Link Between Pregnancy Complications and Heart Disease

by Nina

The Kiss by Mary Cassatt

Baxter and I recently read an extraordinary 50-year study Pregnancy Complications and Cardiovascular Disease Death: Fifty-Year Follow-Up of the Child Health and Development Studies Pregnancy Cohort  that was conducted on nearly 15,000 women who became pregnant from 1958 to 1967. The study noted which of the pregnant women had pregnancy complications and then followed all the women through 2011. For those women who had pregnancy complications, the study found a link to death from heart disease before age 60.

We wanted to let you know about this study because of course some of our readers will fall into this category of having had pregnancy complications. We don’t want you to panic, of course. We just want you to be aware of the link between these conditions, and hopefully take a few preventative steps. 

So today I’ll start by telling you about which complications are linked to heart disease, and why. Then I’ll say something about what you should do if you are at risk (Or, what you should help a relative or friend do if she is at risk.)

Which Pregnancy Complications are Linked to Heart Disease?

Pregnancy complications that raised the risk of death from heart disease included:

• High blood pressure before or starting during pregnancy (preeclampsia) 
• Low-birth-weight child
• Early delivery
• A drop in the ability of red blood cells to carry oxygen
• High sugar levels in the urine

According to a co-author of the study, Barbara A. Cohn, PhD, director of the Child Health and Development Studies at the Public Health Institute, all these complications increased the risk of dying from heart disease before 60. Having more than one complication raised the risk even more. Depending on the complication, and the number of them, the risk of death increased by nearly two to seven times. The study concluded:

"The presence of pre- existing hypertension coupled with pre-eclampsia, preterm birth, or SGA birth, strongly predict CVD death. Furthermore, we found that early-onset pre-eclampsia predicts death before age 60."

Why is there a Link between these Complications and Heart Disease?

Apparently the complications themselves aren’t the cause of increased risk of heart disease. Instead, the complications may be a predictor of how well a woman's cardiovascular system can adjust to the demands of pregnancy. So the pregnancy functions as a metabolic stress test for identifying women who are at higher risk of cardiovascular disease later in life.

When you are pregnant, your heart has to work harder to pump enough blood throughout your body and to your unborn baby, as a your blood volume doubles during pregnancy. So pregnancy provides a picture of how well your body is functioning, with complications and preeclampsia showing that a woman’s heart and blood vessels already have problems. While it takes decades for heart disease to develop, these conditions lay the groundwork.

What Should You do if You fall into this Category?

The authors of the study provided advice for doctors rather than patients:

"Physicians should provide early, prompt surveillance and intervention for women with these high-risk pregnancy complications."

and

"We observed combinations of pregnancy complications that predict high risk of death and two new risk markers, glycosuria and hemoglobin decline. Obstetricians serve as primary care physicians for many young women and can readily use these complications to identify high-risk women to implement early prevention."

If you are currently pregnant and experiencing any of these complications, please alert your obstetrician to this study so the doctor can take appropriate actions. 

If you previously experienced any of these complications, take this information to your doctor, whether that is your internist or OB/GYN, and discuss what is the best approach for you. In the meantime, you can support the medical monitoring or treatment you are receiving from your doctor with a yoga practice focused cardiovascular health.

Start by reading our post Heart Health and Yoga for some background information. Then you can check out our yoga sequences for heart health, which are both short and accessible practices. 

The Inverted Heart Health Sequence includes inverted poses because they can have several immediate and long-term influences on your heart and circulatory system. Inversions put your body in a position to take advantage of gravity to assist in venous return to your heart—you flip upside down and gravity pulls the blood back toward your heart and head! They can also have a quieting effect on your nervous system, encouraging a shift from Fight or Flight mode to Rest and Digest mode. Your heart muscle needs both exercise and rest, so a good combination of effort and relaxation in your practice will give your heart a more balanced experience.

The Cardiovascular Heart Health Sequence includes:

Dynamic Yoga Sequences. Linked sequence of poses that move fairly quickly, such as Sun Salutations, gradually warm up your body and your cardiovascular system, both strengthening and stretching the muscles and connective tissue that your body’s blood vessels pass through, both exercising your heart and encouraging more efficient flow through the piping of your system.

Static Poses. Poses that you hold for longer periods increase what is known as the “work load” of your heart, providing a different kind of exercise and challenge for your heart. Those with high blood pressure and diabetes will have to approach these poses with caution and work into the holds very gradually, preferably under the guidance of an experienced teacher.

Gentle Inversions and Restorative Poses. These poses quiet and rest your cardiovascular system and your heart, which is equally important to testing and stressing your system. They allow your heart and nervous system to quiet, and as a result can nicely lower your blood pressure, heart rate and breathing rate.

Pranayama and Meditation Practices. These practices support the effects of the inversions and restorative poses.

If chronic stress is a problem for you, see The Relaxation Response and Yoga for an overview of how yoga helps with stress and a list of techniques to choose from. We also have many posts on insomnia (see Five Tips for Better Sleep, for example). Finally, if you’re struggling with poor eating habits, see Yoga for Healthy Eating. 

See webmd.com for further information. (We can't give you access to the full original study, which Brad obtained for us, but the abstract is at Pregnancy Complications and Cardiovascular Disease Death: Fifty-Year Follow-Up of the Child Health and Development Studies Pregnancy Cohort.)

