Monday, December 23, 2019


The Soul of the Rose by John William Waterhouse

The Accessible Yoga blog will be taking a holiday this year from today until the end of December. We'll resume posting on January 1, 2020. In the meantime, I thought I would share a beautiful quote with you from my long-time teacher Donald Moyer. —Nina

"In the practice of yoga, as in any other spiritual practice, there are many kinds of awakening. There is the sudden awakening that comes out of the blue and is filled with the wonder of discovery. I remember the burst of joy and sense of liberation I felt after my very first class with Penny.

"Then comes the everyday form of awakening—the quiet Ahas! the small but significant insights, the brief flashes of understanding—which, added one to another, mark the incremental growth of awareness, the way a plant forms a bud before it comes into flower.

"Further along comes the awakening to your own nature, to your own potential, the rite of passage that confirms that even though you may benefit from the guidance of a teacher, you have the courage, the integrity, and the sense of responsibility to find your own way out of the labyrinth. This stage of the journey initiates the awakening of the inner body, when the body reveals its secrets, one by one, just as a flower unfolds, petal by petal."

—Donald Moyer, from Yoga: Awakening the Inner Body

Friday, December 20, 2019

Interview with Shelly Prosko About "Yoga and Science in Pain Care"

Nina: Shelly, can you tell us a bit about yourself, including something about your professional background as a physical therapist, your yoga background, and what led you to become an expert in pain care.

Shelly: My journey of the integration of yoga in pain care started with my personal experience with yoga. The physical, emotional, mental, social, and spiritual benefits related to my personal yoga practice drove me to explore how yoga could be integrated into physical therapy to enhance patient care and outcomes, particularly for those patients who were struggling to find relief and ways to return to their most meaningful activities. Early on in my clinical practice, the necessity of taking a whole-person approach was evident. I quickly learned I was not treating conditions or addressing body parts; I was guiding a human being who was experiencing pain or living with or recovering from an injury or condition, within the context of their environment. 

I also started learning about the emerging and more current science surrounding pain from a variety of resources, researchers, clinicians, and pain educators, including Lorimer Moseley, David Butler, and Neil Pearson. At the same time I was continuing my studies and exploration of yoga therapy. I found that yoga offered an incredibly inclusive, accessible, practical, and compassionate biopsychosocial-spiritual framework from which I could work while staying within my scope of practice as physiotherapist. This integration of yoga and science in pain care has helped me be more understanding, compassionate, effective, and creative in the way I guide and support people in pain to find an empowered way to live with more ease and peace.

Nina: There are already a few books out there on yoga for pain management, so can you tell us why you and co-editors/authors, Neil Pearson, and Marlysa Sullivan, decided to write “Yoga and Science in Pain Care”?

Shelly: The three of us are physical therapists, yoga therapists, continuing education providers, and clinicians who have been blending yoga and science into pain care in our professional healthcare practices for several years and witnessing the value that this integration provides. With the current global pain crisis and lack of effective approaches available for people with chronic/persistent pain, we wanted to offer something that could help improve pain care that would be accessible to both yoga and healthcare professionals and serve as a bridge between the two professions. We hope to help both parties gain an understanding about how yoga teachings and practices fit into pain care that is in line with current science, in hopes that yoga therapy could be seen as a respected, evidence-informed and viable approach in pain care. Throughout the book we outline the immense value, with supporting evidence, of this integration of yoga and science for healthcare and yoga professionals and for people in pain.

We also wanted to fill in the knowledge gaps surrounding pain, include the lived experience of pain as an essential part of understanding pain, people in pain, and pain science, include multiple perspectives, and offer a process of inquiry instead of a ‘how to fix’ recipe or ‘these 10 poses for back pain’ protocol book.

Nina: As I read through this book, I noticed that it seemed primarily intended for health care professionals and yoga therapists. But it also seemed to me that the average yoga practitioner who themselves is experiencing problems with pain, either acute or chronic, would benefit from reading at least some of the chapters in this book. What do you think?

Shelly: Absolutely. I have received emails of appreciation from yoga practitioners, yoga teachers, and people in pain who have read the book and found immense value in it. The first chapter, "The Lived Experience of Pain," authored by a person in pain and pain advocate Joletta Belton, is remarkably profound and impactful. A patient I have been working with said that he related so intimately to Joletta’s experiences, that he could have written those words himself. He even asked his family members to read the chapter so that they could better understand where he was coming from.

Also, yoga practitioners and people in pain have expressed gratitude for and said they’ve found value in many other chapters in the book, like the pain biology chapter that describes the pain system, as well as the chapters on movement, breath and awareness, grief and loss, nutrition, addictions, psycho-emotional pain and the compassion and meaning/purpose in pain care chapters. 

Nina: Could you talk a little about the two chapters that you wrote and how you chose these topics?

