Chronic Fatigue Syndrome and Yoga

by Baxter

Floating Leaves by Melina Meza

As we once again pass through the man-made time shift that is daylight savings time (ughh!), I always notice a general malaise and sluggishness in many of my students.  The frequency with which my folks report colds and flu goes way up, and the request for longer Savasana at the end of class is a regular phenomenon. But on occasion, a student will report ongoing fatigue that goes way beyond the seasonal shifts or illness exposure of the fall and winter season. Some of these students return from a visit to their doctor with a tentative diagnosis of Chronic Fatigue Syndrome (CFS). 

It is very likely you know someone with this condition. According to a 2003 study in the Annals of Internal Medicine, the prevalence—the total number of cases of a disease in a given population at a specific time—of CFS is 235 per 100,000 people, with women three times more likely to develop CFS than men.

But just being tired a lot does not get you the diagnosis of CFS. The Mayo Clinic defines chronic fatigue syndrome as:

“a complicated disorder characterized by extreme fatigue that can't be explained by any underlying medical condition. The fatigue may worsen with physical or mental activity, but doesn't improve with rest.”

In fact you have to have significant fatigue for at least 6 months, along with 4 of the following other signs or symptoms, according to the Mayo Clinic:

• loss of memory or concentration
• sore throat
• enlarged lymph nodes in your neck or armpit
• 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

The cause of CFS is still unknown, although there are many theories about how and why it develops, including post-viral infection complication, abnormal immune system function or endocrine system function. And there are no specific tests to “prove” you have CFS, so it is important to rule out other conditions that can be associated with fatigue, like sleep apnea, certain medical conditions (like anemia, diabetes or hypothyroidism) and mental health conditions (like depression and bipolar illness, to name a few). 

Patients with CFS can a lot of variability in their symptoms, with some days better than others, and flares of symptoms can happen with minor increases in activity. However, because the condition does not get better with rest, the recommendations for treatment by your doctor will include medications, physical therapy and lifestyle modifications. Encouragingly, the Mayo Clinic site actually recommends yoga to help manage the pain symptoms of CFS. And although the studies of the effects of yoga for CFS are yet to be done, the Centers for Disease Control does recommend yoga as a part of treatment approach for CFS.

Many of the yoga recommendations I have made for other chronic illness would apply here as well.  Start out slowly, with small, gentle yoga practices, even done in bed. Working with an experienced teacher or yoga therapist initially will give you the greatest chance of gaining benefits from adding yoga to your treatment. Since yoga has been shown in studies to have benefits for stress reduction (an aggravating factor for CFS), and improvements in both endocrine and immune function, systems that can be out of balance in CFS, yoga will likely affect more than just the pain symptoms.

And, as we always advocate here at YFHA, “yoga” implies using as many of the tools of yoga as are appropriate for each individual. If you added in an Ayurvedic perspective, attention to diet and sleep would be included in as well. And on days when a more active physical practice seems daunting or counterproductive, breath work, guided imagery and meditation, including yoga nidra, will allow you to still “practice.” Just the ability to do some sort of practice regularly can give the person with CFS a greater sense of control over their health, which can foster a greater sense of healing and improve their outlook. And as the student progresses to greater levels of ability with the physical poses, which a physical therapist would refer to as “graded exercise,” attendance in a gentle yoga class would be recommended to combat the tendency to social isolation that can often accompanies the lives of those with CFS. Due to the uncertainty of how long CFS may be around, establishing a yoga practice as an ongoing, daily part of your life will have benefits far beyond its effect on only one aspect of your health. 

If any of our readers have personal experiences with the pros and cons of yoga for CFS, please write in and share this valuable information with your fellow YFHA readers. Thanks!

Home Practice: Is There an Optimal Length?

by Baxter

Hours of Operation by Melina Meza

This past August I was back in Ocean Springs, Mississippi at River Rock Yoga, leading a weekend workshop. One of the students, who has been a regular in class with me there over the years, brought in a few pointed questions for me that he hoped I could address on YFHA. He has been a regular reader since we started, and practices yoga on his own as well as attending classes regularly. In his search for the perfect home practice, he was very curious if I thought that there was a recommended minimum time for a home practice, realizing that some yoga is better than none!

In his own attempt to answer the question, he cited an April, 2013 article in an issue of Prevention Magazine which claimed, referring to a study done in postmenopausal women, that 42 minutes of vigorous exercise over 3 days (that means 14 minutes a day) maintains telomeres. As regular readers of this blog will know, telomeres are little “caps” or tails on the end of DNA stands that may have a relationship to longevity of certain cells in the body. Recent yoga studies have shown a positive relationship between yoga and telomere length. However, I don’t think the yoga practices in these yoga studies were only 14 minutes long, and likely would not fall into the category of “vigorous exercise.” However, this is an intriguing idea, and I’d say if you could hit the 14-minute mark in your home practice, that is a good start—more on that in a minute.

My student also cited “100 New Scientific Discoveries” issue of Time magazine, where he came across this:

“Researchers [in Stockholm] say that even a single 20 minute workout can lead to epigenetic changes that help make muscles work better.” 

For those not familiar with the field of study known as “epigenetics,” I offer this Wikipedia definition:

“epigenetics is the study of mitotically or meiotically heritable changes in gene expression or cellular phenotype, caused by mechanisms other than changes in the underlying DNA sequence—hence the name epi- (Greek: επί- over, above, outer) -genetics.” 

In this case, exercise is influencing how the genes of muscles express themselves leading to improved muscle function. I’ll take it! And 20 minutes sounds even better to me than 14 minutes for a home yoga practice.

And real life examples of the power of a regular practice are equally compelling to me as scientific studies. Recently, a long-time student of mine who has chronic back pain experienced a distinct change in his daily health. In the past, he had come to my back care yoga class regularly, but eventually found that some of the poses we did would actually flare his chronic back pain. So we met privately and developed a home practice he could do for 15-25 minutes daily, if he so chose. He found that he would do the practice 2-3 times a week, and it helped his overall back pain nicely. 

But then two months ago, he asked if we could audio record a practice that lasted about 40 minutes. He explained that his partner had become interested in doing some yoga at home and wanted something they could do together in the morning before work. We came up with a balanced routine that included poses beneficial for back health, but also breathing practices and a good Savasana at the end. When he returned for a follow-up recently, it was not the lower back symptoms he reported on, but that the chronic loose bowel movements he has suffered with every morning for years had diminished and stopped, replaced by a normal movement each am. He was thrilled and felt it was a direct effect of his new daily morning practice. And for him, 40 minutes a day works just fine.

We know from the work of cardiologist Herbert Benson, that 10 minutes of meditation is the time frame for the body to shift to the Relaxation Response (the Rest and Digest side of the autonomic nervous system), and by 20 minutes the effects are even more profound. And, of course, there are many other variables to consider when you design your home practice, as you can see from the 24 posts we have done to date that address the topic of home practice. We know, for example, that one study showed that it was regular home practice, more than attending classes over time or regularly, that seems to relate to long term health benefits of yoga (see Does Home Yoga Practice Make You Healthier? and Home Practice: The Best Way to Improve Your Health and Well-Being).

But like most issues we have discussed here over the years, the answer to this question of the optimal minimum time for home practice is really “It depends!” But, given what my astute student has uncovered, as well as research findings on the benefits of regular practice, my observations of my students and my own practice, I’d feel comfortable recommending that you try to hit that 20 minute mark, and on days when you feel like going longer, there is nothing to stop you! 