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Featured Pose: Plank Pose

by Baxter

Plank Pose (Phalankasana, as it is sometimes called in modern times) often shows up in our practice as a brief way station between other poses, such as between Downward-Facing Dog (Adho Mukha Svanasana) and Four Limbed Staff pose (Chaturanga Dandasana). However, more and more, I am turning to it as a held pose for the benefits it can confer on its own: improved overall body strength, more specifically shoulder girdle strength and stability, abdominal/core and arm strength, and even leg strength, too! It can challenge awareness of overall stability vs. when fatigue begins to arise. And it is a great pose to cultivate equanimity and calm in the storm of the physical demands of the pose.

I prescribe this pose for:

• Improving upper body strength
• Improving core/abdominal strength
• Improving spinal stability
• Building forearm, wrist and hand strength
• Building bone strength, especially in the wrists, for those with osteoporosis
• Improving mental focus 
• Building confidence 

Cautions: My number one caution is to start out gradually with shorter holds and slowly add more time to your pose so your body can acclimate to the challenges of the pose and you can build endurance and stability gradually. In addition, since the classic version places a lot of pressure on your wrists, those with wrist issues such as carpel tunnel syndrome or thumb arthritis should try the modified versions, especially the forearm version. In addition, since this pose challenges and strengthens the abdominal muscles, those with abdominal hernias or women with diastasis recti (separation of the abdominal wall) should be cautious to start with short holds and see if the areas of concern do okay before proceeding further.

1. Classic Version

You can enter into the pose from a hands and knees position like the one we take for Cat/Cow, but I prefer entering from Downward-Facing Dog. So, start by coming into Downward-Facing Dog (see Featured Pose: Downward-Facing Dog Pose), and then swing your body forward, bringing your shoulders directly over your wrist joints. Keep your head in line with the rest of your spine.

Once you have your shoulders positioned correctly, draw a mental line from your shoulders to your heels and notice if your hips are higher than that line. If so, wiggle the balls of your feet back a few inches until you sense the hips now in line. If the opposite situation happens and your hips sagging below the imaginary line, float them up a few inches or move the balls of the feet forward a few inches to bring your hips into line.

As you work in the pose, a few internal actions will help you to maintain your alignment, especially firming your elbow joints and imagining an inner lift coming up from the wrists to the shoulders. Also, lift your chest up into your shoulder blades to stabilize your shoulder region (your shoulder girdle). Finally, although most of the work will seem to be coming from the arms and chest, consider firming and lifting your belly up towards your spine without flattening your lower back. Firm your leg muscles, especially around your knees. (I will sometimes practice with a block between my thighs to recruit the help of my inner thigh muscles, and then try activating without the block, and it makes the pose easier for me to do.)

Start with shorter holds, say, 4-6 breaths, and gradually add longer holds over time. To come out of the pose, you can swing back to Downward-Facing Dog or simply bring your knees down to the floor. Once there, try releasing your wrists one at a time with simple circling actions. You might repeat the pose several times during a home practice. 

2. Forearm Version

This version is helpful for those who have any wrist or hand problems and are unable do the full version safely. In addition, most practitioners feel that this version requires even more upper body and abdominal strength, so it might be the next version to practice if the classic version gets easy. 

To come into the pose, start in Hands and Knees position.

Now bring your forearms down to the floor with your elbows where your wrists were positioned a moment ago. Have your forearms parallel to each other and your palms turned down. Next, turn your toes under and lift your knees off the floor pulling your hips up and back into Forearm Dog. As with the classic version, swing the your forward, this time directly over your elbows. In all likelihood, you will need to wiggle the balls of your feet back 2-6 inches until your hips come in line with your shoulders and heels. Keep your head in line with the rest of your spine. Press your entire forearms into the floor, like a big hand, so your weight does not all drop heavily into just your elbow joints.

Time your holds as in the classic version. To come out of the pose, swing back to Forearm Dog and then drop down onto your knees and release into Child’s pose (Balasana), with your arms either straight in front of your or resting alongside your body. Release your wrists with some small circular movements. Repeat 1-2 more times. 

3. Chair Version

Because the angle of your body relative to the ground is higher when you use a chair, this version is easier and requires less initial strength than the first two versions. So this version is a good one for beginners and those who are starting off more deconditioned. This version also does not require you to bend your wrists so deeply, so could be approachable for those with some wrist issues. 

Start by placing the back of the chair against a wall, so it does not slide away during the pose. Next, stand in Mountain pose (Tadasana) about a foot away from the chair. Bend your knees, tip forward from your hips, and place your hands flat on the seat of the chair, close to the front edge. Press down firmly and walk your feet and hips back into a Downward-Facing Dog pose with hands on the chair seat for a breath or so. From here, with straight arms, swing your body forward until your shoulders are just a few inches back of your wrists and your body forms a straight line from heels through hips to shoulders. Keep your head in line with the rest of the spine. 

Use the same timing as the classic version. To come out of the pose, swing your hips back to Downward-Facing Dog with hands on the chair seat, then bend your knees and walk forward towards the chair, eventually rising back up to Mountain pose. Release your wrists with some small circular movements. Repeat 1-2 times. 