Shelly: I wanted to write the breath chapter because I have seen the profound shift even a simple breath practice can make in one’s pain experience and relationship to pain. I had previously created a yoga course on the value of breath and breathing practices for overall health and wellbeing, so I wanted to expand on that content and include how breathing practices specifically can help people in pain. 

For the compassion chapter, as I listened to stories from people in pain, learned from the leading pain educators, and read research surrounding pain, the messages became more and more clear: when pain persists in an individual, the person can start to experience feelings of self-blame, shame, anger, anxiety, guilt and become self-critical. 

But research shows that self-compassion can be an antidote to these feelings and experiences and that it can be trained. Also, compassionate care by the health professional (which includes self-compassion within the health professional) has vast benefits that I outline in the chapter, including mitigating practitioner burnout. 

Nina: Can you give us a quick overview of why working with the breath and pranayama are so helpful in pain care?

Shelly: Overall, breathing practices can be an accessible, easy, safe and effective treatment strategy to modulate pain. They also give the person in pain a sense of self-efficacy and empowerment in their pain care. Working with the breath can serve as a powerful tool to provide insights into one’s current physiological state and can be a profound agent of change.

Nina: And how about compassion? Why is this so important

Shelly: Compassion is the foundation of “care,” pain care and healthcare in general. There are numerous benefits to providing compassionate pain care, which includes some obvious benefits for the person in pain, but also benefits for the health provider. Yet, some national surveys suggest it is lacking in different regions of healthcare around the world. The good news is that compassion is a skill that can be trained and that yoga is inherently a compassionate practice and can also prime us for our compassionate wisdom to emerge in the context of any situation. 

In Compassion in Pain Care, I outline how yoga teachings and practices can be used to cultivate compassion and self-compassion both for the person in pain and the healthcare/yoga professional in hopes that we can all experience the benefits that the research shows compassion can result in, and ultimately improve pain care for the person in pain and promote health and longevity for the health/yoga professional.

Nina: Is there anything else you’d like to say to our readers

Shelly: I think one of the most impactful things we can all do is to ensure we listen to and validate the stories of people in pain, and to recognize the individual living with pain as the expert in their pain experience. The more we can learn about pain from the person’s lived experience and from what the current science is telling us about pain, the better chance we have of successfully guiding and serving people in pain. It is my hope that our book can help you on this path of learning and illustrate how and why yoga can be such a powerful approach in pain care. 

Readers! If you would like to buy Yoga and Science in Pain Care by Neil Pearson, and Marlysa Sullivan, along with several of their esteemed colleagues, and you can find it at Indie Bound, Barnes and Noble, and Amazon, or ask your local bookstore to order it for you. In Canada you can find it at Singing Dragon and in the UK, you can find it at Amazon UK.

Shelly Prosko, PT, C-IAYT is a physiotherapist, yoga therapist, pioneer of PhysioYoga, and educator with over 20 years of experience integrating yoga into physiotherapy and working with people in pain. She teaches in physiotherapy and yoga programs, presents at yoga and medical conferences globally, contributes to academic research and writing, and offers onsite and online courses for yoga and health professionals. Shelly is a Pain Care U Trainer and is co-editor/author of the textbook Yoga and Science in Pain Care: Treating the Person in Pain. She maintains a clinical practice in Sylvan Lake, Canada. Visit

This interview was conducted and edited by Nina Zolotow, Editor in Chief of the Accessible Yoga blog.

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Wednesday, December 18, 2019

Core Qualities of Yoga, Part 6: Creating Intention

This post is part of a series that explores a variety of core qualities and suggested practices to consider for inclusion in your classes and private sessions (whether on a mat, in a chair, or a combination of both).

by Beth Gibbs

An intention, according to Webster’s Dictionary, is: “A concept formed when the mind is directed toward an object.” You can create intentions for all aspects of your life –– physical, energetic, mental, emotional, or spiritual. Here are two ways to think about creating intention.


These can range from short-term personal, work, or family responsibilities to long-term strategic planning and scheduling for running a business, managing personal finances, or completing creative projects such as crafts, writing, or fine arts. Short-term intentions are usually found on our daily to-do lists (if we make them). Long-term planning may start with a big idea that we break down into manageable tasks that we can accomplish on a daily or weekly basis to build a foundation of success over time.

For example, I made an intention to begin a sitting meditation practice. Knowing my habit of getting excited about starting projects and then losing steam over time, I began by choosing a meditation technique suitable for my busy, active, creative mind. I committed to start with five minutes and then add one to three minutes a month. This slow steady pace worked. I am up to twenty minutes a day. I think I may have skipped a total of four to six days in the past year — not a bad start!

