Healthy Spirits: CLEMENT STREET GRAND OPENING

Hey Everyone,

Just wanted to remind you all that we are having a GRAND OPENING party for our new 12^th & Clement Streetlocation!

WHEN:    Saturday March 2nd, 2013 from 11AM - 3PM

WHERE: 1042 Clement St.(the corner of 12th Avenue & Clement St.) San Francisco,CA

DETAILS:

-10% off EVERYTHING in the store for the duration of the event.

-We'll be selling rare and vintage beersfrom our cellar! (bottle limits will apply)

-The first 100 customers will receive a FREE Healthy Spirits canvas tote-bag, while supplies last

-We’ll be sampling our Rami’s Mommy’sline of home-made Middle-Eastern delicacies.

-Loard’s and Bubbie’s will be handing out FREE ICE CREAM!

-All-day incentive-based giveaways, such as Beer / Whiskey signs and other paraphernalia!

The event will begin when the doors open at 11AM.

We hope to see you there!

HEALTHY SPIRITS

1042 CLEMENT STREET

(CORNER OF 12^th& CLEMENT)

SAN FRANCISCO, CA, 94118

(415)682-4260

How to Search Our Blog

by Nina

Recently I ran into a yoga acquaintance who, after saying how she much enjoyed the blog, asked me if there is any way to find a previous post on the blog. Of course, as a blogger and a reader of other blogs, I know exactly how to go about finding a particular post on a blog. But it occurred to me that there may be more than one person out there with the same question, so I decided to write a post about it (and add it permanently to the main page under a “How to Search” tab).

First, you should all know that there are three ways to find a previous post: using the Index, using the Search function, and using the Blog Archive.

I think the index is the most useful, so I’ll begin by describing that. Every single post that we publish is “labeled” with key words (and also with the author’s name). You can see the labels for a given post at the very end of the post. This is basically a form of indexing, and I’ve been doing my best to create a useful index with “labels” that I think readers will want to look up. However, I’ve been indexing the posts as I go along, so the index is a little inconsistent (in a previous life, I indexed whole books on a regular basis, and the best way to do it is after the book is done, in one go).

The Search function allows you to search for posts that include a particular word or phrase. It then provides a list of those posts, from which you can choose the most likely candidate. To be honest, I’m not sure which words it includes in the search because I can’t always find what I’m looking for with this function. But it often does work well.

The Blog Archive lists all the posts by date and title. This is only useful if you have some vague idea of when the post you are interested was published. But this would allow you to, for example, read the very first post or a post from last week whose title you think you may remember.

Now that I’ve got all the background out of the way, here are the basic steps:

1. Start on the main page of the blog. If you are receiving posts by email or as a Google follower, you will need to visit the blog itself to search. Go to: http://heartbeat0521.blogspot.com/.

2. Now look at the right side of the page. If you can’t see the alphabetical index of labels on the right side of the screen, scroll down until you do. It looks like this:

If you have some idea of what you’re looking for (such as “arthritis” or “healthy eating” or “Legs Up the Wall pose” or “Baxter Bell”), scroll through the alphabet to find it and click on that label. You will then see all the posts with that label in the body of the blog. At this point, scroll down through the articles to find the one you’re looking for.

If you don’t have any idea of how the post would have been indexed, scroll down through the alphabet to see if you can find anything that looks likely.

3. If you can’t find the post you want to read again using the index, try using the Search function. On the right side of the window, just above the Blog Archive, you’ll see a Search box.

Click on the empty box, type your search word or phrase into the box, and then press Enter or click the Search button. You’ll then see a list of relevant posts on the left - maybe multiple pages worth. You can then pick the appropriate one by title.

4. If you want to search for the post by year and month, find the Blog Archive between the Search function and the index.

To use the Blog Archive, find the year you want and click the side arrow to open it. Then find the month you want within that year and click the side arrow to open the month. At this point, you'll see the titles of all posts from that month and you can simply click on the title for the post you want to read.

Easy peasy! Happy reading, everyone.

Healthy Spirits: New Arrivals CASTRO

1. Port Brewing Old Viscosity

2. Lost Abbey Devotion

3. Peak Organic IPA

4. Peak Organic Oak Aged Mocha Stout

5. Worthington's Red Shield

6. Worthington's White Shield

7. St. Stefanus Blonde

8. Knee Deep Simtra

9. Marin Old Dipsea Barleywine

10. Mad River John Barleycorn

Healthy Spirits: New Arrivals CASTRO

1. Stone Old Guardian 2013

2. Stone Old Guardian 2013 Oak-Smoked Edition

Healthy Eating: You Are When You Eat

by Ram

That our personality is determined by what we eat is based on the belief “You are what you eat” expounded by Anthelme Brillat-Savarin and  Ludwig Feuerbach who declared that food affects one’s health and state of mind. The philosophy of conscious eating is emphasized in the Ayurvedic texts, the Yoga Sutras, the Bhagavad Gita and Upanishads. According to these texts, if digestion is not optimal, it can trigger imbalances in other systems of the body, including the mind. Optimal digestion directly and swiftly corrects imbalances and in doing so, brings an end to suffering and prevents future disease. Most of us experience digestive disturbances at some time in our lives, some acute and some chronic that cause both discomfort and embarrassment. Correction of the digestive system is a part of the treatment of every imbalance in the body.

The above texts also stress the importance of being in tune with nature while eating consciously. Through food we connect to nature and become one with it. When we live in harmony with nature we experience optimal health and digestion and peace of mind. When we are out of harmony, we experience suffering. In realizing our connection to nature through eating, our relationship with food becomes a sacred experience. Furthermore, our close connection with nature also helps us to become aware of the role of the movement of the sun in influencing and impacting our digestion. The sun represents the fire element and in the physical body this is reflected as the process of transformation of the food by the heat of the digestive juices (jatharagni in Ayurveda). Thus, when the sun is at its peak in the sky, digestion is stronger and optimal. Similarly, digestive capacity is at its ebb during dawn or in the evening twilight when the sun is either rising or setting. Therefore, the above texts also recommend eating our largest meal during the midday hours when the sun is at its peak and smaller meals in the morning and evening. Such timed meals based on the sun’s position not only prevent weight gain and onset of other digestive-related problems but also ensures a disease-free long life. Some of these facts were clearly laid out in Nina’s post Yoga for Healthy Eating: An interview with Dayna Macy

Glad Day by William Blake

The above mentioned principles of consciously eating in tune with the sun’s position is now supported by a recent research study Timing of food intake predicts weight loss effectiveness  that suggests that you’re not only what you eat, but when you eat. According to this research study, having lunch as the main meal of the day (anytime before 3 pm) in fact could help you lose weight. The study just published in the International Journal of Obesity was carried out by a team of researchers at Spain’s University of Murcia, Boston's Brigham and Women’s Hospital and Tufts University in Medford, Mass. In this prospective study, 420 overweight men and women who lived in the Spanish seaside town of Murcia were monitored for 20 weeks while restricting their calorie intake to about 1,400 a day. The participants were divided into two groups: early-eaters who ate their lunch anytime before 3 p.m. and late-eaters that ate after 3 p.m. Among the findings reported in the journal:

• Early eaters lost an average of 22 pounds in 20 weeks; late eaters lost about 17 pounds.
• The late eaters consumed fewer calories during breakfast and were more likely to skip breakfast than early eaters.
• The late eaters had lower insulin sensitivity, which is a risk factor for diabetes.

