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Archive for the ‘Asana and Surya namaskar’ Category

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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There has been a recent spate of eye issues in our family and that presents an opportunity to discuss a serious, negative effect of certain asanas for various eye issues. A of lack of knowledge among practitioners and teachers is a matter of some concern. Contraindications of various asanas and some pranayamas should be a vital part of yoga teacher training curriculum.

It is particularly important to be aware of inversions and their effect on intra-ocular pressure (IOP)–or eye pressure. Look at the case study of a 46-year old woman, Yoga can be dangerous–glaucomatous visual field defect worsening due to postural yoga, in The British Journal of Ophthalmology, October 10, 2007 issue. The woman had worsening glaucoma a year after starting a regular practice of headstand. The effect was reversible after she stopped practicing it. In 10 non-yoga practicing volunteers, the headstand increased IOP two-fold. The study concluded:  “Therefore postural (head‐down) yoga exercises are clearly not recommended for patients suffering from glaucoma.”

To illustrate the point,  the study has pictures of the woman’s visual field some months before starting postural yoga,  one year after starting postural yoga,  and one year after stopping it.

Another study, Progression of glaucoma associated with the Sirsasana (headstand) yoga posture by researchers from the Department of Ophthalmology, University of Texas, Southwestern Medical Center in Dallas concluded: “Transient increases in IOP associated with the yoga headstand posture may lead to progressive glaucomatous optic nerve damage and visual field loss.”

In talking to ophthalmologists and a retinologist, it is clear that they have deep concerns regarding inversions and particularly when the inversions are held for prolonged periods.

Source:

Br J Ophthalmol. 2007 October; 91(10): 1413–1414.

PMID: 17276961 [PubMed - indexed for MEDLINE]

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According to the International Journal of Yoga, January 2012 paper, Effect of yoga therapy on reaction time, biochemical parameters and wellness score of peri and post-menopausal diabetic patients:

It is now recognized that diabetes mellitus (DM) is a lifestyle and psychosomatic disorder in which factors such as sedentary habits and physical, emotional and mental stress play a major role. Modern research has focused on psycho-physiological beneficial effects of yoga as it is more than a physical exercise. It has been reported that even a short life-style modification and stress management education program based on yoga reduces risk factors for cardiovascular disease and DM within 9 days while a systematic review of 32 articles published between 1980 and 2007 found that yoga interventions were generally effective in reducing body weight, blood pressure, glucose level and high cholesterol. 

The  study evaluated the effect of yoga therapy on reaction time, biochemical parameters, and the wellness score of  15 peri and post-menopausal diabetic patients.  The patients participated in a comprehensive yoga therapy program where they received training for a one-hour session three times a week  for six weeks. A post-intervention, retrospective wellness questionnaire was used to evaluate the comparative feelings of the patients after the therapy program. The study was unable to have a control group.

Yoga training reduced the auditory reaction time (ART) from right as well as left hand. According to the paper, reduced ART implies better information processing ability and reflexes. In addition, there were significant improvements in blood glucose levels, low density lipoproteins (LDL), high density lipoprotein (HDL), total cholesterol levels, and triglyceride levels. The patients also reported a greater feeling of well being. The study concluded that yoga therapy can have role in managing diabetes as part of integrative and complementary medicine.

Table 1 in the study gives the sequence and duration times  of yoga asanas and pranayamas used as yoga therapy.

I would like readers to note that these were done under medical supervision and that the same may not be appropriate for everyone. An experienced yoga therapist, along with a medical provider, must be consulted for individual situations. A single program cannot be applied across the board for everyone.

Source: Madanmohan, Bhavanani AB, Dayanidy G, Sanjay Z, Basavaraddi IV. Effect of yoga therapy on reaction time, biochemical parameters and wellness score of peri and post-menopausal diabetic patients. Int J Yoga [serial online] 2012 [cited 2012 Feb 27];5:10-5. Available from: http://www.ijoy.org.in/text.asp?2012/5/1/10/91696

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Returning from our trip to India, my friend Bonnie gave me the The New York Times Magazine, dated January 8, 2011, because of the article “All Bent Out Of Shape: The Problem With Yoga”  by William J. Broad. The author is a senior science writer at the paper and the article is adapted from his upcoming book, The Science of Yoga: The Risks and Rewards.

With the dust of Indian villages, towns, and cities still clinging to my shoes, reading this article makes me think Broad is indeed naive, as he claimed to be until he was enlightened by yoga teacher Glenn Black, along with much of the yoga world here.

