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!

Friday Q&A: Is Yoga Bad for Backs?

Q: Once a substitute yoga instructor stated that she didn't do anything every day, and that yoga can be bad for backs. Could you clarify why this opinion might be so? I love doing yoga, and would really like to know what's going on here.

A: Yoga isn’t "bad for backs" but not all yoga asanas are appropriate for “bad backs.” As an example, let us look at a very common group of yoga poses, forward bends, which can be thought of as both “good” and “bad” for someone with a back injury. Forward bends can be bad in the sense that if too much force is generated by trying to come into the position at the vulnerable area in the back, this will most likely cause more pain and injury. Not bending from the hips to come forward but using the arms as a lever force to pull into a position is unsafe. However, learning to move from the hip joints and keeping the spine in its neutral curves is a very different way to practice forward bends. This is safe because soft tissue restrictions and lack of flexibility will limit range of motion before injury will occur. But the second variation needs a lot of instruction from the yoga teacher to the student to learn to protect the vulnerable area. Also some physical conditions preclude the practice of the asana no matter what precautions are used. This is why studying with a qualified yoga teacher is so important, especially for the student with injuries.

In general, backs don’t go “bad” but there are many factors that lead to backs not functioning optimally. In yoga, learning the skills of perception and discernment are critical. What makes your back feel better when you practice at home or go to class? What makes it feel worse? If you do forward bends and then your back hurts for two days, is this a good thing or not? Whenever you do backbends, if you get searing, burning pain down your left leg, should you continue to do backbends? YOU must answer these questions for yourself and not be dissuaded by someone who makes such an incorrect blanket statement about yoga being “bad for backs.”

Yes, if the practice of yoga asana is done with aggression and non-attention, it can be damaging to the physical body. If the student and the teacher are careless or ill trained then yes, injuries can occur. But for injury to occur, the practitioner is being misguided by the teacher and/or has a lack of pain perception that makes him or her unable to distinguish between “good” versus “bad” pain. Timothy McCall has addressed this issue in his response to William Broad’s claim that yoga is dangerous for men (see Is Yoga Really Dangerous for Men? and Many Bites Downward-Facing Dog).

You state that you love doing yoga. May I suggest that you ask yourself the question: Why do I like to do yoga? The next question to ask is: How does my make my back feel when I practice yoga and then afterward? You certainly don’t want to be in more pain after a practice than before a practice! So instead of blindly listening and obeying an overarching dictate that “yoga is bad for backs,” listen to your own back and let it be your teacher in how you practice asana.

And perhaps you might want to print out some of our prior posts on back management and yoga asana, and educate your health care providers on the benefits of yoga for many acute and chronic life challenges.

—Shari

NOTE FROM NINA: I’d like to add that in many cases yoga is GOOD for backs. It can help strengthen weak muscles and release overly tight muscles, improving posture and reducing back pain. Both Shari and Baxter teach yoga for back care, and there are back care yoga classes, workshops, and videos that are widely available for good reason. Our blog has quite a bit of information on yoga for back care, including Featured Sequence: Low Back Care and For the Young and Old: Back Care.

Fast Exercise vs. Slow Yoga

by Nina 

Image "Borrowed" from The New York Times

The exercises should be performed in rapid succession, allowing 30 seconds for each, while, throughout, the intensity hovers at about an 8 on a discomfort scale of 1 to 10, Mr. Jordan says. Those seven minutes should be, in a word, unpleasant. The upside is, after seven minutes, you’re done. —New York Times

Did anyone else happen to see the recent New York Times seven-minute exercise routine? Well, I did. And my first response was irritation. Something seemed so wrong to me about the routine. At first, I thought it was the seven minutes part. That seemed to me a crazy amount of time for doing twelve exercises, and I thought it would be healthier and more effective to divide up the routine into, say, three or four different routines, and cycle between them on different days. That way, you could spend more time on each exercise and not do the same thing every day (which could lead to boredom or even injury).

But even after I had my private little rant about the subject, every time I saw that picture I continued to feel irritated; it was like a grain of sand in the soft belly of an oyster (not that this rant is going to turn out to be pearl, mind you). But it wasn’t until a few days later that I realized what was really bothering me: it was the phrase “seven minutes of steady discomfort.”

“In 12 exercises deploying only body weight, a chair and a wall, it fulfills the latest mandates for high-intensity effort, which essentially combines a long run and a visit to the weight room into about seven minutes of steady discomfort — all of it based on science.” — Gretchen Reynolds

It seems to me if exercise is something so unpleasant that you do just to get it over with, you’re never going to be able to incorporate it into your life on a regular basis, something people in our exercise-averse culture desperately need to do. I mean, why would you want to add seven unpleasant minutes to your life every day? I can’t help but feel that half an hour of enjoyable exercise has got to be better for you than seven minutes of “steady discomfort.” It’s kind of like the difference between fast food and slow food. For me, yoga asana practice is truly an enjoyable, sensual experience, where I'm present in my body and appreciating what it can do and how it feels. Why would I ever want to trade that for fast, efficient, and unpleasant? (Actually the phrase “all of it based on science” irritated me a bit, too. I’ve had food concocted by nutrition scientists and food made by with love by friends and family members, and, of course, no contest there.)

Granted, sometimes it’s a bit hard for me to get started with my yoga practice—there’s a certain mental inertia that makes me reluctant to switch to that activity—but once I begin, I almost always enjoy myself. Of course, there are moments of unpleasantness (the mild painfulness of a stretch, the frustration of falling out of a balance pose, the feeling of mild fatigue after holding a strenuous pose for an extended period of time), but these are interspersed with moments of pleasure and even joyfulness. (I’m thinking now of a fellow student in my weekly class, who, when we do her favorite pose, now always says to me with a twinkle in her eye, “Oh, boy!”) Then, there’s the huge bonus that a mindful asana practice confers in addition to strength, flexibility, balance, and agility: stress reduction.

