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Friday, September 13, 2013

Friday Q&A: Forehead Massage and Endorphins

Q: I was wondering if you could help me find out if there is any medical evidence that endorphins are released when we roll our forehead on the mat in yoga? Some of the teachers that work for me say that and I just wondered if there is any medical evidence to support that? Or it just feels really good?

Chair Forward Bend
tugging the forehead skin down toward the eyes
A: Thanks for the interesting question!  I am uncertain if your are referring to rolling the forehead on your yoga mat from side to side, while in Child’s pose or rocking the forehead forward and back in a similar position. A technique I was taught by one of my early teachers was to place the forehead on the floor or a low prop like a block while in Child’s pose and then to push the head forward and give a slight tug to the forehead skin towards the chin. My teacher claimed this would have a calming effect on the nervous system, and that moving the opposite way (moving the skin of forehead toward the crown of head) would stimulate the nervous system. I have observed some truth in this pronouncement in my own practice and share it with my students. I cannot find any specific scientific study to explain what might be happening in the brain, but it seems possible that this has some feedback to the autonomic nervous system to shift from sympathetic to parasympathetic (Fight or Flight to Rest and Digest). Whether this is a result of the neurotransmitter class called “endorphins” or not, I also cannot say. But it does feel really good! I found the following info about endorphins on wisegeek.org and it indicates that massage can cause a release of endorphins, so I guess it is possible that this little scalp maneuver could support that assertion:

“Any type of physical activity that causes pain, such as exercise and eating spicy foods, releases endorphins in the brain. Excitement, laughing, crying, or engaging in risky activities can trigger the release as well. The body also releases them while relaxing with a massage, dancing, or when falling in love.
 

Endorphins, also known as endogenous morphine, are an arrangement of amino acids known as opioid peptides. These chemicals function as neurotransmitters that help regulate moods, sleep patterns and the way one responds to pain and stress. When present in the body, endorphins act as a natural painkiller and are able to provide a sense of comfort, wellness and happiness.”

Additionally, in Yoga as Medicine (by our contributing writer Timothy McCall), Timothy shares a similar exercise on pages 11 and 12, this one done while sitting, with the heel of the hands creating the same effect I describe above. Timothy notes that most people find the drawing of the skin down is more calming to the nervous system, but does not theorize exactly why. Yours truly is pictured doing the exercise! 

If this idea is new to you, give a whirl and let us know what you observe.

—Baxter

Thursday, September 12, 2013

Judith Lasater's Favorite Poses

by Nina

In her interview with us (see Judith Lasater on Yoga and Aging), Judith Lasater mentioned the poses that she currently practices, citing "especially Viparita Karanai (Legs Up the Wall pose), Supported Sarvangasana (Shoulderstand) on the chair and Supported Halasana (Plow pose) on the Halasana bench." By chance—or maybe not by chance if you stop to think about it—those are some of my favorite poses, and I recently had a friend take some photos of me doing them so I could share them on the blog. Then, as it happened, someone left a comment on the interview with Judith, asking us to share two of the poses with you: the Shoulderstand in a Chair and Supported Halasana with a Halasana bench. That was the kick in the pants I needed. (We've covered Viparita Karani many times on the blog—see Featured Pose: Legs Up the Wall pose.)