Yoga and Mild Asthma

by Baxter

Ball and Wire, by Melina Meza

I got this inquiry recently, and again was surprised to find that I have not written about asthma in any detail, as it is a very common condition and one that many of my students present to class with. Here’s what one of our readers asked:

“What advice do you have for those with mild asthma that does not interfere with daily activities? Do you have any suggestions on what to do to strengthen the lungs/ bronchial/breath? Any warnings?”

As always, it’s good to start off with defining what asthma is, so we are all on the same page. According to the folks at the Mayo Clinic website, asthma is “a condition in which your airways narrow and swell and produce extra mucus. This can make breathing difficult and trigger coughing, wheezing and shortness of breath.” There are different degrees to which people will experience bouts of asthma flares or “attacks”, from very mild asthma, which our reader is interested in, to those with frequent bouts of asthma-induced shortness of breath. And there are those more rare instances where the condition can be so severe as to run the risk of death. This is a condition that requires some support from your lung specialist doctor, either an allergist or a pulmonologist, even if you don’t require much in the way of medication to help with flares. Even my students with mild asthma usually keep an inhaled medication handy that can be used in the event of unexpected asthma attack.

As far as someone with mild asthma that does not interfere with daily activities participating in yoga, for the most part there should be no problem. In fact, certain benefits gained from a regular yoga practice could positively influence the student’s asthma course. In general, both the physical asana practices and pranayama breathing practices can lead to an overall improvement in strength of the muscles of the body that assist in moving the air in and out of the lungs, including the main muscle of breathing, the respiratory diaphragm. And the stretching of the muscles of the chest region, along with breath practices that lengthen the inhale and exhale can improve your “vital capacity” or the volume of air breathed out after the deepest inhalation. You may only need to use this amount of air movement during truly demanding physical activity.

In addition, two of the triggers of asthma attacks are strong emotions and stress.  As we have highlighted in numerous posts in the past, yoga can be an excellent tool to combat stress and to temper strong emotional swings. Applying those tools that support improved control over stress and emotional lability, especially relaxation techniques and guided meditations, should have positive benefits for those with even mild asthma. 

There are a lot of the other triggers for asthma attacks, according to the Mayo Clinic:

• Airborne allergens, such as pollen, animal dander, mold, cockroaches and dust mites
• Allergic reactions to some foods, such as peanuts or shellfish
• Respiratory infections, such as the common cold
• Physical activity (exercise-induced asthma)
• Cold air
• Air pollutants and irritants, such as smoke
• Certain medications, including beta blockers, aspirin, ibuprofen (Advil, Motrin, etc) and naproxen (Aleve)
• Strong emotions and stress
• Sulfites and preservatives added to some types of foods and beverages
• Gastroesophageal reflux disease (GERD), a condition in which stomach acids back up into your throat
• Menstrual cycle in some women

If any of these triggers are something you’ve experienced, you‘d want to take this into account as it relates to your yoga practice. I’d highlight a few of the above as examples. Exercise-induced asthma is fairly common form of asthma, and I have students who only complain of shortness of breath with physical practices - this might lead to increased work for the heart or lungs. That could include more physically demanding forms of yoga and may mean that you would want to work with an experienced teacher to design a practice that would benefit your overall health without triggering your asthma symptoms.

Another common trigger for my students is the wool blankets that some of the studios where I teach have available as props.  You may have to bring your own cotton blanket or request the studio have a few available for you to use. If reflux or GERD is one of your triggers, you’d need to avoid any kind of inversion and maybe even lying flat on the ground if it causes GERD symptoms, which can lead to asthma attacks. I have students in this camp do things like half Dog at the Wall instead of regular down dog. And if we are doing supine warm ups, you can create a ramp-like lift for the chest and head with blankets. If any of the triggers above are bothering your breathing, default to a quieter, gentler practice for a few days until your breathing returns to normal and then gradually re-introduce all of your normal activities, not just yoga. 

And not all breathing practices are great for asthma suffers. My colleague and friend Barbara Benagh developed a more serious form of asthma as an adult and found that pranayama practices that emphasized lengthening the inhalation or holding the breath after inhaling actually triggered or worsened her asthma.  She went on a personal search to look for better ways to breathe and her findings are quite interesting. I highly recommend you check out her web site to learn more about her recommendations.

I suspect we will return to this topic again down the road, but hopefully the information here will allow you to breathe easy as you work with yoga for asthma!

Studies on Yoga and Asthma: Most have been done in India or other countries, but do point out the benefits of yoga for asthma. On my quick search for recent studies, this study was the first listing, cataloged on the NIH website. Check out the references at the end of the study for more places to look for scientific studies on the subject.

The Get-Up-and-Go Test

by Baxter

Transportation by Melina Meza

A while back I shared with you a study done that looked at “transfer” ability as a predictor of longevity (see From Independence to True Longevity). Today while reading “Putting Prevention into Practice,” AAFP Journal, Dec. 15th, 2012, Vol.86, #12, one of my medical journals, I came across a brief article on preventing falls in community-dwelling older adults. “Community-dwelling” means living at home, not in a care facility. As I read some of the recommendations from the US Preventive Services Task Force (USPSTF), I came across a test I had not previously heard of: the timed Get-Up-and-Go test. This turns out to be a way to assess the risk of falling by testing the ability of a person to get up out of an armchair, walk 3m (10 feet), turn, walk back, and sit down again.  It seems the average healthy adult older than 60 years can do this in an average of 10 seconds or less. As I think about in connection to the four skills of healthy aging, strength, flexibility, balance and agility, the test requires some use of all four of those skills.

By the way, if you’d like to read more about the four skills of healthy aging, we have quite a bit of material on them here on our blog, including an overview about strength called Strength and Aging, another overview about flexibility called Flexibility and Aging, yet another overview about balance called Aging and Balance, as well as an introduction to the concept of agility called Yoga for Agility.

Other than vitamin D supplementation, which the USPSTF felt to have a moderate net benefit in preventing falls, the only other proactive therapy to reduce the risk of falls that the USPSTF recommended was exercise or physical therapy regimens. They feel there is convincing evidence for these two approaches, and, as we have discussed many times before, yoga has similarities to both. So get the word out to your friends and family over 65 to start, continue or increase their exercise regimen by adding some yoga to the mix!

Dizziness and Yoga

by Baxter

Looking Up in Jersey City by Brad Gibson

I recently heard from an old friend who lives up near Glacier National Park (must be quiet up there, what with the park closed—come on Mr. Boehner!). She was wondering what to do about recurring vertigo and yoga. And she is certainly not alone! I know so many people with vertigo, or dizziness, and once it kicks in, doing yoga can be a challenge. 

Because there are many possible causes of “vertigo” or “dizziness,” I’m going to write today about one of the most common causes, known as benign (paroxysmal) positional vertigo. It’s benign because usually there is not a life-threatening underlying cause for this kind of dizziness. The exception is if the dizziness is causing someone to fall, which we have discussed (especially in relationship to osteoporosis) in other posts. It’s paroxysmal because it comes on suddenly. It is positional in that the mild to intense spells of dizziness seem to be triggered by body or head position or movement. Common complaints I've heard are that rolling over in bed brought on the dizziness (and can cause it if done in that direction again) or simply turning the head in a particular way can stimulate dizziness. Dizziness spells can have an intense period that does not last more than a few minutes, but can have a lingering general feeling of dizziness and wobbliness. And although dizziness is the primary complaint, other symptoms can include: the feeling that you or your surroundings is spinning, unsteadiness, loss of balance, blurred vision when dizzy, nausea or vomiting. So although you are not likely to get into serious trouble, BPV can certainly be disruptive to your everyday activities.

