contribute to behaviors leading to weight gain—sort of the old “chicken or the egg” conundrum. Which comes first?

It depends on the individual, Dr. Carmin says. For some people, feeling anxious may cause them to “stress eat,” which will increase calorie intake and could cause weight gain. But for others, anxiety may lead to a loss of appetite. Some studies have found a link between obesity and anxiety.

A person with anxiety may also be more bothered by a less-than-ideal weight than someone without the disorder. “Individuals who tend to be perfectionists may have a greater tendency to focus on appearance-related variables, such as weight,” explains Dr. Carmin.

And then there’s the hormonal aspect to consider, notes weight loss therapist Dr. Candice Seti, Psy.D., CPT, CNC. “Cortisol is our body’s stress hormone, also known as our ‘fight or flight’ hormone,” she explains. “In the short term, a little burst of cortisol can help get us moving and out of danger, so to speak. But long-term exposure to cortisol—through chronic stress or chronic anxiety—can cause all of our body systems to slow down, and ultimately hold onto weight and body fat. So, in that sense, chronic anxiety can lead to weight gain.”

On the flip side, Dr. Seti notes that a build-up of anxiety can cause an excess of nervous energy in the body, which increases movement (think fidgetiness) and decreases hunger. In that sense, anxiety could actually lead to weight loss.

Healthy Ways to Handle Anxiety

Just as every individual is different, no two cases of anxiety are the same. The best approach to handling it will depend on the severity of the problem, says Dr. Carmin—both from the standpoint of the anxiety and any weight-related struggles.

The first step, she says, is to determine whether the person has a diagnosable condition: Is the person suffering from an anxiety disorder, an eating disorder or both? “Having a frank discussion with your primary care physician or a mental health professional will help to put this in perspective,” she says. “There are effective, cognitive behavior therapy treatments and medications for anxiety and eating disorders.”

If the anxiety or eating issues are less severe and aren’t interfering with quality of daily life or causing undue distress, these other strategies could help alleviate symptoms.

Stay active. Anxiety and depression can sometimes make the sufferer feel like crawling in a hole and hibernating, but this usually exacerbates the problem. “Remember to find time for activities that are enjoyable or provide a sense of accomplishment,” Dr. Carmin recommends. In addition to burning more calories, the activity will also help to redirect your attention away from thoughts and worries that contribute to anxiety. Plus, exercise can serve as a natural mood lifter.

Keep a journal. The ADAA recommends writing in a journal when stress or anxiety hits. Over time, you’ll start to see patterns of potential triggers, such as work, relationships, weight or other factors.

Surround yourself with a positive circle. Positivity is a powerful thing. Seek out people who are energizing and encouraging, optimistic and upbeat, and who regard challenges as growth opportunities.

Be mindful of what you eat and drink. The ADAA suggests eating nutritious, well-balanced meals and healthy snacks, and limiting alcohol and caffeine, which can worsen anxiety. If you tend to be a stress eater, Dr. Carmin says to ask yourself if that treat is something you truly want, or if it is just a form of self-soothing that will interfere with a goal. “If it’s the latter, what really is the cause for wanting to snack? Can you deal with the underlying concern in a straightforward manner?” she asks.

Consider seeing a therapist. Dr. Seti believes that some of the most effective ways of dealing with anxiety are rooted in cognitive-behavioral therapy, which involves identifying the stimuli that cause the anxiety and then questioning that reaction anxiety. She recommends seeing a cognitive-behavioral therapist, who can help develop a strong anxiety management toolkit.

Try a relaxing activity. This can be anything that calms and centers you, whether that’s music, meditation, massage or another form of self-care. Diane Malaspina, PhD, a therapeutic specialist with Yoga Medicine®, recommends a yoga practice as a means of relieving anxiety. “Learning how to breathe and control the breath can help to calm the nervous system,” she explains. “Yoga postures also release tension in the muscles and endorphins in the brain, which help us to feel good. Mindfulness practices have also been found to reduce stress, lower cortisol levels and calm an active mind.”

If you’re one of the millions of people who experience chronic anxiety, you don’t have to let it limit your health or quality of life. If you’ve tried your own coping strategies but are still struggling, reach out to a doctor or mental health professional for help.

A Guide to Your Best Health

Diane Malaspina, a Yoga Medicine® E-RYT 500 instructor and Therapeutic Specialist, offers her tips on nutrition, mental health, and setting appropriate health goals.

By Danika Miller for Reviews.com.

