Friday Q A Mitral Valve Prolapse MVP

Q: I was wondering if there are any resources or practices that you can share with me for people who have mitral valve regurgitation. I myself have it, maybe born with it but some of my students mentioned that as well. I haven't found any info on yoga and people who have that and low blood pressure and it is not due to a heart attack. Are inversions ok? Running? The pace of walking and running? 

When I was in my full-time family medical practice, I had quite a number of patients who had a diagnosis of Mitral Valve Prolapse (MVP), which at times resulted in “regurgitation” of blood from heart’s left ventricle backwards into the left atrium, the opposite direction that the blood is supposed to flow. The left side of the heart receives blood freshly oxygenated from the lungs, and pumps it out to the rest of the body. The one-way valve (usually!) between the entrance chamber, the atrium, and the large exit chamber, the ventricle, is the mitral valve. Normally, the mitral valve allows the blood from the atrium to flow into the ventricle when the upper chamber muscle walls contract, and it closes and prevents backflow when the ventricle chamber walls contract and send the blood out the aorta and to the rest of the body. If the valve leaflets just bulge back (prolapse) toward the atrium, there might be no leakage of blood. Sometimes, however, they both bulge backwards and separate a bit, allowing the regurgitation our reader experiences. For most people, MVP is not life threatening and does not require any special treatment. For a small minority however, the condition does require treatment.

Approximately 2% of the US population has MVP. Many people do not even know they have it. Although you may have had this condition your entire life, you may never have specific symptoms related to the prolapsing valve, and if it is discovered by chance while some other condition is being investigated, you may be quite surprised to discover you have it. Often, those who have symptoms also have the regurgitation. Symptoms are usually mild and develop gradually, and can vary quite a bit from person to person. According to the Mayo Clinic, the most common symptoms are:

• Racing or irregular heartbeat (arrhythmia)
• Dizziness or light-headedness
• Difficulty breathing or shortness of breath, often when lying flat or during physical activity (this could require modifications for your yoga practice)
• Fatigue
• Chest pain that's not caused by a heart attack or coronary artery disease

If you are reading this list and realize you have some of these symptoms, it’s best for you to get it looked at, as there are many causes other than MVP for these symptoms, and it is important to know what is behind how you are feeling! Your doctor will often be able to hear a click-swoosh heart murmur when listening to your heart, and an ultrasound of the heart valves will often reveal the MVP. MVP can develop at any age, but severe MVP symptoms most commonly occur in men over 50. It has been linked to several other conditions, most of which are more rare, except for scoliosis and Grave’s Disease, a form of overactive thyroid gland.

In addition to the echocardiogram (ultrasound test), your doc might order a treadmill stress test to see if there are any limitations on your ability to exercise. So, for our reader, you might request this test if you are worried about the safety of a strong yoga practice as to relates to your MVP. And, as with many conditions that might affect your yoga practice or other forms of physical activity and exertion, you will need to do some investigating and experimenting to see what works for us and what does not. If you have MVP AND low blood pressure (see Friday Q&A: Low Blood Pressure), you may want to be more cautious and watchful when entering, maintaining, and exiting inversions. It might actually be getting up after an inversion where you would need to be most cautious, so take it slow and see how your body responds. Start with easy inversions, such as Standing Forward Bend (Uttanasana) Downward-Facing Dog pose (Adho Muka Svanasana) or Legs Up the Wall pose (Vipariti Karani) and see how these go. Then advance to more challenging inversions (it is always a good idea to learn these from an experienced teacher). 

For the majority of people with MVP who take up yoga, the condition will likely be a non-issue, but it is still worth checking with your doctor. For that smaller minority of individuals who are experiencing dizziness, shortness of breath, or heart arrhythmia, I’d recommend discussing limitations with your cardiologist before diving into a more vigorous and rigorous yoga practice. However, gentle and restorative yoga would likely be safe for just about anyone with MVP, as long as you are able rest supine without shortness of breath. 

—Baxter

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Friday Q A Yoga for Athletic Performance

Kayaks by Marie Lossky
(@Marie.Lossky on Instagram)

Q: Read your article Friday Q&A: Yoga for Long-Distance Runners about running and yoga. I am not a runner but have been a kayak/surf ski racer for 20+ years. When I started paddling I did not have a yoga practice and was pretty mediocre in my paddle performance. My yoga practice became serious about a year after paddling became a regular part of my life. After approximately 6 months of a regular yoga practice my competitive paddling performance began to change for the better. I began to win races against other paddlers in "faster" boats. I started to call yoga my "secret weapon" in terms of training. The more refined my yoga practice became the further I moved up the ranks as a competitive paddler. I believe that my yoga practice provided some intangible benefits as an athlete. Being able to "feel" what my body is doing and to relax more during exertion made a huge difference in my performance. Fast forward to today when I am well into my 60's and still managing to outperform most of my competitors that are 20 or 30 years younger than I am is a testament to a regular yoga practice. I am pretty sure these benefits work across other athletic endeavors. It may be hard to measure but I know it to be true from anecdotal observation. I sincerely doubt I would still be paddling competitively at this point if I hadn't had the good fortune to discover yoga!  

And 2 questions for you: Has anybody tracked the longevity of athletes’ careers when yoga is thrown into the mix? Along these lines I have another question. Have there been any studies that show an increase in Vo2 max from a regular pranayama practice? 