In fact, I have known more than a few friends and students who have to modify their activities of daily living for a few days until their symptoms settle down. And because the risk of falls and injury is real, I often recommend that you modify your yoga practice until the symptoms begin to more fully resolve. You can do floor practices on your back (unless that is a trigger), do seated poses on the floor or a chair, and if you are going to do standing work, do the poses with your back to a wall and avoid holding poses very long. Inversions can be tricky, as they could also aggravate BPV symptoms, so either do easier versions of them, such as Legs Up the Wall (Viparita Karani) and Chair Shoulderstand, or leave them out entirely until you are feeling better. Try your restorative poses with your head slightly elevated. See how you feel right after each pose and after a short sequence to determine if they are helpful and/or safe to continue to practice.

Western medicine often utilizes medications that help lessen the symptoms of dizziness or nausea (if you get that, too), and also sometimes recommends a manual adjustment technique called the Epley maneuver. The doctor does this with you lying supine on an exam table with your head held by the doctor, who quickly extends your head and rotates to one side, then the other.  Often, one or two times with the maneuver can help to resolve your symptoms. The theory behind it is that crystals normally found in the inner ear can become dislodged from their normal location and block flow of fluid that helps with normal balance. The maneuver is thought to dislodge the crystals and let the inner ear fluid flow normally. You can see it done here:

I suppose it is conceivable that movements of the neck in certain yoga poses, like Trikonasana (Triangle pose) or Ardha Matseyendrasana (Half King of the Fishes twist) could have a similar effect, but no one has studied them to date, and I am not suggesting you try it on your own. In fact, I’d recommend seeing your doc for three reasons:

• to make sure there is not a more worrisome cause for your dizziness
• because BPV can come back from time to time and it is good to know what your options for treatment are
• because the doctor could perform the Epley maneuver, which may possibly resolve your problem quickly

Then there is the occasional student who will note the onset of dizziness during an asana class. This has happened very infrequently in my experience, but it does happen. I usually have the student immediately sit down on the floor with their back to the wall for support for a few minutes. If their symptoms resolve completely, I’ll invite them to gently try a few more poses, if the sequence is not full of balance poses or inversions, and see how they do. If they seem to have BPV, they need to sit out the rest of class. I have worked with these students at times to develop an individualized approach to their public classes so they can avoid movements that trigger their vertigo and can allow them to continue to enjoy most of their regular practice. Hope that helps way up there in Glacier and anywhere you find yourself!

To learn more about benign positional vertigo, visit mayoclinic.com .

Muscle Tightness and Yoga

by Baxter

I got this intriguing question recently from one of our readers and thought it a good one to address this week:

Baxter, I've been curious lately about the idea of differentiating between tightness due to activity and muscle engagement/contraction, tightness that results from tension or stress, tightness from inactivity and lack of varied movement, and tightness due to overstretching. I'm finding that there are many subtle differences and also different ways to approach these in my practice. Thoughts?

What follows are simply my personal observations of my self and my students as it relates to the “experience” or “perception” of tightness from different causes. My suggestions in no way represent a scientific explanation for the way I or you may experience tightness, but could influence your approach to changing that tightness, which could be by stretching the tight area so you have a greater range of movement at the joint that is restricted by the tightness, or by a regular yoga practice diminishing the intensity of sensation you experience at the point you previously would “feel” the tightness. The purpose of releasing physical tightness could include, but is not limited to, improving range of motion, diminishing physical discomfort brought on by the experience of tightness, or simply feeling generally more comfortable in your body in each moment.

Now I’ll go through each type of tightness our reader mentioned, one by one. I hope that the recommendations I provide for each type of tightness are helpful to you! 

Tightness Due to Activity and Muscle Engagement/Contraction

I’ve recently been doing a bit more aerobic activity than previously, as I am going on a trip soon to Peru where I expect to do some hiking at altitude. To get ready, I’ve been hiking up a pretty steep hill in a local park that takes about 25 minutes to crest. As an expected consequence, I am noticing that my hip and leg muscles are feeling tighter when I do my asana practice, and I have lost a bit of range of motion in certain joints, especially when I do forward bends and backbends. When new students attend class and tell me that their other physical exercises are activities like running, biking and such, I notice, in general, more limited range of motion in these students than in others, and they seem to “experience” the tightness sooner in their journey into certain poses. These students have plenty of drive and stamina, but need to be encouraged to go slow and let things release gradually. 

Tightness from Tension and Stress

This is a useful concept, as you can start to ask yourself: where to I hold physical tension or muscular tightness that I feel is a result of my perceived level of life stress? Many of my students, especially those who have sedentary jobs involving computers or driving, note that their tightness is in the upper back, shoulders and arms.  However, because they are sitting a lot, the lower back can also be a vulnerable area. They often complain about the tightness at the start of class, and will comment on the improvement (that they note as less tightness) by the end of class. I generally suggest that these students work with their tightness by doing short mini-practices at work, as well as taking frequent breaks to stand and walk a bit at work. 

Tightness from Inactivity and Lack of Varied Movement

This situation could apply to the group I just discussed, since sedentary work has a lack of activity for most of the body, as well as limited movement. But this could also apply to a variety of other situations. A common one is with people who are recovering from a significant injury, like a fractured limb, or a bout with serious illness, like cancer or a long-standing chronic illness. So, in addition to possible tight muscles from lack of putting the body’s joints through their full range of motion regularly, you will have underlying weakness of the muscles. Not only will these people experience tightness as they reach their stretching limits, but they may also tire quickly, experiencing shakiness in the limbs affected, and a need to rest frequently. The appropriate kind of practice for these people might include gentle classes and restorative poses mixed in with general all-level classes to give them time to physically recover and very gradually re-build their stamina as they work on diminishing tightness in the muscles and connective tissue. 

Tightness from Over-Stretching

I’d call this kind of experience “rebound” tightness that can occur after a particularly deep or focused asana practice. Sometime my teacher will be doing a class that focuses on backbends almost exclusively. I may not have been doing a lot of backbends in my home practice that week, but will decide to try to do everything offered in class. It is not uncommon for me to notice the next day that the areas that just the day before felt very open and more flexible at the end of class are now super tight and more inflexible. The muscle has a “stretch reflex” that works in a way that if you stretch with too much force or too quickly, the muscle contracts to fight or neutralize the stretch, so as to protect the muscle from tearing or injury. 

It almost feels like my body does a giant delayed “stretch reflex” by the way I feel after one of the classes. For me, the take-home message is to be more mindful while doing the practice for subtle or obvious signs, like pain, and not let my desires to “keep up with the Joneses’” lead to that unwanted side effect. And of course, over-stretching could lead to unwanted ligament damage, which can put joints at risk of injury—not the goal of a smart asana practice!

Aging, Telomeres, and Yoga: New Study by Elizabeth Blackburn and Dean Ornish

by Baxter

A while back, we reported on an interesting potential marker in the body for aging of the cells connected to the genes called a telomere (see Stressed Mind, Stressed Cells and Science, Aging and Yoga). A telomere is like a tail on the end of DNA strands found in our cells, and an enzyme called telomerase influences the length and activity of the telomere. Studies done a few years ago by a Dr. Elizabeth Blackburn at UCSF in San Francisco began to show a connection between telomeres and cell longevity—the longer the telomere, the longer the cell life. Her work garnered her a Nobel Prize in Medicine.

Telomere Caps

Now Dr. Blackburn has teamed up with Dr. Dean Ornish to see what effect his life-style changes approach to prostate cancer has on telomeres and telomerase activity. Dr. Ornish has already shown that a combination of dietary changes (vegan diet with less than 10% fat per day), exercise in the form of walking for 30 minutes most days, and stress management tools that include regular yoga asana and breath work, mindfulness meditation and once a week group stress reduction sessions can reverse heart disease and diabetes, and can stabilize prostate cancer and stop its progression.