Here is a photo of the Shoulderstand in a Chair. I'm doing the pose with my legs straight up because that's the way I prefer doing it. Some people, however, practice this pose in more of a backbend, with their legs supported on a bolster and their feet over the back of the chair. But I find that position less comfortable.
Shoulderstand in a Chair
And here is a photo of Supported Halasana (Plow pose), sometimes called Arda Halasana (Half Plow pose). Okay, fine, I don't have a Halasana bench (a specially designed piece of furniture), but you probably don't, either. So I use a chair for Supported Halasana, instead. Yes, the good news is that you don't need a special piece of furniture to do this pose, but if you are using a chair, you need one that has no bar between the two front legs because you need to be able to get your head underneath the chair seat. And you also need a chair that either has no back panel or that has a space between the panel and the seat that is large enough to fit your legs through (I'm on the small side, so I can use a chair that has a back panel).
Supported Halasana
If you've never done these poses before, you may be wondering how the heck you get into them. Since I practice them all the time, and teach them whenever I teach yoga for better sleep, stress management or emotional wellbeing, I can tell you! However, quite frankly the process is complex enough that I've decided to do separate posts for each of the poses (we took photos of all the steps in and out of them, which will make that easier). But I will tell you that it's like learning to drive a car; at first the process is complicated and a little stressful, but with practice you get to a point where getting in and out becomes automatic and you don't even have to think about it anymore.

So it they take so much practice to learn, why should you bother? Well, as many of you know by now, I'm a huge fan of inverted poses in general (see Just in Time for Holidays: Inverted Poses). Because you are upside down in these poses, they automatically trigger the relaxation response (see Why You Should Love Your Baroreceptors). And perhaps because these poses are slightly more physically active than restorative poses, the rest they provide feels more refreshing to me. So when I'm fatigued, a supported inversion practice is just the trick. These two poses provide the extra advantage of placing your legs higher than your heart (as well as your heart higher than your head). Having your legs higher than your heart means that gravity helps return the blood in your legs to your heart, improving your circulation and reducing swelling in your feet, ankles and legs. So these poses are wonderfully restorative for your legs when you've been on your feet all day, whether standing for your work, walking or running.

Chair Shoulderstand is one of the most soothing inverted poses because you are both supported and completely inverted. Although full Shoulderstand is considered a calming pose, the reality is that for most people—even relatively flexible people like me—the unsupported pose just is not that comfortable. Chair Shoulderstand, on the other hand, is very comfortable and you can hold the position for quite a while. I like to hold it for at least 6 minutes, because I can feel my "quiet switch" turn on after around 5 minutes. And you can do the Chair Shoulderstand in place of full Shoulderstand in any sequence. 

Supported Halasana is a very quieting pose because you fold inward in addition to being inverted. Furthermore, as you hang from your hips in this pose, the traction on your back that this pose provides feels wonderful, particularly if your lower back is bothering you. That said, I really don't think this pose is for everyone. People who don't have flexible necks can find the extreme forward bending of the neck (flexion) in this pose uncomfortable. And some people with round bodies find it very difficult if not impossible to fold their bodies into this position. In this case, turning the pose upside down into a seated forward bend with head support is great alternative.
Supported Seated Forward Bend
Typically, if you were going sequence Judith's three favorite poses, you would do Chair Shoulderstand first, then Supported Halasana, and finally end with Viparita Karani (Legs Up the Wall).

Tip: for women with large breasts, which tend to fall into your face in these poses, I recommend tying a strap around your upper chest before going into the pose.

Wednesday, September 11, 2013

Healthy Spirits: Telegraph Sanus Spiritibus Release

 



We are very excited to announce the latest exclusive barrel aged release from Healthy Spirits!

 

Last year, we partnered with Santa Barbara’s Telegraph Brewing Company to release two bourbon barrel aged versions of their excellent Rhinocerous Rye Barleywine. We were very happy with the results, and since the barrels were still down south, we figured another collaboration was in order.

 

Since the barrels had already seen some serious action, we figured it would be best to give them one last run with a wild ale. This is a style Telegraph does particularly well, as those who have tried beers from their “Obscura” series can attest.

 

The beer they came up with is SANUS SPIRITIBUS (Healthy Spirits in Latin). Aged two months in bourbon barrels with two strains of Brettanomyces, Sanus Spiritibus brings together the vanilla and maple character of the wood with the complex funk of wild yeast. This is a beer that will continue to develop in the bottle for several years, with Brettanomyces coming to dominate the aroma. Only 38 cases were produced.