Yoga is a source of healing and never harm. That is not naive, it is a fact. What is naive is the individual’s delusional, foolish attitude by doing what is harmful, perhaps pushed by a teacher. A knife is an essential tool in the kitchen but if someone does not know how to use it, it can cause harm. In a violent person’s hand, it kills; in a surgeon’s hand, the knife heals. So the knife is not the fault, the way it is used or abused produces the different outcomes.

Yoga does not cause harm. Its abusive, uninformed, and misguided practice causes harm. Normally sensible, intelligent people, who research and question doctors, accountants, lawyers, for some unknown reason drop common sense on the floor along with their shoes when in a yoga class. It never failed to amaze me! I saw someone who had injured his cervical vertebrae through repeated headstands and handstands. He came to me to heal and then went right back to doing what caused him injury even though he was told that these positions were not for him. He could have opted to do simpler poses and held them for 30 seconds instead of several minutes. The choice was his and yoga could hardly be faulted. So the question is, What makes people make poor decisions that are potentially harmful to them? What is in their minds? What is the thinking? Do we desperately want to believe in something that is not real as we evade our own reality? Yoga asks that you face yourself and life with complete honesty, objectivity, and acceptance. It is fundamental.

In 30 years of teaching I stated that we would not do inversions–no headstands, handstands. Only some could do the shoulder stand. Reasons were given to explain why every asana was not appropriate for everyone. Many stayed on, many left because this was not what they wanted to hear–they wanted the asanas that had the potential to hurt them! Here, I totally agree with  Black’s experience after his spinal surgery as he tries to explain that these asanas are not for everyone and finds that people do not want to hear it.

I have heard yoga teachers brag about their yoga injuries as badges of honor. They are totally uninformed about the limitations and contraindications of the different poses. Broad and Black should read Asana Pranayama Mudra Bandha by Swami Satyananda. They seem to have missed one of the most important books written over 40 years ago. Injuries such as stroke, blurred vision, retinal detachment, are all risks associated with inversions (including prolonged downward dog) and those positions are contraindicated for many people. The limitations, risks, people who may be at risk, are all indicated in the book. Even backbends and foward bends require thought. For instance, in the locust the leg should be lifted just 6-12 inches off the floor. Lifting further no longer stretches the spine and instead compresses the lumbar vertebrae. This causes pain and possible arthritis. Observe and feel the body clinically and you will sense it right away.

The problem is that yoga teachers are not taught this, even though the information is there. The ones who know and refer to this book choose to ignore it. It is too much trouble to ask each class member their medical history. Fear of being sued is great. Modifications in a class are disruptive for them. The teachers find all these details bothersome and say that those who come do so at their own risk and as they sign waivers, the teachers bear no responsibility. The teachers are also wary of scaring away people as their aim is to pack the room and promote yoga as the panacea to all ailments and problems. The teachers are at risk themselves because of the ignorance. I have seen this many times at local yoga studios and at teacher training programs. There is a glaring lack of intellectual curiosity, thought, reflection, and scientific observation–all are required in yoga.

Just as every medication or vitamin out there is not for everyone, nor is every asana. An experienced teacher can help choose what is appropriate. Yoga is not just for those in generally good condition, if taught properly. It offers something for everyone. However, the way it is taught in American Yoga, it is true that a general class is for those who are pretty fit.

Several years ago, I went to a teacher training class on chakras at Dharma Mittra’s studio in Manhattan. The teacher was some medical doctor. I came away totally disappointed. The man knew far less about chakras than my students. He refered to a Bihar School of Yoga book and did not understand anything from it. After the class, I asked Dharma Mittra a couple of questions about chakras and came away wondering what the big deal was about him, he had waffled. Yes, he can do many tough asanas but so can an acrobat.

So whose fault is it that we put people on pedestals when they don’t deserve that place? People buy into the marketing and PR but surely after a class or two they should realize if it is for them or not. My yoga friends tell me how they are pushed to do inversions in various yoga classes (I no longer teach) and even though I have drummed into them over the years that they should avoid these positions, at least one of them got nudged into doing it in a class and felt she had hurt her neck.

