Internal Medicine Archives

The Subtle Tide That Moves Within

Leave a Comment / Articles, In The Press, Internal Medicine, Resources, Yoga Medicine News / By Kirsten Beverley-Waters

By Kirsten Beverley-Waters for Yoga Medicine®.

Cranio-Sacral Rhythms Hold a Link to Therapeutic Yoga

The growing desire of our students to become self-healers has shifted teachers’ focus into slower flows and yin style classes to create a space for students to unwind, draw inward, and ride the wave of their breath. What if we could do more than speak to awareness and help create therapeutic shifts in how our students perceive pain, work through suffering, and connect with their nervous system?

The foundation of this technique resides in the power of the cranio-sacral connection. The founder of Osteopathic Medicine, A.T. Still, discovered that the connection between the cranium and sacrum held a key to deeper understanding in human health.¹ Still compiled this into an article to shed light on how yoga teachers can employ concepts of Osteopathic cranio-sacral motion into a simple therapeutic yoga practice. The many complexities of this concept requires an understanding that this practice is only an entry point into this methodology.

Cranio-Sacral Rhythm

Cranio-Sacral Rhythm (CSR) is a subtle two-phase movement occurring throughout the body. Cranio-sacral motions consist of a flexion stage and extension phase. During the flexion phase, the cranium widens transversely, the sacral apex moves anteriorly (nutation), and the extremities rotate externally. During the extension phase, the cranium narrows in the transverse dimension, the sacral apex moves posteriorly (counter-nutation) and the extremities rotate internally.² The flexion and extension are most apparent in the cranium and the sacrum. The teacher within me wanted to relate flexion and extension to pranayama and yoga but the mechanical motion does not always match the cranial rhythm. Instead, I focused on cardinal movements of the sacrum and began exploring how nutation and counter-nutation impacted the autonomic nervous system.

By observing an osteopathic physician treat patients using Osteopathic Manipulative Treatment (OMT), I was able to dig a little deeper into how I could modulate yoga postures to impact this rhythm. The physician explained that patients treated by an osteopathic physician through OMT rely not only on the cranial movement and an associated rhythm, but also with an ability to palpate that movement and rhythm. Treatment proceeds by mobilizing the cranial bones, the sacrum, and the dural tube. OMT helps facilitate the release of restrictions that may inhibit the functioning of the cranio-sacral system— the fluid membranes that surround the brain, spinal column, and nerves. These fluid membranes or sheaths of connective tissue around the nervous system and the brain, and in between those sheaths and the neurons themselves there is cerebrospinal fluid that absorbs shock, nourishes, and supports the nervous system.³

It became easier to envision the cerebral-spinal fluid mimicking an ocean tide and the cranio-sacral motion acting as a gravitational pull of the sun and moon. Osteopaths dial into the rise and fall of these tides in treatment. The tides and their pull impact the entire structural system of the human body, ultimately influencing its function.

Modulating the Nervous System Through Yoga

Three areas in which we, as teachers, can influence the autonomic nervous system are through the parasympathetic nervous system, the sympathetic chain ganglia, and the cardinal movements of the sacrum (nutation and counter-nutation.) By layering in pranayama we can accentuate the innate motions of the cranio-sacral rhythm.

A direct impact on the parasympathetic nervous system is experienced through the subocciput. The vagus nerve, the largest parasympathetic nerve in the body, originates proximally to this area and is influenced by the amount of tension occurring in the suboccipital region. By adapting a myofascial release technique in the subocciput to focus on the oculo-cervical reflex we can induce subtle muscular activation to enhance the release of this posture.

The other contributor to the autonomic nervous system is our sympathetic chain ganglia. Located on the rib angles and along either side of the spinal cord, the afferent (bring information to the brain) and efferent (sending information from the brain) nerve bodies regulate the flight or fight response. By placing two yoga blocks 1-2” apart in supported fish, or matsyasana, we can evenly distribute the applied pressure to the sympathetic chain ganglia. The result is a more direct influence on the sympathetic nervous system.

In order to completely address the parasympathetic nervous system and create a pathway through the entire spinal column we can take advantage of the cardinal movements of cranio-sacral motion (nutation/counter-nutation). These movements are created through the dura of the brain. This tough sheath that surround the brain and spinal cord attaches at the base of the skull, foramen magnum, and upper cervical vertebrae. Another firm attachment is the second sacral segment and then the tailbone self via filum terminal. Through this very hard mechanical connection you can influence by changing how we move in easy pose, sukasana, in what I call the Double Block Sacral Release.