Maybe I’m preaching to the choir here, but for our physical and emotional health (not to mention healthy aging), we each need to find a form of exercise that is a life-affirming experience rather than a form of torture that we must submit to. And it’s worth the extra time, even just, say, 20 minutes rather than 7, to make that kind of practice a part of your life. Of course, I love yoga, so I’m always here singing its praises. But if you hate every minute of the yoga you’re currently practicing, try some different styles. And if you hate all the styles, maybe it’s not for you. Walk, run, cycle, swim, work out in a gym, dance, play golf, tennis, basketball or soccer, ski—get out there and live!

Is Yin Yoga Right for You?

by Baxter

We recently received two questions regarding a style of yoga known as Yin Yoga, in which one assumes certain yoga poses, often done sitting or down on the floor, and passively holds the poses for 3-5 minutes.  An example of a pose done in the Yin way would be Sukasana (Seated Crossed Legs) with a forward fold, done passively for the allotted time. As a disclaimer, I have limited personal experience with Yin Yoga, but have done several two hours sessions over the years.

According to articles that can be found online at Yoga Journal Magazine, as well as the websites of two well-known teachers of Yin Yoga, Sarah Powers and Paul Grilley, Yin Yoga is more than just doing yoga asana a particular way. There is a focus on not just affecting the physical structure of the muscles, bones and connective tissue, but reportedly also influencing the energetics of the body via stimulation of certain Chinese meridians associated with the acupuncture/pressure systems. And there is an emphasis by some teachers also on working with the discomfort that arises in holding the poses longer, as a form of meditation. The concern both of our readers brought up had to do with how safe it might be to stretch the joint stabilizers known as the ligaments via this approach to yoga asana. One of the readers self-identified as being very flexible already, in her 50s, and noted that after a recent Yin workshop (which she found wonderful on many levels), she was left with joint pain for days after the practice and possibly some chronic pain. She specifically wondered if Yin style of practice is safe for students who are hypermobile and don’t really need more flexibility in their joints.

I wish this was an easy question to answer. I might start by saying that there is probably a style of yoga best suited for each of our unique body types, and conversely, there are some styles of yoga less beneficial for you. Secondly, I would recommend, as Paul Grilley does in one of his balanced articles on Yin style of practice, that you need to proceed slowly and with lots of attention, sometimes to subtle body signals, as you try out a new style of practice like Yin Yoga, if you have never done it before. With Yang styles of practice, which is just to say more active asana styles where you are more likely to be engaging muscle groups on both sides of joint that is moving, you will experience what is called your “active range of motion” of your joints, meaning that which you can create by contracting the muscles around the joint alone. However, this is not the “full” range of motion for most joints.

In anatomy circles, there is another term to describe this second stage of joint movement, “passive range of motion,” which usually involves gravity or some other part of the body taking you past the active range of motion place. An example would be lying on your back and using your muscles alone to bring your knees into your chest, like an upside down Child’s pose. This would be the active range of motion of your hip and knee joints in flexion (bending forward). Now, if you take your arms around your shins and pull with your arms (your “outside” force), your legs fold in deeper, thus taking you to your passive range of motion. The idea here is that this may be good for your overall flexibility and joint health, as some compression of the joints seems to be good for the cartilage of the joints as we discussed in our posts on osteoporosis and arthritis. When you flip over and do regular Child’s pose, you now have the full weight of the body pressing down on your hip and knee joints and this might get you even more deeply into the full range of motion of the joint. The question is how much is safe and where do things get potentially troublesome. The answer to that, again, is not easy.

Most sources I can find suggest that keeping your connective tissues—like the fascial containers around all of your muscles—mobile is a good idea. They also suggest that ligaments, the usually smaller bands of connective tissue that keep two bones in a joint close together are not designed to actually stretch much at all without the risk of injury, tearing and chronic looseness. Two things to watch out for if you try out Yin type classes: do I have persistent pain for more than a day or so after class?  And do my joints feel too loose, wobbly or unstable after such practices? If neither situation arises, this style of practice may be fine for you. If either does arise, maybe this practice is not for you. A combination of a Yin type practice with an active Yang style practice may work well for some. And if props take away some of the physical intensity of sensation when you are in Yin poses, this could possibly be a safer way for some to try the longer passive holds of Yin style without causing joint pain or overstretching of ligament. So do experiment a bit and see what you can discover to find the style that works best for you. 

We Didn’t Mean to Scare You, Part 2: We Really Want to Inspire You!

by Baxter

Another View from 1/2 Mile Marker by Brad Gibson

Nina asked me to share my own thoughts on her post from last week, We Didn't Mean to Scare You, and I wanted to begin by saying how much I appreciated her common sense response to this writer’s dilemma. As many of you know by now, our purpose here at YFHA is to provide you with information and tools to assist you in practicing and teaching yoga as you age in healthy and beneficial ways.

Now I'd like to address one particular issue that our questioner raised:

"My own thought about practice is, if I'm not feeling something, why bother? I know most of my students feel the same way."

Indeed, much of what we experience internally as we practice yoga is some sort of increase in sensation, whether it is a feeling of stretch or compression in muscles or near joints, or strong muscle contraction when we are using a muscle group to keep us in our pose. On the level of physical-mental connection, we get this feedback from the body and we know that something is happening. The vast majority of the time, if taught or practiced skillfully, this is probably a beneficial thing that leads to some very positive, “delicious” changes, as our writer points out.

One of the skills that we develop as we practice more consistently is the discrimination to know when the level of feeling is better or worse for us. It is true in yoga and in everyday life. We learn at a young age how hot is too hot, and such.  If we acknowledge this experimental way that we all learn, then even when we go a bit too far in practice and have a brief “injury” or setback, it really shouldn’t be discouraging, because in some way this happens for us to find our limits and edges and provides us with wisdom for our future practice. We actually have learned something valuable about the yoga practice and ourselves. And, just to play devil’s advocate, don’t forget styles of yoga asana and meditation where there is not much going on, very little feedback or “feeling” happening, yet much benefit for the your entire being. This could be the case for restorative yoga or Yoga Nidra. These practices are equally an experience of yoga and the ultimate aim of yoga as a physically demanding style of practice.  