Prioritizing your health is no easy feat — especially when the internet and media flood us with conflicting advice on what works. For many of us, trying to get healthy means committing ourselves with gusto to bold plans with big promises. Whether it’s a Spartacus-inspired boot camp with daily 5 a.m. sessions, or an intense diet that cuts out all but two food groups to mysteriously induce some fat-burning chemical, or something in the murky in between, extreme transformation strategies are usually not the best path for most people.

That’s why we’ve spent years researching real ways to get it right and finding products that can actually help you achieve those health goals. Our team has been consulting doctors and nutritionists, vetting ingredients, taste-testing bars and powders, assembling treadmills, sweating it out on yoga mats, and keeping up on the latest training tech to give you the inside track on all things health and fitness.

To get a pulse on the health goals of our readers, we surveyed over 500 people on their goals for the new year. Over 40% of respondents said they stick to their health and fitness goals for just a few months. We also learned more about what kind of health goals people prioritize (spoiler: it’s exercising more), and discovered that 50% of people in our survey said their fitness and health goes are the same as last year. For those of us struggling to stick to goals, or finding ourselves setting the same goals time after time, we dug into how to set effective goals.

If one of your goals for the year is to be healthy, we can help you define that goal and map out a plan for success. But what does it actually mean to be healthy?

According to most of the experts we spoke to, exercise and nutrition are obvious cornerstones, but mental health is also a vital component. Anna Larsen, CPT & Fit Body Boot Camp Owner, told us mental wellbeing is intertwined with fitness and diet, “if you are under sustained stress, you may start to find relief in over-eating, over-drinking or even over-exercising.” Exercise and a good diet produce hormones that improve your mood and mental health, while a healthy mental state can better equip you to maintain positive eating and exercise habits.

We’ve done 40 hours of research, dug into countless studies, consulted over 50 experts, and rounded up our 23 favorite wellness products. This health guide will help you understand the importance of health and start setting achievable goals.

Fitting in Fitness

Exercising and losing weight are pretty familiar New Year’s resolutions so we weren’t surprised that over 70% of our goal-setters listed one of these as their most important health goal for 2019.

Why is exercise so important?

Exercise eases stress, builds muscle, burns fat, and supports many of your body’s systems. Regular exercise is essential for long-term preventative health as it reduces the risk of serious health issues. A strong body is also better at fighting off minor illnesses. Running, weight training, walking, dancing — anything that gets your body moving is great for your health.

Exercise helps with weight management and weight loss, too. In order to lose weight, your body must burn more calories than you consume. And because muscle cells need a lot of energy, the muscles you build during exercise will continue to burn more calories than fat cells would, even when you aren’t exercising.

Another major benefit of exercising is endorphins. Physical activity, anything that gets the heart rate up, will release hormones called endorphins. Endorphins reduce your perception of pain and trigger positive “morphine-like” feelings in the body. This leads to more energy, improved sleep, and a positive effect on your mental health.

“A lot of times people think of exercise as ‘punishment’ for eating or drinking certain things, but exercise is really just a way to get your body moving, strengthen your muscles and activate the mechanisms in your bones that repair and strengthen them.” – Anna Larsen CPT & Fit Body Boot Camp Owner

How much exercise do you need?

The Department of Health & Human Services (HHS) reports that only one in three adults are doing the recommended 150 minutes of moderate exercise each week. While it might seem daunting to add two and a half hours of exercise to your week, it could be as simple as walking for 20 minutes each day, or doing an hour of strength training or a workout class a few times a week.

Don’t feel pressured to sign up for that marathon straight away. Start slow and build on your progress. Once you’re accustomed to that daily walk, step it up and add some hills, or try to walk your same route a little faster. As your muscles get used to a fitness routine, introducing a variety of challenges to push your endurance, speed, or strength will help you continue to make progress.

Goals to get you started

Though you may feel inspired to tackle an ambitious new fitness goal to kickstart your journey, it’s more important to set a goal that you’re confident you can maintain. Larsen advises that consistency is essential, even if your goal seems too easy at first, it’s important to develop a regular routine before you ramp up the intensity.

For example, rather than pushing for an hour of exercise every day, Larsen recommends, “start with three to five days a week of a 20- to 30-minute routine that you enjoy.” If you hate to run, don’t force yourself to suffer through a sweaty treadmill session. Opt for a different activity like pilates, yoga, or a sport you enjoy. Ask a friend to join you for a swim, take your dog for a long walk, or go on a hike. What matters most is that you’re moving and you’re feeling good about it.

