Supported Forward Bends: Peaceful Poses for Stress, Anxiety, Neck Pain and Headache Prevention

by Nina

We finally took some new photographs, and now I’ve got a portfolio of my favorite poses for stress management and anxiety! So I thought that today I’d introduce you to some of favorite quieting poses: supported forward bends. A supported forward bend is one where you use a prop, such as a bolster, stack of blankets or a chair seat to support your head and arms as you stay in the pose. Relaxing onto the support helps remove straining from the pose and enhances the quieting quality of the forward bend. These are gentle, inward-turning poses that both calming and nurturing.

You can do supported forward bends in two forms: standing and seated. Standing supported forward bends are particularly good for stress as they are partial inversions. See Just in Time for the Holidays: Inverted Poses for information about why inverted poses, including partial inversions, are so beneficial for stress management.

Because the supported seated forward bends are less active than the standing versions, they are more quieting. And because you’re resting the weight of your head and relaxing your neck, these poses may also help with neck pain and headache prevention. I love supported seated forward bends, especially when I’m feeling anxious, however, some people do not enjoy supported seated forward bends, finding them rather too quieting, in other words, sort of deadening. And they’re probably not the right poses for people suffering from depression. So you’ll have to try for yourself and see what you think.

In general, when setting up for these poses, it’s important to be honest with yourself about how many props you need to be truly comfortable. The aim here isn’t to feel a stretch, much less any pain, but to use the pose to quiet yourself physically and emotionally.

As you come into the pose, bend from your hip joints and keep your back straight. This will help prevent back strain that comes from rounding your back. If you need to sit on a folded blanket to encourage the bend from your hips—most of us do—then add that prop as well (see photo).

When you bring your head onto the prop, do not force your head down. If your head doesn’t reach easily, you need a higher prop. For the Standing Forward Bend, you can stack two blocks, with one on the lowest height and the second on the highest. Stacking two blocks end on end, however, is unstable, so be honest with yourself and get your chair! (Besides, if you compare, most chair seats are lower than two blocks end on end, anyway—check it out and see.)

If you want to sequence these poses, I recommend starting with the standing versions first—they are better for warming up your legs and hips, and are more active—and then moving onto the seated ones. Of course, any of these can be done alone, or as part of any restorative or stress management sequence (we’ll have some of those coming in the near future). And there’s no reason at all why you can’t end an active practice with a supported seated forward bend of your choice, followed by Savasana.

1. Standing Forward Bend (Uttanasana), with your head on a block or chair
2. Widespread Standing Forward Bend (Prasarita Padottanasana), with your head on the floor or on a block or chair
3. Wide Angle Pose (Upavista Konasana) or Seated Crossed Legs, with your head on a bolster or chair
4. Seated Forward Bend (Paschimottanasana), with your head on a bolster or chair

I hope these poses bring you peace.

Update: Wondering where those photos are? It turns out, they're not quite ready yet. We took them, but I don't have access to them this afternoon. I'll add them to this post as soon as I get them, so check back again.

Friday Q&A: Neck Pain and Fear

Q: I read of yoga for back pain, but little about neck pain. I've been in PT for months, with good ideas about posture/extension/alignment, etc. And now I'm in a series of skillful massage targeted to the neck muscles...but such stiffness in spite of it all! Did yoga for years, but not lately (still active!) I'm wary of yoga that my pain might be exacerbated. I'm 52. My work is varied, with some hours at a desk but broken up with people interaction. Thanks for your counsel!

 A: I understand why you might be afraid of doing yoga again but I want to reassure you that starting to practice again will be beneficial for you in so many ways. I currently have a student with a lot of physical challenges and chronic pain from prior surgeries. She has told me so many times that even though her body may not be able to move the way she wants it to, when she wants it to do something, she finds that “yoga is good for my mind. It makes me tune in and just listen to myself.” This individual needs a lot of modifications when she practices, but because she trusts both me and my co-teacher Bonnie, she is willing to try new things, "even when they are scary,” specifically because she knows she can stop WHENEVER she needs or wants to and we respect her decisions. We have a “circle of trust” in our class that is very valuable to both the teachers, the students and our assistants.

