"I think I have sciatica"

by Baxter

If I had a dime for every time I have heard this from friends, students and patients, I would be doing all right! Usually, any time someone gets a pain in the back that travels below the buttock, they believe they are suffering from sciatica. And some of them may be right, but others could have something else going on. So before we go any further, let’s step back and try to define what sciatica is, which is easier than that might seem, as it is really a symptom, not a medical condition or disease. What that means is that even if you do have sciatica, you are just at the beginning of a journey to find out the underlying cause of you symptom.

Sciatica gets its name because of the relationship to one of the body’s important nerves, the sciatic nerve, which is really made up of several nerve roots from the lower lumber and sacral region of the spine. These separate nerve roots emerge from the sides of the spine and join together to make a bigger nerve that travels down the back of the legs all the way to the feet. It has a couple of jobs: it supplies sensation to the muscles of the backs of the knees and lower legs, and it also provides sensation to the backs of the thighs, part of the lower legs, and the soles of the feet.

Let’s take a look at what the NIH, National Institutes of Health (see here) have to say about sciatica:

Sciatica refers to pain, weakness, numbness, or tingling in the leg. It is caused by injury to or pressure on the sciatic nerve. Sciatica is a symptom of another medical problem, not a medical condition on its own.

Sciatica usually affects people on just one side of the body. And it turns out that the "symptom" called sciatica is actually a constellation of other symptoms. Here’s what the NIH has to say about that and the pain associated with sciatica:

Sciatica pain can vary widely. It may feel like a mild tingling, dull ache, or a burning sensation. In some cases, the pain is severe enough to make a person unable to move. The pain most often occurs on one side. Some people have sharp pain in one part of the leg or hip and numbness in other parts. The pain or numbness may also be felt on the back of the calf or on the sole of the foot. The affected leg may feel weak. The pain often starts slowly. Sciatica pain may get worse:

• After standing or sitting
• At night
• When sneezing, coughing, or laughing
• When bending backwards or walking more than a few yards, especially if caused by spinal stenosis

Okay, so far so good.  But that, again, is a pretty broad set of symptoms that could account for this thing we are calling sciatica.  So, if we are going to put our finger on the underlying cause, what are the most common culprits?

A few of the more serious and common causes include a slipped disc in the lower lumbar area of the spine, Piriformis Syndrome (a condition associated with a deep muscle in the buttock area beneath the gluts that comes in contact with the sciatic nerve as it heads down the leg), pelvic injury and fracture (which could include sacroiliac dysfunction, a not uncommon problem for yoga students) and tumors.

Interestingly, a lot of cases of sciatica will resolve on their own without a lot of testing or heavy duty treatment. In the old days, they used to recommend bed rest for these kinds of symptoms, but we know now that it is prudent, after a brief period of rest, no more than a few days, that gradual return to everyday activities can be helpful, with gentle spinal movement and core strengthening very helpful for recovery. This is, of course, one way yoga can help. In fact, yoga is an excellent way to promote gentle spinal movements, safely strengthen the abdominal area and the lower back muscles, as well as stretch several muscle groups that are associated with general lower back pain that could include sciatica, such as the psoas and the piriformis muscles.

 In addition to acute treatment with over the counter meds like ibuprofen and acetaminophen, as well as ice and heat, the NIH also makes the following recommendations for early treatment:

Bed rest is not recommended. Reduce your activity for the first couple of days. Then, slowly start your usual activities after that. Avoid heavy lifting or twisting of your back for the first 6 weeks after the pain begins. You should start exercising again after 2-3 weeks. This should include exercises to strengthen your abdomen and improve flexibility of your spine. (Go yoga!)

If your symptoms are not improving, you are having weakness in one leg, you noticing a foot is kind of drooping when you walk, or you have difficulty controlling your bowels or bladder, don’t put off a visit to your doc—schedule is as soon as you can. In these situations, you might need more evaluation, which might include X-rays, MRIs or local injections to help reduce swelling around your nerves if they are determined to be the culprits.

And if you are going to utilize yoga as a healing tool, look for the most qualified and experience teacher around to work with. Later this week I will share the experiences of a good friend and colleague of mine who had sciatica arise during a retreat a few years back and the almost miraculous technique he learned to eliminate this symptom.

Thinking about the Wisdom of Yoga

by Nina

“You have taught the essence of yoga 
is equanimity, Krishna;

but since the mind is so restless,

how can that be achieved?


The mind is restless, unsteady,

turbulent, wild, stubborn;

truly, it seems to me
as hard to master as the wind.”

—The Bhagavad Gita

In my last post "What is Healthy Aging?" I added “wisdom” to the list of tools yoga provides for healthy aging. But since then, I’ve been thinking about how reading a bunch of wise words in an ancient (or modern) text is so different than actually living wisely. Haven’t you all watched someone close to you—or even yourself—be drawn irresistibly into self destructive behavior, even as they know exactly how unwise they’re being? As Arjuna says to Krishana above, the mind seems to me, too, “as hard to master as the wind.”

In The Bhagavad Gita, Krishna replies to Arjuna’s question above by saying that constant practice and detachment are what allow you to move toward wisdom.

"You are right, Arjuna: the mind

is restless and hard to master;

but by constant practice and detachment

it can be mastered in the end."

Gaudi Stairway by Brad Gibson

It is the regular practice of mindfulness that allows us to observe our patterns of behavior and ultimately begin to make changes. In his book Yoga and the Quest for the True Self, Stephen Cope describes it this way:

Acknowledge the pattern. Study it. Observe it. Respect its power. And, if possible, make an intention to interrupt it just at its very end point. For most of us, that endpoint is the reaction to the reaction. Self-hatred. Negative self-talk. Moralizing. Guilt. Let’s begin by deleting a little of that, and then a little more.

When we pare away judgment, something remarkable happens. We’re free, for the first time, to observe how the pattern really works.

He says our behavior patterns are samskaras, which are like ruts in a road that deepen through repetition so becomes inevitable that a car will slide into them unawares. But with our newly gained awareness of our patterns, we can use tapas, the energy of restraint, to stop the slide:

Tapas requires a particular kind of attention—precisely the kind required when driving on a rutted road. We need to be awake. We need to be concentrated in order to avoid the edges of the ruts. And sometimes we need to pull the car wheels—with considerable effort—out of the ridges in the road.

Cowboy Caviar

A recent addiction, a favorite by everyone in our house... big and small alike! Just in time for the Superbowl this weekend... if you are bringing a dish, this would be a great one to share!