For this modification, we add two blocks with a 1-2” gap between them just as we did in supported fish. The use of the double blocks and the firming of the sit bones on them allows for more dedicated sacroiliac/sacral motion. One notation that may be helpful when working with students is awareness of the amplitude in lifting the chest and hollowing the body. By keeping these movements small, almost invisible to the eye, it brings the focus to the superior cranial rhythmic actions rather than the postural (mechanical) axis.

Moving through this practice, we ride the cranio-sacral rhythm from the subocciput to the sacral release. This allows my students to move through some of the areas of greatest muscle restriction and tension in the body to ultimately settle into the quieter motions of cranio-sacral rhythm. Here, I have found that supported savasana provides the deepest connection to the more subtle sensations of respiration and muscular release. Giving space for extended savasana has proven the most beneficial to my students. Remember that cranio-sacral movements and releases can be fine-drawn but their impact on the autonomic nervous system is deeply therapeutic in practice.

1. Double Block Subocciput Release with Oculo-Cervical Reflex [Parasympathetic]

Set-up: Place two blocks into a “V” shape with the ends closest to the head elevated using a small wedge or weight to secure the blocks.
Lie down on your back and place the base of your skull onto the blocks. Bend your knees so they start in a knee-knock pose.
For more intensity you will extend your legs out.
Once you position take 3 deep breaths in through the nose and out through mouth to clear out any extra energy.
Muscular Activation: To start the release you will work through several positions of the eyes. Imagine a compass when moving your eyes. (North, South, East, West).
Take 5 slow breaths in/out through the nose with your eyes gazing in one direction. Repeat this process until you have gone up, down, right, left.
Conclude with gazing up at the ceiling for 5 breaths, then softly closing your eyes.
Allow 3-5 minutes in this pose.

2. Double Block Supported Fish [Sympathetic Chain Ganglia]

Unlike traditional supported fish you will orient your blocks in a vertical fashion with a 1-2” gap between the blocks. This leaves space for the spine.
Lie down on your back. Place the base of your shoulder blades on the bottom of the blocks and lean back. You can place your head on a third block to make yourself more comfortable or a bolster.
Find a comfortable position for your legs either in knee knock pose or savasana Allow 4-5 minutes in this posture.

3. Double Block Sacral Release (Nutation & Counter-Nutation)

Placing the sit bones firmly on the blocks with 1-2” between them to give space for the sacrum to move you will begin by placing your right pointer finger on your chin.
As you breath in draw your chin in and as you exhale extend the chin forward. Both motions are barely noticeable.
Layer in the pranayama with your movement. Breathe in, draw your chin back. Breathe out, your chin slides forward.
Drop your hands down to rest on your knees and add the final movement. As you breathe in, draw your chin back and lift your chest and create a small cow pose as the sacrum moves into nutation. Then as you exhale, extend your chin forward, and arch your back just enough that the sacrum begins to move into counter-nutation.
Continue this sequence for 2-5 minutes. Slow, focused breaths in/out through the nose.

4. Savasana

Place on block on its highest height at the back of the mat.
Place a second block 6-8” away from the first block on a medium height.
Lay your bolster over the blocks.
Bring your low back to the edge of the bolster and keep your knees bent.
Lean back and allow your spine to rest comfortably on the bolster.
Slowly extend one leg at a time and extend your arms out.
Stay as long time allows or a minimum of 5 minutes for a full body release.

References:

DeStefano, Lisa A. (2017). Cranial Technique. Greenman’s Principles of Manual Medicine (4, 159-161).
Beal, Myron C. (1992). The Principles of Palpatory Diagnosis and Manipulative Technique. American Academy of Osteopathy, (2-4).
Waters, K., DO, (2019, October). Personal Interview

The Nervous System Through the Eyes of an Anesthesiologist

Leave a Comment / Articles, Eding Mvilongo, In The Press, Internal Medicine, Resources, Yin, Restorative and Meditation, Yoga Medicine News / By Eding Mvilongo

By Eding Mvilongo for Yoga Medicine®.

The nervous system is a complex network that regulates our vital functions, our actions, and even our thoughts. Its central and peripheral portions link all body systems via nerves communicating through different types of receptors. Moreover, the peripheral portion can further be characterized as either controlling voluntary movements or involuntary reactions (“fight or flight ” vs. “ rest and digest”) to a situation. One could spend years (!) studying its intricacies, but we typically do not spend a lot of time thinking about these inner workings, focusing instead on the end-results of interactions with our environment: how our heart rate increases when we feel stressed, the withdrawal of our hand upon contact with something extremely hot, or stopping movement when we feel excessive pain in a limb.