4. Knees Down Version

Because this version is between the chair and classic versions in difficulty, it is a good transition from one to the other. It is also a good substitute for Upward-Facing Dog pose (Urdva Mukha Svanasana) or Cobra (Bujanghasana) during Sun Salutations if you want a beneficial alternative. 

If you know you’ll need padding for your knees, start by placing a folded blanket in the middle of your mat. Then come in the classic version as instructed above just for a moment. Now bend your knees and drop them down to the floor or blanket. With your knees touching, lift your shinbones up towards the ceiling, and bring your hips in line with your knees and shoulders, maintaining a shoulders-over-the-wrists alignment. This may require moving your hands forward or back a few inches, but do this movement lightly to keep the impact on the wrists to a minimum. 

Use the same timing as the classic version. To come out of the pose, simply push yourself back to Child's pose. Then release your wrists with some small circular movements. Repeat 1-2 more times. 

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Video of the Week: Immune System Support

by Baxter

Because my new vinyasa is a variation of Reclining Vinyasa 2.0, you might check out that video first, if you have not already practiced it. 

My new vinyasa,Version 2.5, adds in some folding and releasing of the thighs to the hips, which massages and squeezes the groin area of your body. This area has some lymph glands and blood vessels that pass through to your belly and chest. You can add this sequence into any practice focused on improving immune function and lymphatic drainage.

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Friday Q&A: Videos in Our Emails

Error on Green by Paul Klee

Q: I’m an email subscriber to your blog. Unfortunately, when you include a video in a post, I just get a black box. So I can’t play the video. Can you please fix this?

A: I wish I had a good answer to this! I’ll start by telling you the easiest way to play the video. Then, for those who are interested, I’ll explain why this problem occurs. Finally, I’ll explain why we are set up so problems like this one are unfortunately beyond our control.

How to Play the Video

The easiest way to play the video that is in an email article is to click on the title of the post (not the title of the email). This appears as a link in your email (possibly colored blue). And clicking on that link will take you to the original post on our blog site, where you can simply play the video on the blog.

Here’s how the article looks in Google Mail, where I don’t get a black box—I just don’t get anything. The title in blue is the link to the original post.

Why is there an Error?

On our blog, we are able to “embed” videos from YouTube in our posts. So you play them from directly from the post without going to YouTube (which is where the videos actually live). We think this is a great feature!

Unfortunately some (or perhaps all) email systems do not allow videos to be embedded in email. They can have text and photos in them, but not videos. So although the original post has a video in it, the message in your inbox can’t include it.

Why Can’t You Fix This?

While some people refer to the emails they receive from us as our “newsletter,” that is not technically what they are. Instead, you have signed up for a free Google service called Feedburner that automatically emails you every time we update the blog and sends you a text only version of the blog post. (At least Feedburner documentation says the emails are “text only” but I’ve noticed photographs do come through—who knows…. Still, it is clear that videos don’t come through.)

Now while Feedburner is not without its flaws, it has two qualities that I like: it is automatic and it is free. So until and unless I find an alternative that, likewise, is also free and automatic, I will continue using Feedburner. (Notice I’m saying “I” not “we.” That’s because I’m solely in charge of the technical side of things. All of the other writers just email me articles. I, myself, do all the work of formatting posts and maintaining/troubleshooting the blog.)

If you decide you don’t like getting the emails because there are too many (we have had that complaint), you don’t like the format, or for any other reason, you can always unsubscribe by clicking on the Unsubscribe link in the email. Then you can just read the latest posts on the blog site by going here directly.

We also use a free service from Google called Blogger to create our blog. It also is not without its flaws. I’m not a fan, for example, of how hard it is to find the special pages on the blog or to sign up for email in the first place. But, again, this is a free service and I find it quite easy to use for formatting blog posts. In my dreams, we have a special web site instead that is custom-designed just for us, but that would cost a lot of money, as I’d have to hire someone to design and program it. And as we receive no income from the blog (it’s a non-profit offering), that's not a real possibility.

If anyone out there wants to nerd out by learning even more about how the blog is put together and how the email service works, see my earlier post From the Inside Out: Our Blog and Our Email Service.

And I always welcome technical assistance of any kind, if any of you have some ideas that might help.

—Nina

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Yoga for Healthy Aging Certified Teachers!

by Nina

Baxter and I are pleased to announce a new feature on the blog: a list of yoga teachers who have been certified by the two us as Yoga for Healthy Aging teachers. You can find the list of these teachers (which we expect to grow—we’re still waiting for some of the written tests to come in) on our Certified Teachers page.

These yoga teachers all attended our Yoga for Healthy Aging intensive, passed a written test, and did a teaching demonstration that we approved:

• Susan Bronson
• Nora Berklich
• Barbara Haxo-Phillips
• Joan G. Manuel 
• Carol Mermey
• Liz Moss
• Nina Rook
• Susan Urquhart-Brown

For those of you who are interested in receiving certification yourself and could not attend our 2015 intensive, we will be having another intensive at Namaste Berkeley in 2016. We will be announcing the date in the near future.

Honorary Mention goes to Bayle Emlein who, while not a yoga teacher, passed her written test and the teaching demo just for her own edification.

