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Article, Pain
If you have neck pain, yoga therapy has a great deal to offer once you have been cleared medically to participate in Yoga. I’ve been an expert witness when there isn’t medical clearance. Trust me, it’s not worth the risk! We’ll look at some postures and breathing that might help, but also touch on some less physical aspects of yoga that often hold keys for relieving the suffering associated with head and neck pain.

 

Viewing the Whole of You

I like to tell people who have been through standard treatment for neck pain without success that sometimes looking “south” holds a key for resolving the problem. By south I mean lower in the body and in fact all the way to the toes.

You see between your head and your toes lay three diaphragms of muscular and dynamic control. Think of them as a musical trio and for you to enjoy their music, the three must be in harmony. In medicine we call these the thoracic outlet (glottis/shoulders/neck/upper chest), the respiratory diaphragm (covers the entire bottom of the rib cage), and the pelvic floor (the part of your body that rests on the saddle of a horse). In Yoga these areas have been described for centuries as important places of balance and awareness, known as the bandhas.

An imbalance or tightness in anyone of these areas throws the other two off and can generate discomfort and pain in any one or more of the other areas as well. A good yoga therapist will help you discover which if any may be affected and prescribe techniques to resolve the imbalance. The causes can be from:

  • Poor postural support and ergonomics
  • Bad sleeping habits
  • Repetitive oral habits (clenching, chewing, etc.)
  • Diet and use of stimulants
  • Faulty breathing patterns
  • Physical inactivity (couch potato-it is)

But be prepared, as often more subtle aspects of our human experience are the cause, such as emotional distress, fear, spiritual isolation or anger that may be fueling the imbalance.

Failure to explore and address these states will keep you on the merry-go-round of pain. A missing ingredient in many students prescription for relief is often that there is no joy in their life. I ask, “What do you do for fun?” and there’s a long awkward silence, often followed by an admission they don’t have much fun and certainly not every day. If that includes you the reader, then start scheduling some at least once a day…and triple your out loud laughter while you are at it. It’s free and non-allergenic, though it can be infectious!


 

Postures and Breathing

These postures, or asana, and breathing (pranayama) will be prescribed based on the evaluation by the yoga therapist. Typically they include grounding the feet and toes as the foundation, then opening both the hips and chest. By performing these in conjunction with your awareness around the above-mentioned subtle issues, you increase your sensitivity and consciousness in that moment and later moments to moments in your daily life. We call those moments “Off the Mat” yoga because what you discover in the formal practice should transform what you do away from the mat. As you explore relationships between how you hold yourself during life and your response to life, you can return to work together with the yoga therapist to address those intertwined relationships that may have gone unnoticed or weren’t addressed in your earlier treatment attempts. Be assured, you will discover the need to change, but then stimulating change is a primary function of pain anyway so the pain is doing its job well.

 

Surrender and Action

As you continue to learn and change, hopefully you will experience the “art” of yoga in your life. It is a beautiful dance of action and surrender. Accepting what is and acting to change what will be.

When we lose our balance and become stuck, often the head throbs, the neck stiffens and the heart collapses in despair.
Restoring that dance we become light and free in our actions, vanishing pain and suffering, and becoming an inspiration to others to wake up and engage the moment with sweetness and calm.


Words of Caution


Not all of the tools and technologies of yoga are benign. Knowing when and what to avoid are probably as important as what to do. Here’s a checklist of things I have observed in yoga injuries that would be good to keep in mind.

We are homo erectus, not homo invertus… if you have issues with your neck, there is no reason to do headstand, shoulderstand, plow or any other postures where you bear weight on your neck and shoulders. Just don’t.


  • No teacher should push you into a posture with their hands. If they have your permission, a light touch to give you a sense of direction is helpful, but no firm or hard adjustments.
  • The nerves in your arms arise from your neck. Use caution moving into and out of any stretches of the arms and shoulders as it could ignite your neck symptoms if not done slowly and with awareness.
  • Use props liberally. Belts, blocks and furniture extend your reach, allowing you to not grip in the neck and to move in safety and ease.

The first Yama in yoga is that of non-violence or non-harming. Following the above guidelines will keep you from harm and keep you safe. With some attention to the whole of you and honoring your limits, yoga has many positive ways of easing your neck pain. Stand up for yourself and know your and the teacher’s limits. Have fun, be safe and look deeply…your neck pain is beckoning you to change.

Article by Matthew Taylor, C-IAYT. Article originally published of YogaMate
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Article, Pain
Physical activity is recommended for arthritis management but many activities are not suitable for people living with joint pain and limitations.Yoga, when practiced with a qualified instructor/therapist, can be easily modified to accommodate limitations, and can be practiced through all stages of disease. In addition, yoga’s breathing practices and mindfulness are useful for stress management, which might reduce frequency or severity of flares. Additionally, yoga philosophy can offer perspective that may foster greater acceptance, contentment, and gratitude in the face of challenges.