Some great products for fitness

The Best Fitness Trackers
The Best Yoga Mats
The Best Treadmills
The Best Exercise Bikes
The Best Ellipticals
The Best Standing Desks
The Best Standing Desk Mats

Healthy Eating Habits

There’s a lot of conflicting information out there about what it means to “eat healthy.” The International Food Information Council Foundation’s (IFIC) 2017 Food and Health Survey found that most people find conflicting advice about what to eat or avoid, causing many to doubt their food choices. Sometimes we’re told to completely cut out carbs, but we also hear carbs are a primary energy source. One authority claims that coffee is carcinogenic, while another suggests it prevents diseases like Parkinson’s. Though defining it may be complicated, 19% of respondents in our own survey ranked “eating healthier” as their most important health goal.

Why is eating healthy so important?

The entire purpose of eating is to fuel the complex systems that function in your body — so feeding it the best nutrients possible is essential. Those nutrients, like calcium and potassium, directly influence bodily tasks like hormone creation and heartbeat regulation. Though vitamins and supplements are sometimes helpful, a balanced and healthy diet is the best way to ensure you’re getting the minerals your body needs.

The perks to eating healthy are abundant — it lowers your risk for health issues, improves confidence, increases energy, aids in weight management, and sets a good example for family and friends. The World Health Organization reports that if people ate healthier, stopped using tobacco, and exercised more — 80% of all cases of heart disease, stroke, and Type 2 diabetes could be prevented. This staggering statistic is reflected in nearly every major health disease — cancer, diabetes, obesity, osteoporosis, and even depression are all less likely for people with a healthy diet.

Calculate your calories: Use the MyPlate tool to calculate how many calories you should eat based on personal attributes.

Which nutrition plan is best for you?

So let’s get back to what it means to “eat healthy.” A good place to start is USDA’s MyPlate. Basically, the ideal plate for each meal contains a balance of essential food groups. Half your plate should be fruit and vegetables, and the other half should be whole grains and protein. Add a small side of low-fat dairy and you’ve got a balanced meal.

Just like with exercise, drastic changes upfront are hard to maintain when it comes to eating healthy (that’s why diets don’t really work for most people in the long term).

While the goal is a balanced plate at every meal, you can start by making small changes to slowly modify your diet. Keeping track of what you’re eating and drinking to help you understand your eating habits. Be aware of portion sizes and don’t over-eat. Try to limit excessive sugars, saturated fats, and sodium. Choose grilled food over fried, opt for fat-free dairy products, and try cooking with herbs and spices instead of salt. Drinking lots of water in place of soda and juice is another simple switch that will benefit your health in many ways.

But know that you don’t need to be overly restrictive or perfect with your eating habits to see success. Making small measured changes over time and striving for balanced nutrition is key to reframing your eating habits. “Eat healthy for 80% of the week and allow for unhealthy choices for about 20% of the week,” Diane Malaspina, Ph.D, Yoga Medicine® Therapeutic Specialist advised. “This is called the 80/20 rule. This approach teaches the skill of moderation and doesn’t call for complete food restriction so that less healthy food can be enjoyed in moderation.”

“Remember that fad diets aren’t easily maintainable, so it’s best to just adopt a healthier lifestyle that you can carry throughout your whole life.” – Dr. David GreunerCo-founder of NYC Surgical Associates

UCLA research found that the majority of people on diets will regain more weight than they lose within five years. Diets, especially overly restrictive ones that eliminate entire food groups, can be hard on your body, make eating at social gatherings complicated, and if they involve exotic ingredients or subscribing to a food plan, can become pretty expensive. Both the USDA and our experts agreed that general moderation and a balance of food groups is the most effective way to achieve long term healthy nutrition.

Goals to get you started

To start eating healthier, just one or two intentional changes can go a long way.

Some great products and services for better nutrition

The Best Water Bottles
The Best Multivitamins
The Best Fiber Supplements
The Best Probiotics
The Best Meal Delivery Services
The Best Weight Loss Programs

Meditate on Mental Health

A healthy mental state helps us cope with the stresses of life, work productively, maintain loving relationships, develop self-confidence, improve physical health, and ultimately live a happy life. But good mental health is not simply the absence of mental illness, just as being in good physical shape is about much more than not being sick. It’s possible to invest in and optimize our mental health and doing so can yield positive effects in every aspect of our lives.

In our survey, 57% of respondents that chose “improve mental wellbeing” as their most important health goal were men. Culturally, when talking about the idea of self-care and mental wellbeing, men aren’t always included. But it’s clear that this aspect of health isn’t a gendered issue. Taking the time to focus on your mental wellbeing on a regular basis is important to everyone’s health.

Addressing your mental wellness doesn’t have to be complicated either. Simple steps like getting more sleep, journaling, disconnecting from electronics, and exercising can make a big difference.

Why is mental health so important?