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Reducing Cortisol Improves Anxiety

by Nina

New Leaves in the Desert by Melina Meza

Have you noticed that whenever we talk about the dangers of chronic stress (see About Stress: Acute vs. Chronic), we always mention anxiety? That’s because anxiety is basically on every doctor’s list as one of the potential problems that can result from ongoing stress. And my personal experience has been that anxiety is the first problem I start to suffer from when I go through a period of chronic stress. That is why I personally value yoga’s stress management tools so much; I’ve learned how much better my life is if I can nip those stress levels in the bud before my emotions get out of control. 

But even though I knew that chronic stress could cause anxiety, I didn’t really know exactly why. You know me—I always want to know why—when it’s possible to know why—so I was very interested to read this paper about anxiety and cortisol levels Elevated cortisol in older adults with Generalized Anxiety Disorder is reduced by treatment: a placebo-controlled evaluation of escitalopram. Even though this paper had nothing to do with yoga (the scientists were using a drug to reduce cortisol levels in older people with anxiety), I was interested to learn that older adults with Generalized Anxiety Disorder have higher levels of the stress hormone cortisol. The paper put it this way:

“Generalized Anxiety Disorder (GAD) is a common and impairing anxiety disorder in older adults, and it has been associated with elevated cortisol in this age group.”

And the paper also said that the experiment they did with reducing cortisol levels in this group helped improve the anxiety!

"Compared with placebo-treated subjects, SSRI-treated subjects had a significantly greater reduction in both peak and total cortisol. This reduction in cortisol was limited to subjects with elevated (above the median) baseline cortisol, in whom SSRI-treated subjects showed substantially greater reduction in cortisol than did placebo-treated subjects. Reductions in cortisol were associated with improvements in anxiety."

In the past, we’ve talked about cortisol in the past in terms of inflammation and celluar stress (Reducing Cellular Stress with Yoga and Cortisol, Stress and Yoga) as well as stress eating (see Yoga, Stress and Weight Management and Stress Eating and the Healthy Eating Meditation Practice), but we’ve never addressed its effects on our emotions. In my post Stress and Your Thought-Behavior Repertoire, I talked about how while you’re in stress mode, your thoughts are restricted to Fight or Flight options. Now it seems possible elevated cortisol levels might be to blame for this and/or for raising levels of anxiety or worry in general.

The paper also said that older adults in general have a harder time with elevated cortisol as, “aging increases vulnerability to adverse effects of elevated cortisol, because compensatory mechanisms preventing its deleterious effects are diminished.” It also mentioned that that chronic over-activation of the Hypothalamic-Pituitary-Adrenal (HPA) axis causes wear and tear to the brain and body via toxic effects of elevated cortisol levels.

So, the bottom line is that elevated cortisol levels in older adults is particularly dangerous, potentially causing Generalized Anxiety Disorder as well as other diseases and physical problems. But although the researchers of this paper used medication to lower cortisol levels, this may not be the only way to do lower them. If you’re feeling well enough to forgo medication (and your doctor agrees with you about this) or if you just want to practice to prevent future problems with anxiety, you can use yoga to lower your cortisol levels. 

Reducing Anxiety with Yoga

I’ve done several posts in the past about how to use yoga to reduce anxiety (see 10 Ways to Soothe Anxiety with Yoga and Yoga Solutions for Anxiety). But it’s worth emphasizing here that some of the techniques we recommend for stress management in general, including meditation and restorative yoga, might not work well for anxiety. That’s because it’s very hard for many anxious people to lie or sit still, as they tend to become even more anxious if they are alone with their thoughts. See When Relaxing Isn't Relaxing.

On the other hand, while an active yoga practice can engage your mind and distract you from your worries (a welcome relief!) it is not necessarily going to lower your cortisol levels. An active practice is generally more stimulating than relaxing, although it is useful for tiring you out (plus, everyone needs exercise).

So, if you’re someone who has trouble lying still due to anxious thoughts, who feels generally hyper (I know that feeling!), or who has been sitting all day for work and needs to move, I recommend starting with an active practice, such as Featured Sequence: Lower Body Strength or Upper Body Strength. Then, after you’ve released some of your excess energy, try practicing one or more supported inverted poses. Because the Relaxation response is triggered by your physical position, supported inverted poses don’t require a mental focus (see Why You Should Love Your Baroreceptors). So you can keep your eyes open and even listen to music while you are practicing them and you’ll still quiet your nervous system. Of course, as with any pose, if you feel bad in an inverted pose, come out of the pose immediately. See All About Supported Inverted Poses to find a supported inverted pose that's right for you.

See When Relaxing Isn't Relaxing for more suggestions for what to do when anxiety means that relaxing isn’t relaxing. Of course, if you’re not experiencing anxiety and are comfortable with other forms of stress management, continue to practice the way you enjoy it the most (see The Relaxation Response and Yoga). Keeping cortisol levels low may very well help prevent problems such as anxiety from occurring or re-occurring in your future.

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Featured Pose: Tree Pose (Vrksasana)

by Baxter

Tree pose (Vrksasana) is typically one of the first “balancing” poses a new yoga practitioner encounters, and the pose has staying power! Not only does it continue to be challenging and relevant for more experienced practitioners, but it also happens to be one of the oldest Hatha Yoga poses in recorded history, according to Richard Rosen, author of Original Yoga. In fact, it is one of only two standing poses from the earliest texts on yoga postures; the other one is a form of Powerful Pose (Utkatasana), also called Chair pose in modern yoga. And although Tree pose has shown up on our blog in a bunch of our yoga sequences over the years, it has never received its solo moment—that is, until today. 