As a practicing Anesthesiologist, I came to Yoga Medicine®’s Nervous System and Restorative Yoga module with a solid knowledge of the nervous system and the physiology behind its activation. After all, I alter levels of consciousness, motor, and sensory responses to nervous stimuli for my patients to obtain the best treatment for their conditions. Most of my work is done with chemicals that affect the brain by modifying the production and/or elimination of messenger particles called neurotransmitters. These neurotransmitters relay the information between the different body systems; changes in their concentration can directly influence how we move, how we think, and our emotional state. Also, acute and chronic pain result from neurotransmitters activating receptors that respond exclusively to intense and potentially damaging signals: nociceptors. Responses generated by these nociceptors could result in lasting unpleasant, unwanted sensory and emotional experiences. As such, acute and chronic pain management is also an important component of my patient care. Using medication is currently my method of choice to address stress and pain issues, yielding a variable degree of effectiveness and patient satisfaction…

However, as a yoga teacher, I brought some big questions to this training. For instance, could practicing yoga help regulate the nervous system to the extent of getting results comparable to those obtained with chemicals (and avoiding undesirable side-effects)? And if so, how? This module gave me an insight on how we can find ways to modulate responses generated by the nervous system for both wellbeing and mindfulness.

A key teaching point for me was that the stress and the pain response to a situation are heavily influenced by the emotional memory one has in regards to similar past events. This causes acute and chronic changes in brain chemistry, which in turn affects both the mind and body. Yes, we need a certain level of stress to enhance our performance or ensure our safety: we want the increased heart and respiratory rates to pump that oxygen-rich blood to our muscles and our brain at critical times! Unfortunately, chronic exposition could gradually transform into a physiological and psychological exhaustion state with devastating long-term consequences impacting our cognitive abilities, our behaviors, our relationships, our energy levels, and our athletic performance amongst others…

Restorative yoga is an excellent tool to balance our emotions, nourish the body, and most importantly, rewire our stress response patterns through relaxation, meditation, body awareness, and breath-centric practices. It focuses on emphasizing physiological goals rather than physical ones. For instance, supported yoga positions are held during longer periods to relax the body and reprogram our central and peripheral nervous systems activation process in a down-regulatory manner. Stimulation of the diaphragm through breathing exercises, pranayama breaths, and myofascial release also enhance this down-regulation. Props (]blankets, blocks, bolsters, straps, chairs, sandbags) are used to minimize the effort exerted in poses and allow for maximal relaxation.

It is crucial that an adequate environment be provided: a warm, dark, quiet safe place will foster a sense of well-being and encourage introspection (awareness of what is going on within ourselves), and visualization. As a yoga teacher, I am there to facilitate the students’ journey and guide them through what is accessible to them.

And yes, I strongly believe that this practice will impact my students and provide a useful way to deal not only with the stress (or pain) in everyday life, but eventually to prepare and cope better when faced with unexpected challenges. As an extension, I also plan to introduce the notion of visualization and breath work with patients consulting for pain issues. After all, the mind can be a powerful ally to help achieve our goals.

Balancing Act

Leave a Comment / Articles, Chinese Medicine, In The Press, Internal Medicine, Resources, Yin, Restorative and Meditation, Yoga Medicine News / By Lisa Muehlenbein

Why are yoga and tai chi so beneficial for our bodies and minds? And can anybody really do it? Here are some moves you can try at home.

By Louise Parfitt For Inspire.

It’s easy to avoid exercise and moving a lot when you have arthritis – if you’re in pain, your natural reaction is to be still and quiet.

But it’s a vicious circle. When we move less, our muscles weaken, and this can increase pain. What’s more, many studies have shown that gentle exercise can help the symptoms of arthritis, easing pain and stiffness.

Exercise doesn’t have to be hard though. Both yoga and tai chi have been found to be beneficial for arthritis, improving strength, flexibility and fitness, while also being good for mental health.

“Yoga is a nice, gentle way for people who are scared of exercise to begin to move,” says Silvia Laurenti, senior physiotherapist and yoga therapist at the Minded Institute. “By learning simple movements, people feel empowered and more confident, and conditions, such as depression, might lift a little.”

This is backed up by a study published in Restorative Neurology and Neuroscience [1]. It found that eight weeks of intensive yoga significantly improved the physical and mental health of people with rheumatoid arthritis, and reduced the severity of depression. It’s something that Lisa Muehlenbein, a Yoga Medicine® Therapeutic Specialist, has experienced herself. “I notice that the pain in my knees and wrists decreases following my yoga practice,” she says.