Setting specific intentions for different areas of our lives lends a depth of richness and conscious self-awareness to our experiences. Our yoga practice is no exception. We can:
  • Focus on physical alignment in the postures
  • Practice postures as simple exercise for bones, muscles, and joints
  • Use breath practices (pranayama) to energize, balance, or relax the mind
  • Select a sequence of restorative postures to promote relaxation
  • Choose specific yoga techniques to work with health conditions such as high blood pressure or chronic pain
  • Take classes to experience community with other
Then there are New Year’s resolutions. Making them has a long tradition on planet Earth. Typically, New Year’s resolutions tend to be grounded in the desire to change something about ourselves: our weight, our behavior, habits, or our health. We set a goal and then dedicate the year toward actualizing them. Sadly, according to most statistics, our efforts to effect those personal changes through New Year’s resolutions are dropped before the year is up.

I confess, I have made New Year’s resolutions in the past–made’em and broke’em. They were mostly about losing weight, meeting the National Institutes of Health guidelines for exercise, cutting out sugar, etc. I’ve had more success by creating practical life intentions with incremental steps for changing my lifestyle, habits, and health.


Sankalpas are best used for a much deeper dive into Self-awareness, with a capital "S," than practical life intentions or New Year’s resolutions. Sankalpa practice starts with a basic understanding of the essential truth of yoga: that we are already whole, just as we are. What comes next is realizing the meaning of this in our everyday lives. Sankalpa practice is designed to bring us closer to that realization and help us find productive ways to express it in our relationships to ourselves, to others, and to our planet. Although a sankalpa is directed toward self realization or self healing, the revered Buddhist monk Thich Nhat Hahn says, “When you say something with your whole being…. it can transform the world.”

Creating a Sankalpa

A sankalpa is a short positive statement made in the present tense. Creating and working with a personal sankalpa reminds us of what is already true so we don’t have to apply ego, willpower, or striving. In the yoga tradition, positive statements tend to bring longer lasting results. This perspective is reinforced by a song from 1944 titled, Accentuate The Positive:

You've got to accentuate the positive
Eliminate the negative
Latch on to the affirmative
But don't mess with mister in between

So let’s not put our sankalpa in the negative, such as: I won’t eat sugar, I won’t smoke, etc.

We first want to find the words that feel right for us and then let it play out in our lives. Sankalpas can be thought of as long-term intentions. It is recommended to work with the same sankalpa until the goal is reached –– over a few months, years, or a lifetime. Some examples of sankalpas are:
  • I am awake and aware
  • I am happy, healthy, and whole
  • I am calm, peaceful, and relaxed
Creating a sankalpa requires some time and careful thinking. My sankalpa (which I will keep private) is a deeply felt intention for reminding me of my true nature. I use it when I practice yoga, when I meditate, and off and on during the day when it pops into my conscious mind. I took my time to choose it. I thought long and hard about which words would inch me toward a deeper realization of my place in this huge, amazing, mysterious experience we all share. I’ve been using it for four years now and will probably use it for my whole lifetime.

Here are some steps to consider when creating your sankalpa.
  1. Find it. A few lines from a character in one of my short stories will illustrate the process. Over lunch, Miss Millie is sharing wisdom with a young woman seeking help for a mid-life identity crisis. She tells her to, “Ask the important questions. Become quiet. Listen within for the answers. Be patient with yourself. Trust your own process and be brave.” Patience is key because it will take time. However, if you want to start right away, you can use one of the three examples above until you uncover your own.
  2. Remember it. You can remind yourself of your sankalpa by writing it on sticky notes and tacking them to your fridge, closet door, or bathroom mirror. They will act as daily visual reminders. You can journal about it, noting any blocks, obstacles, thoughts, or emotions that arise around it. You can state it, silently or out loud. Three of the best times to repeat it silently are when you meditate, set up for relaxation after yoga practice, or prepare for yoga nidra, in which stating a sankalpa is an important step in the process.
In this way, we remind our subconscious mind to work on our sankalpa and send reminders to our conscious mind. These reminders may ‘pop’ upon waking up in the morning, driving to work, during yoga, meditation, journaling, or any at any other time during our everyday life activities. Keeping our sankalpa alive enables us to strengthen our connection to our true nature, make mid-course corrections, and return to our path if we take a detour and get lost, and we always do—we are works in progress!

If you’d like to read more about sankalpa practice, this article from Yoga International is online.

Elizabeth (Beth) Gibbs, MA, C-IAYT, is a certified yoga therapist through the International Association of Yoga Therapists and is a guest faculty member of the Kripalu School of Integrative Yoga Therapy. Her masters’ degree in Yoga Therapy and Mind/Body Health is from Lesley University in Cambridge, MA. She is the author of Ogi Bogi, The Elephant Yogi, a therapeutic yoga book for children. For more information please visit her website at:

This post was edited by Patrice Priya Wagner, Managing Editor of Accessible Yoga blog and member of the Board of Directors.

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Monday, December 16, 2019

Ask the Yoga Doctor: What Does Science Say About Savasana?

In this video, Dr. Timothy McCall discusses what scientific studies of Relaxation pose (Savasana) conclude. Spoiler Alert: It's more "relaxing" than chilling on the couch. Find out why!