And as a teacher of yoga concerned about the general safety of the classes you teach, periodically re-assess the population you are teaching to, their average age and the fitness level of your students.  As your community ages, you may decide to learn new styles of practice and teaching that will better serve the needs of your student base that might be considered “gentle,” “restorative” or even “therapeutic.”  Nothing wrong with that, and you will become a more skilled teacher, able to work with many different kinds of students.  Our education as teachers should really never stop. And instead of letting the expanding knowledge about yoga scare us, let’s get inspired to learn and integrate this new information into our work in such a way to build our confidence, both as practitioners of the art and teachers of the path.

The Power of Fact Checking: Timothy McCall on Elephant Journal

by Nina

Buddha Waiting for Spring by Michele Macartney-Filgate

Just a quick announcement today to let you know that Timothy has a very interesting post up now on Elephant Journal Does Yoga Kill?

Recently Timothy wrote about yoga and strokes on our blog (see Will Yoga Cause a Stroke? Could It Prevent One?), covering the topic in general and how to practice yoga safely. In his Elephant Journal post, however, Timothy directly takes on New York Times science writer William Broad’s claims about the relationship between yoga and strokes, responding point by point to Broad’s claims and looking more deeply into the research that Broad used to back them up. All I can say is, wow, that fact checking thing is really amazing—wonder why Broad's editors didn’t avail themselves.

My favorite fact is this one:

“To bolster his case, he listed several people whose deaths might have been caused by yoga including this one: “In Los Angeles in 2004, Sita White, 43, a British heiress and a favorite of gossip columnists, collapsed and died in a yoga class. The question is why.”

What Broad neglected to mention is that she wasn’t doing yoga at the time. According to eyewitnesses and media reports, White collapsed and died while students were filing in and putting down their mats.”

I also love Timothy’s conclusion:

“The truth, on the other hand, is often complicated, nuanced, and doesn’t always make a great story. And it is precisely that satya—subtle, interpenetrating, endlessly unfolding—that yogis are after.”

But you should go ahead and check out this article! And let us know what you think.

We Didn't Mean to Scare You!

by Nina

View from 1/2 Mile Marker by Brad Gibson

Many years ago—has it really been that long?—I was talking with Rodney Yee about yoga and safety. He was a bit fed up with the topic and impatiently blurted out something that I will never forget:

“You can get hurt sitting at your desk!”

It was so true, I had to laugh! Just think about it: physical injuries, from paper cuts to back problems and carpal tunnel syndrome, are common to desk sitters. And people who exclusively sit all day (at desks and cars and in front of their TVs) and avoid any forms of exercise, often develop life-threatening conditions, such as obesity and heart disease, as a result of being too sedentary. But all of that doesn’t mean anyone is going to tell you never to sit at a desk! In fact, as a writer, I do it every single day.

I was thinking about his statement because we recently got the following comment from one of our readers:

"Sometimes I am concerned, after reading these posts, that there is nothing left in the yoga practice that is okay to teach. My own thought about practice is, if I'm not feeling something, why bother? I know most of my students feel the same way. And I'm becoming very apprehensive about teaching anything because there is always someone for whom the posture or movement is not safe or recommended. And yet, there might be 19 out of 20 for whom it is delicious. How do I know when to hold back? And at what point, in each person's life, does one start to shift from a strong practice to something more gentle? It, obviously, is very individual, so, as a teacher, how am I to know what to recommend, collectively?"

My initial reaction to this comment—especially the phrase “there is nothing left in yoga practice that is okay to teach”—was sadness. That’s because, well, we didn’t mean to scare you! So for today, I just want to point out that yoga asana practice is indeed similar to sitting at a desk. Just as you often get some common sense tips for healthier desk sitting (such as, sitting with good posture and in a good chair, not sitting for too many hours in a row, etc.), we’ve been providing what we hoped we’re helpful tips for approaching the practice (and teaching of) yoga in a healthy way. So, my sincere apologies for scaring anyone.

We’ll be addressing more of the issues that this reader raised in the future. But for now, I’ll end by saying that when I teach yoga, I try not to worry too much about teaching every student “perfectly.” Instead, I remember back to when I was a student in my office building yoga class—I was just so grateful to be moving during my lunch break! You see, as a writer, I know from experience that one of the best ways to practice healthy desk sitting is by balancing it with a regular yoga practice!

Tension versus Compression: the Safety Line for Yoga

by Baxter

An essential ability to cultivate when adding yoga asana to your health regimen is the differentiation between sensations that are potentially good for you, such as the healthy stretch of a tight muscle, and those that are potentially injurious to you, such as overstretching a tendon or ligament, or compressing structures to the point of injury. We are going for the former and trying to avoid the later.

Two of these sensation creators, tension of a stretched muscle and compression of soft tissue or bony prominences, have been the subject of a quite fascinating yoga video by Paul Grilley, entitled “Anatomy of Yoga.”I viewed this DVD many years ago now, but this essential differentiation between feeling tension and compression and its importance to practicing safely has stayed with me. I’ll let Paul tell you more about it in this youtube video:

Experiencing tension or stretch sensation in a muscle is generally a desirable feeling to become familiar with, especially if it is experienced in the mid-portion of a muscle, farther away from the almost inelastic tendons and ligaments that tend to be located closer to the joints. A typical place to become familiar with this kind of body sensation is the hamstring muscle at the back of the upper legs. I chose this intentionally because it is an area that most students feel some sensation when in Downward-Facing Dog or Standing Forward Bend, just to name a few poses that stretch the hamstrings. As most of you know, the intensity of the stretch sensation can be quite strong, and yet it usually does not mean you are injuring yourself. 

The hamstrings are located on the posterior part of the hip joint, so when we are doing a stretch of this muscle group, the structures on the opposite side of the joint, here being the front of the hip joint, are brought into close proximity to one another in Standing Forward Bend. The closer the pelvic bone and the femur bone come together, the greater the chance for everything in between those two bones are to be compressed or smashed together. As far as differentiating between the sensations of stretch and compression, my personal experience is that they feel distinctly different.  Compression really does feel like things (muscles, skin, tendons, ligaments, fascia and bones) are getting smashed together. And sometimes it creates a kind of pinching sensation as well. This pinching sensation is one that I tend to back away from pretty quickly if it shows up in any yoga poses. And because compression could also put collapsing pressure on blood vessels and nerves, if you start to have an unusual pressure sensation in the joint, or start getting numbness and tingling downstream from the compressed area, that is another good indication to release out of the pose a bit.

