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Archive for the ‘Asana and Surya namaskar’ Category

The short and quick answer is often “no”. First it is important to determine what is causing GERD. If it is hiatal hernia, surya namaskar (also known as sun salutations) may not be helpful at all and may even be contraindicated. This comes under yoga therapy and expert guidance is essential as every one is different.

For some with GERD, it may be helpful if it is done after a shat karma kriya/cleansing technique such as kunjal (drink a couple of glasses of slightly warm, lightly salted water on an empty stomach, first thing in the morning, and regurgitate it–basically throw up). This gets rid of the excess acid accumulated overnight. But again, expert guidance is necessary as this may not be good to do for many people. After kunjal, rest for a few minutes in shavasana to get the heart beat and breath settled and then try surya namaskar without holding the positions, particularly the inversions. See how it feels over a few days–if it is strengthening the gastrointestinal muscles and the valves (but these are involuntary muscles that may be affected by voluntary muscles–research evidence is unclear).

There are many questions raised around the practice of surya namaskar. It is considered the most important sequence of asanas and it is almost thought of as a panacea to all ailments–physical and mental. There are many benefits to this important flow of breath and movement but it is not good for everything. There are also as many variations as teachers, particularly in the West/US.

No asanas should be done on a full stomach, but this is particularly true of inversions (where the head comes below the heart and often below the stomach). So anyone with gastrointestinal acid reflux, hyperacidity, gastrointestinal viruses, ulcers, may not benefit and may even aggravate or trigger a worse outcome. This is also true for very high blood pressure, cardiac problems, glaucoma, severe headaches/migraines, back problems. Some people benefit from doing the series with significant personalized modifications.

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It is a fact that yoga can cause injuries. We can debate the reasons–from inadequate teaching to over zealous students. But that conversation can only begin with an acknowledgement of this basic fact that we personally know. It is a conversation I have had online with Alison Eastland, a yoga teacher and blogger, in Australia.

So we accept with openness, objectivity, and maturity when William Broad points out that women’s hips are vulnerable in his New York Times article http://www.nytimes.com/2013/11/03/sunday-review/womens-flexibility-is-a-liability-in-yoga.html. A thoughtful reflection on what is yoga, why each of us practices, how we practice is  long overdue–for teachers, schools, as well as all who practice yoga. Contraindications must be clarified, and they are not. Uninformed teachers hurt themselves as well as their students, perpetuating this state of lack of knowledge.

Men are less flexible and can get hurt from forcing the body into challenging stretches. Women are generally more flexible and can overstretch. As a couple of women said to me in one class, women who clearly know the dangers of overdoing as one has a hip replacement and the other back problems, the ego gets carried away in a class. They want to do what others around them seem to be doing. For a fleeting class, it is important to show others what they can do. This is particularly true of some middle-aged women who feel terrible about their aging bodies–acceptance is hard for them.This is in spite of repeated warnings to not look at others, to feel as if each person is totally alone in that class–nothing to prove, nothing to show-off, nothing about which to feel inadequate or insecure.

So what are the consequences of ignoring warnings? Here is what Broad writes:

To my astonishment, some of the nation’s top surgeons declared the trouble to be real — so real that hundreds of women who did yoga were showing up in their offices with unbearable pain and undergoing costly operations to mend or even replace their hips….

Dr. Hyman said his typical yoga patient was a middle-aged woman, adding that he saw up to 10 a month — or roughly 100 a year. “People need to be aware,” he said. “If they’re doing things like yoga and have pain in the hips, they shouldn’t blow it off.”

Bryan T. Kelly, an orthopedic surgeon at the Hospital for Special Surgery in Manhattan, echoed the warning, saying yoga postures were well known for throwing hips into extremes. “If that’s done without an understanding of the mechanical limitations of the joint, it can mean trouble,” he said in an interview.

Broad goes on to explain the anatomically why women’s hips are more vulnerable and it is suggested that readers read his full article to get a better understanding. It helps to be well informed.