If you want to submit a question to Timothy, email it to

Timothy McCall, MD is a board-certified internist, Yoga Journal's medical editor since 2002 and the author of the Amazon #1 bestseller Yoga as Medicine: The Yogic Prescription for Health and Healing. He practiced medicine in the Boston area for a dozen years before devoting himself full-time in the late 1990s to yoga therapy. He has studied with many of the world's leading yoga teachers, including BKS Iyengar and TKV Desikachar. In 2005, Timothy began his studies with a traditional Ayurvedic doctor, Chandukutty Vaidyar, and spent more than a year at his clinic in Kerala, India. His latest book is Saving My Neck: A Doctor’s East/West Journey through Cancer. For more information see

This post was edited by Nina Zolotow, Editor in Chief of the Accessible Yoga blog.

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To order Jivana Heyman's book Accessible Yoga in the U.S., go to Shambhala PublicationsAmazonBarnes and NobleIndie Bound (for independent bookstores), or your local bookstore. People in other countries who want the order the book see How to Order "Accessible Yoga" from Countries Outside the U.S.

Friday, December 13, 2019

You Don't Have to Climb the Whole Mountain

Climbing on Mount Fuji by Hokusai
by Nina Zolotow

“Can’t we just follow the first part of the path?” I asked, rather plaintively. 

After reading Edwin Bryant’s Yoga The Yoga Sutras of Patanjali cover to cover and learning what the eight-fold path really entailed, I realized that this path is not one that people like me and most of you—householders—can follow in a literal way. First of all, we would have to become renunciates because even being attached to people you love, including your family, interferes with your ability to achieve samadhi. And the path—with its intended goal of liberation from everyday life as we know it—is really quite arduous and severe as we would eventually have to let go of all connection to external reality. As Georg Feuerstein says in The Yoga Tradition

“At the peak of this ecstatic unification, yogins reach the point of no-return. They become liberated. According the dualistic model of Classical Yoga, this implies the dropping of the finite body-mind. The liberated being abides in perfect “aloneness” (kaivalya), which is a transmental state of sheer Presence and pure Awareness.” 

At that time, I decided that despite this Patanjali's Yoga Sutras contains invaluable wisdom, which can bring you a deeper understanding of human nature and help you move toward equanimity in your everyday life. So even if I didn’t commit to following the eight-fold path, I could still make use of the wisdom contained in the famous text that described it. 

But since then I’ve been wondering if there isn’t another path in another yoga text that might be more appropriate for people like me. That was why I began studying the Bhagavad Gita in depth. And, in my post Arjuna is Us: Staying Strong When You Stand Up for What's Right, I wrote about how Arjuna, the hero of the Gita, was a better role model for us because he, too, was a householder, who had a livelihood, a family, a community, and important work to do in the world. Therefore, the path Arjuna was told to follow by Krishna, karma yoga, might be more suitable for us householders than the eight-fold path. 

However, when I was talking with yoga teacher and scholar Richard Rosen about this, he mentioned something that I had already come across in my readings: some yoga scholars believe that the three paths described in the Gita, karma yoga, jnana yoga, and bhakti yoga, were not three separate paths but were three phases of a single path. Oh, no, I thought. After all, the third path in the Gita, bhakti yoga, is devotional practice directed at Krishna, an avatar of the god Vishnu, and I’m not a Hindu (or even religious) so it's definitely not for me.

So that’s why I plaintively said, “Even if that’s true, can’t we just follow the first part of the path?” 

After Richard and I parted, I let that thought percolate for a few days. And one morning, as I sometimes do, I had little epiphany. Was there any rule that said we had to start on every path with the intention of making it to the very end? After all, when you climb a mountain, you don’t always start at the bottom and climb all the way to the very peak. The Bootjack trail on Mount Tamalpais starts at the bottom of a valley in the Muir Woods in the shade of the towering redwoods and ends at the peak of the mountain in sunlit meadows dotted with oak trees. So far, I usually take the path only as far up as my favorite view of one of the cataracts. 

So if the peak of the yoga mountain is “liberation” from samsara—the endless cycle of birth, death, and rebirth—and from everyday life as we know it, if that’s not what you want (or you don’t believe it’s possible), you don’t need to make that peak your goal. How high you decide to climb is up to you. However, a good destination might be completing the preparatory steps. These steps vary from path to path (as on Mount Tamalpais, there is more than one way up the yoga mountain), but basically yogis traditionally readied themselves for achieving liberation through practices intended to pacify their minds and, on some paths, strengthening and purify their bodies. These practices were intended to provide them with a satvic mind, so they could live here on earth in a state of equanimity as they dedicated themselves to achieving their ultimate goal. But equanimity here on earth as my end goal—yes, that sounds good to me. 

The next time I saw Richard Rosen I mustered courage and told him about my little epiphany. I said, “I realized that you don’t need to climb the whole mountain. You can just take the path part way up.” 

To my surprise he told me he really liked this concept. And he added, “This will reassure people about what they have accomplished so far.” 