The hip joint, especially the front of the hip, is one of the main areas to watch out for this.  Poses like Lunge pose and Pigeon pose are two regularly practiced poses where you’d want to be alert to unusual pressure, numbness or tingling kinds of feelings in the front leg. The good news is that if you do experience compression sensations, propping up just a bit higher could completely relieve the more worrisome kind of compression that could lead to injury. As an example, if you normally do Lunge pose with your palms flat on the floor, coming up onto your fingertips or, even better, onto a pair of blocks, might slightly open the front hip joint and relieve the compression. The same thing goes for Pigeon pose; by setting yourself up on folded blankets, with a block or a bolster under the front leg sitting bone, you can probably relieve compression in the front hip joint.

Lunge Pose using Fingertips

Other joints may be less likely to experience compression, but one that I watch out for is the front leg in Triangle pose (Trikonasana) and Pyramid pose (Parsvottanasana) at the back of the ankle joint. This is especially likely to pinch if the feet are too far apart. If the knees are generally healthy, compression of the back of the joint, such as in Child's pose, is not usually an issue for most students. 

Another place that painful compression is often experienced, especially by male students, is in the shoulder joint while doing Upward Bow pose (Urdva Dhanurasana).  Many men have limited flexion of the arm bone at the shoulder joint, and when they follow typical instructions to keep the elbows in while coming up into Upward Bow, they are unable to fully straighten the elbows, not because of elbow issues, but because the back of the shoulder joint experiences a painful compressive pinch.

It is important, as you master the basic yoga poses and begin to try out some of the more challenging poses, to take your time and notice where you feel sensation while in the postures. By once again focusing on mindfulness in your poses, you are more likely to notice poses that are not feeling “right” to you, so you can bring this to the attention of your teacher for recommendations on how to modify properly. Be patient with yourself, allow for slow steady progress in the mastery of your poses, and you will begin to discern the differences between tension in a muscle and compression around a joint.

Staying Safe with Degenerative Disc Disease

by Shari

I thought I would follow up on Baxter’s excellent post about preventing spinal degenerative disc disease Degenerative Disc Disease and Yoga by discussing how you might practice yoga safely after receiving this diagnosis.

To begin, it is important to understand how to influence the health of your spinal discs in your asana practice. The spinal discs acquire their nourishment from movement. In asana we move the spine throughout a range of motion that includes flexion (forward bending), extension (backward bending), rotation (twists), and side bending. Almost all asanas combine these movements. Rotation and side bending always occur together, for example, in Triangle pose (Trikonasana). And flexion poses (forward bends) will often be counterbalanced with extension poses (backbends) and vice versa. A well-rounded asana practice will include all these motions in almost every single pose, even Savasana (Relaxation pose), depending on how you position your legs.

If you have received a diagnosis of degenerative disc disease, this indicates that your spinal discs have become brittle and thin. Because of the inherent changes in their structure, the spinal discs are more prone to injury. The vertebral body is supposed to be the main weight-bearing surface for the spine while the intervertebral disc distributes the weight and acts as a shock absorber for stresses that occur from gravitational loading. But when the disc is compromised, more weight-bearing through the vertebra will be distributed onto other structures. Some of this weight may be transferred onto your facet joints, which are not weight-bearing structures but mobility structures of your vertebral column. And with this increased weight-bearing, your body may then respond by the formation of “more bone” for protection of these structures, which can be come painful bone spurs.

The Spine with Its
Three Curves

So what is a poor yogi to do? Start by returning to your Tadasana (Mountain pose). Because postural habits are one of the most important factors in developing degenerative spinal changes in the discs, learning to stand well both on and off the mat is critical in maintaining spinal health. When you think about it, even though you practice daily for 30 minutes, eat well, get enough sleep, have a good meditation practice, and are happy and healthy, if your posture is compromised, the result as the years go by is spinal compression. Learning to incorporate Tadasana into your everyday activities of driving, sitting, bending, and so on, will go a very long way in lessening the impact of spinal compressive forces. This means keeping a “Tadasana spine” (with all three spinal curves) as you move from your hips, and learning how to bend and reach and twist without causing excessive pressure through your discs and vertebrae.

In addition to maintaining your Tadasana spine, I would also recommend that you use props when either doing your own home practice or attending class. Using a strap, chair, block or wall can be helpful in teaching you what your own body can do without pain. To keep your body safe and healthy, you should ensure that your asana never hurts.

Those of you who practice Iyengar-style hatha yoga will know what I mean when I say “props” but for those of you who practice different styles of yoga this may be a foreign concept. In that case, I recommend that when you practice you at least pay very close attention to how you are moving. Where do you initiate movement from when you go into or out of a pose? Where do you start when you come out of a pose? How do you use your hips? And your legs? Where is the weight and force coming from? Do you quickly move through a motion because it hurts but once past that “bad spot” you are okay? What happens if you don’t go so low or so deep?

In addition, working on core strengthening, using your legs effectively, breathing correctly, and maintaining (or developing) adequate flexibility will all help in keeping your spine safe.

Finally, I suggest examining how you set yourself up in Savasana. Both Nina and Baxter have talked before about different ways to position yourself in Savasana (see Savasana Variations). The version with legs on a chair (be sure the chair is the proper height for your body proportions) puts your spine into a more “neutral position” than when your legs are straight out on the floor. But this isn’t necessarily comfortable for every one. When we lie on our backs, some of us like to feel the small of the back making more contact with the floor while others of us like a bit more arch. That is the thing with all degenerative conditions: one size doesn’t fit all. So a bit of experimentation is important. It’s also a good idea to consider your sleeping positions and the support of your bed. If you aren’t well-rested and comfortable in your bed, then no amount of yoga is going to make you feel better. So take the awareness you bring to Savasana—and all your yoga poses—into your bed with you to set yourself up for a comfortable and healthy sleep.