“This is because yoga gets the synovial fluid flowing in the larger joints, allowing smoother movement and creating a greater range of motion and increased flexibility.”

How Can Yoga Help?

With osteoarthritis, asanas – which are the physical postures in yoga – can increase strength and flexibility, and help prevent and manage flare ups. They can also be used alongside physiotherapy to aid recovery from a joint replacement.

Similarly, with rheumatoid arthritis, yoga can be used to maintain strength and flexibility when the condition is stable. As muscles are stretched, tension that is caused by lack of movement is also released.

Yoga can also change the way a person experiences the condition. “Pranayama (breathing), mindfulness meditation, restorative poses and relaxation can help manage symptoms of chronic pain,” Laurenti explains.

How Can Tai Chi Help?

Originating in China, tai chi consists of fluid, gentle movements that are slow and relaxed. There are many variations, but a program designed for people with arthritis can be beneficial in reducing stress, improving balance and offering some pain relief.

There is some evidence to suggest that tai chi can improve mobility in the ankles, hips and knees in people with rheumatoid arthritis, but it’s unclear whether it can reduce pain or improve the quality of life for people with the condition.

Pain Relief

A review found aerobic and mind-body exercise (such as tai chi and yoga) to be useful for people with hip and knee osteoarthritis. It also found that mind-body exercise had similar effects to aerobic exercise for pain, with the potential to influence central pain sensitization, sleep disturbance, and mood disorders.

Although yoga and tai chi can be done at home, there are plenty of classes throughout the UK that offer friendship and social support, as well. As a space to get help with your practice. Just getting out to a class can lift your spirits and motivate you to continue with the exercise.

Try These Yoga Moves

Before trying any new exercises, check with your GP or get the advice of a qualified teacher. You can adapt the following postures to suit your body.

1. CAT-COW

Stretches the hips, back and chest, and helps increase flexibility of the neck, shoulders and spine.

If you are able to, start on all fours, with support under the knees and wrists. Alternatively, you can do a similar move from a chair.
Inhale, and drop your tummy towards the mat. Lift your chin and look at the ceiling, dropping your shoulders down.
Exhale, then bring your tummy towards your spine and round your back, like a cat stretching. Drop your head towards the floor.
Repeat five times.

2. SEATED MOUNTAIN POSE

Stretches the trunk, waist and shoulders. This can also be done standing up, if you’re able to.

Sit up tall in a chair. Lengthen your spine upwards, keeping your chin parallel to the floor, and breathe deeply.
Lengthen your arms downwards and imagine energy flowing to your fingertips.
Raise your arms above your head and stretch the body, breathing steadily.
Hold this pose for 30 seconds to one minute, if comfortable.

3. STICK POSE

Stretches your legs, quadriceps and calf muscles.

From mountain pose, lower your arms and put your hands on your thighs.
Extend your right knee, lifting up your calf so your leg is parallel to the floor. Flex your right heel, lifting up your toes.
Hold for two breaths, then switch sides. Repeat three times on each leg.

References

[1] Restorative Neurology and Neuroscience

Yoga Techniques for Stress: Calming the Nervous System for Mental Health

Leave a Comment / Articles, Healthcare Providers, In The Press, Internal Medicine, Mental Health, Resources, Valerie Knopik, Yoga Medicine News / By Valerie Knopik

By Valerie Knopik PH.D for Yoga Medicine®.

Engaging in yoga for stress is a common therapeutic modality to calm the nervous system and work towards greater mental health. Valerie Knopik PH.D talks about the stress response and shares a yoga-related technique to activate your parasympathetic nervous system.

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

Sensitivity, Yoga, and Mental Health: A Personal Discovery

Leave a Comment / Articles, Chinese Medicine, In The Press, Internal Medicine, Mental Health, Resources, Yin, Restorative and Meditation, Yoga Medicine News / By Yoga Medicine®

By Rachel Workman for Yoga Medicine.

Increasing sensitivity is encouraged in the yoga practice. You are invited to tune into subtle engagements, explore energetics, notice thoughts, and experience emotions. It is thought that a continuous practice will increase awareness and sensitivity in all aspects of the human condition so up until recently I had wondered why, after 10 years of dedicated practice, I still felt disconnected from my emotions.

When I began practicing yoga, I was drawn to certain components that were missing from a regular workout regimen. Yoga allowed me to explore something that I had long forgotten — sensitivity. I enjoyed the deep relationship to my physical body that yoga provided, but as others were sharing experiences of emotional release within the practice, I became aware of how long it had been since something had warmed my heart or allowed me to cry. Although I remembered being a sensitive child, I realized as an adult I felt emotionally numb.