Arthritis and rheumatic conditions is an umbrella category that consists of over 100 different disease diagnoses. Some of these include rheumatoid arthritis, lupus, ankylosing spondylitis, gout and fibromyalgia. What these diseases have in common is that they are often accompanied by pain, can interfere with activities of daily living, and can result in reduced quality of life. In addition, many people living with these conditions experience fatigue, trouble sleeping, depressive symptoms, and even social isolation. Some of these conditions are autoimmune in nature, some are more mechanical, and some are closely associated with central nervous system dysregulation.

Regardless of which rheumatic disease is involved, the tools of yoga can help individuals to balance activity and rest, improve mood, find social connection, and reframe life with chronic disease.

Physical activity is recommended for general health, and certainly that applies to people with rheumatic conditions also. Unfortunately, it is more challenging to exercise in the face of pain, fatigue, stiffness and swelling. While people with arthritis should exercise for all of the same reasons as the general public (cardiovascular health, weight maintenance, improved energy and mood, bone density, etc), there are some unique considerations for this population. Physical activity can help to maintain joint mobility, which can decrease over time. Some diseases can involve rheumatoid cachexia, or muscle wasting, which can be reduced with strengthening exercises. Strong skeletal muscles can help keep joints stable with the loss of connective tissue. Therefore, it is imperative to find safe, accessible, and sustainable ways for this population to balance physical activity and rest.

Unlike physical activities such as running or swimming, yoga is infinitely modifiable. The physical poses of yoga can be adapted with props, such as blocks, straps, and blankets. Poses can also be moved to a chair or a wall, and can be flipped around to change the impact of gravity. What must be maintained is the essence of the pose, and the intention of the pose, but this can take many forms.


Adaptation of a yoga practice for someone with joint limitations is best done with the guidance of a yoga teacher or yoga therapist with specialized training and experience. Yoga professionals who have worked with limitations have an extensive set of tools at their fingertips, and a creativity about how to find new modifications on the spot.

This is best done while working one-on-one in a private session, or in a small group where the professional can provide individualized attention. A fast-paced class is not ideal for the process of learning and creating individually tailored poses, but a more fluid practice might be available after the individual gets comfortable with how to adapt a practice for the fluctuations that come with disease flares and/or disease progression.

When many Westerners think of yoga, the focus is on the physical practice of static poses and moving pose sequences. However, these are relatively new compared to the more ancient practices of meditation, mindfulness, attention, and breathwork. In fact, the physical postures were initially used as a tool to bring the body into balance for greater comfort, balance and attention in seated meditation. While the physical practice of yoga offers potential for many benefits to those living with arthritis, it is perhaps the other practices that help yoga to stand out from other activities in addressing both mind and body simultaneously.

Alteration of the breath can be used to engage parasympathetic nervous system engagement, which counters the stress response. Since stress can trigger flares and exacerbate symptoms, tools for stress management are important for stable disease.

Mindfulness and meditation have long been associated with better mental health, and even measurable changes in brain activity and pain response. Many people initially pursue yoga for the physical practice, which can be an introduction to the other practices that can confer an important impact. Furthermore, tools such as deep breathing and mindfulness can be easily practiced without an instructor and can be seamlessly incorporated into daily life.

A skilled yoga teacher or therapist uses not only the practices of yoga, but also incorporates the underlying philosophy. The yogic philosophy can provide perspective that can support ways to think differently about life with chronic disease. The yamas and niyamas, or ethical principles, can also help to guide individuals in safe execution of the physical practice. For example, the first principle is “ahimsa” or “non-harming.” This is, of course, aligned with the medical profession’s aim to “first, do no harm.” While this applies to the yoga professional, it also applies to the individual student. It is important to do no harm to others, but also to do no harm to self. This may mean a more gentle physical practice on some days, or a reminder to not judge oneself on days that are physically more limited. Other principles encourage practitioners to avoid envy of their previous ability or the abilities of others, to be honest with themselves and their instructor about limitations and pain, to listen and honor bodily cues, and to foster contentment and equanimity in any situation. While it cannot be suggested that these are easy concepts to understand or master, these concepts are where the practice of yoga can become transformative, not just physically, but mentally, emotionally, socially, and even spiritually. While yoga is not a religion, it may encourage an inner quiet that could foster connection to an individual’s sense of spirituality, whatever form that may take.