Ingredients:
2 Tbsp red wine vinegar
1 1/2 tsp Olive Oil
1 clove garlic, minced
1/8 tsp. pepper
1 firm avacado
1 can black beans
1 can corn
1/3 c. sliced green onion
2/3 c. chopped cilantro
1/2 lb. tomatoes, coarsely chopped
sea salt to taste
a squeeze of fresh lemon juice


Directions:
Dice your ingredients and mix all together right before serving. Serve it with Corn Tortillas Chips as an appetizer or use it  as a dip or use as a filler for tacos with corn tortillas! How about over a bed of cabbage and turn it into a southwestern salad.. the possibilities are endless... and so filling!

Kleiber's law and its possible implications for obesity

Kleiber's law () is one of those “laws” of nature that is both derived from, and seems to fit quite well with, empirical data. It applies to most animals, including humans. The law is roughly summarized through the equation below, where E = energy expenditure at rest per day, and M = body weight in kilograms.

Because of various assumptions made in the original formulation of the law, the values of E do not translate very well to calories as measured today. What is important is the exponent, and what it means in terms of relative increases in weight. Since the exponent in the equation is 3/4, which is lower than 1, the law essentially states that as body weight increases animals become more efficient from an energy expenditure perspective. For example, the energy expenditure at rest of an elephant, per unit of body weight, is significantly lower than that of a mouse.

The difference in weight does not have to be as large as that between an elephant and a mouse for a clear difference in energy expenditure to be noticed. Moreover, the increase in energy efficiency predicted by the law is independent of what makes up the weight; whether it is more or less lean body mass, for example. And the law is very generic, also applying to different animals of the same species, and even the same animal at different developmental stages.

Extrapolating the law to humans is quite interesting. Let us consider a person weighing 68 kg (about 150 lbs). According to Kleiber's law, and using a constant multiplied to M to make it consistent with current calorie measurement assumptions (see Notes at the end of this post), this person’s energy expenditure at rest per day would be about 1,847 calories.

A person weighing 95 kg (about 210 lbs) would spend 2,374 calories at rest per day according to Kleiber's law. However, if we were to assume a linear increase based on the daily calorie expenditure at a weight of 68 kg, this person weighing 95 kg would spend 2,508 calories per day at rest. The difference of approximately 206 calories per day is a reflection of Kleiber's law.

This difference of 206 calories per day would translate into about 23 g of extra body fat being stored per day. Per month this would be about 688 g, a little more than 1.5 lbs. Not a negligible amount. So, as you become obese, your body becomes even more efficient on a weight-adjusted basis, from an energy expenditure perspective.

One more roadblock to go from obese to lean.

Now, here is the interesting part. It is unreasonable to assume that the extra mass itself has a significantly lower metabolic rate, with this fully accounting for the relative increase in efficiency. It makes more sense to think that the extra mass leads to systemic adaptations, which in turn lead to whole-body economies of scale (). In existing bodies, these adaptations should happen over time, as long-term compensatory adaptations ().

The implications are fascinating. One implication is that, if the compensatory adaptations that lead to a lower metabolic rate are long term, they should also take some time to undo. This is what some call having a “broken metabolism”; which may turn out not to be “broken”, but having some inertia to overcome before it comes back to a former state. Thus, lower metabolic rates should generally be observed in the formerly obese, with reductions compatible with Kleiber's law. Those reductions themselves should be positively correlated with the ratio of time spent in the obese and lean states.

Someone who was obese at 95 kg should have a metabolic rate approximately 5.6 percent lower than a never obese person, soon after reaching a weight of 68 kg (5.6 percent = [2,508 – 2,374] / 2,374). If the compensatory adaptation can be reversed, as I believe it can, we should see slightly lower percentage reductions in studies including formerly obese participants who had been lean for a while. This expectation is consistent with empirical evidence. For example, a study by Astrup and colleagues () concluded that: “Formerly obese subjects had a 3–5% lower mean relative RMR than control subjects”.

Another implication, which is related to the one above, is that someone who becomes obese and goes right back to lean should not see that kind of inertia. That is, that person should go right back to his or her lean resting metabolic rate. Perhaps Drew Manning’s Fit-2-Fat-2-Fit experiment () will shed some light on this possible implication.

A person becoming obese and going right back to lean is not a very common occurrence. Sometimes this is done on purpose, for professional reasons, such as before and after photos for diet products. Believed it or not, there is a market for this!

Notes

- Calorie expenditure estimation varies a lot depending on the equation used. The multiplier used here was 78,  based on Cunningham’s equation, and assuming 10 percent body fat. The calorie expenditure for the same 68 kg person using Katch-McArdle’s equation, also assuming 10 percent body fat, would be about 1,692 calories. That would lead to a different multiplier.

- The really important thing to keep in mind, for the purposes of the discussion presented here, is the relative decrease in energy expenditure at rest, per unit of weight, as weight goes up. So we stuck with the 78 multiplier for illustration purposes.

- There is a lot of variation across individuals in energy expenditure at rest due to other factors such as nonexercise activity thermogenesis ().

Sauteed Lemon Brussel Sprouts

I L-O-V-E brussel sprouts... of course, not boiled, but ROASTED or SAUTEED- they are divine! And if you have written them off because of the stench they used to give off while your Grandma used to boil the life out of them,  give them another chance- you won't be disappointed!

Ingredients:

drizzle of Expeller Pressed Coconut oil
1 small shallot

15- 20 brussel sprouts, washed, halved, and sliced

2 cloves garlic, minced

1/2 lemon, juiced

sea salt and pepper

Directions

These are so tasty and SO quick. Finely slice your brussel sprouts & shallot, and put them in a hot pan with a drizzle of oil. Let them saute a few minutes, then add your sea salt, lemon juice, and garlic. Saute them until they start to brown, but don't over cook or they will become mushy (like your grandma's! ha!) 

P.S. You can totally make these with out the shallot, I don't usually have shallots on hand, so if you are without, don't forgo the recipe, just alter... chop up some sweet onion or go sans- your choice!

Friday Q&A: Yoga Tricks for Better Sleep

Nina: At the end of my post "Yoga You Can Do In Bed", I asked for additional suggestions from our readers. Caryn Dickman, a yoga teacher at Piedmont Yoga Studio (see here), wrote in with such good suggestions, I decided, with her permission, to post them here. What I love about her suggestions is that she obviously listened to her body and used her creativity to come up with "yoga tricks" that worked for her.

Caryn: I have found a way of doing Child's pose in bed using the pillows that doesn't disturb my partner and allows me to bring the awareness inwards when I can't seem to calm myself through the breath. After 5-10 minutes propped on pillows and still under the covers I find that my mind slows down enough to start benefiting from watching the breath. I eventually crawl back to sleeping positions and then concentrate on watching the inhale and exhale through expanding and contracting the back of the rib cage left to right, etc. I usually fall back to sleep, and a very deep sleep, after doing that.