What happened to that sensitive kid? How could I feel so disconnected to myself when I was the most connected to my body that I had ever been?

Introducing Nature vs. Nurture

Recently, I found my answer rooted in both the Western and the Eastern world. This summer at the Mental Health and Wellness module with Yoga Medicine, we explored the concepts of nature and nurture. Nature refers to the biology of our genes which can also be thought of as what we inherit and Nurture is the perception that our minds are a “blank slate” and that we are molded by our childhood experiences, lifestyle choices, and our ‘life as a fetus’.

At this training, teachers Valerie Knopik and Diane Malaspina shared that “what makes us who we are” has often been thought of as nature or nurture dichotomy, but when in reality it is a combination of both. Our genetic make up, perceptions, environment, and our sensitivity factor into who we become and how we behave.

Although we are born with a specific genetic code, it can be altered by environmental factors like stress, lifestyle, community, and maternal exposure. The study of these changes that modify our gene expression is called epigenetics.

As I considered our environment’s effects on gene expression, I realized that I may have come to the practice with a genetic predisposition to be sensitive, allowing me to connect to the physical aspects of the practice more readily, but my lack of emotional connection could be a conditioned response to past traumatic events.

Connecting the Past and Present

I grew up in a home that had little tolerance for being emotional. Most of my parent’s time was spent on making ends meet. My dad worked and my mom tried to make what little he made stretch to cover all of our basic necessities. The lack of space for expression of fear, anxiety, worry, and sadness when the outcomes were less than desirable, eventually took a toll on my mother.

When I was 12, she suffered her first nervous breakdown. No longer was she able to cope with life’s challenges. It was intense. The person I had known—the one who had been so good at hiding her anxiety, fear, and worry—was now an emotional wreck. My mother had finally succumbed to the environment where she was not able to openly express her emotions. Instead, she bottled them up and as financial circumstances worsened, she would ultimately break under the pressure.

I believe I was conditioned for that very moment because the years of seeing my mother hold in her emotions prepared me to do the same. Instead of breaking down at the thought of losing her, I became stoic. I became numb. As one break led to another, as one diagnosis was replaced with another…depression, schizophrenia, mania, anxiety… I shut down. This was the only way I knew how to cope with what was happening.

Gaining Clarity

Fast-forward 25 years and I am beginning to see that my mother’s nervous breakdown was a combination of genetics, environment, and sensitivity. Studies show that everyone carries genes that contribute to mental health disorders. Research on epigenomes has proven that environmental factors like stress effect gene expression and that our vulnerability and susceptibility can create a better or for worse outcome. Before my mother’s illness, I had always thought of her as “tough as nails.” Now looking back, I realized she was incredibly sensitive but wasn’t allowed to express herself.

Adapting to Survive

This childhood experience translated into years of creating boundaries to insure that I would not end up like my mother. There were long stints away from home in those early teenage years and as I grew older, I ignored phone calls to avoid her ruminations on past events or worries about the future. Without realizing it, I was reducing my exposure to an environment that I was highly susceptible to. I was living in survival mode.

So, what happens when the dysfunctional environment no longer exists?

Unfortunately, the past experiences that helped me adapt to dysfunction in my youth continued to play out into adulthood. I associated being emotional with my mother’s nervous breakdowns so I thought that if I let myself become emotional, then I would eventually lose control. I learned to be afraid of emotions and the result was to subdue my own and avoid anyone else’s.

Putting It All Together

I lost my mother August 1 st , 2018, six days before I was to attend Yoga Medicine’s myofascial release training. I told no one for fear I might not be able to control my emotions. As the week went by and we worked deeper into the connective tissue, I could no longer ignore the connections emotions have with the tissues of the body. I cried more at that training than I was capable of at her funeral.

Now, after years of practicing and studying yoga, I’m beginning to truly understand why I am so drawn to yoga and its lessons on life. I am slowly rediscovering that sensitive kid I spent years learning how to protect through avoidance. The simplicity and familiarity of the asana and pranayama practices are teaching me how to feel again before I realized that I was missing this capacity. I went to the mental health module expecting to gain insight and affirmations about my mother’s illness. However, I left that training with the fledgling understanding of how her illness affected my own mental health and emotional development as well as influenced the lessons within my yoga practice.