Tree pose is a great pose for the obvious purpose of challenging and improving balance, as requires both downward rooting and upward stretching, and commands your full attention, lest your tree topples to the ground! If you have trouble balancing in the classic version of the pose, our three variations will allow you to gradually improve your balance in the pose as you work your way toward the full pose.

In addition to helping you maintain and improve balance, Tree pose is also a strengthening pose. Standing on one leg helps strengthen your standing leg, ankle and hips, and holding your arms overhead helps strengthen your upper body and arms.

I prescribe this pose for:

• Improving balance
• Building strength (in the ankles, legs, and hips as well as in the upper body)
• Improving mental focus and concentration
• Improving flexibility (in the hip of your lifted leg and shoulders and upper back)
• Recovering from ankle sprains
• Cultivating equanimity with success or failure

Cautions: If you have poor balance, please use practice the second version of the pose with your knee on the wall. If you have an acute ankle sprain, you may need to wait until swelling and pain have resolved to try this one out. For everyone, avoid placing the heel of your raised foot against the inside of the knee joint; it should always be either above or below that landmark. If you do not know where the inside of your knee joint is, ask your teacher show you.

When you loose your balance in this pose—which is almost inevitable at first—simply step your lifted foot back the floor as efficiently as you can, as you lower your arms.

1. Classic Version of Tree Pose

Start by coming into Mountain pose (Tadasana) with your feet just a few inches apart. Then shift your weight onto your left foot and bend your right knee a bit, coming onto the big toe of your right foot. Swing your right knee out to the right about 45 degrees. Then, lift your right foot up and place it against the inside seam of your left thigh, with your heel somewhere between your left groin and your mid-thigh and with your toes pointing straight down the inseam of the left leg.

Place your hands on your hips for and check to make sure your hip points are even with the wall in front of you and that the top edge of your pelvis is parallel with the floor. Don’t try to force your raised leg out to the side a full 90 degrees if that comprises the alignment of your hips; instead, allow your raised leg to turn out to the most comfortable angle you can maintain with even hips, even if that is less than 90 degrees. To keep your raised leg from slipping, press the sole of your right foot firmly into your inner left thigh and firm your left thigh back into your right foot.

When you are settled in the pose, move your gaze straight forward in front of you and chose an item in the room or on the wall to focus on. Then inhale and bring your arms overhead, moving them in line with your ears if your shoulder flexibility permits. Keep your breathing even and your entire body as steady as possible. Create an internal feeling of rooting down into the floor with your left leg and foot, while simultaneously lengthening up from hips to hands towards the sky, like a tree searching for life-giving light!

Stay in the pose for 5-6 breaths the first time, and gradually work your way up to 1-2 minutes. To come out the pose, on an exhalation release your arms and lifted leg back to the starting position. Take a few breaths to notice the effect of the pose, and then repeat on the second side.

2. Knee on the Wall Version 

Standing with your knee against a wall is a great version for beginners and those with generally poor balance, as it eliminates fear of falling and allows you to work on the key leg, arm, and chest actions.

Start by standing perpendicular to a wall with your right hip about one foot or so away from the wall. Now shift your weight onto your left foot and bring your right foot into position as in the classic pose, using your right hand on the wall to stabilize yourself. You can place your right foot anywhere along the inseam of your left leg that works for your hip openness and ability. Don’t feel compelled to get your heel high towards the groin right away, especially if your hips need tip up dramatically to get it into that position.

Now you are ready to place your knee on the wall. Ideally, you will be just a few inches away from the wall when you initially bring your right leg into position, and I usually use my left foot to heel-toe my body a bit closer to the wall until my right knee can press into the wall while I still maintain the hip alignment of the classic pose. This means your right knee will probably be a bit forward of perpendicular to the wall. You might gaze down to make sure your left foot is slightly under your pelvis and not directly under your left hip.

When you knee is on the wall to stabilize you, bring your arms overhead and work on your foot-thigh squeeze and your rooting-lifting action. With the wall support, you may to able to stay up longer, but be reasonable the first time you try it, staying for 6-8 breaths. Then bring your right foot down and your arms to your sides. Turn to the other direction to do the second side.

3. Foot to Calf Version

For those with stiffness and tightness in the hips who cannot easily take the leg position of the lifted leg in the classic pose (this requires combination actions of a combination of hip movements—flexing, abducting and externally rotating—whihc are not possible for everyone). This version can also be a good starting version of the pose, or just a stage in learning as you try to bring the lifted foot a bit higher. Practice this pose the same way as the classic version, pose, except that you will place the foot of your bent leg against the inner calf muscle of your supporting leg (the shape of the bottom of the foot and the calf fit like a hand in glove for many!) instead of your upper thigh.

4. Ball of the Foot on the Floor Version

For people with balance issues, keeping the ball of your foot on the floor is even easier than keeping your foot on your calf, because having your toes and the ball of your foot on the floor help stabilize you. This is also a good version for those with weak or recently sprained ankles.