Another "yoga trick" I do is when I wake up and feel anxiety in my body. I have this need to move some or else sleep will not come. So I stand near the side of the bed in the dark and pay attention to the inhale and exhale. I then very slowly lift my arms towards the sky and then slightly bend my knees as I come forward to a very gentle Uttanasana. I keep bending my knees more so that I come to a gentle squat (very gentle squat) and let my arms dangle towards the ground. When I reach the ground I slowly start to roll into my back body to come on up. I do this a very times. Again, very slowly and gently watching the breath throughout. It tends to get rid of the anxiety in my body and then I can either just go back to sleep or do the Child's pose I mentioned above and I go back to bed.

Nina: I think I'm going to try that under-the-covers Child's pose myself sometime soon. Anyone else have some good yoga tricks up their sleeves?

Healthy Spirits: New Arrivals

Lots of good stuff today!

1. Brasserie DuPont Posca Rustica

2. Brasserie DuPont Monk's Stout

3. Jester King Black Metal Imperial Stout

4. Jester King Wytchmaker Rye IPA

5. Jolly Pumpkin Bam Biere

6. Jolly Pumpkin Calabaza Blanca

7. Hogan's Dry Cider

8. Bayrischer Banhof Berliner Weisse with Brettanomyces Lambicus (Special Limited Edition!)

9. Leipziger Gose

10. Dieu Du Ciel Peche Mortel Imperial Coffee Stout

cheers,

dave hauslein

beer manager

415-255-0610

"Crunch-n-Munch Lunch"

Cucumber, apple, sweet yellow pepper, avocado, green onions, pumpkin seeds, hemp hearts, sultanas, fresh lemon ginger root, maple syrup, ground cinnamon, cooked millet...a list of mouth-watering ingredients that combine easily to make a delicious mid-winter salad. It is wholesome and hearty enough for a satisfying lunch. Added to a more elaborate meal, it's sure to please the eye and the palate while revving up the body's energy in a sustained and solid way. My meal-time guest called it a "crunch-n-munch lunch". He thoroughly enjoyed every bite!

You'll need: 1 English cucumber; 1 crisp apple; 1 avocado; 1 small yellow pepper; 2 tablespoons chopped ginger root; 1/4 cup pumpkin seeds; 2 tablespoons sultanas; 1/4 teaspoon ground cinnamon; 2 tablespoons olive oil; 1.5 tablespoons fresh lemon juice; 2 teaspoons maple syrup; 1 cup cooked millet; 2 green onions; 1/4 cup hemp hearts; salt to taste. For Garnish: 2 teaspoons hemp hearts; lemon slices; green stalk of green onion, thinly sliced lengthwise.

 

Method: Soak 1/4 cup of pumpkin seeds in water for 2 hours. Rinse and set. Soak sultanas in water with 1/4 teaspoon ground cinnamon until plump. Drain and pat dry.

 In a large serving bowl, whisk 2 tablespoons of olive oil, 1.5 tablespoons of lemon juice, and 2 teaspoons of maple syrup together until creamy. Add pumpkin seeds, chopped ginger root, sultanas, and cooked millet. Mix gently to coat grain with dressing. Set aside to blend flavours.

Peel and chop cucumber into bite-size pieces. Wash and dice apple with peel on. Pit, peel and cut avocado, and spritz with lemon juice. Slice white and green parts of green onion into thin rounds.

Add chopped fruit and vegetables to millet mixture along with 1/4 cup hemp hearts. Toss well. Sprinkle with a few grains of sea salt, if desired.

Garnish the "Crunch-n-Munch Lunch" salad with an additional sprinkling of nutritious hemp hearts. Add a few thin lemon slices with long slivers of green onion leaves along side them. Enjoy!

Harvest Potato Soup...

It is definitely soup season,  we have been getting our fill this winter, and as I scanned my recipes, I noticed I never posted pictures of this delicious Harvest Soup. So if you are the visual kind, take a peek and give it a whirl!

Ingredients:

1 TBSP butter

1 onion, chopped

1/2 cup green onions, chopped

4 cups chicken broth

4 cups potatoes, diced (any kind, red, yellow, finger, etc)

4 carrots, thinly sliced

2 cups zucchini, sliced

4 cups spinage, torn

s&p to taste

** optional: shreaded chicken (2 breasts in the crock pot; precooked) 

Directions:

In your big pot, melt your butter and then add both of your onions. Cook those over low heat for 5 minutes, covered. Then add your broth, carrots, and potatoes. Simmer those guys for 15 minutes, covered. Next add your zucchini and simmer for 5 more. Then add your spinach and s&P to taste. Let that simmer thoroughly. If you want to add the chicken (all ready cooked), throw that in right at the end with your spinach and let it soak up the flavors. **If you DO add the shredded chicken, you can cook it easily in the crock pot the morning of. I usually just throw 2 breasts in the crock pot, 1/2 cup water and let it cook on high for 4 hours. Then I shred it and throw it into the soup. I also recommend adding more broth to the soup if you use the chicken because the chicken soaks a lot of it up. Also, for the record, I don't measure all the vegetables out, I just eyeball it and it is yummy every time!

Serve with: warm FRENCH BREAD!! This is a great meal in it's self because it has all those hardy veggies, yummy broth, and the chicken for extra protein if you choose to throw it in. 

What is Healthy Aging?

by Nina

Despite the horrifying vision of “exergames,” Brad’s post on Tuesday ("Successful Aging and the Thinking-Moving-Feeling Triad") got me interested in Dr. Dilip Jeste’s work. After all we’re all blogging away here about “healthy aging” without ever having really defined what it is. And that’s exactly what Dr. Jeste, Estelle and Edgar Levi Chair in Aging and Director of the Sam and Rose Stein Institute for Research on Aging at the University of California, San Diego, is currently trying to do. In an interview on Medscape (here), he said the following:

“Successful aging has not been consistently defined; that is one reason why this area is ideal for research. There have been some studies funded by the MacArthur Foundation beginning in the mid-1980s going on through the mid-1990s. But the [scientific] literature is limited, and there is no consensus on what is successful aging. Our research goals include developing a definition as well as criteria for successful aging.”

Jeste and his colleagues observed that while the components of successful aging typically include: longevity, life satisfaction, absence of physical disease, freedom from disability, mastery/growth, active engagement with life, high/independent living, and positive adaptation, sometimes only physical functioning and disability are considered. But most importantly, very few scientists include “self rating” in their assessments (that is, to put it bluntly, they don’t bother asking the subjects how they feel about their own experience of aging). So they decided to do a study in which “participants’ subjective ratings of successful aging were contrasted with sets of researcher-defined criteria, and correlates of subjectively rated successful aging were examined.” (See "Correlates of self-rated successful aging among community-dwelling older adults".)

One result of this study was this: “Nearly all the study participants rated themselves as aging successfully, but far fewer met researcher-defined criteria for absence of illness and physical disability.” (Note that only participants with higher levels of cognitive functioning were studied.)