A: Before I briefly address this reader’s questions, I need to tell you that I was very intrigued by what he initially wrote to me so I sent him a few more questions to give me a better picture of his experience as a yogi and competitive paddler. Here are my questions along with his replies. 

Baxter: Can you describe your yoga practice in the early days and how it has changed over time? Which yoga tools do you practice regularly? Asana, pranayama, meditation, and any others?  

Ken: When I began practicing yoga in earnest it was all about getting to as many classes as possible. I would usually take three or four classes a week and as many workshops as I could. My approach was to have my asana practice be very physical and athletic. No pain, no gain. 

A serious injury forced a totally different approach. I rarely attend classes these days and have a very sensitive, gentle and "sensational" home practice. I have learned to "feel" my way into poses and strive to "release" as opposed to "stretch"—a subtle difference but an important one. Most of my practice is asana based with breath work being an integral part. I also do some pranayama as well. 

Baxter: How aerobic is your sport? How long is a typical race or event? What are the ranges of courses or times? Is it all like running, with short and long distance events?  

Ken: My paddling is a pretty physical and aerobic experience. Over the years my races have ranged between 10-40 km with my favorites in the past being the longer ones. The last couple of years I have been leaning toward shorter events. I am hoping to do some longer distance races this season. 

The races are really just the carrot to get out and paddle. I do a mix of Long-Slow-Distance training sessions that are between seven and twenty miles, mixed with various forms of high-intensity interval training. Both seem to be necessary to be competitive. In the last few years I have segued from paddling more traditional kayaks to high-performance surf skis. These are light, fast and tippy craft. They require much more core strength and balance. Longer events can be more of a challenge in terms of comfort and fatigue.

Baxter: Do you feel your yoga practice has had any potential benefit regarding reducing typical paddling injuries when you compare your health to that of your competitors? 

Ken: My yoga practice has been profound in terms of my paddling performance. All athletes have the potential for injury. I can't really say with authority if I have fewer injuries than others but I know I have fewer than I would if I didn't have a regular yoga practice. When I do have injuries, I tend to recover more quickly. If I sense a problem, a sensitive approach to my practice often allows me to release spasming muscles. I like to call it "active healing"—very slow and gentle.

I train regularly for paddle events and achieve good results while having spent less time training than many of my peers. That is certainly the result of a regular yoga practice. An efficient paddle stroke is much like a well-done asana. It begins with grounding and engaging the whole body. Being able to relax your body and mind during competition makes a tremendous difference in the outcome. Better to be a willow than a brick. 

As important as yoga is to my athletic endeavors, it also benefits most other aspects of my life. When I am not doing yoga or paddling, much of my time is spent in my shop building boats or furniture. Believe it or not, the likelihood of an injury is higher in the shop than on the water. Moving in a relaxed and mindful way is always a challenge when distracted by work! No doubt that yoga has helped there as well—the yoga of daily life. 

Thanks, Ken! 

And as for Ken’s questions, I could find no studies on whether professional athletes who do yoga have longer careers than those that don’t, but found a few off-hand comments to that effect in some online articles-yet another field for future yoga research. As to whether pranayama improves V02 max—a measure of excellent cardiovascular endurance and something desirable for endurance athletes—I did find a few studies that stated just that. For those interested in learning more, see Estimation of VO 2 max before and after Yoga Training in Healthy female Medical Students and Effect of Yogic exercises on aerobic capacity (VO2 max. 

—Baxter

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Friday Q A Benefits of Squatting

Q: I recently decided to try the experiment of sitting cross-legged more, starting out on my sofa, as sitting in this position seems to help my achy hip and back. I will see if I can progress to the floor. I am also wondering about squatting more, not comfortable for me, but a common position in many countries (such as Vietnam, where many families still eat squatting on a low large table). Any thoughts on this position, besides needing to be careful of wonky knees?

A: Do I ever! I happen to like squatting, even though I have an old tear to the cartilage in my left knee, the medial meniscus, which I have to been mindful of getting in and out of squats. My hips turn out decently, which is necessary for  squatting, and my ankles also dorsiflex—what we typically refer to simply as flexing—pretty well so my heels can stay on the ground if my feet are about a foot or so apart.

I became interested in squatting as an alternative way to sit for short periods of time after a yoga adventure trip to Bali in the late 90’s. As we drove down a country road past rice fields one day, I noticed a group of men squatting and talking near an intersection. Returning the same way a few hours later, the same group was still there, squatting and talking as they had been earlier. I was shocked, remembering how challenging the pose could be for me in class when I only held it for a few minutes. So I became motivated to see if I could safely master this position, although I was not sure what I would use it for.

We do need to keep in mind that in these cultures, people squat starting from their early stages of life, and often live in places where western furniture is not the norm, as Ram mentioned in his post To Sit or Not To Sit (on the floor)?. So we are at a distinct disadvantage learning to squat as adults. However, there may be some good reasons to try it out.  I find it particularly helpful in certain social or activity situations, such as when camping and not wanting to sit directly on dirty, sometimes wet or rocky ground, or when using a primitive or non-existent loo! I use it in social situations where there are limited chairs, where I want to be down interacting with kids, or when talking with another person who is sitting and I don’t want to loom over them by standing. And when my back is flared up, being able to squat to pick things up off the floor is quite handy.