Experts Weigh In on Injury Risk with Yoga Poses

by Baxter

A few months back, I had the honor of moderating a panel discussion for Yoga Journal Magazine on the topic of injuries that occur when performing yoga poses. In the West, you and I know this physical part of yoga as “asana practice” or the doing of a series or sequence of yoga poses. In many settings, these yoga pose sequences can be devoid of any of the other limbs or aspects of yoga, such as meditation or lifestyle guidelines (like the niyamas). As has been suggested elsewhere, there is an inherent risk of injury to our oh-so-human bodies when we humans engage in physically demanding activities, such as exercise, and yes, even yoga asana.

Joining me for the panel discussion (which appears as an article in the February 2013 Yoga Journal Magazine) were three of the country’s most experienced yoga teachers, representing different yoga traditions:

Gary Kraftsow trained under TKV Desikachar, who focuses on one-on-one instruction, often with a more therapeutic bent.

Patricia Walden has studied with BKS Iyengar for some 40 years, with his attention to solid alignment, static held poses and the assertion that doing asana is another way of doing meditation.

Ana Forrest, also a veteran of almost four decades of teaching, is the founder of her own style of yoga, known as Forrest Yoga. From my limited experience of taking a session with her, I would describe her style as a physically demanding and strong practice, but with attention to the mind and breath.







As we began our discussion, each one of us was able to recall at least one, and sometimes more than one incident of having sustained an injury during yoga practice. In my case, through inattention, for Ana, secondary to being generally disconnected from her body when she first started practicing, for Patricia due to her ego wanting to impress her teacher, and for Gary, long inversions with unskillful sequencing or lack of adequate preparation. So we all had the personal perspective of being a human being who can get injured doing physically challenging yoga poses. Interestingly, in each case, these injuries, which could have been viewed as negative, unwanted events, actually led to important insights as healing occurred, allowing us to feel compassion for our students and for ourselves and giving some tools to help others avoid our mistakes and heal more quickly when injured. 

Some of the important take-home messages from our conversation were that we all would benefit from:

•    Remembering that the underlying purpose of yoga is not to master a bunch of difficult yoga poses, but to develop a healthy, deep relationship with our bodies as a gateway to a more important relationship with our mind and heart.

•    Working mindfully and gradually to build intelligence in your body and understanding of the poses you do decide to learn, with the guidance of a skilled and experienced instructor who has the same intention for you and who can provide feedback as to your readiness to go further safely.

•    Reframing our intention as it relates to yoga poses from mastering poses to helping bodies. If that were your underlying purpose, we would all be less likely to move into situations where we injure ourselves.

•    Realizing from the start that we often bring somewhat injured bodies to our first yoga class, just by virtue of being human and living a typical human life.  If we can keep this in mind, compassion for ourselves arises naturally and we can truly be kind to our bodies as we enjoy the challenge and newness of yoga.

•    Studying with teachers whose sequences of poses leaves us feeling really good at the end of practice and the next day. Then learning for ourselves in our home practice how to sequence to do the same. And cutting ourselves some slack if we end up tweaking our bodies now and then!  If three of the country’s most renowned teachers did it, don’t you think we probably all are going to have it happen to us at least once?

The conclusion of all four of us is that yoga’s benefits far outweigh any risk for injury that exists. Setting clear intentions as to what your purpose and hope is by doing yoga is as essential an ingredient as a safe and fruitful practice. Coming back to a relationship with the movement of the breath as a grounding focus for the mind was also strongly encouraged. And finally, as Gary mentioned, remembering the poses are just tools designed to help individuals understand their bodies and transform them, and that the practice is about you and not the poses! Such an attitude goes a long way toward keeping you safe and injury free.

For those last-minute folks who might think about joining us, Gary, Ana and I will all be teaching at the San Francisco Yoga Journal Conference this coming weekend. To read the entire article “Injuries: Why They Happen & How to Avoid Them,” pick up the February issue of Yoga Journal out now or look for it online at yogajournal.com.

Be safe out there while you are having all that fun doing yoga!

Is Yoga Really Dangerous for Men? Dr. Timothy McCall's Response to William Broad

by Timothy

Science reporter William Broad, who a year ago woke the proverbial sleeping (downward facing) dog of the yoga world with his NY Times Magazine article How Yoga Can Wreck Your Body, is back at it. This time he's claiming—based on a review of injury statistics—that men are at much greater risk of serious injury from yoga (see Wounded Warrior Pose). The claim may or may not be true, but I don’t think you can really tell from the data he presents. I plan on writing more about this topic in my next email newsletter, but wanted to respond to Nina's query for the blog today.

Man in Unwounded Warrior 3 Pose by Nina Zolotow

As Broad makes clear in his book, The Science of Yoga (from which the first Times yoga article was excerpted), the subject of his inquiry is the physical practice of yoga as found in most classes. He’s not talking about meditation, chanting, selfless service or spiritual development. Even so, styles of asana practice, different teachers and classes vary enormously. It’s my feeling that Broad's failure to account for these differences could entirely explain his findings.

Back when I was taking a lot of classes of different styles (which I'm not doing anymore, so if things have changed I’d love to get feedback from readers), I found that in the more meditative and restorative classes, I was often one of the only males in the room. But in some of the more vigorous and acrobatic classes, the gender split was closer to even. Thus, men having a higher incidence of yoga injuries could simply be a reflection of their favoring the kinds of classes where injuries seem more common, and not actually reflect any greater vulnerability to injury.

It is also my experience (and that of most yoga teachers I’ve spoken with) that people who are more flexible are generally at greater risk of injury, particularly for injuries like hamstring muscle tears, and overstretching of the ligaments. It varies from person to person obviously, but on average men are much stiffer than women, and seemingly less prone to these types of injuries.

Many yoga injuries—again based on my experience, since we lack data—happen when people are trying too hard to achieve a particular result. Your foot won’t go into Lotus pose, for example, so you pull a little harder to get it into position, and in the process tear ligaments in your knee. But before that happens, the body almost always gives warning signs, such as pain or strained breathing. If you decide to ignore them and power your way through, problems may result. Both men and women can do this, but if I had to guess I’d say men are more likely to, so in this way may be at higher risk.