Yoga for Mental Health: Epigenetics, Neuroplasticity and a Practice for Community Support

Leave a Comment / Healthcare Providers, Internal Medicine, Mental Health, Resources, Valerie Knopik, Yoga Medicine News / By Valerie Knopik

How can certain yoga related modalities get “under the skin” to positively impact our mental health? Yoga for mental health can be a powerful tool but when teaching or practicing this as a therapeutic practice it’s important to understand the role of epigenetics and neuroplasticity in reframing our experience to paint new neural connections. Valerie Knopik PH.D and Professor at Purdue University speaks on the subject of epigenetics as it relates to our DNA expression and how we can use neuroplasticity and emotional regulation to take control of our mental health.

After the lecture at 7:00, Valerie welcomes you into a short yoga technique based on the idea of community support. For this yoga practice, you’ll need a partner or a wall. This technique for mental health can be access by a yoga student of any level, including beginners, and is an exercise you can integrate into your yoga class if you are a teacher interested in utilizing community support and mental health techniques in a yoga setting.

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

Self-Care Yoga for Stressful Times

Leave a Comment / Articles, Cristina Kuhn, In The Press, Internal Medicine, Mental Health, Resources, Yin, Restorative and Meditation, Yoga Medicine News / By Cristina Kuhn

By Cristina Kuhn for Thrive Global.

Simple steps you can take to rest, repair and keep common stress from becoming chronic.

Stress is a given in these modern times we live in. Stress in and of itself is not a bad thing, as we need the stress response when important actions need to be taken. The issue is when that stress goes from acute to chronic and we are unable to return to the repair, rest, and digest state. The longer our bodies and minds remain locked in the stress loop, the more likely we are to suffer from anxiety, insomnia, pain, and illness.

Our connection between body and mind is a two way street, so it is entirely possible to affect stress in the mind with the body and stress in the body with the mind. Do not stress about whether you are doing the recommendations below “right”, as that will not help. Simply go for the ride, notice how you feel along the journey, and take note of how you feel at the end. Since it can take 30 days to solidify a new habit, so if you want to see a change, commit to your own health and well-being.

Daily Schedule/Routine

Establishing a regular schedule can promote stability when we are feeling discombobulated, and establishing a regular sleep schedule is tantamount. Waking and going to sleep at the same time daily (+/- 30 minutes) helps to combat the irregularity that chronic stress can cause. A waking and bedtime routine can be helpful to prepare the body and mind for activity and rest (respectively). If you are unsure of what that could look like, some examples are below.

Post-Waking Routine:

Use the bathroom
Brush your teeth
Meditate
Yoga
Eat
Shower

Pre-Sleeping Routine:

Turn off all screens
Take a bath
Brush your teeth
Yoga
Read
Use the bathroom

If you have insomnia, do not stress out if you cannot sleep. Just stick to the routine for 30 days and see what happens.

How Can Yoga Help?

A stress relieving yoga practice is slow and grounded. As you practice the simple sequence below, keep your awareness on your connection to the floor. Notice the pressure of gravity pulling you down as you press down in resistance to gravity. Cultivate downward moving energy. Also be attentive in your transitions and treat them with as much importance as the poses themselves. If you experience any pain, take less range of motion or skip the motion entirely. Your self-care starts now!

Seated/supine meditation (3-5 minutes) – Focus on your connection to the floor. Inhale say “I am” and exhale state a quality that is the opposite of your stressed state (stable, smooth, heavy, warm, peaceful, or still).
Flowing Bridge – Start by bending the knees, feet on the floor, arms along torso. Inhale to tilt the pelvis forward and exhale tilt the pelvis back (keeping it on the ground). Take 2-5 rounds then move into lifting the pelvis off the ground into bridge on the inhale, then lowering it on the exhale for 5-10 rounds.
Apanasana (Wind Relieving pose) – Hug knees into chest. Explore rocking side to side and/or circling the knees. Take 5-15 breaths.
Low Lunge w/hands on blocks – Slowly transition into Tabletop (your hands on blocks and knees on a blanket/mat). Step your right foot forward to a low lunge, inhale to extend the knee keeping the foot on the floor, exhale to bend the knee an sink just slightly into the hips. Take 3-8 rounds. For extra credit use a 4 count inhale and 4 count exhale. Repeat on the left leg.
Low Lunge Twist & Side Bend w/hands on blocks – From tabletop step right foot to lunge. Keep the right hand on the block and inhale the left arm alongside left ear, then exhale to side bend to the right. Take 3-5 breaths, then release the left hand back to its block on the exhale. Right hand on sacrum and inhale to twist to the right taking 3-5 breaths before switching legs and repeating on the other side.
Windshield Wiper Twist – Lie on your back, knees bent, feet on the floor placed wider than hip width apart. Inhale at center and exhale to lower the knees to the left, then inhale to center and lower the knees to the right. Take 5-10 rounds.
Savasana – Lie in a comfortable supine position and cover at minimum your pelvis (the home of Vata) with a blanket.