 

Sanus Spiritibus is only available at our two Healthy Spirits locations.

 

$19.99/750ml

 

Tasting Notes:

 

The cork popped off with a bang.  No spillover, no gusher, just extremely carbonated.

 

Appearance:  murky apricot / tangerine colored

 

Nose:  brett bomb.  once you get past that there's warm vanilla / caramel / toasted oak intertwined with potpourri / mulled cider spice-like aromas / some vague fruity notes

 

Flavor:  brett bomb.  funk (not too gritty, earthy or peppery, just right) and fruit (apple-skin).  heaps of vanilla and toasted oak follow very closely behind.  a little acidity and subtle tartness peaks out just before the beer dries out, relieving one from the heavy bourbon / toasted oak character.

 

Finish:  toasted oak, dried apple, vanilla...

 

The body is round and creamy - perfect dry finish.

 

 Excited about the aging possibilities on this one as the bourbon influence + the ABV make for a powerful beer that will benefit from time in the cellar.

Healthy Spirits: New At Clement n Twelf'


-Widmer + Cigar City "Gentlemen's Club" collaboration series (oak, rye and bourbon varieties)-$19.99/22oz

-Santa Clara Valley Brewing Electric Tower IPA-$7.99

-Santa Clara Valley Brewing Peralta Porter-$6.99

-Hangar 24 Polycot (apricot wheatwine)-$9.99/22oz

-Sierra Nevada Flipside-$9.99/6pk

-New Belgium Lips of Faith Yuzu Imperial Berliner Weisse-$9.99/22oz

-New Belgium Lips of Faith Coconut Curry Hefeweizen-$7.99/22oz

-Uinta Organic Punk'n   $9.99 /6pk

-Anderson Valley Hop Ottin' IPA  $9.99/6pk

-Robinson's Trooper (Iron Maiden collaboration beer)-$6.99/16oz

-Malheur Zestig (hoppy golden ale)-$15.99/25oz     

-Local Option Blood Ov The Kings American Wheat Ale  $9.99/16oz

-Local Option Dampf Loc California Common Ale $9.99/16oz

Healthy Spirits: New at Castro

 
 
1.  Widmer + Cigar City "Gentlemen's Club" collaboration series (oak, rye and bourbon varieties)-$19.99/22oz

2. Hangar 24 Double IPA-$9.99/22oz

3. Hangar 24 Polycot (apricot wheatwine)-$9.99/22oz

4. Alaskan Pumpkin Porter-$9.99/22oz

5. Sierra Nevada Flipside-$9.99/6pk

6. Karl Strauss Tower 20 Imperial IPA-$7.99

7. New Belgium Lips of Faith Yuzu Imperial Berliner Weisse-$9.99/22oz

8. New Belgium Lips of Faith Coconut Curry Hefeweizen-$7.99/22oz

9. Russian River Consecration-$12.99/12oz

10. Santa Clara Valley Brewing Electric Tower IPA-$7.99

11. Santa Clara Valley Brewing Peralta Porter-$6.99

12. Robinson's Trooper (Iron Maiden collaboration beer)-$6.99/16oz

13. Malheur Zestig (hoppy golden ale)-$15.99/25oz

14. Uinta Organic Punk'n Pumpkin Ale-$9.99/6pk

15. Hofbrau Oktoberfest-$9.99/6pk

Fizzy Yoga!

by Shari
Trees in the Ocean by Brad Gibson
I recently looked into physioyoga (aka "fizzy yoga") because I was very displeased with the knee rehabilitation I was currently receiving from a local and very well-respected (in the medical community) orthopedic physical therapist. I was displeased for a number of reasons but the most glaring issue was my feeling that she was myopically looking at my problem. She focused solely on my injury, not on the many parts of  the “whole me” that predisposed me to injury, and when I brought up the various imbalances in my body, she politely listened but refocused the visit on my acute injury. I would leave feeling frustrated, but I would dutifully do my home exercise program and feel my mind disconnect from my body as I was doing them. Though we could “talk shop” about my injury, she didn’t understand or appreciate my yoga practice and couldn’t recommend anything other than “take a couple of weeks off and rest your knee.” Well in my world that recommendation wasn’t going to pay my bills!