I think (though no studies have been done), based on common sense and personal observations over 30 plus years, that gentler styles of yoga will be less prone to injury while still being significantly helpful for arthritis, range-0f-motion, backs, hips, shoulders, breathing, and many other health problems. The gentler yoga is the bedrock of Satyananda Yoga, Sivananda Yoga, Integral Yoga (all founders were disciples of Swami Sivananda of Rishikesh). Himalayan Institute founded by Swami Rama also is firmly in the gentle yoga approach. Interestingly, the founders were all grounded in raja/tantra yoga and not predominantly hatha yogis. Krishnamachari, and his most prominent disciples B.K.S. Iyengar and Pattabhi Jois, are master hatha yogis. But they too, particularly the late Krishnamachari (and now his son Desikachar), cautioned on extremes and having the right attitude and approach.

Somehow the practice of yoga has gotten out of hand and we need to fix it.

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So many readers come to this blog searching for answers on surya namaskar. There is a whole book, a small one, devoted to this series of poses. Surya namaskar, or sun salutations, is one of the most popular flows of yoga asana. There are perhaps as many variations as there are teachers. Many questions come up on how to do this sequence of the traditional 12 poses. Some poses are repeated in the cycle. This can be a complete yoga practice as shown by Surya Namaskara: A Technique of Solar Vitalization by Swami Satyananda.

For the full review please go to http://mahasriyoga.com/bookreviews/SuryaNamaskara.html.

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As the days get cooler, it is time to resume the practice of surya namaskar (sun salutations) which may been stopped for hot summers. It is also a good time to review the sequence and move into deeper aspects. A good number of visitors to this website come through the search on this sequence of 12 positions.

For detailed instructions, pretty much a transcript, the chapter on surya namaskar in Asana Pranayama Mudra Bandha by Swami Satyananda is an excellent resource. It not only lists benefits, it also gives contraindications. The book Surya Namaskara, also by the same author, expands upon the sequence. It demonstrates how this is a complete practice to which progressive layers can be added.

Readers are cautioned that the practice is not recommended for people with high blood pressure, heart disease, stroke, hernias, and intestinal diseases. Hernias and sciatica can be aggravated. Back issues may require modifications. Past blog posts on this blog are good resources for more information:

Questions on how to practice:

http://yogamedblog.wordpress.com/2011/10/27/qahow-to-practice-surya-namaskar/

http://yogamedblog.wordpress.com/2011/11/03/updates-on-surya-namaskar-practice/

Research on fast and slow surya namaskar:

http://yogamedblog.wordpress.com/2011/10/25/physiological-effects-of-slow-and-fast-surya-namaskar/

Surya Namaskar part of fall routine:

http://yogamedblog.wordpress.com/2012/10/06/adjusting-mind-and-body-to-fall/

One chair yoga version I do with seniors:

http://mahasriyoga.com/asana/chair.html

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Working with the seniors in Ridgewood, we try different movements determined by their needs. There are constant adaptations as the limitations and requirements change. Three upper body exercises from our repertoire have been added to www.mahasriyoga.com/asana/upperbody.html. They may be helpful to the readers of this blog and the website. Gentle movements, like these, can be excellent for warm-ups. These exercises could also be good for fibromyalgia.

Shoulder See-Saw

This movement can be done sitting, standing, or lying down. In addition to loosening the stiffness in shoulders, the neck muscles also get a gentle stretch. There is movement in the upper chest and upper back as well. All these areas are connected and pain in one part may cause residual pain in the others. So it is helpful to work gently on the entire area.

Arm Swings

These can be done sitting or standing. The movements continue to work more deeply in the areas of the body detailed above.

Rowing

This movement is best done sitting down. In addition to working on the entire upper body, it is also helpful to in toning or massaging the abdominal organs and for peristalsis.

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For years we were told that the “core muscle” was the ab and there was a great emphasis on working the muscle for a stronger back as well as a slimmer waistline. School gym teachers praised children who could do the most sit-ups and crunches in a minute. Many kids came home with painful backs. Now those routines are out-of-favor because they are harmful for the back.

The January 3, 2013 issue of Harvard HEALTHbeat, writes:

Sit-ups once ruled as the way to tighter abs and a slimmer waistline, while “planks” were merely flooring. Now planks — exercises in which you assume a position and hold it — are the gold standard for working out your core, while classic sit-ups and crunches have fallen out of favor. Why the shift?

One reason is that sit-ups are hard on your back — by pushing your curved spine against the floor and by working your hip flexors, the muscles that run from the thighs to the lumbar spine of the lower back. When hip flexors are too strong or too tight, they tug on the lower spine, which can be a source of lower back discomfort.