Dr. Jeste concluded, as he said in the Medscape interview, “It is also important to say what is not an essential part of successful aging—absence of either physical diseases or physical disability is not necessarily a part of successful aging. I want to stress that people who have physical illnesses or physical disabilities can be aging successfully.” Instead he lists the components for successful aging as:

•    Higher level of cognitive functioning
•    Adaptation to changes associated with aging
•    Socialization—that is, some kind of social activity and/or social contacts
•    Life satisfaction

And in the very same interview, he gives two examples of people he considers to have aged successfully, and they are: Franklin Roosevelt and Frank White, a well-known Los Angeles yoga teacher. Hmmm. It appears we're not on different wavelengths after all. You may want to watch this video of Dr. Dilip, in which he speaks about wisdom and successful aging. Around the 12-minute mark, you can hear him speak about the Bhagavad Gita.

For some time now, I’ve been going around saying that yoga provides two out of the three of the requirements for healthy aging: exercise and stress reduction (the third is a healthy diet). As of today, I’m going to add a new one: wisdom.

Healthy Spirits: SF BEER WEEK EVENTS

Our SF Beer Week events will go live on thier website as of February 6, but you can start planning for them now! We hope to see you all there!

-02/11/12: Exclusive Barrel Aged Ale Industries bottle release: “Someone Talked” Imperial Stout aged in our Elijah Craig 18 Barrel with Blue Bottle coffee. Bottle sales begin at 11 am. Club members may reserve by phone once the event begins. No advance reservations accepted.

-02/14/12: Bottle Signing Event and Vintage Bottle Release with Firestone Walker’s David Walker. He will be in the shop from 3 to 5 PM answering your questions and signing bottles. We will have a limited number of vintage bottles of various Firestone Walker releases behind the counter for purchase. This is one of VERY few instances in which we WILL NOT be accepting bottle reservations from club members. We only place this restriction to ensure there are enough bottles for the duration of the event. Bottles for sale will include Firestone Walker Anniversary XIII, XIV and XV, Abacus, Parabola, and Sucaba. Limited stock, so get there early. Bottle limits will apply. -02/15/12: Exclusive Barrel Aged High Water bottle release: Old & In The Way Barley Wine aged in our Buffalo Trace barrel. Bottle sales begin at 11AM. Club members may reserve by phone once the event begins. No advance reservations will be accepted.

Yoga You Can Do In Bed

by Nina

Did I say “in bed? Yep. It’s normally not a good idea to fall asleep when you are doing yoga (you can overstretch your muscles if you fall asleep in a restorative pose and if you’re practicing conscious relaxation, well, being unconscious pretty much negates the positive effects you’re aiming for). However, there is one exception to this rule of thumb: when you’re lying in bed sleepless due to insomnia.

Whether you have trouble falling asleep initially or can’t fall back to sleep after waking in the middle of the night, instead of working on your To Do list (it’s tempting, I know), try a little yoga. There are a number of yoga practices that just might help you relax enough to finally drift off to sleep and/or improve the quality of your sleep.

Patterns in a French Garden by Brad Gibson

While practicing any of these techniques, be sure to stay warm and keep the lights off to keep stimulation down to a minimum.

Breath Awareness. This is the simplest yogic breath practice and one of the most basic forms of meditation. Simply bring your awareness to the sensations of your natural inhalations and exhalations. When you notice your mind wandering to your To Do list or elsewhere, gently return your mind to your breath.

Extending Your Exhalation. After observing your natural breath for a few minutes, you can try extending your exhalation (while inhalations are slightly stimulating, exhalations are naturally relaxing). When you reach the end of your exhalation, instead of immediately inhaling, lengthen your inhalation by one or two beats. Keep it relaxed, and if at any point you find the practice irritating, return to your natural breath.

Silently Reciting a Mantra. Just as you would when you are meditating, you can use a silent mantra or any word or phrase in bed to keep your mind from drifting into anxious thoughts. This is helpful for those of you who don’t find focusing on the breath effective (or when you have a cold!). When you notice your mind wandering from your mantra to your To Do list or elsewhere, gently return your mind to your mantra.

Guided Relaxation. Following the instructions for a guided physical relaxation (see here), with or without ear phones, allows you to focus your mind on a soothing voice and your physical sensations, enabling some people to drift off to sleep.

Self-Guided Relaxation. When you are familiar with the basic instructions for deep physical relaxation, it’s simple enough to skip the relaxation track and just gradually relax your body by following your own instructions. Many years ago, my first yoga teacher recommended this as insomnia practice.

Slight Inversion. Take the pillow out from under your head and lie on your back with your knees bent. Lift your pelvis up and place the pillow underneath it. You’re now in a very low version of Supported Bridge pose, a gentle inversion that naturally triggers the relaxation response. Try to stay in the position for five to ten minutes.

Supported Forward Bend. If you sleep alone or aren’t worried about disturbing your partner and you find forward bends soothing, you could try a supported bend in your bed. Sit with your legs straight or in crossed-legs position (whichever is more comfortable and allows a deeper forward bend) and place a stack of pillows on top of your straight legs or in front of your crossed legs. Then lengthen your spine forward and rest your forehead and arms on the pillow and relax. Try to stay at least three minutes. If you can’t get comfortable in the pose, then this one isn’t for you.

If you suffer from insomnia, I sincerely hope you’ll something on this list that will help. Most of these are techniques are ones I’ve found useful myself (I'm a bit too lazy to sit up and try an actual pose, however). Readers, if you have any additional suggestions, please chime in!

Successful Aging and the Thinking-Moving-Feeling Triad

by Brad

Early this month I attended a symposium sponsored by the Longevity Consortium at the Buck Institute for Research on Aging on “Environmental, Developmental, and Genetic Factors in Aging and Longevity.” There were lots of interesting presentations, especially on the search for genetic determinants for longevity, or what we call genome wide association studies (GWAS). It turns out that almost nothing survives rigorous statistical scrutiny at this level, suggesting that the genetic factors for long life are very complex and highly dependent on a host of environmental factors.

However, there was one talk on a very different subject that was of particular interest. Dr. Dilip Jeste from UCSD gave a lecture on the meaning of successful aging, and why almost no one asks patients directly to assess their views of their own aging experience.  Almost all definitions of successful aging (and again, many prefer the term “healthy aging”, although they are often used interchangeably) are based largely on the absence of age-associated physical disabilities, such as cardiovascular disease, diabetes, neurodegenerative disease, etc. Dr. Jeste made a compelling case that self-assessment of one’s physical and psychological well-being at advanced age is critical for a better determination of what constitutes “successful aging.” Interesting concept, and one that may be more in sync with the yogic idea of the mind-body connection and mindfulness.