So I decided to be more pro-active. I found a local sports medicine internist who did less invasive office procedures and had my knee drained of the edema and injected with cortisone for pain relief. I also knew that I had to find another type of physical therapist who could look at me as a whole person, not just my knee injury, and begin to assist me in the road to healing. I figured I needed to meld the traditional medical approach with the CAM model (complementary alternative medicine) to begin to address my knee injury.

I was already a member of a group called Bridge Builders to Awareness in Healthcare, a world-wide internet group of rehabilitation professionals who all practice yoga and use yoga as a therapeutic modality or therapy to treat a wide variety of chronic and acute health care conditions that have not been successfully treated in the reductionistic American health care system. Perusing this site, I found a lot of talk about “fizzy yoga” and “physioyoga.”

On the various news feeds that I have on my computer there was a lot of talk about one of the stars from “Sex and the City” who was healed from a knee injury under the care of a “fizzy yoga” therapist. Her comments about how “fizzy yoga saved my life” were sensational to say the least, and I was intrigued not only by the name but by the enthusiastic endorsement.

On the Bridge Builders site, I found an article by a Canadian physiotherapist (that is their name for the profession that I call physical therapist) named Shelly Prosko, BPT, PYT, CPI, who wrote a definition of physioyoga for a local news station. Briefly, physio-yoga therapy (PYT) is a type of rehabilitation where the client (patient) and the  medical practitioner enter into an equal partnership toward healing. It is a holistic approach, where the focus is on individual self empowerment and self healing. The physio-yoga therapist is the guide in addressing the imbalances between body, breath, and spirit of the client within the guidelines and principles of yoga.

Upon further reading, I came across some writings by one of the influential originators, Matthew Taylor, MPT, EYT, about the new 21st century health care system (see here). In brief, he draws many parallels between soft tissue structural changes (body), effects on breathing patterns (spirit) and central nervous system vigilance (mind) , emotions (mind) that all interact to create dis-health. I felt that I had finally found my health care community and wasn’t “alone” with how I approached individuals in my physical therapy work!

Okay, so now not only was I hooked, I wanted to find someone in my area to assist me on my path to healing because I knew I couldn’t do it by myself. Looking on Ginger Garner’s Professional Yoga Therapy site, I found someone who was geographically close to me. I read the testimonials that prior patients had written so I could get a sense of her treatment approaches. (This was scary because usually all of my connections are from word of mouth and this was the first time I was doing a search “blind.”)

But from the moment that I walked into this fizzy yoga therapist's office I could feel the pragmatic shift in her model of health care delivery!  She asked me numerous questions, actually LISTENED to my answers and did an incredibly through structural evaluation (physical-therapist based) and started putting associations together between my various weak links. Together on that first visit, we worked on a simple home practice that made sense to me as well as to my knee. Well, I knew that together we would figure this out! We were partners together. It was more egalitarian and not hierarchical so there wasn’t a power discrepancy. Each and every visit I have had after the first is a meeting of minds. I come with my requests for care, she discusses her observations and together we work.

Though it still isn't 100 percent, my right knee is regaining function! I can now kneel with padding for very short periods of times. I can squat, though I still can't come upright without pain. I can sit in Virasana (Hero pose) on one block and I can do Child's pose. I still can't do a lot of the activities that I was doing before the injury, and now my uninjured knee (noting how much it was compensating) has become cranky as well. But I've made a lot of progress over the last 6 months, and hopefully with time I will make even more progress.