But are there any other benefits, you might ask. Well, squats take the knees into the deepest flexion possible, both active flexion (that created just by the muscles contracting) and passive flexion (created by an outside force, such as your body weight and gravity in this case). Fully flexing and then straightening the knees takes them through their full range of motion, which is generally a good thing for your joints. And the ankles also have to flex quite a bit, so their range of motion is exercised. The muscles at the front of the shins have to contract and work in a unique way not required for many other yoga poses, contributing to strengthening this area. The hips and lower back can get a nice stretch as well. You do want to increase your time in squats gradually, as there is an effect on your blood pressure, so that when you stand again, if you have timed it well, you don’t suddenly feel light headed.

If you have tight, stiff knees, you can do a modified version with a block or blocks under your sitting bones, creating a block chair of sorts that still allows you to experience the general shape of the squat.  If your heels don’t touch down easily, put a prop, such as a rolled-up blanket or yoga wedge, under your heels so they can ground. This relaxes the leg muscles and allows the bones to hold you up, which is why those men could hold the squats so long—they weren’t exhausting their muscles! And keep in mind that you might want to design a short sequence of poses that prepare you for the squat, such as, Reclined Knee to Chest pose, Reclined Leg Stretch, Warrior 1 pose, and Cobblers pose (Baddha Konasana), to name a few.

If it doesn’t work for your body to do squats, it is no big deal! There are so many other good postures that can be of benefit for you, so let go of the ones that may seem injurious for your body. And as my old friend Gary Morgan used to say as we played a silly riverside game on canoe outings, “Squat what you got!”

—Baxter

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Friday Q A Spinal Stenosis and Osteoporosis

This question of the week for this week came in about an older post from A Pair of Serendipities Re: Spinal Stenosis.

Q: Hello, I found this article very helpful and appreciate your information. I have a student who just started my class at a community college who has spinal stenosis, which as described here can be relieved by mindful forward bends. However, she also tells me she has osteoporosis (all on an intake form), which from my understanding is an indication to avoid forward folding. My class is very large and is beginners yoga, and I plan on talking with her about self monitoring and awareness, emphasis on hip hinge for forward folds, however I am wondering if you have any other thoughts in that these two conditions exist in one student simultaneously. In her early 60s, she is very motivated to be in my class.

A: Thanks for your question, and I am so pleased that you were checking out a much older post. I worry they will get cyber-dusty from not being read anymore. And your question is a great one! Even if we were not talking about spinal stenosis and osteoporosis, this sort of conundrum happens quite often for those of us who are teachers and for those of us who are students: two or more difficulties happening at the same time in the same body! Can a person get a break here!  Which one takes priority, are the recommended practices for each applicable for both, are the conditions somehow connected, and other questions can come up.

But to address your question directly: If someone has symptoms from their spinal stenosis already, but has only a diagnosis of osteoporosis without ever having had any complications (such as a fracture of wrist, thoracic vertebrae or hip), this may make your approach easier. One certainly would want to be cautious about practice intensity, opting for milder styles of practice, and since we’d like to keep the osteoporosis asymptomatic, you’d want to avoid techniques that would transmit hard, sudden forces into the bones. This can happen when jumping into and out of poses, as well as coming out of arm balances without control, in a thumping manner. But since arm balances would not serve the osteoporosis person due to the fracture risk, particularly handstand-like hand positions, this last group of poses should usually be avoided.

Regarding the safety of forward bends in osteoporosis, which we have noted can be helpful for spinal stenosis, I usually suggest that osteoporosis folks can try most beginning level poses, so spinal movements, but not to their limit. I recommend entering and exiting the poses slowly and mindfully, and not pushing or pulling on the spine once in the pose. Since most of the vertebral fractures in osteoporosis that I have seen were in the thoracic area and often associated with sudden thumping action through the spine as described above, such as jumping while dancing, if cautious, your basic beginning level yoga practice would be fine for the student with double the trouble. More specifically, I would try forward bends, back bends, twist and side bends, but gently and not to maximum range of motion. If you want to modify for this person, standing forward bends are safest, seated on a chair version the next safest, and on the floor versions the least desirable. But that still does not mean that doing seated forward bends on floor could not be included if done carefully and not to full intensity. 

As far as poses you might recommend for osteoporosis, including those that are weight bearing for both the legs and arms, it is the standing poses that are good for osteoporosis. However, those are the very poses that might make the symptoms of spinal stenosis worse. So when your class is weighted towards more standing poses, you will need to check in and make sure your student is doing OK!

So keep the conversation going with your enthusiastic student, checking in for a moment before and after class. Perhaps, if you provide that kind of service, you could even offer to meet one on one with your student to design a practice more personally suited to her needs. 

—Baxter

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Friday Q A Glasses and Balance

Q: I always wonder if my vari-lens glasses affect my ability to balance.

A: The answer depends a lot on each individual and how strongly you rely on your eyes for balance and alignment. In general, for new practitioners, keeping your glasses on so you can see what is going on with you and also with the demonstrations you might be using to learn new poses can be essential for your progress. But as many more seasoned practitioners have noted, it is often natural to begin to close your eyes at times as you practice and rely on a more internal sense of awareness and balance for many poses. The obvious exceptions are balancing and arm balancing poses, like Tree and Handstand, but I have found myself on occasion closing my eyes in Headstand and Shoulderstand quite successfully.

The good news is that the eyes are only one of several systems that work together to assist in good balance, and the others can pick up the slack when needed. So I'd probably try periods of practice at home without your glasses, when looking at demos is not an issue. Then try it a bit in class and notice how it goes.