Having  just returned from our annual India trip to life in villages, small towns, and middle class urban areas (as opposed to affluent South Mumbai), clearly people live very different lives. They squat to go to the toilet, wash clothes, sweep and mop floors, and clean dishes. They sit on the floor to cook, iron, eat, bathe, and socialize. The diet is whole grains, legumes, and fresh vegetables. Their lives are physically active. Most sleep on a mat or hard mattress on the floor. There is no air conditioning in the summer or heating in the winter. The gait of the walk is different. They do not wear high-heeled shoes. Asanas that apply to them may not work for the lifestyle, weather, diets, and bodies over here. For instance, laghoo shankprakshalan (bowel cleanse) is so much easier for the people in India than it is for people here. The yoga that I learned in India was physically far less challenging than anything I see now.

Yoga injuries arise for various reasons: inappropriate use of yoga, ignorant teachers, students who refuse to use common sense. Adequate data and statistics are not available to assess yoga injuries. As more people practice yoga, the number of injuries will rise but the ratio may remain the same. People who practice yoga here also have other activities that can cause injury–dance, Pilates, jogging, weight training, strength training. It is often impossible to assess what caused injury.

Finally, people understandably feel compelled to go to “brand” names whether it makes sense for them or not. As I look around, none of these “yoga teachers” are really yogis to me. They are in the business of physical fitness classes that use yoga asanas out of context and with little understanding. It is more about the business of yoga, the inflated personal ego of the teacher, and the ego of the student.

Simpler asanas are far more effective than complex ones. But hardly anyone teaches the simple ones because people think they are getting more for their money with the difficult, showmanship asanas. There are places that hold true to the integrity of yoga–Satyananda Yoga and Himalayan Institute from the northern lineages of raja and tantric yoga; and Desikachar from the southern hatha tradition. A general class is possible for people if it is designed with thought and care. I did it for many years and we had no injuries.

As far as Indian gurus go, not all are the gurus they claim to be–many have their own ego trips and issues. Using some common sense is always helpful. Iyengar will be the perfect teacher or guru for many but he is not for everyone. For me, it was Swami Satyananda and even though I respect Iyengar, he was not for me and I would never have suited him.

Traditionally, the guru is a spiritual guide as well as a psychotherapist and a physical therapist. He holds you by the hand, body, mind, and spirit. This relationship is rooted in trust. It is nothing like dropping into a “yoga class”. A true guru is hard to find and how many out there really want one?

People get what they seek. So please don’t get all bent out of shape about yoga.

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The effect of an integrated yoga routine for osteoarthritis of the knee, conducted by Swami Vivekananda Yoga Research Foundation in India was published in the September 27, 2011 issue of the International Journal of Yoga.

The aim of the study was to evaluate the effect of adding integrated yoga to electric and sound therapy to randomly selected outpatients from Dr. John’s Orthopedic Centre in India.

There were 118 participants in the integrated yoga group and 117 in the control group who received physiotherapy exercises. The age range was 35 to 80 years. Both groups underwent their respective therapies after the electric and sound therapies they all underwent. The yoga group received yoga therapy for 40 minutes each day, six days a week, for two weeks. Follow-up was expected for three months after that.

Integrated yoga included the following: asana, pranayama, meditation, and counseling on yoga-based holistic living with life style changes, weight management, and management of psychosocial stress.

The participants did yoga-based loosening exercises for feet, ankles, knees, hips and waist, upper limbs, neck, and a 17-step relaxation. Then they did strengthening asanas for back, thighs, legs, knees, and ankles, followed  by a guided relaxation based on abdominal breathing. They ended with standing asanas, a guided deep relaxation, nadi shodhan (alternate nostril breath) pranayama, and om chants. All these steps with the number of repetitions and time allocations are listed in this highly detailed, well written study.

The results indicated greater improvement in the integrated yoga group than the control physiotherapy group in the following indicators: quality of life, physical function, problems with work and daily activities, emotional problems, energy and fatigue, social functioning, experience of pain, and general health.

The integrated yoga routine is very similar to the program I have for our seniors in Ridgewood, NJ. Some of it is on www.mahasriyoga.com/asana. Breathing and relaxation audio tracks (shorter than meditation tracks on the website) are on www.mahasriyoga.co/pranayama. Based on what the seniors say to me, our results are similar to those in this study.

Source: International Journal of Yoga

Year : 2011 | Volume:  4 | Issue Number:  2 | Page: 55-63

Effect of an integrated approach of yoga therapy on quality of life in osteoarthritis of the knee joint: A randomized control study
Ebnezar John, Nagarathna Raghuram, Bali Yogitha, Nagendra Hongasandra Ramarao
DOI: 10.4103/0973-6131.85486

PMID: 22022123

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