A positive state of mind will increase motivation, renew your energy, and help you make good choices. It also improves your ability to handle the inevitable stresses of life and maintain positive relationships with those around you.

“[Mental health] affects our emotional, social and psychological well-being; how we deal with others, handle stress and make choices.” – Dr. David GreunerCo-founder of NYC Surgical Associates

Your emotional disposition and outlook will affect how your body feels, too. Fatigue, cravings, irregular appetites, and weakness can all result from a poor mental state. “The mind-body connection is clear,” explains Malaspina. “Our thoughts, beliefs, feelings, and attitudes can positively or negatively affect our biological functioning.”

Goals to get you started

Most people will benefit from simply taking time to practice self care. What exactly self care means to you will be highly personalized. But simply put, give your mental wellness a boost by doing activities that help you feel relaxed and joyful. For some, that could mean spending time in nature (known as shinrin-yoku, or forest therapy). For others, it could be a lively family game night. Whatever helps you feel rejuvenated and balanced.

Some great products and services for self-care

The Best Body Washes
The Best Face Washes
The Best Eye Creams
The Best Face Moisturizers
The Best Lip Balms
The Best Online Flower Delivery
The Best Mattresses
The Best Pillows
The Best Sleep Aids
The Best Noise-Canceling Headphones

How to Set Good Goals

Setting goals is hard. So it’s no surprise that half of our survey respondents are setting the same health and fitness goals as last year. In our enthusiasm for self-improvement, it’s all too easy to design unattainable goals — e.g. “I want to run a marathon next weekend” or “I want to lose 60lbs by Valentine’s Day” — or keep things too general — e.g. “I want to eat better” or “I want to lose weight.”

While there are a large number of factors that can make reaching health goals difficult, we have some suggestions and a few tips from our experts for setting better goals.

According to the HSS, there are four stages to changing a health behavior:

It can be helpful to journal your progress through these stages as you instill new healthy habits. If you find yourself listing the same goals year after year, take some time to think about why you’ve struggled to reach this goal in the past, and then reflect on how you can change it to set yourself up for success.

Steps to setting better goals

*Make it a habit. Most people can form a habit in about three weeks. This is usually enough time to start experiencing the benefits of your new habit. So instead of setting huge goals for the whole year, try setting incremental goals for one month, three months, six months, etc. Successfully hitting these milestones also motivates us to keep up the habit to hit the next one.
*Set SMART goals. SMART is an acronym for specific, measurable, achievable, relevant, and time-bound. Use this goal structure to craft an achievable and targeted goal. For example, refine general goals like “lose weight” or “exercise more” into “lose 20 lbs in six months” or “walk for 30 minutes five times a week.”
*Track your progress. There are many ways to keep track of how well you’re sticking to a new goal: journal daily, check-off micro-goals, set specific mile-markers, or take photos. Larsen’s a big fan of this last idea, “take a photo of everything you eat during the day. You may think you’re only having a couple of treat meals a week, but photos may show that you’re actually having one or two a day —this way you can monitor that. Taking weekly full-body photos and comparing them each week or month can show you the progress you won’t see on the scale or in the mirror.”
*Reward yourself. Whether it’s with a day of rest, a movie out, or a cheat meal. “Reward yourself by feeling proud of yourself,” Malaspina recommends. “The more you feel good and rewarded for your efforts, the more likely you are to repeat your behaviors.”

11 Dos And Don’ts of Coping with Soreness After Yoga

Dr. Amy Sedgwick, MD and Erica Yeary for Yoga Journal discusses how to deal with your discomfort and still stay Zen.

Here’s what to do to get over soreness after yoga, and what not to do according to experts.

It’s no surprise if you feel a little ache-y after yoga—especially if you’re just getting back into it after some time away or practiced postures you don’t normally do. The reason a good yoga practice can feel so wonderful, after all, is because it can deeply stretch certain muscles that you’re not accessing in your everyday life.

“You may think your muscles are active, but some yoga poses will still stretch them in unfamiliar ways,” says yoga teacher Loren Fishman, MD, medical director of Manhattan Physical Medicine, author of Healing Yoga, and the creator of the Yoga Injury Prevention program. “Muscles can also become sore because they’ve been overused.”

The soreness after yoga you may be experiencing is called delayed onset muscle soreness (DOMS), which usually occurs 12-48 hours after exercising. The level of soreness you might feel depends what style you’re practicing, how intensely, and how frequently—as well as your individual body type, says Fishman. And even if you’re experienced in your practice, there’s a good chance you might feel sore from time to time. Though yoga is typically a low-impact exercise, it can still put a big strain on your muscles.