So that's my personal testimonial! But what about you? Should you seek a fizzy yoga therapist for your physical problems? Would there be any problems or conditions that would preclude you from seeking care of a fizzy yoga therapist/physio-yoga therapist? I would answer there is only one scenario where this type of health care approach wouldn’t work. If an individual wants to be “fixed” and take no active responsibility in their rehabilitation then I don’t think this system would work for them. You can’t just receive but do have to be an active participant. The fizzy yoga therapists are licensed health care professionals and are vested with the ability to practice their profession by the state they live in. What is different—and this is a huge difference—is how they approach the issue of injury and illness.

Finally, what would I recommend in looking for a fizzy yoga/physio-yoga therapist? I would start with the links listed above and add to that another link http://www.professionalyogatherapy.org/patients/find-therapist to search for someone geographically convenient. I would not choose an individual who has only taken a couple of weekend yoga continuing education classes, and then attempts to use yoga as a modality like other types of “exercise approaches.” In this type of yoga therapy, the clinician really has "walk the walk,” and can’t be an armchair or book yogi. Your therapist's personal practice is really important, in my mind, for them to use yoga as a healing modality. The depth of personal practice can be shared and modified to individual client needs.

Now you might be wondering, since I myself am both a yoga teacher and a physical therapist, am I going to become a fizzy yoga therapist and not just a patient? I think I have been doing yoga with my physical therapy patients for years, but I just never was upfront about it. I'd say things like: "Balance training; lets do some standing poses!", "Respiratory distress? Lets work on ujaaii breathing or deep belly breathing and posture, posture posture! Where is the still point?", and "Self pacing skills? Let's learn to move with intention." The difference is that I have never identified what I do with my patients as "yoga" unless they say to me "this is like yoga!" Because I work under the constraints of Medicare, I have to play by the rules. But my therapeutic skills and my yoga skills complement each other and aren't put into diagnostic boxes when I work clinically. So for now, I would classify myself as "an undercover fizzy therapist."

Tuesday, September 10, 2013

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!

Monday, September 9, 2013

Pranayama for Everyone: Bhramari Breath Practice

by Timothy
Bee and Flower by Melina Meza
One of the dirty secrets of the yoga world is how few yoga practitioners—and how few teachers—do pranayama, yogic breathing exercises. It's better in some yoga traditions than others, but overall I've been shocked to see how few of my colleagues practice pranayama regularly. This is a shame!

The breath is probably the single best way to affect the autonomic nervous system, which in turn controls the function of every internal organ, as well as systems like digestion and immunity. Pranayama can also be the gateway into meditation and higher yogic practices. Furthermore, there is a potential synergy: the regular practice of pranayama can make your asana practice subtler and more refined, and your meditation deeper and more concentrated. For therapeutic purposes, I believe there is synergistic benefit from doing some asana, along with pranayama, meditation, and other yogic practices.

Some schools teach that only experienced practitioners should attempt yogic breathing practices. There is wisdom in being careful, as pranayama done incorrectly—and especially if it's done too aggressively—can lead to problems with the nervous system and, in extreme cases, to psychological decompensation. But there are a few basic pranayama practices that I have found are safe for virtually everyone, and I'll be writing about them in this and my next few blog posts.

I'll begin today with one of my favorites: Bhramari [pronounced brah mah REE], which means the "buzzing of the bees." Although, in my experience, this is one of the pranayama techniques that's rarely taught (at least in many traditions), it's simple, safe, and has tremendous therapeutic potential.

To do a simple version of Bhramari, sit in a comfortable upright position as you would for meditation. Keeping your mouth closed, with your exhalation make a low- to medium-pitched humming sound in your throat. As you make the sound, which should last the entire length of the exhalation, tune into the literal vibration of the sound waves in your throat and even in your skull and brain. Then inhale through your nose, and if you're comfortable, repeat. Try to make your transitions into and out of each humming exhalation as smooth as possible.