“Hear now the wisdom of Yoga, path of the Eternal and freedom from bondage. 

No step is lost on this path, and no dangers are found. And even a little progress is freedom from fear.” 

 —Bhagavad Gita, translated by Juan Mascaro

Wednesday, December 11, 2019

How Yoga and Meditation Help Me with Multiple Sclerosis

by Patrice Priya Wagner

Ten years after my diagnosis of multiple sclerosis (MS), I took my first yoga class offered by the MS Society. A friend of mine who has MS suggested I go to it, and so I gave it a try. Although I enjoyed it, I thought it was too easy for me as I mistakenly assumed that yoga was only about physical exercise. I was curious to learn more about yoga, so I enrolled in a class that would suit me better with more difficult poses.

In my new class, my balance wasn't good in standing poses so the teacher quietly moved a chair near me in case I needed to hold onto it. I ignored that chair for a long time until, one day, I put my hands on the chairback to support me in a pose and realized how much more comfortable I could be in the pose if I accepted my disability and made friends with that chair.

At the weekly sessions, I started taking deeper breaths from the abdomen as the teacher instructed me to do, which I liked because it made me feel calm and centered. The poses gave me the sense of being able to move my body and strengthen muscles, something I needed badly since I could no longer jog or play tennis (the ways I got aerobic exercise before then). At that time, my practice was limited to the minutes spent in the yoga studio and I didn't attempt practice on my own at home, even though I had bought all the necessary props in hopes I would give it a try!

About ten years after my first yoga class, a friend organized a 200-hour Accessible Yoga teacher training for people like me, so I enrolled. That’s where I learned how to teach students to do poses, pranayama (breathing exercises), and meditation. At this point, I needed to use a few props to demonstrate some of the poses but most of my symptoms were largely invisible, such as severe fatigue, heat sensitivity, and cognitive "slowdowns." Thankfully, the training accommodated all these challenges and more. My symptoms didn't keep me from participating in class and I ended up really liking what I was learning.

Fast-forward another ten years and you'll notice that I walk with a cane, but other than that, my symptoms are still largely invisible except to people who know me well. I teach a weekly yoga class to people with MS and maintain a daily practice at home. Yoga has helped me manage my invisible symptoms but it’s not the asanas that are providing these benefits. I enjoy stretching and doing poses, standing ones included, but breathing exercises and meditation have played a much larger role in my maintaining optimum health than the asana practice.

That is because over the years I came to realize how badly I deal with ordinary stressors, while I also learned that chronic stress is unhealthy to carry around every hour of the day and, anecdotally, may lead to a worsening of MS symptoms. A few years after the 200-hour training, I took a meditation training that was held at a convenient time for me and would give me enough hours to reach the next level of certification (500-hours). I began to meditate daily as homework for the course, but soon after completing the program, I realized that I was getting a full night's sleep without having changed my medications, diet, or exercises. So I continued meditating even though it was no longer required! During the daytime, I felt more relaxed and calm than I had in a long time, which added to my resolve to continue meditating daily.

I increased my daily practice of pranayama and meditation in order to reduce the level of nervous tension that tends to stay in my body and mind unless I consciously remove it. Without a deliberate "intervention," I might be highly reactive, not allowing a second of pause between hearing something that disturbs me and saying something I would later regret.

As I came to recognize the nervous anxiety I carried around, I began to seek comfort in longer periods of meditation. Currently, I practice two breathing exercises before I sit to meditate each morning for a combined time of fifteen to thirty minutes, depending on how I feel and what I need to accomplish that day. Practicing pranayama brings me into the present moment to witness how my body feels as I inhale and exhale to perform a brief energizing breathing practice of Skull Shining Breath (Kapalabhati) to wake me up a bit, followed by a calming practice of Alternate Nostril Breathing (Nadi Shodhana) with my exhalations twice as long an my inhalations.

Then I sit for meditation and usually use my breath as the focus. While some days it seems impossible to keep my mind steady on this one thing, my breath, on other days I'm able to experience a deep calm as soon as my mind stops jumping around. But my mind doesn't stop whizzing around quickly or easily; it always takes some work.

I've had to relearn on occasion that although yesterday's meditation involved less effort, it doesn't mean that today's will come easily. The mind has its own logic, like the heart, and I've come to accept that my task is to slow down a force that won't listen to reason. Each day I start from where my mind tells me we are at that moment, remembering that I'm trying to control a slippery, fidgety thing that needs to be treated gently and never coerced.

Over the years, I've found that meditation is a journey of making friends with my inner mind and thoughts. Through negotiating with my mind during rough times as well as easy days, I've been able to learn when my mind is so troubled that it could be affecting my stress level and, hence, my MS symptoms unless I add one more meditation to my day. Without that awareness, my symptoms may have become worse than they currently are, twenty years after my first yoga class. When I started doing yoga, it was for the exercise, but I've continued practicing because meditation and pranayama help me cultivate a serene mind to better accept my disability and the world around me.