The great thing about yoga in my mind is the ability to stop whenever necessary. The practice is an internal dialogue not an external show. Sometimes we need to be reassured we can still do an activity but are afraid because it might hurt. Well, if something or an activity causes an increase in pain, then we have the ability to stop the action. Sometimes although our minds fear something when there really isn't a physical correlation between the fear and the action, we have to teach our mind not to fear the action. It is kind of like relearning to ride a bike when we have fallen off in the past and done some serious damage but now have the desire to get back on the bike. But where to start? With all activities it is helpful to imagine the activity first before attempting it. So, if you had some yoga poses that you used to do that gave you pleasure, start with those. I would set myself up in a position of comfort where I was warm and felt safe, and then I might mentally begin the practice using only my memory. After a while of envisioning the pose, I would try it just a little bit. If I felt scared that I was going to hurt myself, then I would stop and leave it and try again tomorrow.

If this type of mental re-entry into yoga doesn't work for you, then you might re-contact your teacher (if you had one) and ask to talk about your concerns about returning to a class. If you don’t have a teacher anymore, look for someone in your local area who has experience with working with individuals with neck injuries and discuss your concerns about re-entering a class. If that isn’t possible, look for a class either for people recovering from injuries or with a gentle focus, and, again, approach the teacher with your concerns. Going back to a class has to feel safe for you, and in order to feel safe you have to be able to trust the teacher to not make you do more than you are comfortable with. Don’t be afraid to be frank about your needs and to have the ability to keep yourself safe. If you still can't find a teacher who fits this profile, contact the International Association of Yoga Therapists and ask for a teacher in your area or near to you that you can work with. They keep a registry on file for all members.

 And finally when you do begin to practice I would follow the motto of “less is better” because more than that might spiral you back into a flare-up cycle and put you off of yoga for quite a while. Poses that I particularly like when my own neck is feeling fragile are more passive poses like Viparita Karani (Legs Up the Wall pose) or a passive backbend over bolster with neck and head support. Active practice like standing poses with arm motions often make my own neck feel worse, so go easy on those. Learning to twist again without using arms for leverage also is important. I also like Chair Shoulderstand with a bolster under my upper back and no weight on my neck.

You mention only the physical aspect of asana but as you can see on many of the posts on our blog, that is only one small part of the practice of yoga. I might use this opportunity to re-visit some of the other limbs of yoga, especially some pranayama or basic breathing practices. The ability to fully breathe is a gift in learning to manage chronic pain and stiffness because it's like doing a massage from the inside out. I suffer from major neck issues myself, and I find that my neck will often let me know when I am overworked or overly stressed because the littlest things can set off my own pain cycles. There is no quick fix, but there are many pieces to the puzzle in learning how to manage ourselves in life.

—Shari

Thoracic Outlet Syndrome and Yoga

by Baxter

For many of you out there, Thoracic Outlet Syndrome, abbreviated TOS, is one you may not have heard of. Yet, it arises most commonly in people who have been in traumatic accidents, typically in car accidents, or who do repetitive jobs, such as computer work at a non-ergonomic workstation, so that is potentially a lot of people. In addition to the two causes mentioned already, there are other less common causes of Thoracic Outlet Syndrome, like the presence of an extra small rib that can compress nerves and blood vessels near the lower side of the neck.  Regardless of the underlying cause, folks who develop Thoracic Outlet Syndrome often complain of a host of symptoms, which can include, but are not limited to, numbness and pain in the affected side of the neck, that is, in the arm, front chest and neck. There can also be weakness in that arm or hand. Symptoms often come and go, and in some situations can be positional in nature, only arising when the affected side arm is lifted and held overhead for a little while. 

What’s happening under the skin, so to speak, is that any of a number of structures could be getting compressed that should not be. More specifically, the cervical nerves that come out of your spine and come together to form the brachial plexus, (a kind of super highway interchange of different nerves from the cervical spine before heading down into the arm) can be pushed on by muscles and/or bones and lead to the symptoms described above. The same fate can befall the subclavian artery, the large blood vessel from the heart that feeds the arms, as it moves through the area of the side neck, under the collar bone, and out into the upper arm. 