Larch Tree in Autumn by Philip Amdal

Intrigued by this, I went on to look at some of Dr. Jeste’s publications on these topics, and came across a very recent editorial published last year in BMJ titled, “Promoting successful aging through integrated care” (see here). I was struck the following statement:

“Another way of dealing with physical and mental health comorbidity may be through use of interventions that simultaneously increase physical activity, cognitive stimulation, and positive affect, thereby affecting all three components of the thinking-moving-feeling triad implicated in poor health related quality of life.”

As I read this I thought this is a pretty good definition of yoga, a “thinking-moving-feeling triad.” Maybe not an especially elegant summation, but pretty succinct. But what followed next took me back a bit:

An example of such an approach is the use of “exergames”—entertaining video exercise games. If such approaches were specifically adapted to the needs of older people, they could conceivably affect obesity, diabetes, heart disease, and depression simultaneously.”

Exergames? Not exactly sure what the meaning of this is (I confess to a horrible vision of a group of seniors playing bingo while clapping their hands to a Lady Gaga video), but if that's the best example they can come up with then something is wrong. Is yoga still met with such suspicion in the medical and academic community that such an obvious and natural connection is not made here? Is it going to take another generation for the current (and aging) yoga practitioners to retire before this can go more mainstream?

As I wrote in my last blog entry, one of the main reason I started practicing yoga at the age of 50 was that I was looking for a more age-appropriate exercise routine that would provide me with more flexibility, balance and core strength without exposing me to injuries. Sounds to me like yoga would be a much better fit here addressing all three of these goals (“thinking-moving-feeling triad”) in a much more integrated and natural fashion….

Healthy Spirits: New Arrivals

1. Anchorage "The Tide and its Takers (Belgian Style Triple brewed with Sorachi Ace and Styrian Goldings hops and aged in French oak chardonnay barrels with brettanomyces)

2. Palo Alto Brewing Company Hoppy Ending Pale Ale 6 packs

3. Palo Alto Brewing Company Atlas DIPA

cheers,

dave hauslein
beer manager
415-255-0610

Yoga for Osteoarthritis: Interview with Shar Ser

By Nina

Last Saturday, I took a wonderful workshop at the  Berkeley Yoga Room on Yoga for Bone Health, with Bonnie Maeda and Shari Ser. We covered yoga for osteoporosis, osteoarthritis, and joint replacements. Because I know that many of you are concerned about osteoarthritis (and I have it myself), I asked Shari if I could do another interview with her, this time about yoga for osteoarthritis.

Nina: Why is yoga so beneficial for people with osteoarthritis?

Shari: Yoga is beneficial for people with osteoarthritis because it is something proactive that they can do for themselves to cope this chronic disease. Arthritis is due to imbalances on the ends of bones in the joints with uneven wearing down of the cartilage that covers the bone ends, which allows the bones to move smoothly on one and other. Arthritis is a wear and tear syndrome, an alignment syndrome, or a result of inactivity as well as obesity.

People stop moving with arthritis because it hurts, but when you stop the joint motion you decrease the nutrition to the joint structures. The body tries to repair the area by laying down more bone to protect the area and the result is spurring, which then cause more irritation from the “bones rubbing.”

When the cartilage has deteriorated and there is no movement, the synovial fluid that bathes the inside of all synovial joints decreases, which then decreases nutrition to the joint and the cycle reinforces itself with pain=no movement=more pain with swelling and inflammation=even less movement.

Yoga is so perfect for arthritis because it can stop that cycle by providing infinite variations in joint mobility and ways to maintain the joint alignment to improve joint weight bearing. You need to keep the joint moving in its full range of motion to keep the joint healthy, and yoga allows you to do that.

Nina: Should you do yoga if it hurts?

Shari: Judicious usage of pain meds to allow movement but not to obliterate the feedback mechanisms that pain provides us with is important. Medication that decreases inflammatory response will allow people to move more, but pain medications that mask pain so people overdo activities are dangerous. Pain keeps our expectations and engagement focused. You don't want to be stoned and do something dangerous!! So a healthy respect for pain is important. You can start out with a small movement and then as fluid in the joint increases you can increase the range of motion slowly till you are at your limit. Deep knee flexion (bending) is very difficult with knee arthritis so modifications to the yoga poses are important are important for people with knee arthritis.

Nina: Is there anything that people with osteoarthritis should watch out for?

Shari: You need to study with a teacher who can observe your alignment when you are doing poses to help you correct your imbalances. Co-contraction of muscles is extremely important. I would not do a lot of jumping into poses but stepping into them instead. Playing with joint position is really key because you may need to change things considerable to minimize your pain. Also being gentle with yourself is important because it took years for the arthritis to develop and will take years to manage and prevent it from progressing. It is true that you CAN remodel cartilage but how long it takes is unknown (at least I haven’t seen any studies).

Nina: What are some of your favorite poses for osteoarthritis and why?

Shari: Favorite poses—hmm, this is a hard one because you have to think about what joint you are focusing on. If I am dealing with osteoarthritis in the spine, I would focus on accessible twists and gentle back bends. If it was hips, balance is the key of co-contracting to keep the joint in good congruency and neutral alignment—maybe Ardha Chandrasana (Half Moon pose) would fit. For knees Warrior 2, but not too deep and starting with a chair if it is problematic bear weight in a knee flexed position. Warm-ups are very important to try to get the fluid circulating first, and then adding non weight-bearing isometrics before starting weight bearing activities. Also cool down poses shouldn’t be missed!

Shari Ser has over 25 years of orthopedic experience as a physical therapist and has been teaching yoga for a wide range of medical conditions since 1999. She graduated from The Yoga Room Advanced Studies Program in 1999, and was certified as a “Relax and Renew” teacher by Judith Hanson Lasater. She currently  teaches ongoing beginner level and back safe yoga classes, and co-teaches Yoga for Chronic Health Issues at The Yoga Room in Berkeley, California (see here.)

All diets succeed at first, and eventually fail

It is not very hard to find studies supporting one diet or another. Gardner and colleagues, for example, conducted a study in which the Atkins diet came out on top when compared with the Zone, Ornish, and LEARN diets (). In Dansinger and colleagues’ study (), on the other hand, following the Atkins diet led to relatively poor results compared with the Ornish, Weight Watchers, and Zone diets.

Often the diets compared have different macronutrient ratios, which end up becoming the focus of the comparison. Many consider Sacks and colleagues’ conclusion, based on yet another diet comparison study (), to be the most consistent with the body of evidence as a whole: “Reduced-calorie diets result in clinically meaningful weight loss regardless of which macronutrients they emphasize”.

I think there is a different conclusion that is even more consistent with the body of evidence out there. This conclusion is highlighted by the findings of almost all diet studies where participants were followed for more than 1 year. But the relevant findings are typically buried in the papers that summarize the studies, and are almost never mentioned in the abstracts. Take for example the study by Toubro and Astrup (); Figure 3 below is used by the authors to highlight the study’s main reported finding: “Ad lib, low fat, high carbohydrate diet was superior to fixed energy intake for maintaining weight after a major weight loss”.