The researches also noted that the effects of sleep and biological clocks have a close association with weight regulation in animals. If the timing of meals doesn’t match with the sleep cycle, there is a disconnect between the different body’s biological clocks leading to obesity and other physical problems. Thus, the results of the study not only demonstrate the need to avoid eating late at night but also the findings unequivocally demonstrate that timing of meals is a clear predictor of weight-loss effectiveness. While shifting to an early feast may not be too difficult for folks in Spain where the main meal of the day happens to be at mid-day, it could take quite an effort to convince folks here in the U.S., where the largest meal of the day (aka dinner) coincides with the setting sun. But give it try—remember to make hay and eat your biggest meal while the sun shines.

Holding It All Together, Part 1: Ligaments

by Baxter

As I was prepping for my upcoming workshop this Saturday on Yoga and the Musculoskeletal System out in Brentwood, CA (see Brentwood Yoga Center Workshops for registration information), I decided to look back at my old blog posts to see what I had written regarding tendons and ligaments, two of the main structures we’ll be talking about this weekend. And much to my surprise, I found that I had not yet addressed these basic and vital topics. So today I thought I’d begin a discussion on ligaments, anticipating that I’ll come back to tendons again in the future.

Let’s begin by looking at some basic definitions for these two structures. Both ligaments and tendons are composed of something anatomists call “connective tissue,” which is a collection of tissue types that often serve the function of keeping our different body structures together, and include such diverse tissues as the above tendons and ligaments, as well as fascia, intervertebral discs, cartilage in the ears and nose, cartilage coating the ends of bones and others. Connective tissues, depending on what their function in the body is, will either be more or less elastic by virtue of the proportions of the components that make up connective tissue: collagen and/or elastin fibers, which float in a semi-fluid gel called ground substance. According to Mel Robin, in his book A Physiological Handbook for Teachers of Yogasana, connective tissue works as a mechanical support or binder for other tissues, allows for food and waste from cells to move in and out, acts as a lubricant and is the body’s glue. 

So what then are the structures that ligaments glue together and what are the unique features of ligaments? Ligaments are specialized connective tissue that binds bones to bones. They keep the bones of your joints in close proximity so they don’t dislocate (which sometimes still can happen, in the shoulder joints, for example), and they allow for a certain amount of passive movement in some directions and restrict movement in others.  In fact, restraining movement is one of the main functions of ligaments. They happen to be high in collagen fibers and low in elastin fibers, which makes ligaments strong, but not very flexible. According to David Coulter in his book Anatomy of Hatha Yoga ligaments are:

“...made up of tough, ropey, densely packed inelastic connective tissue fibers, with only a few cells interspersed between large packets of fibers.”

Knee Joint (with ligaments)

Usually, the amount of stretch that can take place in a ligament is very minor, only around 4%, but there are exceptions, such as ligaments in the cervical spine region, which have been found to stretch up to 200%! In contrast, those around the knee joint have very little elastin, so are much more rigid to provide more stability to the joint. This can have relevance for our yoga practice. As an example, deep flexion (forward bending) of the neck as in Shoulderstand will not permanently overstretch the neck ligaments. But deep flexion (bending) of the knee as in Supta Virasana has to be approached cautiously and mindfully so as to not overstretch the supporting ligaments of the knee. If the ligaments are overstretched, they will not return to their original length and will be permanently loose and ineffective in stabilizing the knee. In general, you want to focus on stretching the muscle and not the ligaments in your yoga practice.

Another reason to avoid overstretching or, even worse, tearing a ligament, is that ligaments have a poor blood supply. Due to this poor supply, getting repair cells into an injured ligament and taking away the waste and injured material is more difficult, and healing is therefore slow. Also, ligaments have very few cells—which are the things that have to be stimulated in an injury to produce more fibers and fluid—and this contributes to slow healing as well. 

Those out there who have injured the ligaments at the side of the knee joint, the collateral ligaments, via sports like soccer or football, can attest to the long healing times I am referring to here. When we sprain a ligament, not only do we experience some pain and swelling, but the area also seems looser and more prone to re-injury. A ligament sprain that almost everyone has experienced at one time or another like this is the outer ankle.

It seems that one of the safest ways to stretch your tight muscles, and avoid stretching your supportive yet rigid ligaments, is via moderate intensity, slow, held stretches. Warmer muscles and ligaments seem to do this more healthily then cold ones, so I like to move slowly and mindfully in and out of a position a few times to warm up the tissues, and then follow that up with a more sustained hold. And the good news regarding safe stretching is that our nervous system warns us as we approach the kind of overstretch that could tear our ligaments (and tendons) through pain (which can have a whole range of variety and intensity), trembling or weakness. This is yet another reason to pay close attention to the sensations that arise as you perform your asanas. Also important is the location of the sensations, as those arising in the mid-length of the muscles is much more acceptable than sensations occurring right over joints. You might hang in there a bit longer in the first instance and come out of a stretch promptly in the latter!  

Next time, I’ll discuss tendons, which share some similarities with ligaments, but have some unique functions as well.

What is Osteopenia? And How Can Yoga Help?

by Shari

Last Friday Baxter answered a reader’s question about osteopenia (see Friday Q&A: Yoga and Osteopenia), regarding whether or not yoga practice on its own is sufficient to maintain and/or increase bone strength. By chance, we recently received a request for an article addressing “dangerous” poses for osteopenia. Since most of you probably don’t know much about osteopenia—and its relationship to osteoporosis— we decided it was about time to provide some background information about the condition. I promise I’ll get around to answering the reader’s question eventually! Look for it this coming Friday.

Let’s start by discussing osteoporosis, which is a disease in which bones become fragile and are more likely to break or fracture due to loss of density (not bone strength). It is not painful and many people (both men and women) don’t even know they have it or are at risk for developing it until they take a DEXA scan. The DEXA scan (dual energy X-ray absorptiometry scan) measures bone mineral mass, because medical researchers have discovered that there is a correlation between bone breaking and bone density loss. But the DEXA scan can also cause lot of confusion because it doesn’t take into consideration the different way bones are constructed. Some bones are short and fat, and some are long and thin, and differently shaped bones can have different density readings. Bone mass is affected by both how densely a bone is constructed and by its corresponding physical dimensions.

Femur Bone

The World Health Organization has defined the statistical measurements of bone density through a system of comparing your numbers to women of the same age, height and weight, and then comparing them to the average measurements of women age 25-30 that are at the peak of bone strength. Three areas are measured in the DEXA scan: lumbar spine, total hip, and surgical neck of the femur (thigh bone). Two scores are given:

• T score, which is the measurement of bone mineral density and how your score compares to healthy 25-30 year old women.
• Z score, which is the comparison to women your age, height and weight.

Osteopenia is defined as a T score of 1 to 2.5 standard deviations below the mean (negative numbers), and means that you are at risk for developing osteoporosis. Osteoporosis is defined as a T score of 2.5 standard deviations below the mean (negative numbers). The higher the T score (or the more negative the numbers), the higher the fracture risk.

The correlation between a low bone mineral-density reading in a DEXA scan and a higher fracture risk is stronger than the relationship between high blood pressure and a stroke. But even though the test detects 9 out of 10 people with osteoporosis, the test is not perfect and it wrongly diagnoses healthy bones between 5-7% of the time. Also, readings will differ in different test sites, so for consistency the same test facility needs to be used for repeated scans.