Second, planks recruit a better balance of muscles on the front, sides, and back of the body during exercise than sit-ups, which target just a few muscles. Remember, your core goes far beyond your abdominal muscles.

Finally, activities of daily living, as well as sports and recreational activities, call on your muscles to work together, not in isolation. Sit-ups or crunches strengthen just a few muscle groups. Through dynamic patterns of movement, a good core workout helps strengthen the entire set of core muscles — the muscles you rely on for daily activities as well as sports and recreational activities.

This information echoes what Dr. Stuart McGill has been advising for many years. Dr. McGill is a professor of biomechanics at the University of Waterloo, Canada. Dr. McGill is a highly regarded back-pain expert in the sports world. In an informative New York Times article of June 17, 2009, “Is Your Ab Workout Hurting Your Back” by Gretchen Reynolds, it appears that the isolation of the abs (transversus abdominis) for a core workout began with an Australian study in the 1990s. Reynolds writes:

The lab worked with patients in pain to isolate and strengthen that particular deep muscle, in part by sucking in their guts during exercises. The results, though mixed, showed some promise against sore backs.

Perhaps that is how the trend of working the abs started. Dr. McGill says that this thinking spread to trainers and through them to the public. According to him, the core is not just one muscle but a “corset” of muscles that circle the spine and hold it in place. By working on just one muscle the spine is destabilized and it loses its alignment. All the muscles must be balanced in order for the spine to bear large loads. The analogy used is that of a fishing rod. Think of the spine as a fishing rod that is held in place by muscular wires.

“If you pull the wires closer to the spine,” McGill says, as you do when you pull in your stomach while trying to isolate the transversus abdominis, “what happens?” The rod buckles. So, too, he said, can your spine if you overly focus on the deep abdominal muscles. “In research at our lab,” he went on to say, “the amount of load that the spine can bear without injury was greatly reduced when subjects pulled in their belly buttons” during crunches and other exercises.

Hollowing the belly and pressing the spine against the floor is a bad idea that has made its way into yoga studios and routines as well due to cross-pollination with trainers and fitness routines. Dr. McGill says sit-ups put a “devastating” load on the spinal disks. Instead, he suggests a side plank and a “bird dog” (in yoga it is the tiger pose or vyagharasana).

For more, please read The New York Times article, see the short video Core Values that accompanies the article, and visit Dr. McGill’s website www.backfitpro.com for his articles and more information. Readers may also want to visit a previous blog post Do Yoga Classes Hurt Your Back?

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Admittedly, there is some gratification in knowing that medical advice now supports what should have been part of asana teaching for decades. A 45-year old woman, a glaucoma suspect, is advised by an ophthalmolgist to avoid inverted positions such as a headstand and  “semi-inversions” such as downward dog. This was discovered in the post by the ophthalmologist Dr. Carolina Valdivia on her blog http://www.glaucoma-eye-info.com/yoga-positions.html.

With increased attention regarding yoga injuries in the main stream media, there is some openness now that did not exist some years ago. This is a welcome change for everyone. Yoga injuries are not a badge of honor or any indication of a high level of personal commitment to an asana practice. This attitude to yoga is completely misguided. The risks and limitations of asanas are still not part of most yoga teacher training programs.

Dr. Valdivia answers the following question by a 45-year old woman from New South Wales, Australia:

“Hi Dr. Valdivia. I have been very recently diagnosed as a glaucoma suspect, but at the moment my eyes are healthy. I am not taking any medication for it.

I practice yoga and my eye specialist has told me that because I am a glaucoma suspect I should not attempt any fully inverted yoga poses (legs above the head, for example: headstand) and to limit time spent in semi-inverted yoga poses and postures (head below the heart, for example: downward dog).

My question is, how many seconds can I safely hold the semi-inverted yoga poses and postures before I create an eye pressure problem?”

In response to that question. Dr. Valdivia gives an extended and thorough explanation that readers can read via the above link. However, for people who do not like to click, here are the commonly identified triggers which cause a temporary increase in intra-ocular pressure (IOP) that must be avoided not just for glaucoma but for macular degeneration, high myopia, retinal tears, and retinal detachments.