In their most recent study, published in Lancet Oncology (see Effect of comprehensive lifestyle changes on telomerase activity and telomere length in men with biopsy-proven low-risk prostate cancer: 5-year follow-up of a descriptive pilot study), the two researchers looked at how the lifestyle program impacted the cellular genetic level in regards to telomere length and enzyme activity. What they found was that the 10 men studied had longer telomeres in the short (as quickly as three months!) and long run, if they stuck to the program, and the 25 men who were controls had shorter telomeres. And they also looked at gene activity in their ten study subjects, and found that 500 genes were turned on, and all were beneficial, according to Ornish. 

Even though telomeres may be an indicator of longer cell life, and by extension, longer overall lifespan, this has not been definitively concluded, so more studies will need to be done, looking at much larger numbers of people. But the early evidence is promising, and even if the telomere/aging cell theory does not pan out, it seems evident that yoga, diet, exercise and stress management do have significantly positive impacts on health, disease progress or remission, and are therefore worth the effort. And as Dr. Ornish noted, his study participants found the lifestyle plan easy to follow, with 85-90% compliance, much better than most pharmaceutical based treatment plans. Why, you might ask? Well, has he says, it’s because it’s pleasant and comprehensive and “most people feel so much better they change their lifestyle.”

To read more, you can check out articles at ucsf.edu and today.com—among others—which reported these new findings.

Available on Video: Yoga for Healthy Digestion Practices!

by Baxter

Since I last wrote on subject of yoga and your digestive system (see Irritable Bowel Syndrome and Yoga), I completed two live one-hour lectures on the topic for YogaU Online, which are now archived and available on their website if you had hoped to join me live but could not. See yogauonline.com to access these lecture.

And, in addition to the information-packed talks, I completed a one-hour video practice on Yoga for Healthy Digestion in August! It is part of the package you get if you purchase the sessions from YogaU, and it is the first significant video practice I’ve produced in a long time, so I am pretty pleased to have it to share with you! To give you a sense of how I came up with the practices on the video, I wanted to share a bit about how yoga is applied to imbalances in the digestive system.

As I discuss in my talks on yoga and the digestive system, when you have an imbalance in your digestive system, it can often be classified in one of two ways: either a condition of excess digestive energy, such as with heartburn or reflux disease or a condition of deficient digestive energy, such as with chronic constipation. This way of looking at digestive imbalances comes from the work of TKV Desikachar, which I was exposed to back in 2005 when I studied at his center in India. Addressing these imbalances can then be done by applying a particular yogic quality to the practice you design to bring the situation in to better balance, towards homeostasis. 

If a condition is one of excess energy, you’d address it with a calming, cooling, restorative approach. The word we use in the world of yoga therapeutics to describe this is Langhana. On the other hand, if the condition is one of deficiency, you’d address it with a more stimulating, active or heating practice, known as a Brahmana practice. There is a slight paradox here however, for if your deficient condition is really causing you to be depleted, you can always start with a more Langhana style approach, and as your energetic reserves improve, switch to a more Brahmana style practice.  So, you can never go wrong going with the quieter, calming, gently grounding yoga practices, which include gentle asana, restoratives, pranayama (such as a 1:2 ratio inhale:exhale breathing), and guided meditations, to name a few of the Langhana tools.

In the video, you will get a 30-minute practice that exemplifies Langhana practice for conditions of excess and another 30-minute practice that exemplifies a Brahmana practice or conditions of deficiency. I hope you find both the talks and the video helpful as you attempt to get your digestion into optimum balance! You can find them both at yogauonline.com.

The Psoas Muscle and Yoga

by Baxter

If you have been around the yoga classroom for any reasonable amount of time, you have likely heard of the psoas muscle. But you may not have a good idea of where it is or what it does! You should though, as your daily activities—or inactivity if you are sitting a lot during the day—can actually create a short, tight psoas muscle that could use a bit of lengthening. So today I’ll introduce you to your psoas muscle in a deeper way than can sometimes take place in the yoga classroom, inform you of some of its roles in posture and movement and suggest a few ways to lengthen it, if it is on the tighter side of life.

The only other time I could find on the blog that we had talked about the psoas muscle was way back in January of 2012 (I Think I Have Sciatica), where we first introduced this drawing of the lower torso and pelvis which shows nicely the psoas muscle seen here with everything except the skeleton and select muscle removed.

The psoas is said to originate from the sides of the lumber vertebrae, possibly even starting as high up as thoracic 12 (T12), so it has multiple spots on the side of the spine where it attaches. It then travels downward, close to the midline of the pelvis, just in front of the sacrum and ileum, until it heads slightly lateral and anterior, so it can leave the pelvis by sliding right over the lateral pubic bone and just behind the inguinal ligament in order to dive down and laterally attach to the upper inside of the femur bone (at a bony bump known as the lesser trochanter of the femur). Now we can actually feel the greater trochanter with our hands, just about six inches below the side of our pelvic rim, but the lesser bump is not accessible - due to lots of muscles which make touching it almost impossible. And due to the fact that the psoas lies deep within the pelvis, it can be challenging to feel it - both literally and perceptually. 

Hopefully, with the help of the picture and my written description, you are starting to get oriented to where the psoas is. But what does this muscle do when it contracts and shortens? It depends a bit on which part of the set-up is stabilized and which part is free to move. And it also depends on whether it is working in concert with other muscles to help you walk (for instance), or to help you maintain upright posture when you are standing still.

Let’s look at it working alone first. If the spinal origins of the psoas are stable and not moving, the psoas is said to have the following effect on the femur bone (to which it attaches): it flexes the femur toward the belly, pulling it slightly medially toward the pubic symphysis, and rolls the thigh bone externally on its axis. If we wanted to take the femur bone in the opposite direction as a way of stretching it, we’d need to take it backward towards the buttocks, swing it slightly out to the side and internally rotate it. Doing a modified Locust pose (Salabasana), with the legs apart a bit and an emphasis on rolling the thighbones in would be an example of a pose that could lengthen the psoas.

When we stabilize the femur, as when you are sitting in a chair, and contract the psoas, the origin gets pulled forward and down, encouraging the forward folding action known as flexion of the lumbar spine. We use this action whenever we bend over to pick something up off the floor.  The psoas also works in concert with several other spinal muscles to encourage the upward lift of the spine that we cultivate in poses like Mountains pose. In that setting, it does not create excessive lumber flexion, but does allow the natural curve in the lumber area to be present. So that is a bit about what the muscle does (realizing that the psoas works with other muscles that flex the femur bone, such as part of the quadriceps).

When the psoas is overly tight and short, it can affect the lower back in a negative way (contributing to back pain), influence the ease of a neutral pelvic tilt and affect gait. There are passive ways to release tension in the psoas and more active ways to lengthen and stretch the psoas.

In The Psoas Book, author Liz Koch recommends “releasing” tension in the psoas by lying in Constructive Rest position (on your back, with your knees bent and the soles of your feet on the floor), with your feet about 1-2 feet from your hips, and staying there for a while (maybe 5-10 minutes) with close attention to sensations in the area of the back belly and hip joints, as you attempt to sense the releasing of tension in those areas. Another version of Constructive Rest involves having your calves on a support, like our Easy Inverted pose (see Easy Inverted Pose). Once you get better at sensing release in tension in this area, slowly move one foot further away from the hips without letting the pelvis tip or tuck and stop when tension is encountered in the areas you are observing. Gradually moving that foot until the leg is straight, if you can do so without changing the pelvic alignment. A more advanced variation involves folding one leg into the chest (in an upside-down Pigeon pose), without tipping or tucking your pelvis, and then again slowly extending the other leg long on the floor (it’s the lengthening leg that will stretch that side's psoas).