—Baxter


A: I don't know what vari lenses are but I do know what progressives are, as I have been a wearer of them for three years. In progressive lenses, the glass is graduated between far, closer and closest distances. And if you try to look through a part of the lens that isn't made to do that task, your vision is blurred. And if you have a slight astigmatism, this can in turn cause you to overwork certain eye muscles, which leads to head aches/eye aches. I don't understand all the ways new lens are now made, but in my own practice I have found that if I take off my glasses then my balance is more impaired than if I leave them on. However, if I take away all my vision by closing my eyes, it makes me work more with my other balance centers (proprioception, pressure sensation) and it actually improves my balance!

Although we use our eyesight to help us balance, we can indeed improve our balance by removing this or other senses from the equation. And I personally find that if my vision is impaired, it is more stressful for my nervous system because I’m trying to correct something that can’t be corrected. As someone who is extremely myopic, if I can't see clearly, I can't hear as well and I can't mentally focus. But if I close my eyes, my nervous system can focus on strengthening the balance sensors that remain. My other senses are clearer. I hear better because I direct my attention more to my hearing. I feel more, and I direct my breath into improving my sensation and relaxing areas that I might tend to overwork if I am using my eyes.

Like Baxter, I recommend that you experiment with glasses on/off. When practicing with your eyes open, try finding a focal point (something to visually focus on that you can see clearly) and use that to assist in balancing.

—Shari

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Friday The Times They Are A Changing

Falling Leaf by Melina Meza

I know it’s Friday and that you may be asking, “Where is my Friday Q&A?” Well, as the title of today’s post states so well (thanks, Bob Dylan!), things are changing for us here at YFHA, and we think it’s all for the best. Stay tuned to learn more about that early next week.

Before I get to what will likely appear in the future in our Friday slot, I just want to tell you how much I have enjoyed writing the Friday Q&A over the past few years! It is one thing to generate topics to share with you on my own, be it out of my own curiosity on a certain yoga-related subject or some news worthy study or issue that is of interest to this yoga-loving blogger. But I always love to know what our readers are curious about, and your questions over time have been sincere, interesting, and inspiring for me. In fact, I often spend quite a bit of time and do quite a bit of research on the topics you ask about in preparation to thoroughly answer your probing questions on health, illness, injury, yoga technique, and so many other compelling areas of inquiry. So, thanks for prompting me to learn, relearn, or update my understanding of so many varied and intriguing topics!

And my apologies for any recent questions that I have not yet addressed. I do keep them all in a file, and at some time in the not-to-distant future I foresee coming back to a regular Q&A offering on these bloggy pages, and I’ll keep yours at the top of the list. 

As for what Fridays will look like starting next week, I’m thinking of calling the day “Friday’s Practical Pointers,” where I will share various tips, guidelines, and wisdom that I discover as Nina and I work on our new project. I look forward to sharing my first new post next week! 

—Baxter

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Friday Q A Costochondritis

 Q: How can yoga help people that have costochondritis? I have it now and then and I can't do some yoga poses that open the chest as they trigger the pain. I had it for the first time 3 years ago and it never really went away, keeps coming back.

A: Costochondritis (CC) is a fairly common cause of chest wall pain in adults in the US and around the world. According to the Mayo Clinic website: 

“Costochondritis (kos-toe-KHON-dri-tis) is an inflammation of the cartilage that connects a rib to the breastbone (sternum) — a junction known as the costosternal joint. Pain caused by costochondritis may mimic that of a heart attack or other heart conditions.”

This last statement about this kind of pain mimicking heart attack has led many a student of mine with sudden onset of chest pain to the hospital, fearful they were having one! In the case of costochondritis, all the tests come up normal, which is obviously a huge relief, but the pain can persist, as it has for our reader.

Let’s look at some other facets of costochondritis before we specifically look at what yoga’s role is in helping or hurting it. Modern medicine’s view on CC is that most of the time there is no apparent cause for the inflammation between the rib and cartilage, which can be frustrating if you have it because if you knew what caused it, you could change what you are doing to possibly avoid it happening again! So the focus shifts to treating the pain, usually with anti-inflammatory medications like ibuprofen, as well as modifying your activities to avoid movements that aggravate your pain. Since most of the connections between the ribs and breastbone involved are located to the right and left side your breast bone, this is usually where the pain shows up. Apparently, it shows up more often on the left side of the breastbone (same area some heart attack pain can be) and often involves more than one rib.  One distinguishing feature that sets it apart from heart pain or angina, is that the pain from CC often happens with a deeper breath or when coughing. 

And although I mentioned above that most cases of CC have no known cause, some cases are associated with a blow to the chest, heavy lifting or strenuous exercise, severe bouts of coughing, certain types of arthritis, or the spread of tumors to this area. In addition, you are at greater risk of developing a bout of CC if you are woman or if you are over 40 years of age. The diagnosis of CC is usually made when your history is consistent with the kind of pain I described above, if you are tender-to-touch over the side of your breast bone or when you move your chest and arms in certain ways, and if you have ruled out more serious problems, like heart pain, GI reflux or lung related illnesses, like pneumonia. Hopefully, you won’t have to do the ER full heart work up like one of my students had to undergo this past week!