  • Abrupt or sustained physical exertion, such as lifting a heavy object.
  • Squatting.
  • Bending over, while standing or sitting, so that the head is below the heart.
  • Straining during defecation.
  • Playing a brass or woodwind musical instrument.
  • Wearing constrictive clothing around the neck.
  • Various acrobatic or gymnastic maneuvers.
  • Certain yoga positions.

 Several scientific studies have specifically investigated the effects of yoga positions on generating high intra-ocular pressure in adults. The concern has been that not only do certain yoga positions carry a risk of creating a transient eye pressure problem, these positions often are held for extended periods, which carries the risk of sustained high intra-ocular pressure.

Here is an outstanding table from Dr. Valdivia’s post that illustrates how some commonly practiced inversions increase intro-ocular pressure:

The table below presents combined (meta-analysis) data obtained from 12 published studies looking at the effects of various yoga positions on intraocular pressure (IOP). Particular emphasis is given to inverted yoga poses and those that are semi-inverted. Participants in the studies were free of ocular disease, were between the ages of 22-63 years, and ranged from intermediate to advanced levels of proficiency. Average intraocular pressure at a seated position for this combination of studies was 15.2 mmHg.

YOGA POSE

AVERAGE IOP AFTER
INITIATION

INCREASE IN IOP

Salamba Sirsasana
(headstand)
33.6 mmHg +18.4 mmHg
Urdhva padmasana
(Inverted Lotus)
33.2 mmHg +18.0 mmHg
Parsva Sirsasana
(side headstand)
33.5 mmHg +18.0 mmHg
Parivrttaikapada Sirsasana
(Revolved Split-Legged
Headstand)
33.9 mmHg +18.7 mmHg
Pincha Mayurasana (peacock
feather pose)
31.5 mmHg +16.3 mmHg
Eka Pada Viparita Dandasana (one-legged inverted-staff
pose)
28.2 mmHg +13.0 mmHg
Utthita Pada Sirsasana
(extended-leg headstand
pose)
33.7 mmHg +18.5 mmHg
Valsalva Maneuver
(attempting to forcibly exhale
while keeping the mouth and
nose closed)
38.1 mmHg +22.9 mmHg
Adho Mukha Vrksasana
(handstand)
34.8 mmHg +19.6 mmHg
Salamba Sarvangasana
(Shoulder Stand)
25.4 mmHg +10.2 mmHg
Urdhva Dhanurasana
(wheel pose)
22.4 mmHg +7.2 mmHg
Halasana (plow pose) 19.0 mmHg +3.8 mmHg
Adho Mukha Svanasana
(downward-facing dog)
19.9 mmHg +4.7 mmHg
Setu Bandha Sarvangasana
(bridge pose)
24.3 mmHg +9.1 mmHg
Urdhva Mukha Svanasana
(upward-facing dog)
14.5 mmHg -0.7 mmHg
Viparita Karani
(legs-up-the-wall pose)
14.0 mmHg -1.2 mmHg
Virasana (hero pose) 13.8 mmHg -1.4 mmHg
Padmasana (lotus pose) 13.7 mmHg -1.5 mmHg

Meta-analysis by Carolina Valdivia Cáceres, MD and Ángela Pattatucci Aragón, Ph.D., 2011.

Dr. Valdivia advises the woman:

Spikes in high intraocular pressure appear to be immediate upon entering yoga poses and postures. Thus, there appears to be no safe period of time for you to practice either inverted yoga poses or semi-inverted yoga positions.

Here we have one doctor saying no inverted or semi-inverted positions and one saying semi-inverted positions are not to be held for extended periods of time. What is “extended period of time”? To me, it is anything beyond 10-15 seconds but depending on the individual experience even that may be too much–we generally did not hold more than 5 seconds.

Why the gratification? Because ever since I have been teaching yoga, new students were asked about any medical conditions and family history of eye problems. Returning students were asked about changes in medical conditions. This way, they could be cautioned about what to avoid and modifications, where possible, could made for them. When people who said they had a family history of glaucoma (or high blood pressure, cardiac problems, GERD, high myopia, hernia, etc.) were told they could not do the only inversions we did sometimes do–the shoulderstand and the plough (a modified plough), the explanation was almost always received with disbelief. They said that no other teacher said this to them and it was taken as an unnecessary restriction that limited the physically challenging practice they wanted.

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