What is Meditation

Leave a Comment / Articles, In The Press, Internal Medicine, Rashmi Bismark, Resources, Yin, Restorative and Meditation, Yoga Medicine News / By Rashmi Bismark

Have you asked yourself: what is Meditation? Dr. Rashmi Bismark M.D, Mindfulness teacher and Yoga Medicine® Therapeutic Specialist explains the different styles of meditation while offering a short, 5 minute meditation for beginners geared towards an awareness of sounds.

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

Oh, My Aching Back! 5 Poses to Relieve Low Back Pain

Leave a Comment / Articles, Chinese Medicine, In The Press, Internal Medicine, Resources, Yin, Restorative and Meditation, Yoga Medicine News / By Lisa Muehlenbein

By Lisa A. Muehlenbein for Yoga Medicine®.

Whether you have been outside raking leaves, playing with the kids (or grandkids!) or if you spent your weekend cheering on your favorite sports team, odds are, you’ve found yourself saying, “Oh, my aching back!” There is good news and bad news. The bad news is you are not alone. Back pain is one of the most common complaints and according to the Mayo Clinic, most of us will experience it. The good news is that relief is available and may not require a trip to your doctor or medications.

While no remedy is a miracle cure for every individual, many people find relief for back pain through yoga. Yoga is a 5,000+ year old practice that originated in India and has been embraced by over 20.4 million Americans. While there are many benefits to practicing yoga, relieving low back pain is one plus that many practitioners have experienced.

The following Restorative Yoga sequence of poses (asanas) are suggestions that may help bring some relief to your low back.

Supported Child’s Pose (Salamba Balasana)

POSE BREAKDOWN

Begin with a blanket in a Foundational Fold (fold in ½ vertically, then in ½ horizontally 2x), roughly in the center of the mat. This will provide cushioning for the knees. It’s not required, but most students find it a nice, supportive addition.
Kneel on the blanket, bringing the big toes together and sliding the knees apart until they are wide enough to snuggled the short edge of the bolster inside.
Slowly begin to lower down onto the bolster from the belly, ribs, heart center and finally the head comes to rest on the bolster, allowing whichever ear is most comfortable to come to rest.
Ideally, the head, heart and hips would be in alignment. If the head is lower, another folded blanket may be placed on top to lift the torso slightly.
Hold 5-8 minutes.
Turn the head to the opposite side half way through.

ENHANCEMENTS

Use a Foundational Blanket folded in half or a rolled up mat to create some space in the back of the knee for students who have knee issues.
A mat square or hand towel can be rolled and placed on the front side of the ankle if the student is experiencing discomfort.
A sandbag can be placed horizontally across on the low back/top of pelvis.

Supported Supine Spinal Twist (Supta Matsyandrasana)

POSE BREAKDOWN

Begin with a Foundational blanket in the center of the mat with stripes going left to right across the mat horizontally.
Place bolster on the mat, going the same direction as the mat, just in front of the bolster.
Use a second Foundational blanket folded in half the long way or in a Long Tri-Fold Blanket as a mini bolster and keep it close by.
Sit comfortably on top of the Foundational blanket with one hip up nice and close to the short edge of the bolster.
Draw the knees up to roughly 90 degrees and place the second blanket in between the knees, shins and ankles for comfort.
Place the hands on either side of the bolster.
Inhale to lengthen. With the exhale, gentle twist toward the bolster and slowly lower down, bringing the belly button, last rib and heart center to rest on top of the bolster.
Hands and forearms rest on the floor next to the bolster.
Same ear (as the hip that is up close to the bolster) resting on the bolster will be a gentler sensation on the neck for most students, while the opposite ear coming to rest will provide a deeper twist and sensation for most students.
Hold 5-8 minutes, then switch sides.

ENHANCEMENTS

A blanket, block or bolster may be placed under the arm (that is on the same side as the legs) if it is hovering/lifting/not resting flat on the floor.
A sandbag can be placed on the top thigh to enhance the twist.