Patrice Priya Wagner, RYT 500, C-IAYT, teaches yoga to people with disabilities in Oakland, California, and has been published in New Mobility Magazine, Works and Conversations, Artweek, and Kitchen Sink. She is Managing Editor of the Accessible Yoga Blog and a founding member of the Accessible Yoga Board of Directors.

This post was edited by Nina Zolotow, Editor in Chief of the Accessible Yoga blog.

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To order Jivana Heyman's book Accessible Yoga in the U.S., go to Shambhala PublicationsAmazonBarnes and NobleIndie Bound (for independent bookstores), or your local bookstore. People in other countries who want the order the book see How to Order "Accessible Yoga" from Countries Outside the U.S.

Monday, December 9, 2019

Second Opinion on Practicing Inverted Poses During Menstruation

Carolyn Vandyken
by Nina Zolotow

Because there was some debate about and, indeed, disagreement with, Dr. Timothy McCall's advice about doing inverted yoga poses while you are menstruating (see Ask the Yoga Doctor: Are Inverted Poses During Your Period a Bad Idea?), I decided to look for a second opinion on the subject. For this second opinion, I was looking to hear from someone who themselves experienced menstruation and someone who had health training in a related field. I started by contacting yoga teacher and physical therapist Shelly Prosko, and she connected me with Carolyn Vandyken, who is a pelvic health expert. Here's what she had to say:

"Despite many attempts to find research to support the widely held belief that inversion poses contribute to endometriosis or endometriomas (endometrial tissue found outside of the uterus) there appears to be no evidence to support that claim. Listening to your body and what feels good throughout your cycle should be an individual choice; fear of potential harm should not play a factor in the decision-making process for self-awareness and intuitive practice throughout a women's cycle. Young girls and women do not stop their athletic endeavors during menstruation, including gymnastics, synchronized swimming, or other sports that place them in an inverted position. There is no increase in prevalence of endometriosis in these athletes. In short, empirical and experiential evidence does not support this belief."

Thank you so much, Carolyn! It is good to know there has been research into this issue and that you conclude it is safe to practice inverted poses while menstruating.

I think one of the reasons there was so much debate about this is that different yoga traditions have treated this issue in different ways. In the Iyengar tradition (which is the one in which both Dr. McCall and I received our training), there was some concern that long-held inversions during menstruation might have a negative effect on the reproductive system (as Carolyn described above) and so they were completely prohibited. Naturally, before there was scientific research on this, most teachers felt like they wanted to err on the side of caution. Hopefully, health experts like Carolyn can now help spread the word that there is no evidence of the need for safety concerns about doing inverted poses while menstruating.  

Carolyn Vandyken is a clinician, educator, researcher and advocate for pelvic health, LBP and all things persistent in the pain world. Carolyn graduated from McMaster University with a Bachelor's degree in physiotherapy in 1987. She became an MDT credentialed therapist in 1999, certified in medical acupuncture in 2002, and received a CBT certificate from Wilfred Laurier University in 2016. She co-founded Pelvic Health Solutions, a post-graduate teaching company and is actively involved in research with Dr. Sinead Dufour, publishing several studies on the connection between low back pain and pelvic floor dysfunction. Carolyn won the distinguished Education Award from the Ontario Physiotherapy Association in 2015.

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Friday, December 6, 2019

A Caregiving Warrior Exhales with Yoga Practices

Mount Fuji in Clear Weather by Hokusai
By Elissa C. Rosenthal 

In the early morning darkness, I awake with muscles taut, staccato breathing, and my mind on watch. Before my sleepy consciousness catches up to the present reality, it reverts to caregiver mode. It’s a reflexive response. I cared for both my parents, who lived with me until my father’s death at home two years ago and my mother’s passing in a nursing home six months ago. It has been a brutal few years. 

I can still hear the sound my father’s frantic voice calling me downstairs at 2:00 a.m. Off we’d fly to hospital more times than I can count, he in the ambulance, me driving behind. My memory flashes frequently on to my mother, ten months after my dad died. Her slight frame is sprawled across the floor with a fractured hip, her walker spilled over inches from her grasp, and her moans steeped in pain, fear and anger. 

For each crisis, I assumed the stoic stance of a soldier on the verge of war. I constricted my emotions and my breathing to perform the duties demanded of me. At home, at the hospital, or at the rehabilitation center, I met each medical complication like a warrior in hand-to-hand combat. And it was messy. 

When I was actively caregiving, one of the few places I could be myself and for myself was my yoga practice. In this refuge I exhaled the breath I was unaware I had been holding. Breathing became the counterweight to my futile attempts to direct events beyond my control. 

Slow, deep inhalations followed by even slower exhalations steadied me during moments of emotional turmoil. Standing at my father’s bedside in the emergency room in the middle of the night, I would perform conscious breathing: inhale to a count of 4, pause for a count of 4, exhale to a count of 6, and pause again for a count of 4. This pranayama corralled my runaway thoughts and deepened my shallow breath pattern. 