“Yoga is filled with eccentric contractions that cause microscopic injuries to the muscle and fascial tissues,” says Erica Yeary, MPH, RYT, an exercise physiologist and a Yoga Medicine registered therapeutic specialist based in Indianapolis, Indiana. “Our bodies produce an inflammatory response to these micro-tears and this causes muscle soreness.”

But, it turns out this muscle soreness is actually a good thing. “Once your muscles recover, you’ll experience muscle growth and improved performance,” says Yeary, ultimately making you stronger.

Of course, if your soreness after yoga is very painful, see a doctor. However, for run-of-the-mill soreness—which means pain is minimal—there are plenty of smart tricks you can try to ease your discomfort.

Here’s what to do—and what to avoid—to cope with muscle pain and soreness after yoga, according to medical and yoga experts.

Drinking water will help the muscles heal after yoga practice.

DO hydrate, then hydrate some more.

Drink water, not sports drinks, says Amy C. Sedgwick, an emergency medicine doctor and Yoga Medicine certified yoga instructor in Portland, Maine. “We want to help increase our blood volume so this fluid can be distributed more easily to the tissues to allow transfer of nutrition, healing cells and flushing out metabolic waste. Hydration is the way that happens.”

DO get plenty of sleep.

Without sleep and rest, your body can’t “gear down” to allow for the parasympathetic nervous system (rest-and-digest mode) to be in charge, says Sedgwick. “Without enough sleep, the neuroendocrine system will not prime the body and tissues for repair and relief.”

DON’T down caffeine and energy supplements.

Unless you’re an ultra-endurance athlete, you are not likely depleting your system so much that you need caffeine, energy drinks, or supplements, says Sedgwick. “This only adds unnecessary calories and other substances to a body that simply needs gentle movement, hydration, and rest,” she says.

DO exercise—gently.

Exercise is the best way to relieve soreness after yoga, says Sedgwick. In fact, research shows doing the same muscle movements and sequences you did prior to feeling sore—but in a less intense way—can help relax muscle spasms and allow muscles, connective tissue, and joints to find greater range of motion, she adds.

Foam rolling is a great way to reduce muscle tightness after yoga.

DO use a foam roller.

Foam rolling for 20 minutes immediately after working out can reduce tenderness— even if it causes some discomfort, says Yeary. Take it slow and be gentle; you don’t want foam rolling to cause so much pain that it actually makes your soreness worse.

DO eat a balanced meal.

Make sure your post-workout snack or meal includes protein, which repairs and builds muscle, and carbohydrates, which will also speed recovery, says Yeary.

DON’T take anti-inflammatory drugs.

It may seem like a smart idea to pop an aspirin to take the edge off your soreness after yoga, but it’s not the best way to help speed your recovery, says Yeary. “Inflammation is how the body responds to any type of injury,” she says. “In order to properly repair any damaged tissue, you must have inflammation. If you take away that inflammation with a drug you are hindering your body’s natural healing mechanisms.”

DO take a hot bath.

Not only does this feel great, but it actually helps to initiate the parasympathetic nervous system to reduce tension and allow the body to be in a state of healing, says Yeary.

Increase circulation in the body through stretching.

DO stretch.

And when you do, be sure to stretch through all planes of motion. This will increase circulation and range of motion while also preventing chronic tension and pain, says Yeary.

DON’T do intense stretching.

Long, static stretches or over-stretching sore muscles can do more harm than good, says Yeary. “The tissues are already slightly damaged and working on healing.” If you over-stretch your muscles and “wring them out” of all their fluids, you reduce their ability to heal and may even damage them in the process, she adds.

DO continue to practice yoga, gently.

One of the absolute best ways to cope with soreness after yoga is to do more yoga, says Fishman. “Concentrate on the areas that hurt and try to gradually relieve tension and tightness,” he says. “Becoming inactive because activity gives you some soreness is a very poor response to your soreness, and is likely to leave you in even more pain the next time you practice.”

Upper Hamstring Tendinopathy Treatment

 for Yoga Medicine® discusses what upper hamstring tendinopathy is, what causes it, and how to treat it with a few simple stretches.

A Short Guide For Yoga Teachers

Upper hamstring tendinopathy is among the most common injuries in the yoga community. Whether it’s a yogi who overshot hanumanasana in a public group class or an athletic private client who sprained their hamstring tendon during a sprints workout, it’s fairly safe to bet that as a yoga teacher, a student will approach you with this issue at some point. They’re often in pain and frustrated: the deep, achy sensation under the glute comes and goes with varying intensity. This type of injury is notoriously slow and difficult to heal.  And, when severe enough, it can impact even daily activities like walking, standing, and sitting.