But what does the figure above really tell us? It tells us, quite simply, that both diets succeeded at first, and then eventually failed. One failed slightly less miserably than the other, in this study. The percentage of subjects that maintained a weight loss above 25 kg (about 55 lbs) approached zero after 12 months, in both diets. This leads us to the conclusion below, which is always missing in diet studies even when the evidence is staring back at us. This is arguably the conclusion that is the most consistent with the body of evidence out there.

All diets succeed at first, and eventually fail.

In using the terms “succeed” and “fail” I am referring to the diets’ effects on the majority of the participants. This is in fact better demonstrated by the figure below, from the same study by Toubro and Astrup; it is labeled as Figure 2 there. Most of the participants at a certain weight, lose a lot of weight within a period of 1 year or so, and after 2 years (see the two points at the far right) are at the same original weight again. What is the average time to regain back the weight? From what I’ve seen in the literature, all the weight and some tends to be regained after 2-3 years.

The regained weight is not at all lean body mass. It is primarily, if not entirely, body fat. In fact, many studies suggest that those who diet tend to have a higher percentage of body fat when they regain their original weight; proportionally to how fast they regain the weight lost. Since the extra body fat tends to cause additional problems, which are compounded by the dieting process’ toll on the body, those dieters would have been slightly better off not having dieted in the first place.

Guyenet and Schwartz have recently authored an article that summarizes quite nicely what tends to happen with both obese and lean dieters (). Take a look at Figure 2 of the article below. The obese need to lose body fat to improve health markers, and avoid a number of downstream complications, such as type 2 diabetes and cancer (). Yet, with very few exceptions, the obese (and even the overweight) remain obese (or overweight) after dieting; regardless of the diet.

So what about those exceptions, what do they do to lose significant amounts of body fat and keep it off? Well, I rarely use myself as an example for anything in this blog, but this is something with which I unfortunately/fortunately have personal experience. I was obese, lost about 60 lbs of weight, and kept it off for quite a while already (). Like most of the formerly obese, I can very easily gain body fat back.

But I don’t seem to be gaining back the formerly lost body fat, and the reason is consistent with some of the studies based on data from the National Weight Control Registry, which stores information about adults who lost 30 lbs or more of weight and kept it off for at least 1 year (). I systematically measure my weight, body fat percentage, and a number of other variables; probably even more than the average National Weight Control Registry member. Based on those measurements, I try to understand how my body responds in the short and long term to stimuli such as different exercise, types of food, calorie restriction, sleep patterns etc.

And I act accordingly to keep any body fat gain from happening; by, for example, varying calorie intake, increasing exercise intensity, varying the types of food I eat etc. With a few exceptions (e.g., avoiding industrial seed oils), there is no generic formula. Customization based on individual responses and cyclical patterns seems to be a must.

Looking back, it was relatively easy for me to lose all that fat. This is consistent with the studies summarized in this post; all diets that rely on caloric reduction work marvelously at first for most people. The really difficult part is to keep the body fat off. I believe that this is especially true as the initial years go by, and becomes easier after that. This has something to do with initial inertia, which I will discuss soon in a post on metabolic rates and their relationship with overall body mass.

For people living in the wild, I can see one thing working in their favor. And that is not regular starvation; sapiens is too smart for that. It is laziness. Hunger has to reach a certain threshold for people to want to do some work to get their food; this acts as a natural body composition regulator, something that I intend to discuss in one of my next posts. It seems that people almost never become obese in the wild, without access to industrial foods.

As for living in the wild, in spite of the romantic portrayals of it, the experience is not as appealing after you really try it. The book Yanomamo: The Fierce People () is a solid, if not somewhat shocking, reminder of that. I had the opportunity to meet and talk at length with its author, the great anthropologist Nap Chagnon, at one of the Human Behavior and Evolution Society conferences. The man is a real-life Indiana Jones ().

In the formerly obese, the body seems to resort to “guerrilla warfare”, employing all kinds of physiological and psychological mechanisms, some more subtle than others, to make sure that the lost fat is recovered. Why? I have some ideas, which I have discussed indirectly in posts throughout this blog, but I still need to understand the whole process a bit better. My ideas build on the notion of compensatory adaptation ().

You might have heard some very smart people say that you do not need to measure anything to lose body fat and keep it off. Many of those people have never been obese. Those who have been obese often had not cleared the 2-3 year “danger zone” by the time they made those statements.

There are many obese or overweight public figures (TV show hosts, actors, even health bloggers) who embark on a diet and lose a dramatic amount of body fat. They talk and/or write for a year or so about their success, and then either “disappear” or start complaining about health issues. Those health issues are often part of the “guerrilla warfare” I mentioned above.

A few persistent public figures will gain the fat back, in part or fully, and do the process all over again. It makes for interesting drama, and at least keeps those folks in the limelight.

Sunday Update: Loren Fishman's Current Osteoporosis Sequence

by Nina

It has been brought to our attention that the osteoporosis sequence designed by Dr. Loren Fishman for the osteoporosis study that we discussed on Friday (see here) is not the sequence he currently recommends. The sequence he currently recommends is described in great detail (with many photographs) on his website under "A Dozen Poses vs. Osteoporosis". This sequence is not only much more accessible (and by that I do mean easier) than the original sequence, but it now excludes forward bends entirely (probably because forward bends are contraindicated for people with osteoporosis rather than due to concern about back strain).

I sincerely apologize for not being up to date on Dr. Fishman's work! However, I do think the exercise Baxter and I went through in evaluating his original sequence was useful because we were able to identify some issues regarding poses that should not be practiced on an everyday basis, which are useful for everyone to consider.

But you may be wondering, is the current sequence safe to practice on an everyday basis? That will have to wait until after Baxter returns to town. (I know you're all dying of suspense, right?) In the meantime, feel free to chime in with your own thoughts.

Friday Q&A: Is Loren Fishman's Osteoporosis Sequence Safe?

Q: You say that people should not do the same poses all the time. What about programs like Dr. Fishman's osteoporosis study, which has participants doing the same sequence of poses every single day?

A: Thanks for this question. Indeed, if a person does the same sequence day in and day out, you could run the risk of a repetitive strain injury. The fact that Dr. Fishman's sequence is only supposed to take 10 minutes a day to do means that the practitioners are not holding the poses terribly long, which would reduce this risk considerably. However, a review of the poses taught (see here) reveals several poses that I feel could be potentially injurious to the wrists, neck and lower back, these being Upward Bow pose and the deep seated forward bends. I would consider other poses if I were to design such a practice, but Dr. Fishman does mention tailoring the sequence to students individual needs. I would suspect that this had to be done quite a bit.