A commonly cited aggravator of this condition is poor posture, which we have mentioned in many other contexts as contributing to other body pain conditions, and for which yoga is such a great antidote. In fact, most people diagnosed with Thoracic Outlet Syndrome will first be referred to physical therapy for postural re-alignment and stretches to open up the area of the neck and upper chest in order to create more space around the brachial plexus and arteries and veins to lessen or eliminate the symptoms associated with the condition. One muscle group that is often implicated in compressing the nerves and blood vessels is the scalenes, specifically the anterior and medial bodies of this three-muscle trio.

Muscles of the Neck

It would be worth your while to review an anatomy book if you are interested in understanding these muscles, which movements they normally create, and how one might stretch them to relieve tension on our delicate nerves and arteries.

Yoga could be a great adjunct to this healing process, since many of our sequences and poses address this area of the body nicely. Even simple warm up exercises like shoulder rolls, where you bring your shoulders forward, then up, then back and down, can start to improve this area immensely. I start class with this kind of attention to the upper chest quite often. Basic attention to Mountain pose and supported reclining backbends would be good starting places as well. And there are a few postures that directly affect the scalenes, such as the head positions in Bharadvajrasana seated twist in which you rotate and then side-bend the neck.

Conversely, since folks with Thoracic Outlet Syndrome often get symptoms when their arms are held overhead, some caution must be used when doing yoga poses with the arms ups, like Warrior I pose, for instance, especially if you intend to hold the pose for a while. I would not be surprised that a few people out there may have become aware of their positional symptoms after starting yoga due to the demands of the poses on the arms. (Yoga would not “cause” Thoracic Outlet Syndrome, but could alert you to its presence in such positions as Mountain pose with arms overhead, Urdhva Hastasana.) If such postures do bring on pain or numbness, it might be more prudent to experiment with dynamic versions of such poses, moving the arms up and down with the breath to see if the dynamic action precipitates symptoms. If not, you could continue to practice this way or even add in short holds as long as no symptoms arise. 

By moving and liberating held tension in this area, ultimately you may be able to relieve the compression that is underlying the Thoracic Outlet Syndrome. In fact, most patients with this diagnosis find some improvement with modalities like physical therapy and, I suspect, yoga as well, and very few have to resort to surgical intervention to find relief. 

Neck Muscle Strain and Spasm (Part 2 on Neck Pain)

by Baxter

As promised last time (see A Literal Pain in the Neck), I want to look at a more specific cause of neck pain today and talk about ways to approach it with your yoga practice. And as in “life imitates art,” I was on a red-eye flight last week, and despite my use of the neck pillow and good sleeping alignment, my four-hour plane nap left me with a very stiff and sore neck. In all likelihood, the source of my discomfort was my neck muscles suffering a mild strain from the unnatural immobility I placed them in. Muscle strain and spasm is probably the most common source of neck pain in all ages, young and old.  But although it holds the number one spot, the good news is that it is also the one that is most likely to resolve quickly, especially if addressed appropriately. You can bet your bottom dollar I was doing some of the exercises described below the next day!

Now here comes an overarching principle that will likely apply to other causes of neck pain we will cover down the road: when your neck is hurting, avoid putting direct pressure on your skull and neck structures. That is, avoid poses like Shoulderstand, Headstand, Plow pose, Rabbit pose and the like while you are hurting. Especially in the case of muscle-related neck pain, you should be able to return to these poses when your muscles return to working order. I also have a secondary caution for certain standing poses, in which your neck is hanging out in space and your muscles are fighting gravity to keep your head in the requested alignment of the pose. The two examples of basic poses include Triangle and Extended Side Angle poses, which can then be extrapolated to Half Moon, Revolved Half Moon, Revolved Triangle and Revolved Side Angle. To keep your head in the traditional position in these poses you need to work multiple muscle groups in harmony.  Even Warrior 3 could be a challenge if the offending muscles are on the back surface of your neck. And in reality, you will need to carefully assess all of your asana that requires significant contraction or stretch of the neck muscles.