In my regular classes, I often take advantage of the back leg position in Warrior 1 to bring attention to the psoas of the back leg, as it needs to lengthen in order to keep the pelvis neutral (not going into dramatic anteversion or forward tip).  From there, doing drop knee lunges, both with the hands on the floor next to the feet for an easier version, but gradually coming up higher, with hands on blocks, and finally with hands on the front thigh, while letting the hips and torso move a bit forward while keeping the pelvis stable, are great ways to lengthen the psoas. The back leg in upright Pigeon pose also gives a good stretch to the psoas.

This list of ways to work with your psoas is by no means complete. You might look at Mary Pullig Shaztz, MD’s book Back Care Basics for her approach to psoas stretching in the face of back pain. And Jean Couch’s classic The Runners Yoga Book is sure to have a few suggestions as well.  And if our readers have any favorites, please write a comment back to us! Happy stretching!

Yoga After Cataract Surgery

by Baxter

A teacher wrote in to ask us about a student who will be having cataract surgery. The teacher said that the student's doctor told her she should avoid lifting for two weeks, and asked us: Are there any yoga poses that should be avoided? Inversions come to mind but does that mean downward dog as well? Because cataract surgery is one of the most common surgeries performed in the US each year, many of us will have students in this very situation, and some us will find ourselves there as well. So I decided to do a full post on the topic.

It is estimated that 50% of adults over the age of 80 have a cataract. Cataract is a clouding of the lens of the eye that lies just behind your pupil and iris, the front and center most parts of your eyeball. The lens allows light and images to pass through to the back of eye onto the retina, which is the part of the eye that sends that image info to the brain. The clearer the lens, the better the image. The lens also focuses the images onto the retina, not unlike the focus feature on a slide projector or movie projector.

What causes the clouding of the lens that we call a “cataract”? The lens is made up of mostly water and proteins. As we get older, some of the proteins begin to clump together. If the clumps get big enough, they begin to partially block the light trying to pass through the lens. As long as the clumps stay small, you may not even notice the changes, but if a clump gets big enough, your vision will start to get blurry or even color tinted, usually brownish.  Even though cataracts are sometimes referred to as “age-related” and I mentioned the percentage of elderly with them, you can sometimes develop cataracts in your 40s or 50s, and there are even rare forms of congenital cataracts that infants can be born with. You are at increased risk for developing one if you have prolonged exposure to sunlight, smoke cigarettes, drink alcohol, or have diabetes.

The good news is that treating cataracts with surgery is quite safe in general.  However, during the post-surgery period, there are risks of developing problems such as bleeding, infection, or changes in the pressure inside the eye, either up or down. And there is a very slight increase in the chance of the retina at the back of the eye coming away from inside surface of the eye, a condition known as retinal detachment. This last complication is considered a medical emergency as it can lead to sudden loss of vision. To learn more about cataracts in general, check out this National Institutes of Health-sponsored web page Facts About Cataracts.
 
On the NIH web page, I found the following recommendations for modified activity after cataract surgery, but without specific connection to the above risks:

“When you are home, try not to bend from the waist to pick up objects on the floor. Do not lift any heavy objects. You can walk, climb stairs, and do light household chores.”

I can only assume that these recommendations are made to reduce the risk of bleeding, pressure changes in the eye (which can be position- and exertion-influenced) and retinal detachment. So, how should you modify this student’s yoga practice during the two-week post-operative period, and maybe for a full eight weeks, the typical time for the surgery to completely heal up?

Inversions should certainly be avoided. This includes standing forward bends like Uttanasana and Prasarita Padottanasana, and even Downward-Facing Dog. You can still include modified poses like Half Dog pose at the wall.  If you apply the rule of not bending past 90 degrees from vertical, you will minimize the pressure increase to the head and subsequently to the eye.  As far as I know, there has not been a specific study to confirm eye pressure changes doing inverted yoga postures, but it seems likely that they would potentially cause it and are therefore best avoided. Also, as I think I have mentioned before regarding yoga and high blood pressure, you also need to limit the length of time you stay in a static or held pose, especially the standing poses, as the exertion required often leads to an overall increase in blood pressure, which could also influence pressures in the eyes.  Other rather obvious poses that could have a similar effect are those that require strong, sustained contraction of the abdominal muscles, which would also increase blood pressure in the eyes.  Poses like Boat pose (Navasana), deep held twists (even sitting versions), and arm balances like Crow pose (Bakasana) also fall into this category. 

In a time of healing—for cataract surgery or any other health recovery time—you want to keep the nervous system quieter, spending more time in the “rest and digest” part of the autonomic nervous system. So spend this two week healing period doing gentler practices, including lots of supported restoratives and guided meditations on health and healing. It would be great to hear back from the person who sent in the question on how things turn out for your student, and from any of our readers who have worked with this situation before.

Nocturnal Leg Cramps and Yoga

by Baxter

Recently while reading through one of my Family Medicine journals, I came across an article that caught my interest due to the frequent complaints of some of my students.  It was on nocturnal leg cramps.  Yes, quite often my students will ask me what they can do to address these ill-timed leg cramps (as if there is any good time for a leg cramp!).  I’ll get into what we know about the nocturnal leg cramps (NLCs) in a minute, but what caught my eye in reading was the recommendation for treatment:

“Limited evidence supports treating NLCs with exercise and stretching…”

Now, they don’t specify yoga, but as we all know by now, modern yoga would fit the bill. This treatment was recommended before any mention of medications, which is quite unusual for these journal articles.  It is usually the other way around—meds first, non-drug options mentioned last. This gave me a great sense of hope that modern medicine is beginning to grasp the benefit of starting with non-drug treatments for some conditions!

So what are these NLCs and how common are they? Well, according to the American Academy of Family Practice, they are super common, with up to 60% of adults reporting they get these kind of leg cramps.  They are described as recurrent, painful tightening of muscles in the legs, usually the calf muscles. And the NLCs can contribute significantly to insomnia. The exact cause in not known, but they hypothesize that the cramps are probably caused by muscle fatigue or nerve dysfunction, as opposed to low levels of blood electrolytes like sodium, potassium and such, or from other abnormalities.

Just to flesh out the symptoms of NLCs, they are painful and incapacitating, like no walking while they are occurring! They last an average of nine minutes per episode, and the first bout can be followed by hours of recurrent episodes and residual pain. Even though the calf is the most common muscle affected, cramps in the feet and thighs are also fairly common. Sufferers describe them as a spasm, tightening, twinge, strain, or a muscle seizure. And they are usually in one leg, and can cause the limb to move.

Folks with other conditions are sometimes more likely to have NLCs, such as those with vascular diseases, lumbar canal stenosis (narrowing of the spinal cord channel in the lower back), cirrhosis of the liver, patients on hemodialysis, and those who are pregnant, to name a few. Certain medications are also associated with NLCs, such as estrogen, Naprosyn and others. So, definitely check that out with your family MD if you start having them. NLCs are different from other conditions that might seem similar, like restless leg syndrome, claudication (cramps due to vascular narrowing of blood vessels in legs that occur with walking), myositis (muscle inflammation), and peripheral neuropathy (which has many causes).  So you do need to get checked out with your doc to rule out these other conditions, which may not respond to yoga so favorably.

Once you have been diagnosed, you will obviously want to do something to diminish the number of attacks or completely prevent them. A yoga asana approach would include practices and poses that bring movement and stretching to the lower legs, as well as practices that quiet the nervous system, as nerve dysfunction is one of the purported causes of NLCs. I’d start by reclining on the back and doing Thread the Needle pose (Sucirandhrasana), also known as Eye of the Needle or Figure 4 pose. Focus on circling your ankles as well as flexing and extending your foot at the ankle joint.