William Broad loves to create controversy. Beyond claiming that yoga can wreck your body, he has also written that yoga can make you fat, and that the entire practice started out as a sex cult (neither of which is true). Statistically speaking, if Broad’s analysis is correct (and given the methodological problems in how he did his analysis—see Is Yoga Really Dangerous for Men? Dr. Ram Rao Weighs In—I don't think we can know), men may indeed be at higher risk of injuries when practicing asana, but this may miss a larger truth. My guess is that if a man practices less demanding forms of yoga, or any style of yoga in a less aggressive and more mindful way, that his risk probably isn’t any greater than that of a woman, and may even be less. Uh oh, there’s a potential future headline for Mr. Broad: Women at Greater Risk of Yoga Injuries! You heard it here first….

Is Yoga Really Dangerous for Men? Dr. Ram Rao Weighs In

by Ram

Recently William Broad, author of The Science of Yoga, wrote an article in the New York Times Wounded Warrior Pose, which claimed that yoga is “remarkably dangerous” for men. While this article is a must read for folks who practice yoga asanas (practitioners, teachers in training or students), there are several important issues mentioned in the article that needs to be properly understood and clarified.

Happy, Healthy Warrior Pose

Let’s start by clarifying for the benefit of practitioners and non-practitioners: the main reference throughout the article is to yoga asanas and not yoga per se. While this seem trivial, it is very important because one can resort to other yoga activities like dharana (focus), dhyana (meditation), pranayama (regulated breathing) and sustain very minimal if no injuries. Also, yoga is not a competitive sport; for more on this kindly refer to BKS Iyengar’s book Light on Yoga.

While it may seem that the practice of yoga asana is largely a feminine pursuit, such gender inequalities exist in several other sports and training programs. We do not see a mainstream ladies equivalent of American football, the zumba and pilates classes in the gym that I go to is dominated by females and it is mostly men that are busy working out their “ceps and packs” in the weight lift arena. Uncoordinated or improper movements can put an individual at risk and subsequent injury in any sport or training program. The same is true for yoga asanas, which require coordinated movements of several areas/parts of the body.

William Broad acquired medical data, performed a non-scientific partial analysis and concluded that gender differences in yoga injuries exist and men are at most risk for these types of injuries. To me it seems that the differences could be explained at least in part by differences in the amount of training and asana practice.

Retrospective training/sport injury studies have to be normalized (a suitable denominator has to be factored in). Typically, total exposure time in hours or months or years have to be factored in to draw a reasonable conclusion. In a retrospective 12-month scientific study reported by a group in Finland and published in the 2009 issue of Journal of Sports Science and Medicine, the authors concluded that after combining all reported acute injuries sustained by cross-country skiers, swimmers, long-distance runners and soccer players, no significant difference was observed in such injuries when calculated per 1000 exposure hours.

Similarly, another study comparing sports injuries in men and women that was reported by a group of family practitioners from Kaiser Permanente found no statistically significant gender difference for injuries per 100 participant-years (Sallis et al; Int J Sports Med. 2001 Aug;22(6):420-3. Comparing sports injuries in men and women).

If proper scientific standards were applied to Broad’s yoga analysis, it would mean factoring in the mean exposure hours of yoga asanas performed. Based on the above studies my gut feeling is that no gender differences would similarly be found in injuries sustained from yoga asanas.

So do not be put off by Broad’s article! Remember yoga philosophy, which includes asana practice as well, does not discriminate between estrogen and testosterone. The major component of the practice is about “letting go” of the ego, including your body image, and finding your true self. So focus on yourself and your personal practice. And focus less on a “macho” body and more on achieving stability, mobility and encouraging integration—gently coaxing all the muscles that are tight from sports and weight training to move and work together. Pay close attention to connections—between one part of the body and another, between thought and action and between breath and movement. Moving with this awareness helps in reducing risks from any serious injuries.

Balance and Safety

by Shari

A lot of my students tell me that they have balance issues and want to improve their balance with yoga practice. There is no unifying factor on why these students have balance issues. Some are due to injuries with surgical repairs (ankle fractures or other bone fractures, joint replacements of the hips or knees, spinal surgeries). Some are due to soft tissue injuries of muscle, tendons or ligaments. Some are due to brain injuries, such as strokes, multiple sclerosis, or Parkinsons Disease. Some are due to coordination issues, visual issues, inner ear issues. Some are part of medication side effects. I think you are getting the picture. So how does the yoga student and teacher address their own or their student’s balance issues?

I don’t specifically ask people if they have balance issues but instead I observe how they are in class. Then I am very free with using the wall as my favorite prop! I LOVE THE WALL! I can face it with the front of my body, I can have it behind me or I can be perpendicular to it. It depends on what I am working on at that particular time and the needs of my students. If there is a “yoga horse” in the place that you practice then it can be an even better love affair! I use the wall to allow me not to be afraid. Fear of falling can occur in all ages of students. Falling when you are younger is a lot less injurious than when you are in your 50’s and 60’s. Young bones “bounce” but older bones shatter. There are many reasons for this but the simplest can be attributed to osteoporosis and how we fall. Certain body parts are more prone to breaking than others and the surfaces that we fall on also contribute to fracture risks.

Bones of the Right Leg

The other unfortunate thing is that as we age we are less efficient in making new bone through the “remodeling process.” Bone is living tissue and it is constantly being formed and remodeled throughout our lifetime but like all parts of aging things get less efficient and slower (sigh). So falling in yoga class or during practice is not good for anyone’s health or confidence. For standing poses for some students, I may use a combination  of the wall and a chair, having them use both to assist in their balance as they are learning poses and then later on for them to increase their endurance when holding a pose. I think of blocks more as making poses accessible but not as a tool to safeguard from falling because they are too small and unstable themselves. If I have someone in class who is very unsteady I might place them in a corner so they have three points of stability (feet, side and then with a chair).