So now that you have a few cautions to consider, what can you do when you get a muscle spasm or strain the muscles in your neck? On way to assess and to begin to encourage gentle movement in your neck is to lie down in Constructive Rest position (lying on your back with your knees bent and feet on the floor).

From there, decide if you need a little lift under your neck and head in the form of a folded blanket or if you are comfortable simply resting your head on your yoga mat. Then, as you inhale, gently roll your head toward your right shoulder, and then exhale back to center. Repeat this to your left. I strongly recommend that you roll only a few inches in each direction at first, feeling your way gradually to increase the arc of movement to a point of gentle stretch, but without pain. I’d do at least six rounds of back and forth, and see how that goes. Make sure you are not sliding the back of your head as you do this, as this requires far more muscular contraction than you want for this first exercise. 

Another way to influence your neck somewhat indirectly, or maybe less obviously, is to work on arm movements that involve neck muscles. So, from Constructive Rest, inhale your right arm up and overhead to floor behind you, and then exhale your arm back down to your side. Repeat with your left arm. Keep your arm straight, creating an even arc of movement in what is referred to as, in anatomical terms, flexion and extension at the shoulder joint. Do this about six or so rounds. When you finish, pause for a few moments and see how your neck is feeling. If things are quiet, proceed to the next exploration, which combines the two previous exercises.

Still in Constructive Rest position, inhale your left arm up and overhead, and as you do so, gently roll your head to the right shoulder. As you exhale, bring your head and arm back to the starting position. Repeat on the second side, doing a minimum of six rounds. Upon completion, pause and re-assess.  If you are doing fine at this juncture, move on to Dynamic Bridge pose, as way of assessing your neck’s ability to safely bring your chin to your chest, or to flex your cervical spine.  From Constructive Rest, move your heels about four inches from your hips, with your arms resting at your sides. On an inhalation, lift your hips up just two to three inches off the floor. On your exhalation, lower down.  Repeat for six rounds, gradually lifting up a bit higher each round as your neck permits. When dealing with an injury like this, check in with your neck after completing each series of movements before moving on.

To assess and work with the opposite action, extension of your head and neck (the movement you use to look up to the sky), try a low Cobra pose. Flip over onto your belly and rest your forehead or chin on the floor, depending on which action feels better your neck. Place your hands palms down on the floor beneath your shoulders, and as you inhale, gently lift your head, neck and chest up a few inches into low Cobra pose. In this low back bend, try to keep your head and neck in line with the gentle curve of your spine.  Exhale and lower down. If that felt ok, on the next time up, let your chin lift up an inch higher, so your neck is taken into gentle extension.  Repeat this process, you guessed it, six times, finding the most appropriate amount of extension of your neck and not going past that. Rest and assess before going further.

If all is well, I’d recommend you sit up in a comfortable seated position and follow the Prime Directive, that is, lift from your sitting bones through to crown of head.  From here, repeat the gentle rotation movement you did lying down by inhaling as you rotate your head gently to the right and exhaling it back to center.  Repeat to the left.  Do six rounds. I call these Owl turns, for obvious reasons. 

Curious Dog Tips are next. As you inhale, side bend your right ear towards your right shoulder, then exhale back to center. Repeat on your left side. It is helpful to do these in a mirror to make sure you are not adding in any rotation of the neck.  Do six rounds and assess.  This last movement stretches and contracts the scalene muscle group in the neck, which is a frequent culprit in muscular neck pain.

From here, you can start to explore some of your more basic poses. Two that I like for their gentle tractioning qualities on the neck are Standing Forward Bend (Uttanasana) and Downward-Facing Dog. In both cases I would encourage you to let your head dangle towards the floor so gravity can help to passively stretch your neck.  If you feel okay in these positions, you might shoot for 90 seconds in order to give your muscles the maximal chance of lengthening.