Start in Mountain pose (Tadasana). Shift your weight to your left leg, turn your right leg out to about 45 degrees and lift your heel so you’re only the ball and toes of your right foot are on the floor. Then slide your right foot up against the inside of your left ankle, placing your right heel just above your left ankle bone but keeping the ball of the foot and toes on the ground. Press your right heel firmly into your left ankle and your left shin back into the right heel. From here, practice the pose the same way as the classic version.

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Balance Pose of the Week: Slow Dynamic Eagle Pose

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Friday Q&A: OPLL (Ossification of the Posterior Longitudinal Ligament)

Q: I have a friend who has this so-called OPLL disease, with problem started from the cervical spine, would YOGA really help? What are specific restorative poses she could learn? How I could help her to use yoga in pain management?

A: Let’s start by figuring out what OPLL disease is! If you are like me, you may not have heard of this condition before. OPLL, which is short for Ossification of the Posterior Longitudinal Ligament, is a gradual hardening and calcification of one of the long ligaments that runs the vertical length of spine.

Posterior longitudinal ligament in the thoracic region
(runs vertically at center)

This ligament runs the length of the spine from the base of the skull to the sacrum, and it is located along the posterior surface of the vertebral bodies, just in behind of cushiony discs. It helps to keep the vertebral bones together and usually limits the degree of forward rounding (flexion) that the spine can do. It also acts as a barrier for the discs when the spine goes into forward rounding (flexion), preventing the discs from pushing or bulging back into the spinal cord. 

Now about the ossification of this ligament. To ossify means to turn into bone or boney material. Ossification of the posterior longitudinal ligament (OPLL) is most commonly found in men, in the elderly, and in Asian patients. The disease can start with mild or no symptoms, but some patients progress slowly to develop symptoms of myelopathy (disease of the spinal cord). It most commonly affects the cervical spine area. An X-Ray, CT scan or MRI can allow diagnosis of the condition, and these tests are often repeated to monitor the progress of the disease. When symptoms are mild and are not progressive, conservative treatments and periodic observations are considered adequate treatment from a western medical perspective. However, once symptoms of myelopathy are present and neurologic symptoms are progressive, the treatment of choice is surgery, even though it is controversial, to relieve spinal cord compression. 

(A quick aside about myelopathy: According to the Columbia Medical Center, myelopathy is, “The clinical syndrome that results from a disorder in the spinal cord that disrupts or interrupts the normal transmission of the neural signals is called a “myelopathy”. For anatomical reasons, cervical myelopathy may involve the arms and hands, legs, and bowel and bladder function.” But OPLL is only one of the conditions that can cause myelopathy.) 

OPLL not a very common condition, except in Asian populations, where the incidence of OPLL is 2.4%. It is twice as common in men as it is in women, and symptomatic OPLL usually presents in the 5th to 6th decade of life. OPLL can be associated with other musculoskeletal diseases such as Ankylosing Spondylitis. The underlying cause or pathogenesis of OPLL is still unknown, although many factors are being investigated, including the role of lifestyle and environment. With the much higher incidence in Asian populations, genetic factors are also being closely looked at. A few of the more interesting lifestyle factors that have been suggested include family history of myocardial infarction, high body mass index at age 40, long working hours, and working the night shift. I mention these in particular since yoga could influence heart health, weight management and work choices. Good sleep habits may lower the risk, and yoga can help with this as well (see Five Tips for Better Sleep).

As a yoga instructor, you would be more likely to meet someone with mild symptoms. At the early stage, most OPLL sufferers do not have symptoms, or only complain of mild pain, discomfort, or numbness in hands. As OPLL progresses, symptoms increase in severity due to compression of the spinal cord and nerve roots. The most common symptoms in the early stages of OPLL include unpleasant and tingling sensations in hands, and clumsiness. 

The typical western medical approach to early symptomatic OPLL consists of pain medication, topical agents, anti-inflammatory drugs, antidepressants, anticonvulsants, non-steroidal anti-inflammatory drugs and opioids, along with bed rest and assist devices, such as a brace for local stabilization of the spine. 

Yoga and OPLL 

There have been no studies done to date on yoga for OPLL. Therefore, the following suggestions are my educated guesses based on yoga being used for other forms of cervical arthritis and disc issues that share some similarities to OPLL. As always, in such unusual cases, proceed slowly and gradually, and allow some time to see how the person you’re working with responds to your yoga recommendations. 

Start by asking the person with OPLL to share with you any movement restrictions they have been given by their MD or Physical Therapist and integrate those into what you suggest.

Avoid any poses that add stress to the cervical spine or worsen any symptoms that might be present. Obvious examples include any pose that bears weight on the head, such Shoulderstand (Sarvangasana), Headstand (Sirsasana), and Rabbit Pose (Sasangasana).  

Approach preserving cervical range of motion through gentle dynamic poses, even something as basic and simple as Cat/Cow pose. I have a simple dynamic series I often teach that includes simple neck rotation I call Owl Turns, and side-bending I call Curious Dog Tips (see Friday Q&A: Safe Neck Movements). You could also move the neck in gentle rotation in such standing poses as Warrior 2.