You may remember from a previous post Nina and I did way back when she interviewed me on balance (see Aging and Balance), we talked about balance receptors being found in hands and feet in large number. Being barefoot in class is really an important component of balance, and whenever possible I encourage my students to be barefoot if possible. Sometimes usage of a sticky mat isn’t as optimal as not using one (it may be easier to balance directly on the floor), so you have to decide what works best for you. Learning how to feel the intrinsic muscles in your feet (which Baxter has been so eloquent on in his recent posts on feet) and hands WILL affect balance in standing poses and some inversions.

Also, remembering to use your eyes in yoga class is also going to affect your balance (again see Aging and Balance about vestibular reflexes). Focusing on a fixed object as you move into and out of one-legged poses helps with stability. Keeping your head in neutral and not compressing your upper cervical spine into hyperextension (thrusting your chin forward) will also improve your balance (there are balance receptors at the base of your skull).

Other factors that affects our balance and safety are our individual levels of flexibility, strength and endurance. Being able to access a pose requires a certain degree of flexibility as well as alignment. When we try to do poses we aren’t ready for, we almost certainly will fall (think Headstand, arm balances, and Shoulderstands). These are truly advanced poses and take years to safely prepare to do them. Fatigue and endurance are factors in balance because we are unable to access the required muscular strength to perform an asana when we fatigue.

Lastly anticipation is also a factor in how balanced you are. The mental mindset “I always fall in Ardha Chandrasana when I do it on my left” pre-programs those pesky neural circuits into anticipating that you are going to fall so they aren’t going to be able to prevent it. Now I am not saying to disregard past experience or history it just that always doing the pose so that you fall isn’t a way to learn how NOT to fall in it. Learning to sense your balance changes within a safe context is extremely important as we try to improve our balance.

Balance like strength and flexibility is not static but improves with practice and time. I have a current student with me who began yoga because his wife told him to. He is a retired physician and told me when he started that he had cerebellar problems and couldn’t balance. Well he was correct the first year. He is now going on his second year with me and is now starting to do Ardha Chandrasana with just one foot at the wall. He can also now balance on each foot when he does tree pose (not very long but the time isn’t the issue but that he is starting to be able to do it). When I recently mentioned to him that his balance is improving he agreed and said, “I didn’t think it ever would and I am as surprised as you by it.”

I am truly humbled by the body’s ability to transform. That's one of the things that gets me onto my mat daily!

Take Care of Yourself or Your Students: Yoga and Safety

by Shari

I have been thinking a lot about the topic of safety when I teach these days, so I thought I might share some of my insights with you all, both students and fellow teachers.

So many people wander into a yoga class these days that it can be overwhelming for the teacher to juggle all the special needs that people may present. Let me give you some examples of my typical yoga students. I may have a student with glaucoma/cataracts who can’t do any poses where her head is lower that her heart, a student with a total knee replacement, hip replacement, hip fracture with surgical pinning, or students with osteotomies, acromioplasties, heart attacks, high blood pressure, low blood pressure, heart surgeries, strokes, vertigo, garden variety joint pain, spinal pain, herniated discs of the neck, back, sacroiliac issues, chronic pain of any body part, vertebral artery occlusion, carotid artery stenosis, etc. I think you are getting the point! And not all of these people are seniors or even over 55. In fact, some of my healthiest looking students have significant chronic illnesses and issues. How can I teach a class that has this variety? (I am not even talking about special needs yoga class here, but general classes.) Yes, it’s really easy to feel overwhelmed.

Navigating Through Icebergs by Michele Macartney-Filgate

But I have learned over time to ask some very simple questions in two minutes or less to get a feel of the student:

1. Have you done any yoga before? Now this question is very challenging because sometimes an individual will answer yes, but you have to qualify how long ago this was and what type of yoga.
2. Do you have any conditions that I should be aware of? Now here is another question that may appear simple but isn’t. Sometimes when people live with chronic conditions it is so normal for them they don’t even think about it being a problem. So you may have to probe a little.

Then, most importantly, I tell my new students this: “You are responsible for yourself in this class. Please don’t think I have ESP and know when something is overtaxing for you or causing you pain. And please come out of any pose and let me know of the difficulty you are experiencing.” Yes, it is paramount that every student take the responsibility for his or her own actions and does not pass that responsibility onto the teacher.

After this, you have set the stage for having engaged students in your class, but you aren’t done with providing a safe environment for your students. Throughout every class, you need to observe every student to make sure that people aren’t becoming overly fatigued and distressed. Is someone looking paler than usual? Is a student sweating more than normal? Is a student more red-faced than usual? Looking for subtle changes in your familiar students is important. Also, give people (or yourself!) permission to stop and rest (see Resting Between Poses for information about resting). We are all so driven, whether it is internal competition in our own selves on how much we want to or need to do or external competition where we are looking around at our classmates and competing. Yes, yes, this isn’t supposed to be yoga, but it does happen to the best of us and when we compete even against ourselves, injuries can occur.

These are very general suggestions that both teachers and students can immediately apply to their personal practices as well as to yoga classes. In future posts we can all discuss particular strategies for keeping yoga students who live with various medical concerns safe while they practicing asana.

Friday Q&A: Which Forward Bends Are Safe?

Q: Nina's post earlier this week on how to get comfortable in forward bends was very informative (see Getting Comfortable in Forward Bends). But I was wondering whether both versions shown in the photos--the one with the rounded back and the one with the neutral spine--are safe for everyone.

A: Forward bends always need to be approached with awareness, caution and respect, especially for people with acute low back injuries or chronic low back conditions. People with herniated discs, facet irritation, or degenerative joint conditions in their spines may find that too much bending forward will increase their pain.

Several leg muscles attach to your pelvis and tight leg muscles can restrict the movement of your pelvis, which needs to be able to roll over the top of your hip joints. If your leg muscles are tight, sometimes sitting on a folded blanket can allow you to get the proper movement of your pelvis. However, if you have very tight hamstrings and don't have the ability to keep the natural curve in your low back as you bend forward, then the version with the bolster under your thighs may still be problematic.