So how does yoga fit into this picture? Bone has two main components: outer bone and inner bone. Bone is a living matrix of living cells and canals that are interrelated. Outer bone, which surrounds inner bone, is called the cortex and it forms a hard outer ring and is a large part of bone strength. Its construction is fairly uniform in individuals. Inner bone is spongy and is called cancellus or trabecular bone. It varies greatly in individuals. For us to improve our bone health we want to not only build outer bone but also inner bone.

Wolff’s law describes bone strength as follows:

1. The architectural strength of a bone develops along the lines of force that the bone is subjected to.
2. If a bone is loaded, the bone will remodel itself over time to become stronger and resist that sort of loading.

In conjunction with Wolff’s law there are some other important forces that act on the bones to improve bone strength and density:

1. Gravity increases bone loading. 
2. Muscle contraction increases bone loading. Dynamic tension occurring between muscle agonist and antagonist affects the bones by applying opposite pressures, and the forces are doubled on the bone.
3. Muscle activity stimulates bones to strengthen themselves more vigorously than weight bearing alone.

In our yoga asana practice, we not only take weight-bearing positions, such as standing poses, but all the active poses involve muscle contraction in some form. And the great variety of poses and movements means that all your bones are involved! In addition, Dr. Loren Fishman cites from his extensive research on osteoporosis that bone stimulation (growth) occurs after 12 seconds of static (isometric) hold but not more after 72 seconds of hold. 20-30 second holds are recommended for bone stimulation. And 20-30 second holds are quite typical for many of the poses we practice.

Now you can see why yoga is recommended for people with osteopenia as a way to prevent the development of osteoporosis and is also considered beneficial for people who already have osteoporosis. And for those of us who don’t have either condition, yoga is a very versatile and adaptable way for maintaining our bone strength. However, because osteopenia means more fragile bones, certain yoga poses are considered risky for people with the condition. Tune in Friday for my answer to the reader’s question about those poses.

CLEMENT STORE GRAND OPENING! - Saturday March 2nd, 2013 11AM-3PM

Hey all,

The guys over at Clement are throwing their GRAND OPENING party!


WHEN: Saturday March 2nd, 2013 from 11AM - 3PM

WHERE: 1042 Clement St. (the corner of 12th ave and Clement St.) San Francisco, CA


WHAT'S GOING DOWN:

-10% off everything in the store! (from 11AM-3PM)

-We'll be selling rare and vintage beers from our cellar! (bottle limits will apply)

-1st 100 customers receive a FREE Healthy Spirits canvas tote-bag, while supplies last

-Rami's Mommy's Middle Eastern snacks and dips tasting! We'll also provide non-alcoholic beverages for in-house consumption.

-All-day incentive giveaways, such as Beer / Whiskey signs and other paraphanelia!



The event will begin when the doors open at 11AM.

We hope to see you there!

Healthy Spirits: Fresh batch of St. Florian's IPA!

Both CASTRO and CLEMENT just got fresh 22oz and 6 packs of the delicious St. Florian's IPA! We are still the ONLY PLACE IN THE CITY where you can purchase St. Florian's beers!

Tasting Notes:
Bracingly dry and citrusy, with huge aromas of pineapple and mango. A straightforward IPA that revels and excels in its simplicity. The combination of Cascade and Zythos hops creates an interplay of bold tropical fruit, juicy citrus, and palate wrecking bitterness that demands repeat performances. I like it. 

 -Dave Hauslein, Beer Manager

Friday Q&A: Yoga and Osteopenia

Q: I have been going to a yoga class 3x a week for about three months. It's at my gym, and my teacher trained with one of Erich Schiffmann’s students.  I used to weight train, for about ten years, but found my motivation ebbing, but loved having muscle definition. I love doing yoga! My body feels so much better, I walk better, my shoulders feel more open, and I have a wonderful sense of peace. My questions are, is yoga enough to maintain my bone mass? (I am small, with slender bones, have osteopenia). Also, are cardio and walking ok? Not strenuous enough? I want to incorporate a daily yoga practice in addition to my classes. I can tell my energy and strength are different now, how to stay healthy now that I'm almost 61?

A: Thanks for your interesting question. I am so excited to hear how the yoga practices are feeling for your body and your life! A balanced yoga asana practice may indeed provide enough stimulation to your bones to stabilize or improve your condition of osteopenia, the precursor state to osteoporosis. We know that yoga asana can increase the density or mass of bones, and we think it also may add the added benefit of changing the structure of the bone to be stronger and more pliable. In addition, as Loren Fishman, MD points out in a recent interview on this topic:

“There are numerous other important ways in which yoga benefits people with osteoporosis, such as improving balance, muscular strength, range of motion and coordination, while lessening anxiety.” 

 In fact, I recommend that you read this interview on YogaU Yoga for Osteoporosis - An Interview with Loren Fishman, M.D. and Ellen Saltonstall, as it is quite informative.

Cardio workouts and walking are certainly good additions for your overall health, and walking is beneficial for your osteopenia as well. You do need to be mindful of any forward bending in your regular yoga classes, as these are usually contra-indicated for osteopenia, and go easy on any side-bending poses, as they are also a potential problem. We’ll have more on osteopenia from Shari next week, including information about how to modify your yoga practice, so stay tuned!

I love Erich Schiffmann’s style of yoga and have studied with him over the years, but for your condition I would recommend adding in a more alignment-based style of yoga (such as Iyengar or Anusara) with a well-trained, experienced teacher. As you become more familiar with the poses that are likely to benefit your bones, you can start doing some of these each day at home as the foundation for your home practice. Another good resource for your home practice is Dr. Fishman’s book Yoga for Osteoporosis: The Complete Guide. It sounds like with all that, you’ll being doing a lot for your health each week. Please let us know how things go for you!

—Baxter

Drawing a Line in the Sand: Where Yoga Teachers Should Not Go

by Baxter and Nina

Yesterday Baxter was interviewed by YogaU (we will announce when the interview is available online, sometime in April), and he was asked to discuss the concept of yoga as “Lifestyle Medicine” looking at its potential and its challenges. One of the challenges that came up during the discussion was something Nina mentioned to Baxter while he was preparing for the interview, and we both realized it was something so important that we decided to share our thoughts with you about it on the blog today.

The challenge is: Where do we draw the boundary between yoga therapy and practicing medicine, physical or other types of rehabilitation therapy, or psychotherapy?

Silver Beach by Brad Gibson

One clear line in the sand we can draw is that yoga teachers should never try to diagnose a medical or psychological condition. This is because we are not trained to do so and, in fact, are not legally permitted to. This means if a student comes to you with a complaint that has not been formally diagnosed, you must refrain from offering an opinion as to what could possibly be wrong. However, as you are in an influential position, you can—and probably should—encourage your student to go and get a diagnosis.

Once you have the diagnosis, if you’ve had proper training in yoga therapeutics, you can then make suggestions for yoga tools that could help your student. This is where you come into your own! Yoga has an enormous repertoire of different physical movements—some not available through other forms of exercise—that can be of tremendous benefit to a large number of conditions. Teaching asana to release held tension, build strength, increase flexibility, and improve balance and mobility provides a powerful approach to healing that western medicine typically doesn’t include. And teaching stress reduction techniques can be tremendously helpful for a number of both physical and psychological problems.