In addition to NSAIDS like ibuprofen, your doc might add other medications to your treatment regimen. If the pain is severe, a narcotic medication might be suggested. If the condition lingers and becomes more chronic (which does not happen often but does happen), certain anti-depressants and anti-seizure medications can be added, not for depression or seizures, but because they have been found useful for chronic pain management. The downside to all these meds is that they often have unwanted and occasionally serious side effects.

On the non-medication side of things your doctor may recommend, you might be referred to a physical therapist, who could teach you gentle stretching exercises (ding, ding, ding!) or the use of an electrical stimulation unit called a TENS unit. On your own, you can experiment with the effect of ice or heat on your symptoms to see if they provide any relief from the pain, as well as good amounts of rest to avoid aggravating activities.

Our reader is interested in how yoga might be used to help costochondritis, but also, I suspect, how to do so cautiously, as she has noticed that the yoga asana can also aggravate or trigger her CC pain. And therein lies the rub. If you are pain free, a regular yoga practice can keep the rib cage and the joints that CC affects mobile and the muscles in the region strong and open. A regular yoga practice has been found to improve conditions that could lead to costochondritis, such as arthritic conditions. And yoga has been found to decease inflammation in those who practice it regularly, so it might help reduce the chances of developing CC in the future.

On the other side of the fence, some forms of yoga and certain yoga poses fall into the category of strenuous exercise or stressful activities for the sternal joints. Dhanurasana (Bow pose) comes to mind as a pose that stresses the joints along the sides of sternum as it stretches the front chest, and a 90-minute power yoga flow with lots of Chatarunga Dandasana could also overtax the front chest joints as well.  So you would want to assess if you developed CC within a short time of doing such poses, and give ‘em a rest if you make the connection.

Hopefully, your yoga practice is not the source of this kind of pain. But once costochondritis shows up, you will likely need to assess, monitor and modify your poses and practices if they seem to trigger or aggravate your symptoms. It is almost always a safe bet you can do supported restorative style poses, as they are less likely to negatively affect the front chest if done with the goal of keeping that area quiet.  And supported, gentle practices are likely to lower your stress response, which should have a positive impact on healing.  They should also allow your immune system to function optimally, thereby reducing the chances of developing new respiratory illness like the common cold, thus avoiding illness associated with coughing. In addition, always think outside the yoga asana box, and add in gentle pranayama (probably not long, deep inhales and exhales for a while), visualizations and meditations in supported positions while the inflammation around the breastbone joints diminishes. 

And as the pain symptoms of costochondritis diminish, gradually re-introduce more active poses and practices to get your body back to its previous healthy balance, hopefully leaving the memory and risk of recurrence of costochondritis in your rear-view mirror. 

—Baxter

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Friday Practical Pointers Applying Muscular Skeletal Health Techniques to Medical Conditions

by Baxter and Nina

Richard Rosen by Melina Meza

Many medical problems, such as arthritis or Parkinson’s disease, have an impact on your muscles and/or bones. By working on strength, flexibility, balance, and agility, you can use the asana practice to improve or maintain the health of your musculoskeletal system. Using these techniques qualify as rehabilitative and/or maintenance treatments (see 5 Ways Yoga Can Affect Your Health).

Strength. Improving muscle strength can help with any condition that causes weakness, such as age-related muscle atrophy, chronic fatigue syndrome, post-broken bone recovery with secondary weakness from disuse, or having been bedridden as a result of illness or surgery. Improving bone strength can help with osteoporosis and osteopenia. 

Because so many conditions that affect muscles and bones lead to early weakness of the musculoskeletal system, strength building is generally the most effective technique to use at the start of rehabilitation. So we recommend that you ease in by beginning with dynamic strength poses and sequences, and then work up to static holds as your endurance improves. 

Flexibility. Improving flexibility can help with any condition that causes stiffness, such as osteoarthritis or Parkinson’s disease. Because some of your joints have limited range of motion, start rehabilitation with dynamic poses to gently release stiffness. Next, add in short static holds of stretching poses, and gradually work your way up to 90-second holds, which can lead to improved overall flexibility. 

Balance. Improving balance can help with any condition that negatively affects you steadiness on your feet, including frailty from aging and inactivity, multiple sclerosis, Parkinson’s disease, peripheral neuropathy from diabetes, and poor eyesight. For rehabilitation, start by practicing the versions of balance poses that use the wall and/or props to keep you steady, and work up to more challenging balance poses as your balance improves. 

Agility. Improving agility can help with any condition that affects nimbleness and response time, such as multiple sclerosis, Parkinson’s disease, and stroke, as well as age-related slowing of brain-body nerve conduction. For rehabilitation, we recommend you start with slow, precise changes of position in your asana practices, such a slow Sun Salutation, and gradually increase the pace as you notice your agility improving. 

Balanced Practice. Overall a balanced yoga practice, including vertically oriented standing poses, such as Mountain pose (Tadasana), Warrior 1 and 2 (Virabradrasana 1 and 2), Arms Overhead Pose (Urdva Hastasana), in addition to a selection of forward bends, back bends, side bends, and twists, can improve your posture. This helps problems caused by poor physical alignment, such as carpal tunnel syndrome, arthritic joints in the lower extremities, and back pain in all areas of the spine.

Caution: Make sure that the poses you choose are compatible with the medical problem that you have. See the following posts for details on the poses and movements that you should not practice if you are suffering from a particular medical condition. 

Who Should Avoid Certain Wrist Movements?

Who Should Avoid Certain Knee Movements?

Who Should Avoid Certain Shoulder Movements?

Who Should Avoid Certain Hip Movements?