I also discovered a meditative practice that clicked with my jumpy monkey brain. Seated in a chair with eyes closed, count internally from 1 to 4. Completing each cycle, start again. Wandering to 5 or 6, guide the count back to the beginning. In the face of complex decisions and upsetting events, the simplicity of this repetitive task practice rests the mind. 

Sometimes, I’d join my breath with a mantra. Although there are beautiful Sanskrit mantras to support acceptance and strength, I reached for the language of my spiritual heritage, Hebrew. Repeating with my inner voice to my hurting heart until I believed it to be true, I recited,: "Hineni.” “Chazak.” “Har.” The words translate to: “Here I am.” “Strong.” “A Mountain.” This has become my go- to mantra when my faith in my ability to endure falters. 

There were also many asanas that served me during these hard days. Three poses in particular offered me what I needed most as caregiver: a place to be strong and a place to be vulnerable. 

In Warrior 2 pose, centering my torso and hips between my heels, I rooted myself in the present. I resisted the urge to lean too far forward into the future, leaping to the next imagined catastrophe, or to lean backwards, lingering on past what ifs. Warrior 2 affirmed my view of myself as a solder, one who could be both fierce and gentle. 

Mountain pose was the physical embodiment of my mantra. It showed me how much can be happening in the body when one is standing their ground, rising from a solid foundation. I monitored myself for tension and released my shoulders away from my ears. When I lifted my sternum and stretched my pectoral muscles, it was as though I was opening my heart towards hope. 

Half Pigeon pose (One-Legged King Pigeon) allowed me to express my pent-up feelings in the safe zone of my mat. I’ve heard the hips don’t lie when it comes to emotion and this was true for me. Then, as I moved into the forward bending version of Half Pigeon I could finally release tears of worry and fatigue onto my mat. I was grateful to a respectful yoga teacher who offered me the space and compassion to cry them. 

During my caregiving days, loving family and friends kept me aloft. But my yoga practices were also essential, and I can’t imagine how I would have emerged intact without them. They gave me the structure and permission to care for myself. And they renewed my warrior spirit so I could more effectively care for those in my charge.

Elissa C. Rosenthal is a yoga teacher and registered occupational therapist who has worked in mental health settings, nursing homes, home care, public and private schools, and a residential care facility for developmentally delayed adults. Inspired by her patients and her own deepening yoga practice, in 2014 she completed a 200-hour teacher training through the Mukti Yoga School taught by Elyse Foster and Jacqui Bonwell. She holds additional certifications in children’s yoga, chair yoga, and Yin Yoga, and completed her Accessible Yoga teacher training in October 2019. The principles and practice of accessible yoga are a natural complement to her more than forty-year long career as an occupational therapist offering a client-centered compassionate approach to individuals with disabilities. Her articles and essays have been published in newspapers, magazines, and online websites in the Boston area. 

This post was edited by Nina Zolotow, Editor in Chief of the Accessible Yoga blog.

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To order Jivana Heyman's book Accessible Yoga in the U.S., go to Shambhala PublicationsAmazonBarnes and NobleIndie Bound (for independent bookstores), or your local bookstore. People in other countries who want the order the book see How to Order "Accessible Yoga" from Countries Outside the U.S.

Wednesday, December 4, 2019

Overcoming Sjögren’s Syndrome with Yoga

by Ram Rao

Autoimmune diseases are characterized by our immune system going awry and mistakenly attacking our own body tissues. The immune system is our body’s defense mechanism consisting of leukocytes, macrophages, dendritic cells, mast cells, bradykinin, histamine, interleukins, and tumor necrosis factor among others (similar to the various armed forces). 

Normally, these defense molecules protect the body from foreign particles including bacteria, virus, toxins, and all types of allergens. When the body senses these foreign invaders, it signals the immune system to send out its plethora of defense molecules to attack them, a process known as inflammation.

The immune system is extremely important as it is involved in protecting organs, tissues, and cells. In a perfect setting, the immune system will release these defense molecules only when needed––and when the threat has been sufficiently addressed, these defense molecules retreat to their garrison (specific cellular location). Thus, in a perfect setting, a body’s defense system can differentiate between foreign cells and the body’s own cells.

For reasons that remain unclear, in autoimmune disease conditions, the immune system mistakes the self––the body, including tissues, joints, muscles, nerves, or skin, as foreign. Since the “self-tissues” get recognized as “foreign,” the body’s immune system starts attacking it them. This is the negative aspect of the immune system characterized by an aberrant, out-of-control defense system––the body operating as if it is constantly under attack and the body’s defense molecules going haywire and attacking its own tissues. This results in bodily damage, and as the system goes out of control, it self-perpetuates and is the basis of chronic autoimmune conditions including, but not limited to, fibromyalgia, neuralgia, systemic lupus erythematosus, systemic sclerosis, and polymyositis.