If weakness, especially of the extensor muscles at the back of the neck, is a concern, practicing low Cobra (Bhujangasana) and Locust (Salabhasana) poses dynamically or for very short holds can help to build more muscular strength and support for cervical neck extension.

As for restorative poses, most of them could be fine as a way to allow for some gentle neck stretching and also to provide support to the neck for general muscular and fascial relaxation. But let the student’s responses to the poses guide you in deciding which poses to remove or keep in your original sequence. Reclined Cobblers pose (Supta Padangusthasana), Legs Up the Wall pose (Viparita Karani), and Supported Child’s pose (Balasana), are a good place to start (see see Featured Sequence: Mini Restorative Practice). But keep an eye on Child’s Pose, as the rotation of the neck may be more challenging for some students and if it causes pain, you will need to help them modify it. 

As for yoga suggestions for pain management, see our postYoga for Pain Management, which is relevant for OPLL as well as many other pain conditions.

Disclaimer: This article is not meant to diagnose, treat or act as medical advice. Please consult your health care provider for clearance and guidance before following or participating in these activities. 

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Yoga Meditation Techniques

by Nina

From Tantra Song by Jamme

I can’t even remember the first time I meditated—or who taught me to do it—though it was probably my very first yoga teacher back in the 80s. Because I’m pretty sure we just sat in a simple Seated Crossed Legs position on the floor and focused on our breath. Like it was no big deal. So, in a way, basic meditation is very simple. Sometimes a teacher will even just say, “Let’s sit for a few minutes.” 

But those basic techniques don’t work for everyone. First of all, not everyone can be comfortable sitting on the floor without support or even with support. And being in pain while you are sitting—or sitting in such a way that you might injure yourself because you are slumping or overstretching—is not conducive to regular, long-term practice. So it’s important for there to be different options for the meditation position you use. 

Second, not everyone is comfortable using his breath as the object of meditation. I have a student who instantly becomes anxious when he focuses on his breath. So he definitely needs to meditate on something else. And the rest of us will no doubt having breathing problems eventually, whether from a cold or allergy, so it’s good to have an alternative up your sleeve.

So I thought that today I’d write a bit about the options you have when you are meditating. And because the position you take and the object of meditation you choose will be influenced by the environment in which you’re practicing, let’s start by talking about location. I’ll then address position, mental focus, timing, and meditating.

Choose Your Location

You probably have an image of the perfect quiet, warm, clean environment in which you should meditate, but real life doesn’t always present that. If you can’t set up a separate space because you live in a small apartment or crowded family house, you shouldn’t let that stop you from practicing. As long as there is room for you to sit—whether on the floor or even on a chair—you can meditate.

So by all means, if you can set up a separate quiet space for your meditating practice, do that. But if not, just do the best you can. And when you’re traveling or are stuck somewhere busy and noisy, such as at an airport or even on an airplane (yes, I’ve done that), go ahead and practice there, too. It’s more challenging to practice when there are distractions or you are in a public place, but it is still practicing, and in fact it’s probably a more realistic way of learning to quiet your mind.

You might even choose to meditate somewhere challenging just for the experience of it. If you haven’t read Achieving Stillness in Turbulent Situations, I strongly recommend that you do. I, for one, was forever changed when I read that Ram’s grandfather took him to an Indian train station to meditate just to teach him to experience meditating in the most challenging environment possible. As Ram said:

"The goal of meditation is to be at ease, relaxed and at peace with our surroundings. It is important to not resist the disturbing/distracting influence that comes in the way of your meditation practice (in your case traffic or the cold environment). So do not try to ignore the influence or to block it out, for if you try, you will only meet with stiffer resistance, ending in frustration. Instead, simply let it be (“thathaasthu” in Sanskrit) and continue with your meditation. Everything is a part of meditation, all the influences including the noise, the thoughts, the emotions, and the resistance from the mind. Treat everything that arises in meditation the same way—let it be and just be there!"

Choose Your Position

Typically people meditate in a seated position on the floor. That’s simply because an upright, unsupported position allows you quiet your mind without falling asleep. For those who can’t sit for long periods of time without major discomfort, reclining is also an option if you’re in the right environment. And, finally, for short meditations, you can even meditate standing up. Obviously your environment affects your position choice, as sometimes your options are limited.

Seated Positions. Our recommended positions for seated meditation are Seated Crossed Legs and Hero pose (although a few people are comfortable enough in Half Lotus or even Full Lotus to meditate in those poses). In his post Learning to Sit on the Floor, Baxter described how you can use props to get comfortable in these poses. 

Seated Crossed Legs Pose

Hero Pose

For people who just can’t get comfortable on the floor—or who can’t get up and down from the floor—sitting on a chair is always an option. But rather than leaning against the back of the chair and slumping, sit on the front edge of the chair with your feet flat on the floor (if you are short, you might need to put a prop under them or if your legs are long you might need to put some padding on the chair seat) and your spine in its natural curves and your head in line with your spine. Obviously someone with physical disabilities who is in a wheelchair can meditate in whatever position they are able to take, in whatever chair they happen to be.

Reclining Positions. In his post Starting a Meditation Practice, Timothy said, “Although it may not be ideal, for those who can't sit comfortably, it is possible to meditate lying down. Yes, there is a greater tendency to get sleepy or zone out while supine, but we should not let the perfect be the enemy of the good.” And Baxter invites students with body pain that makes it very difficult for them to keep their meditation focus to lay in supported Savasana.