If you don’t yet have a diagnosis but the student’s complaint seems like one of those problems whose symptoms can be relieved by yoga, such as back pain, muscle soreness or joint stiffness, you can suggest some possible poses without promising any particular result but being willing to stay open to see what happens. An undiagnosed back pain, for example, might be relieved by general low back practices but also might not be if there is a serious underlying condition. If the complaint seems like one that would be helped by stress management, such as anxiety or insomnia, you can always offer relaxation techniques, as these are safe for anyone. And, finally, as Nina wrote yesterday in Yoga to Reduce Suffering, we can always offer possible suggestions for reducing suffering. But this is all with the understanding that if the problem persists, the student should consult a professional.

Conversely, if you are a student hoping to get some help from a yoga teacher, you need to understand that your teacher is not licensed to diagnose your problem even if he or she is billed as a “yoga therapist." And if your teacher is offering you what seems to be diagnostic advice, you might want to check to see what their training is. If your teacher has additional training, such as Baxter (an MD) and Shari (a physical therapist) do, you might feel more comfortable taking his or her advice. But without a thorough physical examination, even a medical doctor or physical therapist can only make an educated guess, which you should take as a suggestion more than as a definitive diagnosis. (And if he or she does not have additional training, you should definitely be wary.)

And if you want to get the best out of your teacher, go see a professional first and find out exactly what is going on. Then share your diagnosis with your teacher. At that point, your teacher will be free to make suggestions and recommendations that might be very helpful for you, and he or she can also do a better job of keeping you safe in the classroom. Keep in mind that yoga therapists will often have areas of specialty, such as back care, cancer care, or depression, so you may need to find a different teacher or yoga therapist who has expertise your area. The good news is that yoga has been taught in the US for over 50 years, and there are experienced teachers now in almost every part of the country. So after you’ve been to the doctor or therapist and received your diagnosis, if you've taken the time to find a teacher with the right expertise, you’ll have someone with a powerful set of tools to help you on the road to healing.

How’s that for a line in the sand?

Healthy Spirits CASTRO: New Arrivals

New Arrivals CASTRO:

 1. Almanac Farmer's Reserve No.1 (Ale brewed with plums and cabernet, muscat & concord grapes and aged in used wine barrels)

2. Almanac Farmer's Reserve No.2 (Ale brewed with Heirloom Pumpkins, Fuyu Persimmons and fresh ginger and aged in white wine barrels)

3. 21st Amendment Lower De Boom (barleywine in nip-sized cans)

4. Dogfish Head+Sierra Rhizing Bines

5. Lagunitas WTF

6. Firestone Walker Sucaba (limit 2 per person)

7. Mateveza Morpho

8. Maui+Dogfish Head Liquid Breadfuit

9. Maui Aloha B'ak'tun Stout

10. Bruery Sour in the Rye

11. Port Brewing Board Meeting Brown Ale

12. Russian River Supplication

Yoga to Reduce Suffering

by Nina 

II.16 Suffering that has yet to manifest is to be avoided. —Yoga Sutras, trans. by Edwin Byrant

Melitta's post Aging, Diabetes and Yoga  and Shari’s post Ruminations on Health reminded us that although yoga can be helpful for many conditions, it is far from a cure all. Melitta’s life is sustained through western medicine (that is, insulin), without which she would have died. And as Shari said:

My own personal pet peeve is the often unspoken allegation within alternative healthcare communities of “healthy living” that if you lived a more “pure and holistic life,” this illness or health problem wouldn’t be happening to you. Too many women I have known with breast cancer have felt the twinge of anxiety that they were the cause of their own cancers. But how much do we owe to our own genetic predispositions rather than to emotional and environmental stresses?

On the other hand, I think all three of us believe that yoga has something important to offer to people suffering from chronic and even terminal diseases or conditions: the reduction of suffering.

This message came home to me in a very powerful way when I attended a therapeutic workshop on yoga for cancer, taught by Bonnie Maeda, RN. As a nurse, Bonnie has a clear-eyed understanding that yoga cannot cure cancer and, indeed, that even western medicine cannot always do the job. So what she has been offering her students, along with a chance to move and regain strength, is the reduction of suffering. This was especially evident when she led us through a sequence that she had designed specifically for this particular set of yoga practitioners. The sequence—which was unlike any I’d ever seen before—was a gentle Vinyasa series that used the wall for support. Bonnie explained that she felt this particular group needed to engage their minds by moving mindfully from one pose to another as they followed their breath, but, because they were often weak from illness or treatments, the wall was necessary for support and safety. To be honest, I thought the sequence was brilliant! It was providing gentle exercise for people who needed to build up their strength, while at same time functioning as a mindfulness practice to help focus minds on the present and distract from worries about the future.

After the movement came supported poses and relaxation. Stress management is also invaluable for people with chronic illnesses as it can help reduce both physical and emotional pain, as well as supporting healing. As we’ve mentioned before on this blog, yoga provides such a wide range of stress management tools (meditation, breath awareness, pranayama, conscious relaxation practices, restorative poses, supported inverted poses, and active practice to release physical tension) that there is something suitable for almost everyone.

For those of us who are teachers, it is important for us to remind ourselves both of the limitations of what we can offer and of the simple but powerful solutions that we can provide. Both mindful movement and stress management techniques are safe practices that can help reduce the suffering of people enduring great challenges.

And as human beings, it is heartening to remember that there are powerful practices we can rely on when difficulty arises.

Yoga and Heart Health: Atrial Fibrillation

by Baxter

A yoga workshop to Cincinnati brought me face to face with my first “medical emergency” in the yoga classroom. On the first night of a two-day workshop, one of the students began to complain of a rapid heartbeat and some shortness of breath. I took her off to the side while my co-teacher continued to work with the rest of the group, and discovered, after a few more questions, that she had a condition know as atrial fibrillation. Turns out she had been feeling well lately and had decided to cut back on the medication used to keep her heart rate in a safer range. Fortunately, in this instance, I was able to get the life squad there quickly and shuttle her off to the ER for appropriate care, and the rest of the workshop continued without a hitch. Now a dozen years later, an ongoing study at the University of Kansas seems to suggest that yoga may be helpful in treating this particular heart condition!

So what is atrial fibrillation? According to the National Institutes of Health:

“Atrial fibrillation (A-tre-al fi-bri-LA-shun), or AF, is the most common type of arrhythmia (ah-RITH-me-ah). An arrhythmia is a problem with the rate or rhythm of the heartbeat. During an arrhythmia, the heart can beat too fast, too slow, or with an irregular rhythm. AF occurs if rapid, disorganized electrical signals (emphasis mine) cause the heart's two upper chambers—called the atria (AY-tree-uh)—to fibrillate. The term "fibrillate" means to contract very fast and irregularly.”

Sometimes, people who develop this condition notice the rapid, irregular beating of the heart, but sometimes it can go unnoticed for a while. And two very serious conditions can result from untreated atrial fibrillation: strokes (which occur suddenly) and heart failure (which develops more gradually). The underlying problem has to do with the heart’s electrical system not functioning correctly. And because the normal spread of the electrical impulses is both too fast and uncoordinated, the heart becomes both less efficient at sending blood out to the lungs and the body, and blood tends to pool or hang out in the heart chambers longer than it is supposed to. This pooling can lead to blood clots forming in the chambers of the heart, which could then be launched into the arteries that lead to the brain, and—whammo!—a stroke occurs. For more information about AF, check out What is Atrial Fibrillation? from the National Institutes of Health.