While it isn’t within our scope as yoga teacher to diagnose a proximal hamstring tendon sprain or tear, there’s a lot that we can do to help our students with this common issue in a safe manner. Understanding the basic physiology of the healing process will not only enable you to guide your student effectively but also educate your student about the process so that they can participate in it actively and intelligently.

The proximal tendon of the hamstrings. The attachment at the sitting bone, circled here in red, is a common site of injury and irritation.

Proximal Hamstring Tendon Injuries: The Basics

Tendons are made of connective tissue that is composed of two types of fibers: collagen and elastin. Collagen is very tough, while elastin is more elastic. We have many different types of tissue in our bodies, each with a composition designed to fit their particular function. Tendons are not designed to stretch very much, for example. They are therefore mostly composed of collagen with very little elastin.

If the tissue is forced beyond its rather limited capacity to stretch and into a range of motion that it can’t spring back from, it will tear or sprain. As was the case of our Hanuman yogi and sprinter athlete. Damaging the tissue in this manner can be very painful and also reduces the overall tensile strength of the tendon.

The collagen fibers in tendons (and in other tissues) are arranged in a direction that matches the directional load that the tendon is designed to absorb. In a healthy tissue, the fibers are aligned in an orderly manner. This allows them to easily glide past each other. When the tissue is damaged, the body initiates the inflammatory response and a healing process. This process begins to lay down new collagen fibers at the injury site.

Injuries & Scar Tissue

This is where things can start to get messy. From the body’s perspective, an injury is effectively an emergency scenario. The main focus is on crisis control and patching things up quickly. During this period, the orderliness of the fibers is not a priority. The result is collagen fibers that are a cross-linked, multi-directional, bungled mess. That’s what scar tissue is: disorganized, misaligned connective tissue.

The disorganization of the tissue can be problematic for a variety of reasons, but mainly because the cross-linking of the fibers causes scar tissue to adhere to itself and the surrounding tissues. This impedes the repaired tissue’s ability to interface smoothly with the tissues around it, or maybe even to lengthen and stretch in its own limited capacity.

All of this, in turn, limits range of motion, which ironically makes you more likely to reinjure the same area down the line. Without the appropriate intervention, it’s possible to get stuck in a self-fulfilling, chronic cycle of a limited range of motion, tension, injury, inflammation, and fibrosis. With this information in mind, it is clear why it’s crucial to treat a hamstring tendon injury correctly right out of the gate. If we can control and direct the course of the healing process, we can also minimize scar tissue. This will hopefully avoid a lot of hassle, physical pain, and wasted time dealing with reinjury down the line.

The Fine Line Between Healthy Stress and Reinjury

The main goal of any rehab process is to bring the injured tissues’ capacity to handle load back up to a functional level. We want to strengthen them to the point where they can once again withstand the demands of daily activities, yoga practice, and athletic training. We do this by applying stress to the tissue, thereby encouraging it to strengthen in response to that demand.

The word stress tends to have a negative connotation. However, as it pertains to the tissues in our bodies, stress is actually highly productive when applied mindfully and in healthy, manageable doses. The stress of lifting weights is what stimulates muscles to grow stronger to meet similar future demands. The stress of your feet hitting the ground as you run tells your bones and joints to strengthen in response. Our bodies absolutely need stress in order to stay healthy and functional; athletic training of any kind is by definition controlled, systematic application of stress stimulus. In a rehab scenario, we’re using stress in a very moderate, controlled manner to harness and control the strengthening effect it has on our tissues.

With that in mind, how exactly can we nudge the healing process in the right direction and encourage the new collagen fibers to be laid down in an organized, aligned formation? Aside from stimulating the healing process, we also need to stress the tissue in a way that gives it feedback on the direction of the force it needs to handle. This will help determine how the collagen fibers are laid down; ideally, in a neat, tidy orientation rather than the disorganized bungle of scar tissue.

Strengthening: Next Steps

Conventional wisdom states that the initial injury needs complete rest for at least 72 hours.  It may need more depending on the severity). This is to ensure it’s no longer actively painful or inflamed. After that, it’s OK to begin some very cautious strengthening exercises. Slow and gentle is the name of the game. We want to apply the tiniest bit of stress to the tissue. This will encourage the fibers to align themselves in an orderly fashion. We want to avoid applying enough stress to reinjure the area.

That pulling sensation under the glute now becomes a helpful tool that lets you know when you’re pushing too hard. Keep in mind that an injured tissue’s ability to handle stress is very much reduced. So triggering the familiar ache is a sure sign that you should take it down a notch. Overshooting the mark actually just creates fresh irritation and keeps the tissue in a chronic state of low-level inflammation.