From there, I’d take one leg up into Reclined Leg Stretch pose. Start with the strap on your heel pad for a few breaths, move it to the arch of your foot for a few breaths, and finally place it on the ball of your foot and more actively pull down with the strap as you push up with the heel of the foot. This last variation will likely give you the most feeling of stretch in the calf muscles, which include the superficial gastrocnemius, the deep soleus, the posterior-lateral peroneus longus, and the posterior-medial tibialis posterior.

Many of the standing poses will bring some stretch to your calves and feet, especially the back foot in poses like Warrior 1 and Pyramid pose (Parsvottanasana). But even Warrior 2, Triangle pose and Extended Side Angle pose (Parsvokanasana) will provide a little stretch to the area, and might be better starting poses for newer students with lots of tightness in that calves. Wall Calf Stretch (a modified version of Warrior 1 with the toes of your front foot touching the wall and either hands or forearms on the wall) really isolates the calf muscles nicely, too. There are other poses that will have some nice benefits for the calves as well, like versions of Childs pose that will bring some stretching pressure and compression from the thigh bones and body down onto the calves and lend to some widening of the muscles. So throw a few Childs poses in the mix. And you can fulfill the “exercise” part of the recommendation by doing more active flowing practices, which will encourage warming and improved circulation to the lower extremities. And finishing off with some supported inversions like Legs Up the Wall or Chair Shoulderstand will release increased blood pressure from the legs for a bit, which could have a lovely calming effect on your legs, as well as your nervous system.

Pranayama practices that quiet the nervous system, like extending the exhalation (perhaps a 1:2 ratio of inhale to exhale) and others would be of great benefit, as would a body scan meditation, where you encourage all of the muscles of your body to release deeply.  Such a meditation could be done just prior to bed to prepare you for a good night’s sleep. There are, of course, other options you could include, but this will get you or your students started if nocturnal leg cramps are disturbing your rest. Let us know if you have a favorite calf release that I did not mention. We love your feedback!

Friday Q&A: Multiple Sclerosis

Q:I am curious about how yoga might be used to benefit someone with a diagnosis of Multiple Sclerosis (MS).  I have heard about it, but am not sure how to proceed.

A: Thanks for checking in about this. I am surprised we have not addressed this to date, so I am happy we will go over it today! After I did my teacher training in 2001, one of the first workshops I ever attended was down in the South Bay, where a well known teacher from Catalina Island, CA named Eric Small was teaching a weekend workshop for the National MS Society on “Yoga for People with Multiple Sclerosis.” In my previous incarnation as a full-time family MD, I had cared for a few patients who had the diagnosis of MS. But honestly, it was their neurologist that really addressed their MS and its symptoms more than I did. If only I had known then what I learned from Eric back in 2001, I would have had some very powerful tools to address this serious condition. And, boy, was I learning from the right person. Eric was diagnosed with MS as a young adult and had a pretty severe first episode, which made it hard for him to even walk without the aid of crutches.  Fortunately, he attended one of BKS Iyengar’s first classes in San Francisco in the late 60s and was taken under the master’s wings and taught how to work with his condition using yoga practices. Eric has rarely had any additional symptoms, a rare story with MS, indeed.

For those of you out there unfamiliar with MS, it is the most common neurological condition that leads to work disability in younger adults. Two-thirds of people with MS are diagnosed between the ages of 20-40, and although it is not a cause of premature death, it does often lead to significant disability. The theory behind MS is that the body develops an auto-immune response to the protective sheath that surrounds the nerves in the brain called myelin sheath, attacking it as if it were a virus or bacteria. Not only does this lead to scarring of the myelin, but it can affect the underlying nerve as well. The result is that communication running down the damaged nerves slows or stops, leading to all kinds of unwelcome symptoms, like muscle weakness, spasticity, lack of coordination, loss of balance, gait difficulties, tremors, swallowing trouble, speech disorders; numbness, tingling, burning, or pain; blurred vision, double vision, blind spots or blindness; bowel and bladder problems like urgency, frequency, retention, incontinence and constipation; as well as vertigo, depression, or emotional labiality; and short term memory loss and impaired concentration are the most common cognitive signs. This is a staggering array of symptoms, and because no two MS suffers will have the same constellation of symptoms, it can take a while to even get to an accurate diagnosis of MS.

There are a few different patterns for the affects people experience, and I am going to suggest that if you want to know more about that, check out the National MS Society website. But let's say that in many cases the symptoms will intensify for a while, referred to as a relapse, and at times they will diminish for a while, called remission. One of the main complaints from those with MS during a relapse is fatigue and heat intolerance. They often note fatigue arising in the late afternoon, and symptoms worsening if the environment is hot or if they overheat with activity. This is a perfect point of entry for yoga, especially quieter poses, restorative practices and breath work.

Viparita Karani (Legs Up the Wall Pose)

Although we have mentioned yoga’s benefits before, the MS society notes the following as particularly relevant in dealing with the huge list of possible symptoms that MS folks may experience: breathing becomes deeper and more regular; circulation increases, for better distribution of O2 throughout the body; flexibility increase; muscles and joints are toned; internal organs are massaged; and a general feeling of well-being arises. And since fatigue and heat intolerance are the most limiting factors to the MS student, the breathing and restorative practices are extremely beneficial for managing these symptoms and you might start out learning these for your benefit or teaching these first for your student with MS (see Mini Restorative Practice).

Because these students also often have some degree of spasticity as well as movement and gait disturbance, the systematic stretching and breath attention of yoga releases tension in the areas affected, while improving circulation and enhancing awareness of the student’s body. Body awarenessaids in recognizing and regulating an individual’s unique MS symptoms. In addition, regular practice will also improve coordination, helping directly with balance issues and helping with transferring.

Many MS students may be using a cane, crutches or a wheelchair some of the time, so you will need to become familiar with using all of the props you can. Chair practices (Chair Yoga) are helpful, but even having poses these students can do in bed will be very helpful if they can not transfer to a chair or the floor easily. So, depending on the individual’s function on any given day, you will either be doing a fairly typical yoga class, a chair yoga class or a very modified class in the wheelchair or in a bed. The key will be to keep things quiet and cooling in general. During times of remission, if there are minimal symptoms, you could try sharing a regular intensity class, as long as heating poses or sequences don’t lead to a flare of symptoms. I’m hopeful these general guidelines will give you a place to begin your exploration of yoga for MS.

—Baxter

Cortisol and Good Health

by Baxter

Fallen Tree by Brad Gibson

We have mentioned one of the body’s important hormones, cortisol, on these pages a few times in the recent past, but always with the slant of it somehow being a problem child, a bad actor, a rotten apple, as it were. But cortisol, when it is working in harmony with a well-balanced body and mind, is part of a elegant system that tries to help us respond in the best way possible to short term stressful situations that are bound to arise in our daily lives. So on a daily basis, during the early morning hours - around 4-5 am, the body releases a bit of cortisol to get your inner furnace ready for the first foot hitting the floor in the morning. It releases a bit of sugar into the blood stream, sends a bit more blood to the brain and heart, and really gets us ready for action, however mellow or intense our morning will be. Then, if the day is relatively uneventful, the level of cortisol gradually diminishes to its lowest levels around 10pm.

When released in response to unexpected stressful events, it has many more helpful roles to play. It has a strong anti-inflammatory effect, which is helpful with acute injury, so it can act like a fire truck when the body’s immune response to infection is too strong by decreasing the life span and production of one of our white blood cells known as lymphocytes. Basically, it tries to keep a balanced approach to infections.