Back to 12 years ago, when I was confronted with someone who was having acute symptoms of her rapid heart rate, I needed to get her to a facility that could quickly get her heart rate in a safer range and make sure she was not at risk of a stroke. And I did not have information then on how yoga might impact the course of her problem. Now, research being conducted in Kansas is suggesting that yoga may be a part of the future treatment of AF. At the University of Kansas Hospital, an ongoing study is looking at the effect of regular yoga practice on irregular heartbeat. The yoga world has long known about the connection between yoga meditation and breath techniques and the ability to influence the heart rate. This connection between the mind and the heart is at the center of the theory on how yoga may help with AF. Via yoga’s ability to influence and change the autonomic nervous system, patients may be able to have more control over their heart rate than those who do not do yoga. It is also known that stressful situations and emotional moments can trigger the AF person’s heart to beat more rapidly. So the researchers are monitoring the study participants for how many episodes of recurrent AF happen while on the yoga regimen. They report that the initial results look promising.

AF is one of those medical conditions where a combination of modern western treatment, which includes medications that help control the rate and rhythm of the heart and procedures to help if meds don’t, and lifestyle modifications, like yoga as well as diet and other exercise, will optimize the health of the person with AF. The study is not yet completed, but we will try to keep an eye open for the final report and give you an update when that happens. In the meantime, see Yoga My Heart  for more about the University of Kansas Hospital study.

Ruminations on Health: What We Can and Cannot Control

by Shari

Branches by Brad Gibson

I grew up in an eastern European Jewish household where dinnertime conversation often centered around health. Family gatherings were punctuated by relatives recounting details of various  ailments and how many doctors they were seeing. They were often pretty graphic in their descriptions during these mealtime conversations. My family’s preoccupation with their bodily functions struck me as odd as a child, and I didn’t understand how people could complain about their health but not really do anything about it. I made a conscious decision at that time to be proactive with my own health, and my lifestyle decisions and pursuits since then have reflected this.

Now I'm at the age where I am regularly receiving AARP notifications, and I'm starting to reflect on how I may be more like my parents and family than I may like to think. How many of you regularly talk with your friends about your health concerns or routine tests that a physician may be prescribing or recommending? We talk about these issues partly to become informed about procedures, but also to commiserate and offer support and empathy when complications occur. We often compare notes on which care providers have been helpful to us. There have even been times where I have looked up providers on YELP to see what their ratings were. During the AIDS epidemic in the 1980’s, my husband and I lost many friends, so we learned that illness isn’t just for “old people.” And how many of us have lost loved ones and acquaintances to cancer or other chronic diseases?

In the yoga community there are many passionate individuals who believe whole-heartedly in a way of health that I feel is fairly rigid. My own personal pet peeve is the often unspoken allegation within alternative healthcare communities of “healthy living” that if you lived a more “pure and holistic life,” this illness or health problem wouldn’t be happening to you. Too many women I have known with breast cancer have felt the twinge of anxiety that they were the cause of their own cancers. But how much do we owe to our own genetic predispositions rather than to emotional and environmental stresses?

My mother, for example, died of multi-infarct dementia, which caused severe dementia in her last years. She was a cholesterol producer, and no amount of dietary restrictions or faithfully taken statins could keep her cholesterol levels within “therapeutic ranges.” And lo and behold, right after I turned 57 and went for my annual physical and blood work, my doctor contacted me to tell me my “bad cholesterol levels were high.” With further blood work, using more sensitive lipid panels and getting a more complete picture, my numbers came back better. But I was still demonstrating risk factors, so my doctor counseled me on good nutrition (which I already practice), exercise (which I already do), and stress reduction (which I already do). She then commented to me, “Well I suppose this is where your genetic history is coming into play and we just have to watch it.” Oh dear, I thought, now what?

In Melitta’s recent post Aging, Diabetes and Yoga I was struck by her self education regarding Type 1 diabetes, and how she had to play an active role in her healthcare management, even educating her physician on the nature of her disease to get a proper diagnosis. Her story emphasized the need to be involved in your healthcare decisions and not be passive in accepting what “experts” tell you. But it was also inspiring to me because here was someone who was both realistic about her condition (yoga cannot cure Type 1 diabetes) but who at the same time found yoga invaluable for helping her live with (and work with) a chronic condition.

It got me thinking about my own situation. I considered becoming more restrictive with my fat intake, but then concluded it would lead to more stress in the long run. I came to the conclusion that I had to accept my genetic heritage. No, I wouldn’t become like my extended family and bemoan the state of my health, discussing it whenever the opportunity arose while taking no responsibility for my actions. Nor would I become strident in regimenting my life with countless restrictions and intentions. Instead I decided to mindfully continue to engage in activities that made me feel good while maintaining an awareness and consciousness of what and when I ate. As in my yoga practice, I will aim for balance and intention. My genetics are a big factor in my health, but my lifestyle and personal practice of yoga seem to be potent tools that I can use in accepting my genetic hand of cards!

Healthy Spirits: New Arrivals CASTRO

New Arrivals CASTRO:

1. Cismontane Mesa (lactobacillus table beer w/Nelson Sauvin hops and riesling grape juice)

2. Cismontane Oso (Imperial Porter aged in rye barrels)

Healthy Spirits CASTRO LOCATION: New Arrivals

New Arrivals CASTRO:

1. Trois Dames L'Amoureuse Blanche

2. Trois Dames L'Amoureuse Rouge

3. Prairie Artisan Ales Prairie Ale

4. Prairie Artisan Ales Prairie Hop

5. To/Ol Barrel-Aged Mine is Bigger Than Yours (Muscatel Barrel)

6. Uncommon Brewers Siamese Twin Ale

7. Uncommon Brewers Golden State Ale

8. Uncommon Brewers Bacon Brown Ale

9. Uncommon Brewers Baltic Porter

Cheers,

Dave Hauslein

Beer Manager

415-255-0610

Friday Q&A: Bypass Surgery

Q: I have a 65 year old male student who is having open heart surgery in a couple of days. He will be having a triple bypass with valve repair/replacement. How long (approximately) will his recovery be before he can come back to a Yoga Basics type class where we do basic postures and sun salutes? What will be the main cautions for me to be aware of as a teacher? Will his breathing be impaired? Thank you for your guidance.

A: As you might imagine, there are a lot a factors that will play into how quickly your student might return to a typical yoga asana practice after such a major surgery. So, his clearance to return to yoga will be entirely up to your student’s heart surgeon and post-operative care team. In all likelihood, he will have some physical therapy to guide him back to activities, as he will have a major chest scar that will take a while to heal. In addition to the chest scar, your student is also having a valve in the heart replaced, and will likely be on blood thinning medications for at least the short term. This can lead to bruising easily.

Cow-Face Pose Arms

 As for main cautions to be aware of as a yoga teacher, as with most situations, you want to meet your student where he is at on any given day. It would be helpful to meet with your student for at least one private session to try out some very beginner, basic movements that would likely show up on class. Keep in mind that anything that engages the muscles of the front chest, either contracting or stretching, will affect the healing breastbone area. So go slowly with things like arms overhead, out to the sides, or behind the torso. Be very mindful of more advanced positions for the arms, such as Eagle pose or Cow-Face pose arms. Lying on the chest may not be possible for a while, so keep that in mind when doing prone poses like Locust or Cobra. He may have to do a seated or standing variation of such poses. And back-bending postures will likely need to be much shallower then pre-operatively.