Supported Bridge Pose (Setu Bandhasana)

POSE BREAKDOWN

Begin by placing the bolster at the foot of the mat; horizontally spanning the mat from left to right.
Place a Foundational Folded blanket on the mat just behind the bolster with the fringed edge on the bottom and toward the bolster to avoid uncomfortable pressure points from the knots on the fringed edge.)
Create a Long Rolled Blanket and place it on top of the Foundational blanket with the open edge of the roll toward the corner that was created by the Foundational blanket and the bolster.
Position yourself so that you are sitting on top of the bolster with their feet on the floor in front of their mat. Slide all the way to the front edge of the bolster—almost as if you were about to slip off of the front edge—this will leave room for the hips to rest on top of the bolster as you begins to lay back.
Place the hands on the Foundational blanket or mat as support as you descend, slowly lowering the shoulders to the mat.
The Foundational blanket serves as a cushion for the shoulders, the head is on the mat. The rolled blanket fills the space in the lower/mid back, while the height of the bolster provides a lift of the pelvis creating a release in the lower back.
Arms reach wide out to the side; palms face up.
Hold 5-8 minutes.

ENHANCEMENTS

A flat hand towel or blanket may be placed underneath the head if there is evidence of discomfort in the neck.
Students may extend legs straight for a deeper sensation; however, this variation should be used mindfully for students with low back issues.
Blocks can be placed under the soles of the feet if the back is showing signs of “breaking” or sharpness/compression in L5-S1.
For students who are managing low back concerns, they may enjoy using a folded blanket under the pelvis in a height that is lower than the bolster.

Legs Up The Wall (Viparita Karani)

POSE BREAKDOWN

To get into Legs Up the Wall, sit with one hip all the way up close to the wall and then slide forward toward the long edge of the mat.
Place hands next to the hips and slightly behind. Use them for support as you shift and swivel on the hips, bringing the shoulders to the floor, swinging the legs up toward the sky.
If the sitting bones are away from the wall, shift and shimmy the hips and walk the shoulders toward the wall until the sitting bones make their way to the wall.
Arms can extend wide out to the sides like a “T,” down by the sides or wherever comfortable.
Hold 8 minutes. *May also be used as an alternative to Savasana.

ENHANCEMENTS

If hamstrings are too tight to fully extend the legs up the wall, students may opt to take the hamstrings out of the pose by placing the legs on top of a chair. In this case, place a blanket over the seat of the chair for warmth and comfort. Another option would be to stack two bolsters on top of each other instead of using a chair.
A blanket with a partial roll may be placed underneath the neck for support.
If legs tend to roll out to the sides and be unruly or distracting, we may opt for straps around the thighs and mid calves.
To ground the hips and release the low back, a sandbag may be placed on the soles of the feet. Straps around the legs may also be used in conjunction with the sandbag.
To take Legs Up The Wall into more of a Supported Shoulder Stand, we can find the foundational pose of Legs Up The Wall and then slide the feet down the wall, pressing into the wall and lifting the hips high enough to slide the bolster (or folded blanket) underneath the hips.

Savasana

ENHANCEMENTS FROM TRADITIONAL SAVASANA

A partially rolled blanket may be placed behind the neck to fill the space between the cervical spine and the floor. The remaining flat portion of the blanket would provide a soft cushion underneath the back of the head.
A blanket roll may be placed behind the knees instead of a bolster with the optional additional blanket roll underneath the ankles.
Legs can drape over a bolster with the option of a rolled blanket underneath the ankles.
Legs on a chair.
Add an eye pillow.
Add essential oil temple to deepen relaxation.

The sequence of yoga poses described are suggested for use to relieve low back discomfort and are therapeutic and restorative in nature. When exploring your options for yoga classes, it is important to educate yourself before entering into a yoga studio and unrolling your mat.

If your lower back is in need of TLC and you have never done yoga before, look for classes that list Gentle, Restorative or Therapeutic in their names.
Upon meeting your teacher, be sure to inform them of any injuries or health issues you may have so that they are able to specifically address your needs.
With Restorative Yoga, it’s important to remember that less is often more. These poses are meant to relax and restore the body with minimal effort, so give your body permission to do so!

Finally, when you decide to venture into a yoga studio, don’t be intimidated! Studios are used to seeing new faces each day, and you can be sure that you won’t be the only one! Plus, the staff and teachers are there to help and they want you to have the best experience possible. Their intention is that you leave feeling well, healthy and ready to take on the day!

Mindfulness and Yoga Explained: 3 Minute Mindfulness Meditation

Leave a Comment / Articles, In The Press, Internal Medicine, Rashmi Bismark, Resources, Yin, Restorative and Meditation, Yoga Medicine News / By Yoga Medicine®

By Dr. Rashmi Bismark M.D. for Yoga Medicine®.

Dr. Rashmi Bismark M.D. explains the deep connection between mindfulness and yoga. When yoga is used as a way to live life more meaningfully, we naturally infuse the way we relate to ourselves and others with the care of mindfulness. Rashmi also shares a 3 Minute Mindfulness Meditation.

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

The Subtle Tide That Moves Within