Recall that the number of patients that started the study was much larger than those that completed the study. (117 vs 11). Interestingly, there is no discussion as to what caused so many to drop out  and why they were unable to do a 10 minute practice everyday. One factor could have been boredom, which is why I often suggest that students alternate practices from day to day to help maintain better focus and follow through. And it is possible that some found the sequence too advanced, despite the individual adjustments offered. The bottom line, in real life, when you can vary your practice, I highly recommend you do so.

—Baxter

A: With Baxter's blessing I'm going to tell you why I wouldn't want to do this sequence on a daily basis. I'll start by telling you that the three yoga injuries I've sustained have all been repetitive strain injuries. I was a pretty enthusiastic practitioner for a number of years, and did a lot of standing poses and sun salutations. And the injuries I had were: sacroiliac joint injury (common among dancers and yoga practitioners, but not the general public), tennis elbow (possibly from sun salutations), and housemaid's knee (from kneeling too much on the bare floor).

Now let's look at the sequence:

1. Triangle Pose (Trikonasana)
2. Downward-Facing Dog Pose (Adho Mukha Svanasana)
3. Upward-Facing Dog Pose (Urdva Mukha Svanasana)
4. Bridge Pose (Setu Bandhasana)
5. Upward Bow Pose/Rainbow Pose (Urdva Dhanurasana), without or with a chair
6. One-Legged Forward Bend (Janu Sirsasana)
7. Two-Legged Forward Bend (Paschimottansana)
8. Boat Pose (Navasana)
9. Reclined Leg Stretch (Supta Padangusthasana)
10. Marichyasana 1 twist
11. Lord of Fishes twist (Matsyendrasana)
12. Reclined Twist (Jathara Parivarthasana)

After I got over the shock of trying to imagine doing all those poses in 10 minutes, without any warm-ups, I examined the poses in detail. First, two of the poses in the sequence are known for causing sacroiliac joint injuries, Triangle pose (Trikonasana) and One-Legged Forward Bend (Janu Sirsasana), with One-Legged Forward Bend a particularly guilty party. For me, personally, I've concluded it's just not good to do either of those poses every single day. Then, as Baxter mentioned, there is a very deep backbend in the sequence, Upward Bow, and doing this every day could put a lot of strain on the wrists and elbows, but of just as much concern to me is that it is followed immediately by a deep forward bend, taking the lower back into such extreme movements with no rest between. In particular, the Two-Legged Forward Bend is known for causing lower back strain. The combination of the deep backbend followed by the deep forward bend could cause a lot of back strain (personally, I would have moved the forward bends to the end of the sequence). The sequence ends with three twists, asymmetrical poses that are also hard on the sacroiliac joint, with no symmetrical counter pose to finish the sequence. (On the bright side, no danger of housemaid's knee here.)

I understand some of the thinking behind this sequence, which tries to engage all the different muscles of the body to strengthen as many bones as possible, within a short sequence, and uses the twists to "release" the back after the strain of the backbends and forward bends. However, if I were to design an osteoporosis practice, for safety's sake, I would develop five or more different sequences that the practitioner could alternate between on different days, rather than trying to cram everything into one single practice. There are so many wonderful poses in the yoga tradition, why would you limit yourself to just 12?

—Nina

Healthy Spirits: SF Beer Week bottle signing/release with David Walker of Firestone Walker Brewing Company!

Just posted our third event, but since it won't be on the SF Beer Week site for a few days, here's an early head's up!

February 14, 2012

3:00-5:00PM

Come meet David Firestone of Firestone Walker Brewing Company! He will be in the store from 3 to 5 PM answering your questions and signing bottles. We will also be releasing a limited number of vintage Firestone Walker bottles for sale, including XIII, XIV, VX, Abacus, Parabola and Sucaba. Bottle limits will apply.

This is one of the VERY few store events in which Beer of the Month Club members will not be allowed to reserve bottles. Please understand that we do this only to make sure we have enough beer to service the event.

We hope to see you all there!

cheers,

dave hauslein

beer manager

415-255-0610

Featured Sequence: Wrist Flossing for Wrist Care

by Nina

In Baxter's post on wrist care (see "Wistful Wrists: How to Keep Your Wrists Safe"), he recommended a wrist "flossing" sequence developed by Tom Alden that was featured in Timothy McCall's book Yoga As Medicine. This is a wonderful sequence you can do if you over-worked your wrists doing yoga, have wrist problems, such as carpal tunnel syndrome, or just want to give your hands and wrists a break during a marathon typing session. There are three different "flossing" movements:

1. Palms Down. Start by interlacing your fingers and turning your palms to face the ground. Move your elbows out the sides, so both arms are parallel to the floor. Gently pull your wrists apart, so you feel a slight traction, then raise your right arm and lower your left, bringing your right wrist into a forward bend and your left wrist into a backbend. Allow your right arm to do all the work, while your left arm is passive.

Repeat the movement on the other side by using your left arm to do all the work while your right arm is passive. Go back and forth any number of times.

2. Palms Facing You.  Start by interlacing your fingers and turning your palms in to face the ground. Move your elbows out the sides, so both arms are parallel to the floor. Now turn your palms inward, to face you. Gently pull your wrists apart, so you feel a slight traction, then move your right arm outward and your left inward, bringing your right wrist into a forward bend and your left wrist into a backbend. Allow your right arm to do all the work, while your left arm is passive.

Repeat the movement on the other side by using your left arm to do all the work while your right arm is passive. Go back and forth any number of times.

3. Palms Facing Away. Start by interlacing your fingers and turning your palms to face the ground. Move your elbows out the sides, so both arms are parallel to the floor. Now turn your palms outward, so they face away from you. Gently pull your wrists apart, so you feel a slight traction, then move your right arm inward and your left outward, bringing your right wrist into a forward bend and your left wrist into a backbend. Allow your right arm to do all the work, while your left arm is passive.

Repeat the movement on the other side by using your left arm to do all the work while your right arm is passive. Go back and forth any number of times.

See http://www.tomalden.com/ for information about Tom Alden. For information about Timothy McCall and his book Yoga As Medicine, see http://www.drmccall.com/.

What is an advanced yoga practice?

by Nina

A number of years ago, I encouraged a close friend of mine, M, to join me in taking Rodney Yee’s advanced class. Even though she had a muscular, athletic, and stiff body that made doing super bendy poses difficult, if not impossible, I knew that she understood how to take care of herself in class, that she would adapt the poses for her particular body type and keep herself safe, so I wasn’t worried about the class being too hard for her. She was interested, however, she expressed some concerns about not being “advanced” enough for the class. I decided to discuss the matter with our teacher himself, feeling fairly sure of what he was going to say. But what he told me when I asked him if she was “advanced” not only took me by surprise but has stuck with me all these years, transforming my thinking about the asana practice in general. What he said was this:

“Of course she’s advanced enough. M does yoga more mindfully than any student I’ve ever seen.”