Beyond the importance of working at a conservative level of intensity that is productive for the student and their injury, also consider the specific loads that we eventually want the upper hamstring tendon to withstand. Since the hamstrings contract concentrically to bend the knee and extend the hip, and also work eccentrically to flex the hip as the knee straightens, it is important to train the muscles’ abilities to engage in these positions. In practice, this means applying stress to the tendon at an intensity that does not trigger fresh irritation or pain.

Tips

Start with very small movements in a narrow range of motion. Encourage your student to tune in to the sensations. This will help them avoid pushing into or past the familiar achy sensation. Isometric holds are incredibly useful in this situation. These holds can be fine-tuned to an appropriate level that will yield long-term results. They also have the lowest inflammatory response. In some cases, they can even have an analgesic effect that provides instant (albeit temporary) relief. Most experts recommend aiming for 5 sets of up to 45 seconds of muscle contraction1.

This could be too difficult (and therefore not constructive) of a starting point for many students, in which case, even contractions of 5 to 6 seconds can have a beneficial effect2. As always, your job as the teacher is to be an observer, problem-solver, and guide. Always encourage your student to pay attention to the sensations while you interpret their reaction to your cues. Make appropriate modifications to help them work productively in a manner fitting their context, needs, and limitations. Work in a variety of positions and scenarios, increasing the load and range of motion slowly. Progressing cautiously will not only encourage sustainable progress, but the resulting growth in body awareness will serve your students well to protect them from future injury, too.

To Find Out More

To find out more about the physiology of the healing process, specific poses and techniques to safely strengthen an injured tendon, and ways to maintain range of motion during rehab, consider downloading the Stronger With Yoga: Hamstring Injury Rehab e-book. An additional video bundle of short practices suitable for all phases of the rehab process, from post-injury to long-term maintenance and reinjury prevention, is also available via the Stronger With Yoga website.

***

Footnotes and References

  1. The effects of isometric exercise types on pain and muscle activity in patients with low back pain, Hyun-Seung Rhyu, Hun-Kyung Park, Jung-Sub Park, and Hye-Sang Park
  2. Therapeutic exercises for the shoulder region, Johnson McEvoy, Kieran O’Sullivan, Carel Bron

Concussion Recovery: Yoga for the “Invisible” Injury

Daya Alexander Grant, Ph.D., M.S. for Yoga Medicine® shares some information on concussions – the most common head injury. Learn how yoga can benefit concussion recovery and how to practice safely as you heal.

Yoga for the “Invisible” Injury

“Are there any injuries I should know about?”

Most yoga teachers begin class with some form of this question. The goal is to become aware of any current physical limitations that a student may be experiencing. This is so that the teacher can make the asana practice accessible by offering the appropriate modifications to protect the injury.

Unfortunately, head injuries are rarely acknowledged – either by the teacher or by the student. Most teachers are not very knowledgeable about concussions, and students recovering from one often remain silent since it can be difficult to articulate their symptoms.

With the heightened awareness of concussions in recent years and the benefits of yoga being touted to a larger audience, it is valuable for yoga teachers to learn about this particular injury.

What You Should Know About Concussions

A concussion is defined as a mild traumatic brain injury, but it hardly feels mild for the person experiencing it. Upwards of 3.8 million concussions occur in the U.S. annually1, with the most common causes being sports-related incidents, falls, motor vehicle accidents, and blast injuries (among veterans). A recent study showed that 1 in 5 teenagers reported having at least one concussion2. Every brain is unique and each concussion manifests differently, but common symptoms include headaches, dizziness, insomnia, mood changes (e.g. irritability, sadness, nervousness), sensitivity to light and sound, difficulty with balance, concentration, and memory, and generally feeling like you’re “in a fog”.

Cognitive dysfunction after concussions is due to transient cellular damage, but not destruction. 80-90% of concussion symptoms typically resolve within 7-10 days, although this tends to take longer with younger people and for those who have had multiple concussions. It is important to note that even after symptoms dissipate, the brain may still have microstructural damage which can cause a resurgence of symptoms in stressful or taxing situations. While most students who attend a yoga class will be outside of the acute injury phase, they still may be dealing with repercussions of the injury.

Benefits of Yoga for Concussion

Yoga means “to yoke” or “to unite” the body, mind, and spirit. That intention is precisely what people who have had concussions are seeking. Furthermore, a gentle yoga practice can offer cognitive, physical, and emotional improvements for someone healing from a concussion.