In working with hundreds of students and clients who live with arthritis or other rheumatic conditions, I have seen the potential for many types of benefits and growth. For some people, finding a way to become physically fit and to feel capable in a body that has provided challenges is euphoric. For others, yoga provides a way to become quiet and pay more attention to the need for balance in one’s life. And in a few rare cases, I have seen individuals come to find gratitude for the very disease that brings them pain, limitations, and daily uncertainty. In a process of true transformation, it is possible to find gratitude in the most unlikely places. Yoga practice is unique in its ability to meet anyone where they are on their journey- physically, mentally, emotionally, socially, or spiritually. It is universally accessible when modified appropriately, and can be practiced for a lifetime with no limit to the lessons and skills that can continue to be utilized, both on the mat and out in the world.
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Article, Pain

Over 65 million people in the US live with lower back pain, with more than a third of people over the age of 18 experience severe enough back pain to seek professional help. It is estimated, that each year Americans alone lose 93 million days of work at a cost of $11 billion due to low back injuries. Another estimated $10-$20 billion is spent in direct medical expenses. 

Traditional treatment modalities have not been shown to be consistently effective at treating lower back pain. Yoga therapy has much to offer in terms of addressing the issue because our focus is more global, considering the whole person, including life-style, personal outlook and self-awareness. In fact,

lower back pain is one of the number one reasons people seek out yoga and yoga therapy and studies have demonstrated the efficacy of therapeutic yoga in addressing lower back pain1.

The challenge is that the pelvis is a complex, weight-bearing structure. Many factors merge in the fulcrum of the lower back, sacrum and pelvic girdle applying various kinds of torque and pressure that can contribute to pain. Too much, too little or an asymmetrical shift in the spinal curvature puts stress on the nerves and the surrounding tissues and organs. The sciatic nerve, the largest nerve in the body originates at the lumbar and runs through the sacrum innervating the pelvis and legs.The major organs of elimination and reproduction sit in this same region and structural misalignment in the lumbar, sacrum or pelvis can impact proper vital function, as well as ambulation. 


As bi-peds, the configuration or relative balance between the structures of the feet, legs and hips can feature as major contributors to lower back pain. Like-wise, excessive kyphosis or scoliosis in the mid and upper torso can put additional strain on the lower back and sacrum.

In many cases, psycho-emotional factors have been demonstrated to be primary, even more so than structural or postural imbalances2.

As yogis, we don’t have to look farther than the first, second and third chakras to recognize the many potential issues that can restrict prana and bind us up in this region. 

To add to this murky equation, students often don’t know the source of their back pain, sometimes they’ll point to their hip or butt and say their back hurts. Even if they arrive at your door-step with an MRI report in hand, the story on paper is usually just one of the critical ingredients to consider.

Therefore, offering simple solutions when there are so many factors to consider is a dangerous business (ie: just do forward bends, or NEVER do forward bends, twisting is bad, backbends are good.) Yoga teachers and therapists need a healthy respect for and understanding of functional anatomy. In my experience, the best source for this information comes from non-asana biased anatomy experts (in other words, not necessarily your yoga teacher!) 

I’ve found it to be incredibly helpful to detach from any ideas about the ‘perfect pose’ or ‘set of poses’ and to learn more about the how the body actually works optimally and what happens in the case of various pathologies.  From there, I’ve come to understand why and how certain asanas, breathing and mindfulness practices can be sequenced and combined to facilitate positive change for a particular individual. It’s important that yoga teachers and therapists are well educated in order to keep students safe and create practices that are beneficial. 


Chronic pain means there are musculoskeletal and psycho-emotional-neuro pathways that are set in a repetitive loop.

Since yoga is principally about transforming patterns that lead to duhkha, or suffering, this is definitely in our purview. Of course, the deeper the samskara, the pattern – the more challenging it is to transform. There has been much written on the debilitating effects of chronic pain. Depression, anxiety, a loss of freedom and ability to participate fully in life often accompany chronic lower back pain. A sense of isolation become a prevalent companion, as people find they are unable to participate in the social activities that bring them joy and connection with friends and family. Lack of restful sleep further aggravates the nervous system, making them more vulnerable to moods and emotional triggers and in fact, more susceptible to pain. We can become good at pain, the same way we can become proficient at many other things, through practice. 


Chronic pain sufferers tend to shut down their awareness and attention to the areas that hurt – to move away from what causes discomfort (dvesha). Scientific studies show that the less kinesthetically aware a person is the higher their perceived pain levels. Increasing proprioception therefore actually decreases pain. Svadhyaya, self-awareness cultivated by attending to the areas that hurt and relinking or reconnecting the body with the mind via the breath as we do in yoga, can actually change the chronic pain pathways. The yoga sutra teaches that in order to alleviate suffering we must reduce avidya, our ignorance or lack of self-awareness.