At first, you might try Bhramari for a minute, but if it's goes well you can progress to a few minutes at a time. Depending on your breath capacity, the exhalation might vary from short to quite long. I'd suggest doing as long an exhalation as feels completely comfortable. At all times, each subsequent inhalation should be smooth, without any breath hunger. If you are feeling at all short of breath, you've likely pushed harder than you should, and if so, simply take a catch up breath and then resume Bhramari. If you feel at all agitated, I'd suggest you suspend the practice for the day and try it again another time with shorter exhalations.

Most people who do Bhramari as I've described it above will find the practice soothing. Since you will be lengthening your exhalation relative to your inhalation, the Bharmari breath activates the parasympathetic nervous system, and within a few breaths can bring you to a greater sense of relaxation and calmness. According to the classic text Hatha Yoga Pradipika, "with regular practice of bhramari, bliss arises in the heart."

A recent study Immediate effect of a slow pace breathing exercise Bhramari pranayama on blood pressure and heart rate suggested that the practice can lower blood pressure. In my yoga therapy work, I've found it useful for stress and various stress-related conditions, including insomnia (try a low-pitched sound). It's also useful for nasal congestion due to colds, allergies or sinus infections (use a slightly higher-pitched sound so that you can feel your nose and sinuses vibrating).

I even sometimes recommend Bhramari as a meditation alternative for people who find their minds so distressingly busy when they sit that they can't do the practice. It's harder for the monkey mind to go wild over the racket the buzzing of the bees makes internally, allowing you to settle in something moving in the direction of meditation.

Next up: Alternative Nostril Breathing.

Friday, September 6, 2013

Friday Q&A: Pain After a Total Knee Replacement

Q: I have had a TKR (total knee replacement) in March this year (5 months ago). I still have pain and swelling in the repaired knee, mainly on the outer side and behind the knee. Is there any yoga exercise recommended to stabilize the knee and make it healthy?

A: I am sorry to read that your Total Knee Replacement (TKR) has not resolved all the issues you hoped it would have accomplished. Literature review states that 90% of all patients are pain free after six months, but sometimes the recovery period can take a full 12 months. Ten percent of TKR patients are not pain free within this time period.

Pain is a symptom of an underlying problem. The cause of the pain needs to be thoroughly addressed by the surgeon who performed your surgery. My advice would be to return to him and have him perform a complete exam, including diagnostic studies (X-ray, CT scan, blood work) to rule out any underlying infection and to ascertain the alignment of the knee prosthesis.

The other thing you might consider is a complete orthopedic examination by a physical therapist who is skilled with post-operative TKR rehabilitation, especially someone who can evaluate the biomechanical basis of your knee pain and look completely at your legs, hips, pelvis, back and how you move in space. A wonderful resource for you to check out is called Bridgebuilders to Awareness in Healthcare, a group of yogi rehabilitation professionals who blend traditional physical therapy and other rehabilitation disciplines with the practice and application of yoga in a therapeutic context to assist you in your journey back to wellness.

It is very common for the TKR to correct the arthritic cause of pain but if the patella is not tracking well and is not aligned within the patellar groove, then the imbalance when the quadriceps tendon contracts to straighten your knee will be extremely irritating. So if you are doing straight leg raises with or without weights, long arc quadriceps sets, or any other quadriceps strengthening exercises, the first thing you can do is stop anything that causes knee pain when the knee muscles are contracting. After you and your surgeon rule out any underlying pathology or prosthesis problems, you also may want to try to figure out how your current pain is different from your old pain. If you had knee issues similar to the ones you are having now then it is definitely important for you to see a rehabilitation professional.

If you are currently in a yoga class or have a home yoga practice, you really need to pay strict attention to the alignment of your hips, knees and feet as well as attention to how you move into and out of poses. You might want to stop all standing poses for now and instead work on passive inversions like Legs Up the Wall pose (Viparita Karani) or Chair Shoulderstand to see if you can mechanically drain some  of the edema. If the edema and swelling is under the knee cap, you could ask your surgeon if he will aspirate the fluid, and if he agrees, it might not be a bad idea to ask him to culture it to make sure there is no infection lurking in the joint.