The general consensus in the neurotrauma community is that prolonged restrictions after brain injury (e.g. sitting in a dark room with no sounds) are actually detrimental to recovery. Instead, doctors now advise patients to avoid strenuous physical or mental activities for the initial 24-48 hours after a concussion. After that period, the patient will follow a gradual and personalized return-to-play protocol. The goal is prompt re-engagement in social and physical activities that do not worsen symptoms or put the brain at risk for another injury.

Yoga is an effective way to improve quality of life and reduce symptoms after a concussion. In a recent study that I co-authored, adults with traumatic brain injury (TBI), including concussions, participated in an 8-week pilot yoga program. At the end, participants reported improvements in quality of life and self-perception, as well as a reduction in negative emotions3. The empirical research on yoga for concussions is in its infancy, but several studies focusing on TBI as a whole have demonstrated the benefit of yoga and meditation on information processing and mental fatigue4, attention5, strength and endurance6, and memory7.

Tips for Working with Yogis who are Recovering from a Concussion

As yoga teachers, we can implement three simple practices to encourage a welcoming and healing environment for anyone dealing with a concussion.

Hold Space

  • Create a safe and peaceful environment where the student can be exactly who they are on that day. Some days, it’s hard to leave your house with a concussion. The world is overwhelming and the simplest tasks can be exhausting. Attending a yoga class may be the one activity they do that day. So it is important to make it a positive and supportive space as much as possible.

Emphasize the Breath

  • We’ve all experienced the benefits of a deep breath. But sometimes it’s easy to forget how powerful that tool is amidst the chaos of daily life. Anyone with a concussion will benefit from conscious breathing – specifically, slow, deep ujjayi breaths. Not only will the breath bring their mind in to the present moment and benefit them physiologically during practice, but it will also help them deal with the overstimulation and intense emotions they’re experiencing off the mat.

Keep it Simple

  • A concussed brain processes information slower, since the myelin (insulation around the neurons’ axons), which is responsible for fast signal transmission, is damaged. Therefore, it’s important to keep instruction to a minimum. Too many words are difficult for anyone to follow, especially someone who has had a brain injury. While alignment is always important, choose your cues mindfully so as not to distract from the goal of helping your students turn their attention inward.

Yoga is designed to meet people exactly where they are on any given day. Let’s keep that in mind as we work with students who have had concussions, since every day is different. As yoga teachers, we have the honor of giving everyone the tools to re-connect their body, mind, and spirit – which, after a concussion, can feel like a daunting task.

***

References

Citation #1 Daneshvar DH, Nowinski CJ, McKee A, & Cantu RC (2011). The epidemiology of sport-related concussion. Clinics in Sports Medicine, 30(1): 1–17. DOI: http://doi.org/10.1016/j.csm.2010.08.006

Citation #2 Veliz P, McCabe SE, Eckner JT, Schulenberg JE (2017). Prevalence of concussion among US adolescents and correlated factors. JAMA, 318(12):1180–1182. DOI: 10.1001/jama.2017.9087

Citation #3 Donnelly KZ, Linnea K, Grant DA & Lichtenstein J (2017). The feasibility and impact of a yoga pilot programme on the quality-of-life of adults with acquired brain injury, Brain Injury, 31(2): 208-214. DOI: 10.1080/02699052.2016.1225988

Citation #4 Johansson B, Bjuhr H & Rönnbäck L (2012). Mindfulness-based stress reduction (MBSR) improves long-term mental fatigue after stroke or traumatic brain injury, Brain Injury, 26(13-14): 1621-1628. DOI: 10.3109/02699052.2012.700082

Citation #5 Cole MA, Muir JJ, Gans JJ, Shin LM, D’Esposito M, Harel BT, Schembri A (2015). Simultaneous treatment of neurocognitive and psychiatric symptoms in veterans with post-traumatic stress disorder and history of mild traumatic brain injury: A pilot study of mindfulness-based stress reduction, Military Medicine, 180(9): 956–963. DOI: https://doi.org/10.7205/MILMED-D-14-00581

Citation #6 Schmid AA, DeBaun-Sprague E, Gilles AM, Maguire JM, Mueller AL, Miller KK, Van Puymbroeck M, and Schalk N (2015). Yoga influences recovery during inpatient rehabilitation: A pilot study, International Journal of Yoga Therapy, 25(1): 141-152.

Citation #7 Azulay J, Smart CM, Mott T, Cicerone KD. A pilot study examining the effect of mindfulness-based stress reduction on symptoms of chronic mild traumatic brain injury/postconcussive syndrome. J Head Trauma Rehabil. 2013 Jul-Aug;28(4):323-31. DOI: 10.1097/HTR.0b013e318250ebda

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