Side Bending the Spine

Who Should Avoid Backbends?

Forward Bending of the Spine

Spinal Rotation

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Friday Q A Research on Yoga for Children with Autism

Q: I was wondering if you have any research on yoga for children with special needs especially autism? This is my area of expertise and I teach yoga to children with special needs but also as an behavioural therapist would be great to support my work with research. Many thanks.

A: Yes! There is a growing body of research in the field of yoga therapy in general. An estimated 500 peer-reviewed studies have been published to date. A fraction of them address yoga for children and, as is the case with all research in this field, larger clinical trials are needed. But it’s fun to peek into this emerging field and see that there is indeed research being published to support our valuable work with children. 

There are a few papers specifically on yoga for children with autism, or what is now called Autism Spectrum Disorder (ASD). The International Journal of Yoga Therapy published a paper by Molly Kenny in 2002 Integrated Movement Therapy™: Yoga-Based Therapy as a Viable and Effective Intervention for Autism Spectrum and Related Disorders. In this paper Kenny states that her approach “…has had especially consistent and remarkable results with children diagnosed with Autism Spectrum Disorders.” Read more about her methods and findings here: samaryacenter.org/assets/ijyt2002.pdf.

A study published in November of 2011 is Relaxation Response-Based Yoga Improves Functioning in Young Children with Autism: A Pilot Study. In the conclusion, the study reports, “Robust changes” and, “Unexpectedly, the post-treatment scores on the Atypicality scale of the BASC-2, which measures some of the core features of autism, changed significantly (p=0.003).” Many other papers cited this paper, so those who are interested can find themselves down a rabbit hole of research. 

Kristie Patten Koenig, Anne Buckley-Reen and Satvika Garg published a research article in the American Journal of Occupational Therapy in September 2012 Efficacy of the Get Ready to Learn Yoga Program Among Children With Autism Spectrum Disorders: A Pretest–Posttest Control Group Design.  Children in this study received this specific program daily for 16 weeks as part of their standard morning routine. In the abstract they report, “This study demonstrates that use of daily classroom wide yoga interventions has a significant impact on key classroom behaviors among children with ASD.”

And finally, a study published in the International Journal of Yoga in January of 2010 Application of integrated yoga therapy to increase imitation skills in children with autism spectrum disorder indicates similar positive benefits. Children with ASD tend to socialize less, make less eye contact and imitate others less than their typically developing peers. This study looked at yoga as a modality for improving theses skills. They concluded from this study that their particular program of yoga “…may offer benefits as an effective tool to increase imitation, cognitive skills and social-communicative behaviors in children with ASD. In addition, children exhibited increased skills in eye contact, sitting tolerance, non-verbal communication and receptive skills to verbal commands related to spatial relationship.”

For those interested in further research, type in “yoga” and “autism” and “children” into either pubmed or scholar.google.com. It can be tedious to read through dry academic publications, yet it’s also inspiring to see how much attention is being given to these three words together.

Each child is unique and there is no “one-size-fits-all” formula to be captured in a study. However, these research papers from the field show that there is interest as well as benefit in yoga for children with autism.

—Mira

Mira Binzen is a registered yoga teacher with Yoga Alliance at the 500-hour level (E-RYT, RCYT) and a certified iRest Yoga Nidra teacher, and is a professional Integrative Yoga Therapist (1,000-hour level certificate). She holds a degree in Child Psychology from the University of Minnesota's Institute of Child Development, with specialized study in Communication Disorders. As co-founder of Global Family Yoga, she he has been training people to teach yoga to children since 2002. For more information about Mira, see her website mirabinzen.com.

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Friday Q A Compressed Lumbar Discs

Q: My 73 year old father's lumbar disks have compressed and are causing nerve problems which result in knee pain & effect his mobility. His western MD recommends surgery to fuse the disks but he is leery of this approach. Any recommendations on a more holistic approach?

A: Thanks for your question regarding your dad’s disc situation. Unfortunately, without the benefit of examining dad and his tests, it would irresponsible of me to offer any advice regarding his treatment at this time. That being said, disc compression is not the same issue as osteoporosis, although if your dad had a dexa scan or some other diagnostic test to screen for OP, he could have this in addition to his disc compressions. 

Lumbar disc compressions are quite common, and get more frequent as we age. Your dad’s symptoms seem to be affecting his daily activities, so yoga may or may not be right for him. A private session with a seasoned yoga instructor or yoga therapist might be a good first step in deciding if some yoga-based movement could help with his pain and mobility. In addition, a visit to a physiatrist, an MD who works to help rehab folks with such conditions and who is not a surgeon, might also be worth considering. Sure hope this information helps!

—Baxter

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Friday Q A Chronic Fatigue Syndrome Part 2

Road by Melina Meza

Q: I find that there are not many yoga teachers with an awareness of yoga practice specifically for Chronic Fatigue Syndrome (CFS). I was diagnosed with CFS 6 months ago and am doing graded exercise therapy, which includes walking. I would love to practice yoga every day, but am lost as to where to begin. Any help would be much appreciated!

A: We received this follow-up inquiry recently from one our readers following an earlier post I did on CFS. Just so everyone out there reading this is on the same page, start by checking out my Nov 5th blog post Chronic Fatigue Syndrome and Yoga.