The challenge for the yoga therapist is that we do not have the capacity to diagnose and often what will facilitate healing for one type of problem may aggravate another. Besides, rarely does someone come in with just one issue, they may have a lumbar disc bulge and be hypo or hyper-mobile; have an SI problem and scoliosis. This is just on the level of the annamaya, without even considering the psycho-emotional, life-style considerations, such as a stressful job, financial issues or divorce. Regardless of the source of the pain, the first gift is to help your clients find a position that is comfortable and relieves the pressure. Sitting or static standing are usually the most uncomfortable positions for back pain sufferers.  I suggest starting in a supine position with the legs either resting on a bolster, pillow or even raised up on a chair. Diaphragmatic breathing that focuses on the exhale, releases subliminal contractions of body and mind. This allows the practitioner to learn new movements and move with less reactivity than when the body is tensely held and on hyper-alert. 


Engagement of the deep abdominal muscles to control the exhalation breath begins a process of connecting the breath with core support. Positional comfort and breathing encourages relaxation. Comfort combined with conscious core support (sukha-sthira, ease and stability) sets the stage for healing by disarming the nervous system and releasing the fear/pain cycle. I’ve created the acronym, B.A.C.K.  that can act as a foundation approach for healing, it’s a reminder that the Breath, Alignment, Core support and Kinesthetic or proprioceptive awareness are all integral to the healing process, especially as it relates to chronic back pain. 


It’s also important for us to be humble and recognize when to refer our clients to seek further medical advice.


The more mindfully we teach our students to tune in and FEEL their body as they practice, the more they cultivate vidya – knowledge and this is ultimately the path to MOKSHA, freedom from suffering. 

keep reading

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Article, Professional Resources, Yoga Therapeutics App

In a recent survey, conducted as part of the inaugural Global Yoga Therapy Day, yoga professionals were asked if there are any yogic practices deemed too dangerous to teach.


Responses from over 1000 yoga professionals around the world identified the following as the 5 yoga poses whose risks outweigh any potential benefits:



No Go Poses #1 and #2:
Handstand & Headstand

In the first instance, these poses require a tremendous sense of balance. In a packed room, the risk of falling & injuring another person is reason enough to not teach these poses; but furthermore, these intense inversions put people with hypertension, heart disease and risk of stroke at extreme risk. The poses are also cautioned for people suffering from neck, back or shoulder injuries, eye conditions like glaucoma, ear infections, heartburn or indigestion, headache, pregnancy, low blood pressure and osteoporosis.


Most yoga professionals indicated there were way too many risks to be worth any potential benefits; particularly when other, safer inversions offer similar benefits.

 

No Go Poses #3 and #4
Shoulderstand & Plow


Shoulderstand followed by plow pose is one of the more common sequences seen in general yoga classes; but many respondents suggested both of these poses has too high a risk for neck injury.  And like the above inversions, these poses put people with hypertension, heart disease and risk of stroke at extreme risk. In fact, our app details 25 health conditions for which individuals should avoid plow pose.


Other reasons to steer clear of shoulderstand and plow? If you have back or shoulder injuries, eye conditions like glaucoma, ear infections, heartburn or indigestion, headache, low blood pressure or osteoporosis. That’s a lot of health conditions to be wary of – and with 52% of students indicating they’ve never filled out a student intake form advising on medical history; teachers need to be wary of what they don’t know!


No go pose #5
Extreme backbends like Wheel

Wheel pose and other extreme back bends can aggravate (and possibly create) disc problems; particularly if you’re not fully warmed up when they’re introduced.


In wheel pose, people also have a tendency to rest on their head as they move into the pose, exerting considerable pressure on their neck, which can be extremely dangerous.


This pose is cautioned for individuals with arthritis, back injury, heart conditions, shoulder or wrist injuries or any of the eye conditions like glaucoma.

 


Keep them safer:


With 2 in 31 of the public survey responders indicating they have a pre-existing chronic health concern or injury, it can be a challenge to keep your students safe in their practice. The unfortunate fact is, hospital visits are on the rise, due to yoga injuries. 


To help keep your student safe in their practice, ensure new students fill out a student intake form so you have a better idea of any pre-existing injuries or health concerns that could put them at risk. Then, in every class make sure to ask questions before class begins if there are any injuries or concerns to report.


To further increase your confidence in keeping them safe, we’ve created an app, Yoga Therapeutics Pro, which provides the cautions and potential therapeutic considerations for over 400 yogic practices. The app allows yoga practitioners to search more than 100 of the most common health concerns and injuries to gain instantaneous access to knowledge that helps you better keep your students safe in their practice.


Available in iPhone and Android. Learn more & buy the app here.

1 Safe Yoga Survey, conducted by Yoga for Better Health (then YogaMate), June – July 2019 of 1058 yoga teachers.  Read more about the Safe Yoga Survey here.

 

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