And for the possibility of bruising easily, you will want to mindful of poses where you are placing body parts on to one another, like the modified version Extended Side Angle pose (Utthita Parsvokanasana), when the elbow is placed on the distal thigh of the front leg. If the student does this pose without mindfulness, he could get a big bruise there, and although this is mostly of cosmetic concern, preventing it from happening will probably be much appreciated.  Stacking the legs, such as in Fire Log pose (a preparation for Lotus pose) is another one to watch out for, and you can probably come up with others as well.

On the positive side of the ledger, if the surgery is successful and the student’s heart is working more efficiently, it will not only positively impact his cardio-vascular fitness, but also should have a beneficial effect on his respiratory status as well. Gentle breath work, taking into account that the stretch of the rib cage area could trigger some pain, can be introduced pretty early on, if his surgeon gives the green light. In fact, pranayama and meditation practices could likely be started pretty soon after surgery, as they primrily require mental focus and concentration rather than physical demands. Good luck, and feel free to let us know how his return to yoga progresses!

—Baxter

Healthy Spirits: New Arrivals CASTRO LOCATION

1. Knee Deep Barrel Aged Tanilla Porter

2. Coronado Orange Avenue Wit

3. Auer Schneebock Doppelbock

4. Weihenstephaner 2 Liter glass boots

5. Stift-Engleszell Gregorius Dark Triple (the latest trappist brewery from Austria)

Labor of Love

by Nina

A question we frequently get asked is: why don't you have ads on your blog?

Another one is: how does your blog make money?

The answer to both questions is: This blog is a labor of love. For our love of yoga. And for our love of the yoga community.

So thank you, dear readers, for your companionship on the journey!

How Much “Stretch” is the Right Amount?

by Baxter

Last week I looked at the concept of “compression” both as a perceivable event in your body and as a potential problem for your body when doing asana (see Tension Versus Compression). After that post, one of our readers requested information about the other sensation producer, muscle tension, and the usually desirable event that occurs when we do asana, stretching in the muscle.

In the vast majority of our yoga classes in the US, we are continually asked to notice the sensations arising from the various yoga asana as we perform them. We are encouraged to find our “edge,” a place or perception of muscle stretch before which we don’t feel much, and beyond which we feel too much or begin to encounter pain. We are led to believe that stretching our tight muscles is highly desirable, but often are not clearly told where the “finish line” of this process might be. So how much stretch is the right amount? How much is too much? And how can we tell the difference? I have an opinion on all of these questions, but I took a look around to see if there was any objective evidence that might give more credence to my opinions.

The first interesting article I came across was How Necessary is Stretching? a New York Times article from 2009. Here Gretchen Reynolds reported on at some new information about stretching that had just been discovered. One study looked at a group of runners at a university in Nebraska. Researchers measured the runners' hamstring flexibility, then compared hamstring flexibility to a measure of their success as runners (known as “running economy”). They found that runners with tighter hamstrings were actually faster and stronger runners. Reynolds noted that, “In fact, the latest science suggests that extremely loose muscles and tendons are generally unnecessary (unless you aspire to join a gymnastics squad), may be undesirable and are, for the most part, unachievable, anyway.” She went on to quote a sports medicine expert:

“To a large degree, flexibility is genetic,” says Dr. Malachy McHugh, the director of research for the Nicholas Institute of Sports Medicine and Athletic Trauma at Lenox Hill Hospital in New York and an expert on flexibility. You’re born stretchy or not. “Some small portion” of each person’s flexibility “is adaptable,” McHugh adds, “but it takes a long time and a lot of work to get even that small adaptation…””

This made me consider what purpose my yoga “stretching” was for. I tend to think that stretching is going to give me more success and less discomfort in performing my asana. The above article did mention one benefit of a regular stretching of the muscles. If done regularly, even if the length of your muscle does not change much, your perception of the intensity of the stretch sensation diminishes. In other words, you don’t feel so tight anymore. So stretching regularly will make your asana more comfortable, and if you are practicing asana to prepare for seated meditation or pranayama, you will also find it easier to sit comfortably on the floor.

Reclined Leg Stretch

For healthy aging, stretching is important for maintaining flexibility as you age. Without regular stretching, your muscles will become stiffer, potentially interfering with your ability to go about the normal activities of daily life, including dressing yourself, driving, walking unassisted and even getting in and out of a chair (see Transferring and Yoga), and can impact your ability to balance. For all these reasons, stretching is very beneficial for you whether or not your muscles actually become more flexible.

Before I go much further with that train of thought, let’s look at what else I found. When a muscle is stretched, it not just the muscle cells themselves that do the elongating, but also the connective tissue or fascia that surrounds and penetrates each muscle of the body. Where the muscle has pretty amazing ability to elongate and contract and change size dramatically, the ability of the fascia is more limited, even when it contains some elastic cells. And when the connective tissue is over-stretched, it can lose its supportive properties for the muscles and lead to increased chance of the muscle itself getting micro-tears that heal more slowly. In addition to the fascia, the other connective tissues, such as the tendons that attach the muscle to bone, are more vulnerable to injury as well.

So, I think common sense regarding stretching muscles is to work up to a point discomfort, but not into frank pain. Try to get the sense of stretch in the center of a long muscle and try to avoid sensation closer to its bony attachment at (or near) the joint.  On occasion, you will know you have overdone it by the sudden quality of pain that accompanies your stretch, but often you won’t know until the next day, when inflammation sets in and the pain is there more persistently. Shoot for taking your stretches slowly and mindfully, keeping your personal goals in mind as you work in your poses.

And as Paul Ingraham points out in The Unstretchables: Eleven Major Muscles You Can’t Stretch, No Matter How Hard You Try, some muscles aren’t actually stretchable the way muscles like the hamstrings—which are quite literally made for stretching—are. I know there are a lot of thoughts on this topic out there, so feel free to add your insights here. I believe in our collective wisdom!

Healthy Spirits: New Arrivals CASTRO

New Arrivals CASTRO

1. Grand Teton Black Cauldron Imperial Stout

2. High Water Campfire Stout

3. Knee Deep Hop Shortage

4. Knee Deep SIMTRA

5. Knee Deep IPA

6. Knee Deep Hoptologist

7. Almanac Barrel Noir

8. Anchor California Lager

9. Karl Strauss Tower IPA

10. Karl Strauss Pintail IPA

11. New Belgium Lips of Faith: La Folie

12. New Belgium Lips of Faith: Transatlantique Kriek

13. New Belgium Lips of Faith: Heavenly Feijoa Tripel (Dieu Du Ciel collaboration)

14. New Belgium Lips of Faith: Cascara Quad

Relax Frequently. Very Frequently.

by Nina

“When we’re renewing, we’re truly renewing, so when we’re working, we can really work.”—Tony Schwartz

On this blog, we’ve talked till we’re blue in the face about how important it is to reduce stress to support healthy aging. After all, chronic stress can cause everything from heart disease and stroke to depression. But when people are busy with their everyday lives, it’s often difficult for them to make lifestyle changes to support a long-term goal. But according to a recent editorial in the New York Times Relax! You’ll be More Productive, there is also a short-term payoff to relaxing on a regular basis:

“A new and growing body of multidisciplinary research shows that strategic renewal—including daytime workouts, short afternoon naps, longer sleep hours, more time away from the office and longer, more frequent vacations — boosts productivity, job performance and, of course, health.”