Now I’ll recap by giving you the Mayo Clinic’s list of CFS symptoms:

“Chronic fatigue syndrome has eight official symptoms, plus the central symptom that gives the condition its name:

•    Fatigue
•    Loss of memory or concentration
•    Sore throat
•    Enlarged lymph nodes in your neck or armpits
•    Unexplained muscle pain
•    Pain that moves from one joint to another without swelling or redness
•    Headache of a new type, pattern or severity
•    Unrefreshing sleep
•    Extreme exhaustion lasting more than 24 hours after physical or mental exercise

And to meet the diagnostic criteria of chronic fatigue syndrome, you must have unexplained, persistent fatigue for six months or more, along with at least four of the above signs and symptoms”

Next, I’ll recap what the folks at the Mayo Clinic have to say about CFS, and explain how I think yoga fits in (in italics):

1. CFS is a condition that does not improve with rest, so gentle yoga movements could help. 
2. Even though the cause is not known, it is theorized that stress may play a role, and yoga is great at reducing the effects of stress.
3. Because the fatigue may worsen with physical or mental activity, a yoga practice for CFS should have several types of practices to take into account the variability of symptoms from day to day.  More on this in a moment!

In addition, I recommend that you read the posts we have done here at YFHA on yoga for pain, yoga for insomnia, and yoga for headaches to get some additional ideas on how to address those symptoms of CFS.

Because our reader mentioned that she has been prescribed “graded exercise therapy,” meaning that the type and intensity of her exercise is slowly and gradually increased, usually in response to how she would be doing from day to day, I would add that such an approach would also have practices that could step things back and down if flares occur. This day-by-day approach to things like walking could be extended to yoga practices as well. And although I mentioned some of these ideas back on Chronic Fatigue Syndrome and Yoga, I am presenting them in a slightly different way today.

On a day when mental fatigue is an issue, longer supported restorative poses would be a good choice, with the easiest of mental focuses, such as simply following your inhales and exhales. A supported Savasana with a recorded yoga nidra might also be appropriate on these days. Remember, conscious relaxation for 10 minutes or for longer times, as in yoga nidra, can provide a different kind of “rest” than typical sleep or napping, which could be beneficial for both physical and mental fatigue.

When increased pain is occurring, gentle yoga practices or restorative practices that don’t aggravate or increase the pain levels while they are being done could keep the body moving and active. The more intense the pain, the more likely restorative poses with a meditation on breath or mantra—so as to remove the “thinking about pain” from the actual experience of pain—should be employed.

As fatigue lessens, you would then start to gradually modify your daily asana practice to slowly and deliberately challenge your endurance, strength and flexibility. If the next day results in more fatigue, you would downgrade your practice to meet the symptoms that are there that day. If all is well, I’d do a few days at a given level of increase in intensity before the next advance of challenge.

Even though the Mayo Clinic only recommends yoga for addressing pain in CFS, as I mentioned above, I think a regular “graded” yoga practice can address many of the symptoms of CFS. And although the research to date is almost non-existent, I hope that the trend towards more research on Yoga and Health will produce more studies to bear out Yoga’s benefit for CFS.

Research Resource: Dr. Timothy McCall lists this study A controlled study of the effect of a mindfulness-based stress reduction technique in women with multiple chemical sensitivity, chronic fatigue syndrome, and fibromyalgia in his 75 Conditions that yoga helps. 

—Baxter

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Friday Q A Text Neck and Head Forward Syndrome

Q: What can we do about "text neck" forward head syndrome that we can incorporate into our lives and practices?  

I’m going to take a crack at this one not because I’m an expert at such things but because I have a bit of head forward syndrome myself, probably from spending a lot of hours per day in front of the computer writing. And I also happen to know that Timothy McCall addressed a similar years ago in his post Cultivating Healthy Posture with a Simple Restorative Pose. 

In that post, he recommended practicing a restorative backbend pose to counteract poor posture (head forward syndrome qualifies as one form of that). He says that when we have a long-term habit of slouching, it may not just be as simple as to start sitting or standing up straight. Long-term slouching leads to shortening of muscles in the front of the upper body, as well as of the fascia, the connective tissue that surrounds and interpenetrates the muscles, and which can limit movement. And this is going to be true for head forward syndrome as well. 

And because longer holds of poses are necessary to help lengthen the fascia, he believes staying in a pose for a few minutes may be ideal. Since that’s hard to do in most regular asanas, particularly the backbends, which open up the back, he recommends a simple supported, passive backbend. I, myself, have been including these in my practice for about 15 years, after my yoga teacher recommended them for me in particular for my posture.

I also have some suggestions for how to strengthen your upper back and neck muscles, and to work mindfully on the alignment of your head and neck over your torso. 

Stretching Your Front Body

Practice a simple passive backbend several times a week, for 3 minutes or more at a time. Because Baxter and I have included a simple passive backbend as one of our essential yoga poses, Melina shot some photos of Baxter doing the pose. So you can choose any of these three version that seems best to you. Make sure the one you choose is comfortable, so you can stay for three or more minutes without pain or discomfort. 

One version shown here actually has the head higher than the torso and that probably won’t stretch your neck, but I remember that my father had head forward syndrome so severe that he couldn’t even lie with his head flat on the floor. So for some of you (or your students) it may be necessary to start with your head supported in these poses and gradually lower the support until you reach a point where you can be comfortable with your head even with and eventually lower than your torso. 

If you can comfortably bend your neck back, this version would be a good one.