Cortisol has an effect on the cardio-vascular (CV) system by controlling the smooth muscles in the walls of our arteries. In normal circumstances, this allows cortisol to help boost our blood pressure in the short run when we need extra work from the CV system. It has effects on the central nervous system (CNS), too, influencing behavior, mood, excitability, and the electrical activity of neurons. When we put all that together, cortisol is designed to respond to stress by providing fuel in the form of glucose, mobilizing fat and proteins for back-up fuel supply, modifying the immune response, heartbeat, blood pressure, brain alertness and the response of the nervous system to get us through the rough spots.

The cool thing about cortisol is that is has evolved to enhance the body’s response to stress while also protecting from excessive response to stress. The key thing about the place that produces cortisol, the adrenal glands, is that they need time to recover after stressful events have passed. And herein lies the rub!  If we give the body some time to recover between stressful events, the adrenal glands can do their job well, cortisol levels are adequate to the demands of the body, and you stay healthy and ready for the next stressful event.

But if you are either under constant stress, or your mind is prone to brooding about the past or anxious musings about the future or even negative assessments about the present moment, your adrenals interpret this as an actual stressful event occurring right now, and cortisol gets released into your system. So cortisol levels remain high in the blood stream for greater periods of time, which can result in swelling of the gland itself, and an increased chance of the following negative effects: loss of immunity secondary to shrinkage of lymph glands, increased risk of stomach ulcers, increased risk of hypertension, heart disease and other vascular disorders, excess sugar in the blood stream and more chance of developing diabetes. Not a good outlook! 

And as I mentioned last week, chronic stress depletes your supply of cortisol and can steal the building blocks of your sex hormones (see Yoga and Male Menopause), thus negatively impacting your sexual function and your reproductive capacity. What’s a yogi to do? 

Supta Baddha Konasana (Reclined Cobbler's Pose)

The good news is that your regular yoga practice, if it includes those much needed restorative poses (see Restorative Yoga), yoga nidra (see Yoga Nidra and Deep Relaxation), long guided meditations and generous Savasana (see Savasana Variations), should be the perfect balancing act for keeping the adrenals healthy and the cortisol cycle in synch with your changing needs. One fact that might influence your asana and even your exercise regimen is that aerobic or effort-full exercise (and some forms of yoga definitely fit the bill) can cause a release of cortisol to deal with the short term “stress” of the increased physical effort. If you work out or do asana in the morning, when there is still a bit of cortisol around from the 4 am release, the effects of the brief elevation are minimal. However, a late day work out could be theoretically more problematic, with a negative effect on sleep patterns as one possible side effect. So I would recommend active workouts and asana for the morning, and restorative practices in the evening if you want or need to do something later in the day.

So remember, cortisol is a good guy just trying to do its job. It’s the stress and our reactions to it that are really the culprits. Fortunately, we have the technology to neutralize this threat to our healthy aging! 

Don't Forget Us Fellas: Yoga and Male Menopause

by Baxter

Baxter and Friend by Melina Meza

Nina and Shari’s posts over the last week (see Yoga for Menopause: An Overview, Yoga for Menopause: Fatigue, Yoga for Menopause: Headaches, and Yoga for Menopause: Joint Problems) and the workshop I just completed this weekend on the endocrine system reminded me that men also face changes related to the sex hormones of the body that can lead to challenges as we age. So it seemed like the right time to talk about men, aging, and the sex hormones or androgens, especially testosterone.

Just as girls begin to experience hormonal changes as they approach puberty that lead to the growth and developments of their sexual organs and ability to get pregnant, boys at the onset of puberty also begin to experience hormonal shifts that lead to the development of the testes and penis and the secondary sexual characteristic, like body hair pattern, muscular development, voice changes and such.  The brain starts putting out signals from the hypothalamus deep at its core that signal the pituitary gland, also buried deep in the center of the brain, to release two hormones found in both men and women: luteinizing hormone (LH) and follicle stimulating Hormone (FSH).  In women, these chemical messengers turn on the ovaries, get them producing estrogen and progesterone, and begin the menstrual cycles that will continue until a woman reaches menopause at around age 50.  For men, these same two hormones cause two things to happen in the adrenal glands (atop the kidneys) and the testicles: the maturation of the sperm and the production of testosterone and other male hormones called Androgens. And for the rest of a man’s life, the brain and the adrenals and testicles maintain communication to ensure proper amounts of sperm are produced and testosterone are around.

The presence of normal levels testosterone (T) and the other male androgens confer normal fertility, ability to ejaculate normally, normal sex drive, and normal bone strength. Testosterone also influences the normal functioning of certain mental processes, such as the ability to concentrate and focus on one task at a time. The downside of this is it does not help men multitask very well! Anyone surprised by that out there? Additionally, T influences fat distribution, muscle mass and strength and red blood cell production in men. (And women:  yes, you all have some T in your system, a lot less (1/16th) than men, but your system is more sensitive to the T that is around.) 

As men age, levels of T usually gradually diminish. According to the Mayo Clinic: “Testosterone peaks during adolescence and early adulthood. As you get older, your testosterone level gradually declines—typically about 1 percent a year after age 30. It is important to determine in older men if a low testosterone level is simply due to the decline of normal aging or if it is due to a disease (hypogonadism).”

This gradual decline, unlike the more sudden changes that occur for most women in the decade before age 50, may or may not lead to specific noticeable changes for men. But there are some changes that could be directly a result of lower T levels: changes is sexual function, changes in sleep patterns, changes in physical appearance (such as increased fat, decreasing muscle mass and strength and decreased bone density), and even hot flashes in rare cases. Emotional changes can also happen. The Mayo Clinic mentions the following: “Low testosterone may contribute to a decrease in motivation or self-confidence. You may feel sad or depressed, or have trouble concentrating or remembering things.”

Keep in mind, just as the changes that women experience as they traverse menopause can be considered normal changes associated with the aging process, some of the signs and symptoms just mentioned are can also be considered a normal part of the male aging process. The only way to find out if they are due to an abnormal drop in T production is to check it via a blood test. Now, one might think: if my T levels are too low, I should just take T as a supplement, right?  Well, the research to date does not support that idea, and T replacement, just like estrogen/progesterone replacement for women, can have unwanted side effects. So what is a fellow to do?

There is one interesting fact having to do with the effect of chronic stress on the male sex hormones that could be great motivation to start or continue practicing yoga as a way to work with the expected decline in male testosterone levels. Chronic stress leads to elevated levels of the hormone cortisol, which helps you deal with the short-term consequences of stressful events, but have negative long-term effects if continually stimulated, as happens in chronic stress. And when levels of cortisol begin to drop in the adrenal glands, the glands starts using DHEA, a precursor to the male androgens, including T, to make cortisol. This can result in an abnormal decrease in testosterone.

Of course, we also know that yoga is a great way to deal with chronic stress, and this has been demonstrated by many scientific studies. Athough we have reviewed this before in a few different posts, we haven't yet made the connection to how it impacts the endocrine system and specifically, the male sex hormones. Now the dots have officially been connected! Take it from me, a well-balanced yoga practice that includes both active yoga postures and restorative practices, including pranayama and meditation, done regularly could be just the ticket to getting your T back where it ought to be, at any stage of your life, fellas!