Yes, author Tony Schwartz says that relaxing on a regular basis “it’s possible to get more done, in less time, more sustainably.” He goes on to say that human beings didn’t evolve to expend energy continuously but rather to pulse between spending and recovering energy. This is a reference to the fight or flight response vs. the relaxation response, which we’ve discussed in previous posts (see Chronic Stress: An Introduction and The Relaxation Response and Yoga). This is not big news to us, of course. What got me intrigued, however, was Schwartz’s statement that “strategic renewal” ideally should come every 90 minutes.

“during the day we move from a state of alertness progressively into physiological fatigue approximately every 90 minutes. Our bodies regularly tell us to take a break, but we often override these signals and instead stoke ourselves up with caffeine, sugar and our own emergency reserves — the stress hormones adrenaline, noradrenaline and cortisol.”

Among other studies, Schwartz cites the work of Professor K. Anders Ericsson and his colleagues at Florida State University. Dr. Ericsson studied elite performers, including musicians, athletes, actors and chess players, and found that in each of these fields, the best performers typically practice in uninterrupted sessions that last no more than 90 minutes. They begin in the morning, take a break between sessions, and rarely work for more than four and a half hours in any given day.

Legs Up the Wall Pose (Better Than Sleep)

 Of course most of us can’t take a nap every 90 minutes—something Schwartz recommends—at work. Besides, unless you’re sleep deprived, sleeping probably isn’t the best way to relax and restore yourself (see Conscious Relaxation vs. Sleep). So—wait for it—how about doing a little bit of yoga every 90 minutes? Maybe shut your office door and do a restorative pose or two (see Mini Restorative Sequence). Legs Up the Wall (Viparita Karani) would be my pose of choice. And if you don’t have a door (yeah, I worked in one of those cubicle thingies back in the day) or feel like being active instead of resting, try some of our office yoga poses. We’ve got a sequence you can do in your office clothes (see Mini Office Yoga Sequence) and a series of seated poses you can do right at your desk (see Chair Yoga Mini Sequence). And, of course, you could always meditate, even in a noisy environment (see Achieving Stillness in Turbulent Situations)!

Healthy Spirits CASTRO: Dogfish Head Immort Ale

Now in Stock!

Aging, Diabetes and Yoga: Stereotypes That Are Truly Dangerous

by Melitta Rorty

When most people think of diabetes, they think of diabetes associated with obesity (particularly abdominal obesity) and older age. When the mass media uses the term diabetes, it almost always is in reference to Type 2 diabetes, but never stated as such. Yet fully 20-25% of all cases of diabetes are Type 1 diabetes, formerly called juvenile diabetes, which is an autoimmune disease that can occur at any age, including in the elderly, and which requires exogenous insulin for survival.

The stereotypes, widely held both by the general public and medical doctors, are that Type 1 diabetes is strictly a childhood disease and Type 2 diabetes is a consequence of older age and obesity. A particular danger for those who acquire Type 1 diabetes as adults is that they will be misdiagnosed as having Type 2 diabetes, an altogether different disease with different genetics, causes, treatments, and potential cures. The consequences of misdiagnosis are extreme:  rapid onset of diabetic complications and even death.  Fully 10% of people diagnosed with Type 2 diabetes have the autoantibody markers for Type 1 autoimmune diabetes and have been misdiagnosed; that equates to millions of people in the United States alone who are misdiagnosed.

Tracks by Brad Gibson

I, myself, experienced the harsh reality of misdiagnosis. In 1995, at the age of 35, I was hospitalized in diabetic ketoacidosis (DKA), but because of my age, I was misdiagnosed as having Type 2 diabetes (by an endocrinologist who is a medical school professor), despite having zero risk factors for Type 2 diabetes. I was removed from life-saving intravenous (IV) insulin and released from the hospital, treated only with oral medications for Type 2 diabetes, a disease that I do not have.  Thankfully, I remained misdiagnosed for only about a week, because in that time I read all the literature about diabetes that was provided to me at the hospital, and realized that the symptoms I had (extreme weight loss, diabetic ketoacidosis, blood glucose 7 times normal, massive ketones in urine) were that of Type 1 diabetes and not Type 2 diabetes. When I confronted the endocrinologist who (mis)diagnosed me, to his credit he admitted he had made a mistake and apologized. Then he changed my diagnosis to Type 1 diabetes and put me on exogenous insulin. Since that time, I have come to know hundreds of others who have been similarly misdiagnosed, and I have worked diligently to dispel the myth that Type 1 autoimmune diabetes is a childhood disease.

Sadly, not much has changed since 1995 and misdiagnosis is still extremely common today, in spite of widely available diagnostic tests that can assist with obtaining a correct diagnosis.  As stated in a recent Wall Street Journal article on the problem of misdiagnosis,

"Most of my [adult Type 1 patients] have been misdiagnosed as having Type 2," says Robin Goland, co-director of the Naomi Berrie Diabetes Center at Columbia University Medical Center in New York. "Once the right diagnosis is made the patient feels much, much better, but they are distrustful of doctors and who could blame them?"

In the United States, a medical doctor faces no repercussions if he/she misdiagnosis a person as having Type 2 diabetes when in reality the person has adult-onset Type 1 diabetes. The governing bodies (the Expert Committee on the Diagnosis and Classification of Diabetes Mellitus; the American Association of Clinical Endocrinologists) describe the different diseases that fall under the umbrella term “diabetes,” but they do not identify any protocols for differentiating amongst the different diseases. So there is no requirement to diagnose, classify, and appropriately treat the different diseases that fall under the term “diabetes.” If there were a standard or guideline, doctors would be held accountable to the minimum standard of care:  anything less would be malpractice. From my perspective, the lack of guidelines appears to be about limiting medical liability, not about enhancing patient care and saving lives.

If you or someone you care about has been diagnosed with diabetes and for any reason you suspect it may not be Type 2 diabetes, request that your doctor run autoantibody tests and the c-peptide test. Dr. Lou Philipson, Director of the Kovler Diabetes Center (University of Chicago) says:

“What I teach is that it is always important to ask oneself why a given patient has diabetes and what kind they have [Type 1, Type 2, or another form of diabetes]. Do not assume. If you have doubts, get another opinion, or get a referral to a see a specialist. Persistence can be life-saving.”

How does all this relate to yoga and healthy aging? I started practicing yoga six months before my first symptoms of diabetes. When I was newly diagnosed, I was in extreme despair—I thought my life was ruined. But yoga saved my life then by allowing me some space and freedom from constant thoughts about my disease. And yoga continues to save my life today by helping me stay calm and focused despite the daily grind of self-care that those of us with Type 1 diabetes must do. I recommend yoga to anyone who has to live with the stress of chronic illness.

Friday Q&A: Yoga and Bursitis

Q: I have a 65 y.o. student with bursitis in right hip next to Greater Trochanter. After x-ray &  MRI to rule out other complications, her Doc says give up the vigorous gym workouts and do more yoga classes!  She has been regular once a week yoga for 14 years in classes small enough to adapt poses as needed. What actions or poses are contraindicated during the healing of the inflammation? What else to consider during healing process?  Love that her doc recommends more yoga!

A: Funny you should ask! This is a very common cause of pain in the hip area, and just last week one of my students on retreat in Mexico mentioned that she had been having pain near the bony prominence at the side of hip known as the greater trochanter of the femur bone. I asked if she had had it evaluated yet, and she said no. But the location of her pain brought your student’s condition to mind. I see this a couple times a year in my students and patients. According to the Cleveland Clinic:

“Trochanteric bursitis is inflammation of the bursa (fluid-filled sac near a joint) at the outside (lateral) point of the hip known as the Greater Trochanter. When this bursa becomes irritated or inflamed, it causes pain in the hip. This is a common cause of hip pain.”