And here I’d been thinking that being advanced meant being capable of doing difficult poses, like 10 minute headstands or extreme backbends, at some level or another! But doing yoga “mindfully”—now, here was goal we could pursue for our lifetimes and no matter our level of physical capacity was, we would always have the the ability to go deeper and deeper into the practice.

Year-Old Snow and New Snow by Philip Amdal

I’m thinking about this today because I’m helping a new friend of mine adapt her practice to allow her to heal from an ongoing injury. It’s taken her a long time to even be ready to temporarily give up certain poses and ways of practicing, because she felt such regrets about excluding poses from her practice that she used to be able to do with such great enjoyment.

But as Baxter mentioned yesterday in his post on wrist care (see "Wristful Wrists: How to Keep Your Wrists Safe"), sometimes rest is the best way to heal from an injury. So being willing to adopt mindfulness as a goal in the practice rather than achievement is a necessary element in being able to heal from an injury.

People who are aging may find themselves in a similar position, not necessarily due to injury but simply due to the physical changes that come along with aging. To be honest, I used to have what I sometimes call a “semi-fancy” yoga practice. But in the last few years, I developed arthritis in my right hip that makes it impossible to do seated poses that involve a lot of external rotation. Lotus and half lotus are now impossible for me, and seated forward bends and twists that require certain leg positions are painful and difficult. And I now need props in many of the standing poses now. Still there is no question I consider my practice more advanced these days than it was in the years when I regularly took the East Bay’s most “advanced” yoga class.

Healthy Spirits: Upcoming SF Beer Week Events!

We just submitted 2 events to SF Beer Week, but I wanted to give you all a heads up, as they probably won't go public on the site for a few days. We will be having 2 exclusive barrel aged beer releases over beer week.

1. We will be releasing our second exclusive barrel aged beer. "Someone Talked" is a collaborative effort from Healthy Spirits, Ale Industries and Blue Bottle Coffee. We gave Ale Industries our hand-picked Elijah Craig 18 barrel to age a specially commissioned imperial stout, brewed with fresh roasted Blue Bottle Coffee beans. 22oz bottles will be available for sale starting Saturday, February 11 at 11:00AM. Quantities are very limited, so grab it while you can! The brewer will be in the store from 11am to 1PM to answer questions.

2. We will be releasing our third exclusive barrel aged beer. High Water Brewing aged their excellent "Old and In the Way" barleywine in our hand-picked Buffalo Trace barrel for nearly 6 months. 22oz bottles will be available for sale starting Wednesday, February 15 at 2PM. This project yielded just over 200 bottles, so this will be a very limited release! The brewer will be in the store from 2 to 4PM to answer questions.

***We have a very cool third event in the works, but we are still working out some scheduling details. We'll be announcing it in the next day or two.

cheers,

dave hauslein

beer manager

415-255-0610

Wistful Wrists: How to Keep Your Wrists Safe

by Baxter

Following last week's hoopla around the New York Times article "How Yoga Can Wreck Your Body" and my interview on San Francisco public radio’s KQED last Thursday (see Can Yoga Be Bad For You?), Nina and I realized that it might be helpful to look at the most commonly injured areas of the body (from yoga or otherwise—more often otherwise!), and see if we could recommend a few helpful ways of avoiding injury or working with trouble when it arises.

I already mentioned Loren Fishman’s survey of 2009, in which he identified the areas of the body most likely to get injured. Wrists ranked number one among yogis surveyed. The main risk factor for modern yogis is the fact that contemporary hatha yoga, the practice of postures, relies heavily on poses that bring lots of pressure and force onto the wrists. The list of these poses includes such favorites as Cat/Cow, Plank Pose, Downward-Facing Dog, Upward-Facing Dog, Push-up Pose (Chaturanga), most of the arm balances (which we should rename accurately hand and wrist balances), and even the bottom hand in the asymmetric standing poses like Triangle pose.

There are very few manual labor jobs anymore that require us to have our hands on the ground supporting our weight. In fact, from an evolutionary point of view, we have evolved to our upright posture so having our hands on the ground is no longer necessary for our survival, except for that precious few months before we begin to walk as pre-toddlers. And modern society places our value as workers squarely on having a functional brain and adept hands to plug into our computers and produce! So the rest of our body is superfluous to the economy. Forgive my tendency to be hyperbolic, but we are stuck between and rock and a hard place. Yoga is wonderful way to reconnect with our whole self, and yet we must simultaneously be cautious with the delicate wrist area. And in fact one could argue that yoga asana is helpful in conditions such as osteoporosis in actually requiring us to bear weight on the wrists, a common area affected by thinning of the bones.

A Rock and Beyond by Philip Amdal

What’s a yogi to do? Well, from the start, gradually introduce weight to the hands and wrists if you are new to yoga. This came up again and again in last week’s discussion: beginners should start at the beginning with a competent guide (aka teacher) and gradually advance and integrate the yoga asanas. Secondly, consider the wrists you bring into your practice, taking into account any preexisting conditions that could put you at greater risk of injury while doing yoga, such as a history of carpel tunnel syndrome, other repetitive stress injury to the area, family history of arthritis, and so on.

You might want to invest in slightly thicker yoga mat to give your hands and wrists a bit more padding. When placing your hands on your mat, make sure to have equal pressure on the first knuckle area of your hand (what I call the ball of the hand) and the heel of your hand (which is closer to the wrist joint). It can be helpful to create a slight lift under the heel of your hand using either the front of your yoga mat rolled under tightly, or by placing a wedge under the front of your mat so it slopes toward the front of mat. There are also specialized gloves that have a small built in wedge in the palm of the glove that can be helpful, as well as a prop called the Gripitz. (For the latter, I find it is helpful to go over the use of the Gripitz with students to keep it helping and not aggravating their wrists.)

And there is nothing better than rest for an angry wrist, so if you have one, consider designing a non-hand weight bearing practice with your teacher that you can do as your wrists settle down. It should not be difficult to create a satisfying practice with the myriad poses that do not require much support directly from your wrists and hands. 

Another factor to consider as that many of the poses mentioned earlier require your wrists and hands to do a movement called extension (the wrist is bending back toward the arm), and there is a risk of hyperextension if you are not paying attention. Conversely, the opposite action of extension, flexion of the wrist (with the wrist bending forward away from the arm), is sorely missing in the asana practice. Practicing flexion of your wrists is a helpful counter-pose for wrist health. So if you are having wrist problems, you might start practicing the “wrist flossing” exercises described in the book Yoga as Medicine by Dr. Timothy McCall, featuring the wrists of moi. My students and I have found them helpful over the years in balancing our wistful wrists!