So if you really can’t get comfortable sitting down (or maybe you sit down all day for your work and just can’t take it any longer), try a supine position. Because you want to avoid falling asleep, I feel that the best recelining position to meditate in would be a supported form of Savasana where your head and heart are higher than your legs (as opposed to being flat on the floor or having your legs higher than your heart). This will keep you a tiny bit stimulated and might help prevent you from falling asleep. 

But, as always, make sure the position is comfortable for you. If a bolster is too high for you, you can try a blanket folded into a long, thin rectangle instead. 

If you are someone like me who doesn’t fall asleep during the day, you could try meditating in any reclined or even inverted position, such as Legs Up the Wall or Supported Bridge pose with straight legs, that you find comfortable, though these may only work for shorter meditations. 

Standing Positions. When I went to see the exhibit “Yoga: The Art of Transformation” at the San Francisco Asian Art Museum, I was surprised to see statues of ancient yogis meditating in Mountain pose. It makes sense, if you think about it. After all, Buddhists meditate while walking, so standing up to meditate is also an option if you have nowhere to sit or would just like to try something different. It is probably difficult to stand up for long periods of time, so I imagine that for us normal mortals this position would only be effective for a short meditation.

Choose Your Focus

Different yogic traditions have different focuses and techniques for meditation. So if you are already practicing mediation or following a certain tradition, you can simply continue using whatever technique you’ve been taught. However, if you are new to meditation or want to change things up, here are some suggestions:

Breath. The breath is often recommended for beginners because it is always accessible and has no religious associations. You can focus on any aspect of your breath, including the sound of your breath, the feel of your breath moving in and out of your nostrils, or the way your inhalations and exhalations affect your body (such as the rise and fall of your belly or the movement of your breast bone). For beginners, Timothy recommends the So Ham technique (see Starting a Meditation Practice). But meditating on your breath doesn’t work some people, and if you’re ill or in pain, it be better for you to take your mind off your body. 

Mantras. Although there are traditional Sanskirt mantras used for meditation, you can use any word or phrase in any language that has a positive meaning for you as a mantra. Baxter reports that he’s used both the word “Om” as well as his grandmother’s name, Genevieve!

Images. There are two ways to use an image as your focus. First, you can open your your eyes and focus on an actual image before you, such as a candle flame or an artwork. The following image, as is the one at the beginning of the post, is from a beautiful book called Tantra Song that contains a collection of amazing 17th Century Tantric images from Rajasthan designed for meditating on,. My purpose in sharing these is to emphasize that your stereotypes of what an object of meditation should be may be limiting your alternatives.

You can also meditate on an image you picture in your mind, as the image of a person or a natural setting that has meaning to you.

Length of Time

If you’re just starting a meditation practice, don’t get caught up in how long to do a practice. The important thing is to start a new habit. As with all yoga practices, a little bit every day will bring greater benefits than longer sessions done intermittently. Baxter recommends keeping it simple and doable, with just 5 or 10 minutes at first. Timothy even says he’d recommend trying to stay for 3-5 minutes initially. Set a timer of some sort so you don’t have to have thoughts about worrying how long you’ve been meditating. As your habit becomes established, you can gradually work up to 20 minutes or longer daily.

How to Meditate

After you have chosen your location, position, and mental focus, and have set your timer, simply:

1. Commit to remaining still. 
2. Focus on your chosen object of meditation. When you realize your mind is wandering (and it will wander), notice the thoughts you were having and then, without judgment, gently guide your focus back to the object. In yogic meditation you are not trying to make your mind empty, but instead are learning how to concentrate your focus (see Samyama: The Trinity of Dharana, Dhyana, and Samadhi). With sustained attention, you may slip into a meditative state. But because our minds tend to wander—even for experienced meditators—there may not be much (or even any) actual meditation in any particular session.
3. Stop when your timer goes off. After your practice session, refrain from judging how well it went. Instead, simply continue with your day. 

If this practice is difficult for you, try not to get discouraged. In Is Meditation an Essential Part of Yoga Practice?, Timothy wrote:

"My mind was very busy when I began, and it was extremely difficult for me to keep my attention from flitting from idea to idea. And it was hard to find comfort sitting in one place, without frequent position adjustments and fidgeting. Many people who try to meditate get discouraged at this point and give up. That, I believe, is a mistake. As with a lot of other areas of yoga, hanging in when things are challenging, even discouraging, can bring rewards."

Now he says that meditation is the most delicious part of his practice. In the meantime, consider that Dr. Herbert Benson’s studies of the Relaxation Response, which he performed on people practicing mantra meditation, showed that even when practitioners didn’t feel they aren’t doing a “good job” of meditating, they still gained the physiological benefits of lower blood pressure, slower heart rate, fewer stress hormones, and so on. (see The Relaxation Response and Yoga).

Other Posts About Meditation

Friday Q&A: What is Meditation? by Baxter

Samyama: The Trinity of Dharana, Dhyana, and Samadhi by Ram

Achieving Stillness in Turbulent Situations by Ram

Is Meditation an Essential Part of Practicing Yoga? by Timothy

Starting a Meditation Practice by Timothy

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