Some autoimmune diseases target only one organ as in Type 1 diabetes that affects only the pancreas. Other diseases, such as systemic lupus erythematosus, affect several areas of the body. While the basis for the immune system to go haywire remains unclear, some people are more likely to get an autoimmune disease than others. Genetics, gender, environment, certain foods, lifestyle, and age play a role in the development of autoimmune disorders. Women get autoimmune diseases at a rate of about two to one compared to men. Some autoimmune diseases are more common in certain ethnic groups. Certain autoimmune diseases, like multiple sclerosis and lupus, run in families.

Sjögren's syndrome is a lesser-known autoimmune disease that primarily affects moisture-producing glands of the body including the tear and saliva glands. It is estimated that four million Americans are diagnosed with Sjögren’s including men and women of different ages and ethnicities. Due to the complexity of diagnosing Sjögren’s, it is believed that many individuals remain undiagnosed after years of experiencing symptoms. 

Patients with this condition have eye dryness, irritation, or painful burning in the eyes. Patients with dry eyes are at increased risk for infections around the eye that can damage the inner regions like the cornea. Some people complain of dry mouth and swelling of the glands around the face and neck. A dry mouth triggers other dental issues like dental decay, gingivitis, or oral infections. Some patients have episodes of painful swelling in the salivary glands, while others complain of dryness in the nasal passages, throat, vagina, and skin. Swallowing difficulty and symptoms of acid reflux are also common.

Treatment for Sjogren's syndrome depends on the parts of the body affected. Many people manage the dryness in the eye and mouth by using over-the-counter eye-drops. Drugs including NSAIDs (non-steroidal anti-inflammatory drugs) or steroids that suppress the immune system are normally prescribed, but steroids can trigger serious side effects. Diet, supplements, and herbs help to reduce the pain and inflammation, protect joint health and promote healing with fewer side effects. Additionally, lifestyle changes also reduce the severity of the condition.

Yoga and yoga related practice including asana, meditation, and pranayama help in mitigating the symptoms of this chronic illness and overcoming its weakening effects. While the health benefits may not appear immediately, they become evident with a sustained and regular yoga practice. Research studies provide ample evidence to show that yoga suppresses inflammation, a cardinal feature of Sjögren's syndrome.

A regular yoga practice may lower the level of several pro-inflammatory molecules in the body, thereby relieving severe pain associated with the inflamed tissue. Yoga poses stimulate flow of blood and oxygen to all the organs, joints, and tissues resulting in reduction in joint pain, improvement in mobility of joints and muscles, increased energy levels and sense of wellbeing. Patients also report improved sleep after a yoga practice.

Sitting, standing, and supine twists, sun salutation, warrior poses, and inversions in general reduce inflammation. This results in improved blood circulation, stimulates respiration, and relieves muscle and joint pain. The inflamed areas are now better equipped to combat stress and function effectively as there is improved blood circulation and oxygen.

Yoga’s pain management techniques including breath work, deep relaxation, and meditation dampen stress and bring in more mental clarity thereby decreasing the level of pain and perceived suffering. All the benefits are mostly observed in patients that have a sustained yoga practice. So, if you are diagnosed with Sjögren's syndrome or an associated inflammatory condition, think of adding yoga and yoga management practices to your list of treatment protocols.

Rammohan (Ram) Rao comes from a family of Ayurvedic practitioners and Vedic teachers in India tracing back to the illustrious Vedic-acharya Rishi Kaundinya (although Ram admits he cannot do the Eka pada or Dwi pada Kaundinyasana). With a doctorate in Neuroscience, Ram was a Research Associate Professor at the Buck Institute for Research on Aging. He focused on various aspects of age-associated neurodegenerative diseases with emphasis on Alzheimer’s disease. In addition, Ram completed the academic training at the California College of Ayurveda (CCA) and received his certification as Clinical Ayurvedic Specialist. He has been a faculty member of the California College of Ayurveda and teaches in their Nevada City location. Ram is also a dedicated Hatha yoga practitioner and is a Registered Yoga Teacher from Yoga Alliance USA. In his spare time he offers consultations in YAMP techniques (Yoga, Ayurveda, Meditation & Pranayama). Ram has published several articles in major Yoga/Ayurveda magazines and has been a featured speaker in several national and international meetings and symposia. He is a member of the National Ayurvedic Medical Association (NAMA) and is on the Research Board of the Association of Ayurvedic Professionals of North America (AAPNA).

This post was edited by Patrice Priya Wagner, Managing Editor of Accessible Yoga blog and member of the Board of Directors.

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To order Jivana Heyman's book Accessible Yoga in the U.S., go to Shambhala PublicationsAmazonBarnes and NobleIndie Bound (for independent bookstores), or your local bookstore. People in other countries who want the order the book see How to Order "Accessible Yoga" from Countries Outside the U.S.