Rounded Back Version: Could Be Problematic

In addition, there are some people with conditions for which forward bends are contraindicated, meaning that the risk is greater than the benefit. This includes individuals with severe osteoporosis as well as individuals who may have had vertebral compression fractures in the past. For them the neutral spine version with the chair or bench may be safe, but, again, be sure to  proceed with caution.

Neutral Spine Version: Proceed With Caution

In general, cultivating flexibility in your hip rotators and hamstrings can help you achieve a neutral spine in your forward bends, which will help keep your lower back safe.

—Shari

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

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/.

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!

Does Yoga Wreck Your Body? A Scientist's Perspective

by Brad

There’s been a lot of buzz after the Sunday Times article on yoga and injuries, "How Yoga Can Wreck Your Body." My own take on this is that this is pretty shoddy journalism. The writer should have looked no further than the New York Times own Science Times format for Q&A.  Maybe a question like “Does yoga cause more injuries than similar exercise regimens?” would have been more appropriate? I suspect the answer would have been “no.”

In any case what’s the control here? No exercise at all, running, or lifting weights at the gym? All of these have both intended and unintended consequences on your physical well-being and injury status, especially as you get older. When I was a graduate student at MIT, I remember one of my professors invoking his own law to explain missteps in some scientific papers: “if you think you know the answer beforehand, you will undoubtedly find it.”  He used this to explain why some scientists misinterpreted their results by either overly fitting data to some preconceived notion, or ignoring or explaining away other types of information that was inconsistent. Makes for a good story, but this is not good science. Not good reporting, either.

My own experience with yoga suggests a different perspective on this question. I started yoga when I turned 50 because I thought that it would be more age-appropriate and not lead to as many injuries. In my case (Caution! N=1), I never injured myself in nine years of practice.  One reason was I had a good teacher (Baxter Bell), who did not push his students too far, and who also paid attention to preexisting injuries to tailor their practice. He was also well-trained and knew about anatomy and physiology. Not all yoga teachers have the appropriate training, so this is one of the most important first decisions in your practice:  choose a good teacher.  Finally, I did not push myself beyond what I thought was appropriate (if it hurts, back off a bit—you're not trying to prove anything to the teacher or other students).

A Crow by Philip Amdal

While I did not injure myself in yoga these last nine years, I can’t say the same about other activities. I have suffered from tennis elbow injury (overzealous gardening and foosball), heel pain (bad shoes as a kid leading to something called Haglund’s deformity), and lower back pain (digging all day with a shovel a year ago to clear a section of the yard).  What’s interesting is how yoga has helped to alleviate and moderate these injuries. Downward Dog and other similar poses have helped stretch my Achilles heel and tendon, considerably reducing my foot pain. I use a strap around my arms now for various positions, and this has seemed to both strengthen and better align my arms and elbows. And, lastly, I have noticed that my lower back feels better after a yoga practice than before—as long as I don’t overdo things.  So, at least in my case, I can honestly say that yoga has helped alleviate injuries, not caused them. Maybe someone should write a follow up article, “How Yoga can Help You Recover from Injuries?” Not as sensational, but....

And speaking of shoddy journalism, Dr. Timothy McCall tells us that although he was quoted in the article, he was not actually interviewed by the author and that the quote from him was taken out of context, from an old article. To read his rebuttal and his advice about practicing headstand, see his website http://www.drmccall.com/ and read the article "How to Not Wreck Your Body Doing Yoga or, How I Really Feel about Headstand" on the home page.

Getting Clearer on Yoga and the Risk of Injury

by Baxter

If you have not had a chance to read Nina’s Monday post (see here) about the New York Times article “How Yoga Can Wreck Your Body,” please do, because she articulates some very important points to consider as you digest all this hype coming from William Broad, a New York Times writer. In addition, you’ll find my take on this issue on Yoga Journal’s blog, where I am an occasional guest blogger (see here).

Before getting into recommendations for modifying specific poses to reduce the risk of injury, I’d like to step back today, and look at what we know about key areas of the body that are at risk of injury from an unbalanced asana practice. What do I mean by an unbalanced practice? In my view an unbalanced practice is one where you are doing one or more of the following:

• Practicing at an incorrect level of difficulty for your present level of expertise 
• Doing the same poses over and over, increasing your risk of repetitive stress injuries
• Attending classes with an inexperienced teacher unfamiliar with guiding students who have special vulnerabilities or who is aggressive with adjustments
• Attending a class or pursuing a home practice that has an overly competitive quality to it

Well, you get my drift. One of the few studies that has tried to get a handle on this topic of yoga-related injuries was published in 2009 in the International Journal of Yoga Therapy by Loren Fishman, MD, et al (see here). He and his colleagues surveyed 33,000 yoga practitioners from around the world, got back 1336 responses, and compiled the results. In descending order, the areas of the body most affected were as follows, with the number of times reported in parenthesis beside it: neck or cervical spine (674), shoulder, including rotator cuff (661), low back, including sacrum, SI joint, sciatica (644), knee (597), wrist (414), back or spine, any area (392), hamstring (332), hip (112), leg, including ankle and foot (64), and groin (52). There were other areas also mentioned, but at much lower frequency, including elbows, headaches and nausea.

A Clear Day on Mount Tamalpais by Brad Gibson

What does this mean for you and me?  Should we be overwhelmed and fearful? Probably not. Remember, only four percent of the surveys sent out were returned, so we still have a relatively small sample of folks here. What we can say is that, just as Nina pointed out Monday, any physical endeavor has some inherent risk of injury to it. However, if we keep returning to the essential quality of mindfulness and honesty in our practice, we can go a long way in minimizing the risks of injury. I can honestly admit that I have injured myself on several occasions, once from inattention in class, once from being in over my head in an advanced class I was not ready for, and once when my ego decided I should do an advanced pose that my hamstring had other ideas about. But I have also had several injuries, yoga related and not, that improved and healed through mindful and attentive practice of yoga asana.

In my next post, I’ll look at Fishman’s number one area of injury, the wrists, with some ideas and recommendations on how to approach poses that are more risky for us ordinary humans! Until then, keep on practicing.