Forbes Magazine Gives Yoga a Thumb$ Up

by Baxter

View From Above by Melina Meza

I love it when capitalist magazines find something good to say about yoga, even if it is how it is making someone lots of money. But in this case, Forbes says yoga might save the US trillions of dollars in lost productivity for our economy. How so, you ask? Why, for a start, by reducing the dropout rate from high schools in this country, rates that shockingly range from 30% in most places to over 50% in our urban “war zones.” (I call them war zones because of the continual violent backdrop that these children are subjected to day in and day out; where just walking to and from school, let alone being in school, is a constant cause for anxiety and worry about getting hurt or killed.)

What was a delight to see is one of the featured yoga experts quoted frequently in the article, BK Bose, in whose Niroga Institute in Berkeley, CA, I have had the great pleasure of teaching for the past several years. Bose, who started his career as a software engineer in the high tech industry in Silicon Valley, has more recently focused his work on bringing yoga to under-served communities, and training teachers to work with these special populations. These include classes at the Alameda County Juvenile Hall, low-income public schools and low-income senior centers, to name just a few. His work, as with most small operations around the country, is done as a non-profit venture. Even on its smaller scale, the results of the yoga classes are significant.

And after all, if we can influence the health of our youngest at an early age, that should lead to a longer, healthier life as they age (and, of course, many of our readers have school-aged children). The key underlying factor that Bose identifies as the culprit in so many of the challenges our young face is chronic stress. We have written on many occasions about the ways in which yoga can help us deal with stress. But what about in our kids, and in the growing number of kids that have to deal with gangs, substance abuse, and crime in their neighborhoods? This adds a whole new twist on doing straight up mindfulness techniques. These techniques can work quite well for children who don’t have the kinds of violent communities that Bose’s programs work with, as you will see below.

For me, as I read the article, I found one concept that comes from mind-body research defined in a new way that I could relate to from my own yoga teaching.  I often refer to the mind’s background chatter as “monkey mind” or “restless mind,” and the tendency is for this kind of thinking to have a background feeling of anxiety or stress associated with it. The following paragraph from the Forbes article talks about what mindfulness practices do to the brain, including the new phraseology “default mode network (DMN)” which I find confirming of my own observations:  

“In 2011, a Harvard study showed that mindfulness is linked to increased gray matter density in certain cortical areas, including the prefrontal cortex and regions involved in self-referential thoughts and emotion regulation. There seems to be a strong connection between mindfulness and the brain machinery involved in self-regulation. Other work has shown mindfulness to be linked to relative de-activation of the default mode network (DMN), the brain system that’s active during mind-wandering and self-referential “worry” thoughts, which are generally stressful in nature.”

Mindfulness practices, then, help us change the way we are thinking, or at least the way we are focusing our minds, which changes our stress response. For a young person, this might equate to changed behavior, in which he or she has more control over emotional reactions that might lead to trouble. Bose, however, notes that in his students who live in violent communities and are more often directly or indirectly victims of trauma, mindfulness is not going to work.  As the article points out:

“This is all well and good, Bose adds, but there’s an obvious caveat. When they’re in the midst of stress and trauma, few kids have the ability to sit still enough to take part in a sitting practice. “If you’re not ready to sit in classroom,” says Bose, “you’re not ready to do sitting meditation. If you have drugs and gangs and violence all around you, you simply can’t sit still. Teachers tell us that they often yell at kids 100 times a day to sit and pay attention. It doesn’t work. And to ask them to do this in the context of meditation can have a worse-than-neutral effect – it could be disastrous.”

He says that you have to go beyond mind-body research to trauma research, which tells us that physical activity can help the brain deal with stress and trauma.

“Trauma research tell us that we hold trauma in our bodies… Neuroscience says mindfulness; trauma research says movement. All of the sudden you’ve got moving meditation or mindfulness in motion. Mindfulness alone isn’t going to cut it for these kids.”

Even for adults who carry a lot of anxious energy stored up in their bodies, we here at Yoga for Healthy Aging have advocated for the necessity of movement practices, sometimes more vigorous yoga styles, as an initial stage in leading to deeper relaxation and stress reduction in your daily practice. Turns out to be true for kids with trauma, too.

The take-away from this Forbes exposure of yoga to a larger audience in the US and for us yogis here as well is that it may prove invaluable to teach young and old alike to do yoga, combining active asana and quieter mindfulness practices for maximum benefit. And that it would be a good idea to change policy on a national level to fund such ventures, so everyone at least has access to trying yoga, to see if it works for them. What an interesting, and possibly wonderful, world that could be! 

Yoga Better than Injections for Low Back Pain

by Baxter

A July 18th New York Times blog post entitled Alternatives for Back Pain Relief surprised me when it proclaimed that a modern and widely used treatment method for low back pain is no longer considered effective, especially for chronic or long-standing low back pain. That treatment is the use of injections into the areas of pain. The injections usually contain the inflammation-decreasing drug cortisone, but can also have ingredients like morphine, ibuprofen and vitamin B12 in the mix. Over the years I have had many patients come to me with low back pain, and from their reports, the effectiveness of the injections never seemed particularly strong. For some patients with new acute low back pain, who experienced more serious signs and symptoms, like radiating pain to the leg or actual weakness, the injections more often seemed to provide some temporary pain relief.

However, several new studies have revealed that, when looking back at those patients treated with injections, the injections were not significantly more effective than no treatment at all. And one study indicated that those who did not get injections for a pinched nerve in the lower back fared better down the road than the patients who received an injection course.  In the commentary published in a recent issue of JAMA:

“Based on the available data, the JAMA authors conclude, doctors “should not” recommend injection therapy to their patients with chronic low back pain.” 

That may be a hard pill for some doctors to swallow, as there has been a steady increase in the use of injections for low back pain, mainly because it is relatively inexpensive, can be done as an outpatient in the office, has fewer risks compared to surgery, and makes the docs some bling. The possible one positive use of injections is that is does often provide some temporary relief of low back pain symptoms.

The New York Times post then went on to reference a recent systematic review of yoga for low back pain that we reported on here early this year. This study looked back at all of the best designed studies on the subject and concluded that there was “strong evidence of short term effectiveness of yoga for low back pain and moderate evidence of long-term effectiveness of yoga.”

But although the New York Times post mentions the clear benefit of yoga for short-term back pain, it does not emphasize the second claim that the study discovered: moderate evidence for yoga's help over the long term. I took another look at the study itself, and discovered an important caveat: the authors would only recommend Viniyoga style practice for long-term benefits, as the other yoga methods studied did not demonstrate the same benefits. As they state:

"The American Pain Society's guidelines recommend that clinicians consider offering yoga to patients with chronic LBP (lower back pain). However, this recommendation is limited to Viniyoga-style yoga as the net benefits for other yoga styles could not be estimated."

Now, I love Viniyoga and integrate its methods into my own practice and teachings, along with the wisdom of the Iyengar method and some other modern yoga styles I’ve learned over the years as well. But I suspect that some of the alignment-strong styles, like the Iyengar method, will prove to be helpful in the long run as well, but we will need better studies to bear that out. That said, for those who are not familiar with Viniyoga (a term coined by American yoga teacher Gary Kraftsow for the yoga he learned from T. Krishnamacharya and TKV Desikachar) I would recommend to you two books to learn more:

1. The Heart of Yoga by TKV Desikachar
2. Yoga for Wellness by Gary Kraftsow

For now, this is all good news for those of us dedicated to our practice. As one of my students said to me just this morning after class, it's his regular yoga class that keeps his back in the best shape over time since he first developed low back pain many years ago. I’d love to hear back from our readers about your experiences with yoga for low back pain, so send me your story!

And don’t forget, my live webinar on Yoga for Healthy Digestion starts today, Tuesday July 23, 2013 on Yoga U online! Click here to learn more about it and sign up to join me Tuesday and Thursday from  8:30 EST (5:30 PST).