It might be helpful to provide some information about the condition before we dive into my yoga recommendations. First off, what are the most common symptoms of the condition? Well, the most helpful in differentiating it from other causes of hip pain would be the location, as described above, along with pain in that area when lying on that side of pelvis or when touching over the greater trochanter. Less specific but still helpful symptoms include pain when getting out of a deep chair or out of your car, or when walking up stairs. And pain located on the lateral thigh or in the buttock area could still be this kind of bursitis. Normally the bursa, a fluid-filled sac that usually lies between tendons and bones to provide more cushion and smooth movement over the bones, is not very big and doesn’t hurt. 

Bursitis, when the bursa becomes inflamed and painful, can result from a variety of situations. An acute injury to the hip joint, via a fall onto the hip, bumping the hip into an object, or lying on one side of the body for an extended period, can result in acute bursitis. Overuse of the area via play or work could also lead to this condition, especially if activities include running up stairs, climbing, or standing for long periods of time. Incorrect posture that results from scoliosis or lumbar spine conditions, or leg length discrepancies could also lead to bursitis.

Other health conditions not specifically related to the hip, like rheumatoid arthritis, gout, psoriasis, thyroid disease or an unusual drug reaction, could also be the cause. In rare cases, bursitis can result from infection. And any previous surgery around the hip, including hip replacement, could increase the risk of developing it.

Usually, most cases of bursitis of the greater trochanter resolve on their own with little or no intervention in a few weeks. In all likelihood, your student either had persistent or recurrent bursitis that led her to seek medical attention. Western medical treatments start with modified activity and anti-inflammatory medications like ibuprofen. If that does not work, a steroid injection into the affected bursa and/or physical therapy to maintain range of motion would follow, adding splinting if necessary. In rare cases, surgery might be recommended. 

And what about preventive approaches for the Western model? The Cleveland Clinic says that because most cases of bursitis are caused by overuse, the best treatment is prevention. So avoid or modify the activities that cause the problem, and correct underlying conditions, such as leg length differences, improper posture, or poor technique in sports or work, that cause the problem. They also make the following specific recommendations:

• Take it slow at first and gradually build up your activity level.*
• Use limited force and limited repetitions.*
• Stop if unusual pain occurs.*
• Avoid repetitive activities that put stress on the hips.*
• Lose weight if you need to.
• Get a properly fitting shoe insert for leg length differences.
• Maintain strength and flexibility of the hip muscles.*
• Use a walking cane or crutches for a week or more when needed.

* The recommendations above that I marked an asterisk are great guidelines for how to approach your student and her practice, as well as for most students in general.

Approach Cautiously...

 As to your approach to yoga, the most obvious places to avoid or use caution would include any side lying positions, such as Anantasana (Vishnu’s Couch pose), where you put direct contact on the greater trochanter. Fortunately, there are not a lot of poses like that in our modern yoga practices.  However, in an acute phase of bursitis, even a strong stretch over that area could slow or reverse healing, so poses such as Standing Side Stretch (sometimes called Half Moon pose) shown on the left, the back hip in Triangle pose, and the top bent leg hip in Marichyasana 3 and Ardha Matsyendrasana should be approached cautiously, and propped a bit higher then usual. You’d want to ask your student regularly if any pose is worsening the symptoms, and play with variations to eliminate the pain.

Ardha Chandrasana (also called Half Moon pose) comes to mind as a potential challenge for both legs, but for different reasons: the top leg because the muscles over the greater trochanter are pulling down on the bursa, and the bottom leg due to possible compression in that area of the hip. Since stair climbing and getting out the car can worsen the pain, approach Fierce pose (Utkatasana) and Garland pose (Malasana) with a watchful eye, especially when the student returns to a standing position.

Because physical therapists teach range of motion exercises for this condition, doing yoga warm ups for the hip in a reclining position would be helpful. In addition, a few of the recommended stretches I found online from a physical therapy site included Marichyasana 3 and Thread the Needle pose, which are part of many yoga classes. For strengthening, they recommended abduction the affected leg while standing, such as the action of the top leg in Half Moon.  So, some of the poses you need to be cautious with during the acute phase may end up being important as healing progresses for either stretching or strengthening the area. Take your time, go slow, and progress gradually.

And tell her doctor if things improve quickly. Let’s get more of those MD recommendations for yoga!

—Baxter

Healthy Spirits: St. Florian's Brewery

Both Healthy Spirits locations are now carrying beer from ST. FLORIAN'S BREWERY, a great new Sonoma micro! We currently have their IPA in 6packs and 22oz bottles. It's brewed with Cascade and Zythos hops. Bold and citrusy, with a touch of tropical fruit and a dry, bracing finish. Great stuff. Hope you all will like it as much as I do

Cheers,

Dave Hauslein

Beer Manager

415-255-0610

Healthy Spirits: New Arrivals CASTRO

1. Fifty Fifty Totality Imperial Stout

2. Moa Pale Ale

3. Moa Methode

4. Lammsbrau Organic Pilsner

5. Lammsbrau Organic Dunkel

Healthy Spirits: Midnight Sun Meet & Greet for SF Beer Week

Join us Friday February 15 as we host Barb Miller and Darcy Kniefel of Midnight Sun Brewing Company! They will be at our 15th and Castro shop from 2 to 4 answering your questions and introducing the new XXX Black Double IPA!

You’ll also have an opportunity to stock up on other great Midnight Sun beers, including Kodiak Brown, Sockeye Red and Snowshoe White in cans!



http://www.sfbeerweek.org/schedule/#q=Midnight Sun Meet & Greet

Healthy Spirits: New Arrivals CASTRO LOCATION

1. Russian River Sanctification

2. Moosbacher Kellerbier

3. Drake's Hopocalypse

4. Alaskan Black IPA 6pk

5. Alaskan Pilot Series Imperial Red

6. Ninkasi Allies Win the War

7. Hangar 24 Vinaceous (Old Ale aged in wine barrels)

8. Big Sky Cowboy Coffee Porter

9. High Water Old & In the Way Barleywine

10. Jolly Pumpkin Bam Biere

11. Jolly Pumpkin Bam Noire

12. Jolly Pumpkin La Roja

13. Logsdon Seizoen Bretta

14. De Dolle Oerbier

15. De Dolle Stille Nacht

16. Le Baladin Wayan Sour 2010

17. BFM Abbaye De Saint Bon Chien 2011 375ml

18. BFM La Douze

19. Anchorage +Mikkeller Farmhouse Invasion IPA

20. Anchorage Tide & Its Takers Tripel

21. Jolly Pumpkin Calabaza Blanca

22. Pretty Things Jack D'Or

23. Upright Bad Brains Dark Lager

24. Upright Fatali Four

25. Mikkeller Nelson Sauvin Brut

26. Mikkeller Yeast Series (American Ale,English Ale, Saison, Brettanomyces Bruxellensis, Brettanomyces Lambicus,Lager)

27. Mikkeller+Grassroots Wheat is the new Hops

28. Timothy Taylor Landlord

29. Ritterguts Gose

30. Cermic Mugs from Mahr's

31. Fresh growlers of Magnola Proving Ground IPA and Blue Bell Bitter!

cheers,

dave hauslein

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415-255-0610

Taking a Sick Day Today

by Nina

Fallen Log by Brad Gibson

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.