If you can't bend your neck back but you can lay it flat, you could do this version (or add more blankets to the first version)

If you can't even lay your head flat, you may need to prop your head up (though you can do that with more blankets in version 1 or 2).

See Cultivating Healthy Posture with a Simple Restorative Pose for Timothy’s instructions on how to practice the pose (his suggested propping is a bit different) 

Strengthening Your Back Body I would also add that strengthening your upper back and neck muscles would be beneficial because those can become weak from slouching. Regularly practicing Locust pose (Salabasana) would easily do the trick. Just be sure that when you lift your head in this pose not to cause strain by bending your neck back too far (this is especially true if you have head forward syndrome). Baxter's neck looks good to me in this pose.

Mindfulness About Alignment

Practicing Mountain pose (Tadasana) is a good way to cultivate awareness of your habitual posture and to move into a healthier alignment, where your head and neck are in line with your spine. Because your habit is going to feel more comfortable than a new alignment, have a partner or a teacher help adjust your head and neck in the pose. 

So practice this pose in the yoga room and then, when you’re out in the real world, take the new awareness you have to change your habitual posture while you’re working, standing around, or, yes, even texting. (Just because almost everyone texts by bending their necks to look down at the phone doesn’t mean you have to do it that way, too. See if you can find a way to prop it up on something higher.)

I hope this helps, and would love to hear what you think after you've experimented with these ideas or if you have some other ideas.

—Nina

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Friday Q A Yoga Solutions for Hypertension

Q: I'm wondering if you could help me ID some yoga resources for my sig other.  He suffered an aortic dissection last Nov while visiting me here from Italy. Barely made it to the ER and surgeon's table on time. Five hour surgery later, he had a new synthetic 4 inch segment replacing his aorta just above the heart and a new lease on life. Six months out he's doing great. He does have a little bit of chance of recurrence, but overall the outlook for his continued recovery is good.

The present goal apparently is to keep his BP down. He's been on medication for it, but our family doctor took him off of it recently as his pressure was quite low before the dissection. He works out lightly at the gym and takes long walks.

He's never done yoga but wants to begin, and I want to help him do that. I'm wondering if you've published (or know anyone good who's published) any videos/sequences of asanas/instructional materials on yoga and BP OR if there's simply a good beginner DVD you might recommend for an older (a young 63 year-old) fit man who's been through what he went through. I've searched around a lot, but am a bit lost in the flood of materials for beginners and finding nothing, on the other hand, other some short articles in YJ, on yoga related to BP.

A: I am so pleased that your partner survived his aortic dissection, which is often, sadly, not the case. And it sounds like for the time being he no longer is showing blood pressure reading of high blood pressure that he had prior to the tear in his aorta. That could change as he gets back to normal activities and eating and such. It is great that he is already doing some weight/strength training and aerobic activity with his gym visits and walks. 

And I can understand your frustration and desire to start off his venture into yoga in a safe way. Please start by checking out the posts we have done here on blood pressure and yoga (see Hypertension and Yoga: An Overview). It is hard to say for sure what kind of beginner practice will be right for him, as he may have other age-related health issues and old injuries to take into account. You can certainly think about having him work with one of the senior teachers in your area individually, initially focusing on stress-reducing practices. There are some general cautions to be mindful of when designing a home practice, like not holding standing poses for very long, skipping and modifying most inversions, other than Downward-Facing Dog and Legs Up the Wall (Viparita Karani) poses, if his blood pressure is elevated at rest. And generally, doing milder forms of most poses including forward bends and twists that also could increase intra-abdominal pressure. Guided meditation, basic breath awareness and yoga nidra would be good to include, with a focus on visualizing a calm and strong heart and vascular system. 

For additional helpful suggestions regarding asana and other yoga practices, there are some written sources that talk about hypertension that you can look over. In Timothy McCall’s book Yoga as Medicine, he devotes a chapter to the subject, featuring experienced yoga teacher Aadil Palkhaivala.  Aadil. He categorizes two kinds of HTN, which he calls “jittery” and “pent-up,” and approaches each a bit differently. Timothy’s book goes on to share three series that Aadil teaches, as well as some specific standing, seated, and reclining poses he recommends. A great warning that Timothy also mentions is avoiding what is known as the “Valsava Maneuver,” in which you hold your breath and bear down, like you would to pass a bowel movement. Doing so can cause a major spike in blood pressure. 

In their book The Woman’s Book of Yoga and Health, Linda Sparrowe and yoga teacher Patricia Walden also devote a chapter to cardiovascular health, and Patricia offers a nice sequence for HTN that is mostly supported restorative poses. This sequence includes one supported Standing Forward Bend and one Downward-Facing Dog (the only two “active poses” in the sequence). 

And finally, Gary Kraftsow’s Yoga for Wellness also has a chapter on cardiovascular system, and he offers an example practice that he did with one of his students that utilizes the Krishnamacharya method of mini-vinyasas. In this case, the opening four poses are either seated or using a chair to modify the depth of the pose, followed by a Cat/Cow variation, dynamic Cobra vinyasa, supine Apanasana (Knees to Chest) sequence, and of course, Savasana.

Although I was not able to find the exact sequence used in the recent study on Yoga for HTN that I referenced in my last post, that would be interesting to review if you can get a copy of the actual study as it likely describes all the poses and practices utilized.

I hope that these ideas will help you to get your sweetie on his way to a safe and effective yoga practice to assist in keeping his blood pressure in a healthy range. 

—Baxter

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