I am sorry that I can’t give you a specific "yoga exercise" for stability because I can’t see your body and how it moves. But if you are feeling that your knee is unstable, this is a sure sign that the leg is weak and it is unable to balance on itself. Please be patient and be a good detective. If your surgeon's assessments all come back negative, that is a good conclusion because you will know you can work on the specific issues at hand. With diligence and compassion for your knee, it will hopefully progress and allow you to resume the activities that are important for you.

—Shari

Thursday, September 5, 2013

Healthy Spirits: Clement New Arrivals


New Arrivals At Clement an' Twelf

-BFM Abbaye de St Bon-Chien 2012 (oak-aged flanders red-style ale)  $27.99

-Almanac Fresh Hop IPA Series (Cascade, Chinook, Cluster) 25oz   $9.99/ea

-Hanssens Cassis Experimental Lambic   $16.99

-Hanssens Raspberry Experiemental Lambic    $16.99

-Apostelbraeu Historic Roggenbier (rye beer)   $7.99

-JW Lees Harvest Ale 25th Anno Brew (finished in the bottle with champagne yeast, 750mL)  $24.99

-JW Lees Harvest Ale 2012   $9.99

-Borgo Perle a Porci Italian Oyster Stout   $9.99

-Aecht Schlenkerla Weizen   $5.99

-Dieu du Ciel! Rosee d'Hibiscus   $5.99


-Gigantic Brewing Hellion (dry-hopped belgian golden)   $10.99


-More Prairie BOMB !   $9.99

Healthy Spirits: New at Castro


Almanac Fresh Hop IPA Series (Cascade, Chinook, Cluster) 25 oz - $9.99 each.

In the interest of preserving freshness, no reservations will be accepted.

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.

Wednesday, September 4, 2013

Healthy Spirits: New at Castro

 
1. Apostelbraeu Historic Roggenbier-$7.99/16oz

2. JW Lees Harvest Ale 2011- 25th Anniversary (special 750ml bottling finished with Champagne yeast)-$24.99/25oz

3. Ducato L'Ultima Luna (kickass Italian barleywine aged for 30 months in Amarone barrels)-$18.99/12oz

4. BFM Cuvee du 7'eme (sour biere de garde with 7 different aromatic hop varietals)-$22.99/25oz

5. Borgo Perle a Porci Italian Oyster Stout-$9.99/12oz

6. Harviestoun Brewery Schielhallion (warm fermented Scottish lager)-$7.99/16oz

7.Sinebyrchoff Porter-$5.99/12oz

8. Hambleton Ales Toleration (gluten free)-$9.99/16oz

9. t'Smisje Vuuve (witbier)-$5.99/12oz

10. t'Smisje Wostyntje (ale brewed with mustard seeds)-$5.99/12oz

Healthy Spirits: New at Clement and Twelf' !

-Bruery Autumn Maple  $12.99

-Anchor Steam Special Edition America's Cup Magnums  $12.99

-Anchor Steam Variety 12pks   $17.99

-Mort Subite Framboise Lambic   $7.99

-Mort Subite Kriek Lambic    $7.99


-Victory Storm King Imperial Stout 6pks  $13.99


-Sierra Nevada Ovila Saison 4pks   $9.99


-Devil's Canyon Full Boar Scotch Ale   $5.99


-Goose Island 312 Wheat 6pks   $9.99


-Lagunitas Lil Sumpin Sumpin 6pks  $11.99


-Ninkasi Oktoberfest 6pks   $9.99


-SUPER fresh St. Florian's IPA bombers !   $6.99


-Grimbergen Double Ale 6pks   $12.99


-Caracole Amber shorties  $6.99


-Port Brewing Board Meeting Brown Ale  $6.99
 

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