Simply doing this complete group of explorations as an initial return to yoga for a while is a good way to start the healing process. Folks always want to know how often to do this routine, but this really needs to be individualized.  However, having said that, I’d do it every other day for a week and see how you are progressing. I always find the following time periods helpful in assessing the safety and appropriateness of my plan: 

•    a few hours after the practice
•    before bedtime the day of practice
•    the next morning
•    24 hours after practice

The less pain at each of these intervals the better! If you are feeling your neck pain diminish, gradually add more poses in, saving the caution group for last. Many of these same exercises will be helpful for other causes of neck pain, but modifications will apply for situations such as arthritis of the neck, which we will take up next we visit neck pain and yoga.

A (Literal) Pain in the Neck

by Baxter

Brad’s post Probability, Aging and a Pain in the Neck got me thinking about the very common complaint of neck pain that my students often share with me. Neck pain can arise from a myriad of circumstances and causes, from something as commonplace as sleeping the wrong way on your neck to traumatic events such as car accidents. It can be a result of longstanding postural changes, such as sitting with your head forward in front of the computer screen (I just corrected my own posture!) to doing seemingly beneficial activities like riding a road bike, where your head is often lifted into extension to view the road ahead. There are familial tendencies towards certain neck problems; both my dad and one of my brothers suffered rupture of one of the intervertebral discs in the neck. And there is the simple process of aging and its wear and tear effect on the bony structures and soft tissues of the head and neck area. I have even had some one-sided problems that stem from holding a violin tucked under one side of my jaw since I started playing at age five.

According to medical experts at the Mayo Clinic, the most common causes of neck pain include: muscle strains, especially from overuse of the neck muscles; wear and tear resulting in osteoarthritis of the bones in the neck; nerve compression as a result of stiffened discs, herniated discs or bone spurs; injuries such as whiplash from car accidents; pain secondary from other illnesses or diseases, such as rheumatoid arthritis, meningitis or cancer.

Perhaps part of the reason why the neck is so vulnerable to painful conditions lies in its structure and anatomy. The top portion of the spine is called the cervical spine, and it spans from the top of the thoracic spine, where the ribs attach to the spine, up to the base of the skull.  Relative to the bones below it, the cervical spine vertebrae are smaller and have small cushioning discs between them. Granted, the cervical spine only has to balance the weight of the head above it, so its bones don’t need the bulk of, say, the fifth lumbar vertebrae that has the entire head, torso and belly to hold up. But given the weight of the head, which is between 10-15lbs, and the amount of movement that the cervical spine allows (a lot in all directions), those smaller bones and discs along with all the muscles and ligaments have a constant and challenging task. And there are nerve bundles and important blood vessels traverse this small region that can also be affected if things are not in proper working order.

When I think about how yoga practices can help improve the function of this area, and how they can allow for healthier aging, I start with the most basic posture, Mountain pose or Tadasana. Applying my Prime Directive, the inner lift from the sitting bones to the crown of the head, immediately impacts the postural alignment of the head and neck region for the better! In fact, if you can master this very rudimentary alignment, you are well on your way to improving how the neck feels on a day-to-day basis.

It can be helpful to work with a friend to find out if you can reclaim this vertical line in your body. One way to assess your overall posture and the cervical region in particular is to have your partner stand to one side of you as you do Mountain pose. Have your partner hold a yoga strap or rope in line with the center of your ear, allowing the rest of the strap to fall down to the floor, in line with the side seam of your body. This is referred to as the “plumb line,” and can give you valuable information about not just your neck area, but your entire spine and legs as well. In this case, you are particularly interested in the span between your ear and the center of your upper arm bone. If the rope falls in front of your humerus bone’s center point, you may have developed the Head Forward position so common in our culture, which puts high demands on the muscles at the back of the neck and can lead to overuse neck strain. If the rope falls behind your shoulder point, there may be flattening of your natural cervical curve, which should normally mirror the curve in your lower back. This situation often occurs following trauma to the neck, especially with whiplash injuries accompanied by muscle spasms in the neck. For each of these different scenarios, a well-balanced asana practice can help bring your neck back into healthier alignment and may help to resolve the pain and limitations that are present at the start of your journey.

The next time I revisit the topic of neck pain, we will look at specific asana practices and how they can apply to regaining a healthy neck and maintaining it is you age.  Until then, stand in a good Mountain pose whenever and wherever you can!