Healing Hamstrings Attachment Injuries in Yoga

a.k.a. Yogic Butt Pain

The most prevalent injury in the field of yoga is proximal hamstring tendinopathy (PHT). You may know it better as a deep pain in the butt, right where your leg and pelvis meet. It is also commonly referred to as hamstrings attachment injury.

hamstrings pain

Studies estimate that nearly 80% of yoga practitioners will experience this injury at some point during their practice. It is most common in flexible, female yoga practitioners. Proximal means that the injury is close to the hip joint. Hamstrings refers to the three muscles that make up this group: semimembranosis, semitendinosis, and the biceps femoris. These three all connect with the ischial tuberosities or the “sitting bones” of the pelvis at their origin (for my anatomy nerds, one of the two biceps heads originates on the femur, not the pelvis). The location of the muscle attachment is the reason for the buttock pain during sitting or deep hip flexion.

I use the word tendinopathy here to cover three types of tendon disease: tendinitis (acute injury with inflammation), tendinosis (chronic injury with cellular degeneration but no inflammation), and paratenonitis (inflammation of the outer layer of the tendon). In the field of yoga, we are not here to diagnose or treat injury, and the way we’d approach any of these conditions or a combination of them is the same, so PHT is a good coverall for our purposes.

Depending on the severity of the damage, an injury to our tendons can take from two to 26 weeks to heal. The average yoga practitioner in America heals a PHT in about 18 months. If we want to shorten the healing time, feel better, and get back to our yoga practice we have to unpack some of the reasons that healing isn’t occurring.

Why are so many yogis getting hurt?

It’s helpful to know that this injury happens most commonly in our most flexible and moderately experienced yoga practitioners. It frequently occurs three, five, ten, even 15 years into practice and is generally seen in a practice focusing more on increasing flexibility and range of motion than on strengthening the muscles and tendons at the back of the leg and hip. This is endemic in American Yoga culture.

The challenge for flexible students is that a few months into their yoga practice, the sensations in forward folds decrease significantly as they rapidly approach maximum range of motion for their genetics. The “pursuit of sensation” leads to a tricky situation where students struggle to differentiate between uncomfortable sensations of stretching and uncomfortable sensations of damaging the muscle or its attachment.

In the field of hot yoga, particularly Bikram Yoga’s 26 posture series, the raging debate about “lock the knee” or “micro-bend” have both led to exacerbating the prevalence of PHT because neither side of the debate addressea the supportive role of the deep six hip rotator muscles in preventing hyper-extension and supporting the hamstrings attachments.hyperextended standing bow

As teachers, we need to deepen our understanding of body weight distribution, hyper-mobility, and the roles our muscles play in taking the pressure off of our soft tissues. Too often, I see Instagram posts of yogis in Standing Bow or Dancer’s Pose with a relaxed posterior hip, internally rotated femur, and a hyper-extended knee. The answer to this problem isn’t a “micro-bend” in the knee. It is a stronger set of hip muscles and a well-aligned femur. More on how to do this under “Pranayama” below.

Note how internally rotated the standing leg is in the above photo and how far behind the ankle her knee is located. (photo credit 105f.com)

Our responsibility as yoga teachers is to help our students both build strength and control, and also tune in to their bodies to listen for clues to injury in its early phases. We are obliged to seek continuing education with experienced teachers who can help us “see” in a body when more or deeper is no longer better.

If you have a history of knee problems, Baker’s cyst, patella-tracking problems, it may all boil down to not stopping the thigh from internal rotation. If you want to heal your knee, you have to strengthen your hips. Or use your ass as a doorstop for your knee.

Did I over-stretch it?

One of the greatest damaging forces to tendons is compression, not stretching. All of our forward-folding postures press the hamstrings tendons against the bones of the pelvis and continually increasing the compression over time gradually increases the extent of the damage.

Many yogis hang in the back of the hip for standing postures with the hip joint behind the ankle. This misalignment puts a tremendous amount of compressive force on the hamstrings tendons against the bone. The issue is often not one of stretching the tendon as much as it is aggressively compressing it.

How do we stop the injury?

The first step in helping my students with PHT is getting them to understand that you can’t stretch out an injury like this. Imagine you are reading the Sunday paper and the top crease has a small tear in it. “Shoot!” you think. “My newspaper is torn. I’m going to grab both sides of the paper and pull them apart so I can get it to stick back together.”

That doesn’t make any sense, does it?

Most of us think, like we do about lower back pain, that the answer to healing an injury is to stretch out the pain. The solution to healing an injury like this is to stop tearing and micro-tearing the area and give it time to heal.

You need to glue the paper and leave it alone so that has time for the glue to dry firmly. That’s our number one problem. We can’t seem to leave the paper alone long enough for the glue to dry. We keep going back to it, “It is ready yet? How about now?” In this way, we keep re-injuring the damaged tissue.

Most of my students say. I don’t want to stop forward bending. It’s going to limit my practice! Here’s the truth bomb. You have a choice to limit your end-range hip flexion for four to six months or be in pain for over a year and have to limit your end-range hip flexion for four to six months then. Which one sounds better?

Understanding the Healing Cycle

The healing response in the human body is a predictable process of three over-lapping phases: inflammation, repair, and remodeling. After an injury, your body immediately rushes blood and white blood cells to the area to stop the injury and begin the healing process. The inflammation phase usually occurs during the first seven days following an injury. This part of the process is generally painful and accompanied by redness and swelling.

Next, the body begins the repair phase or proliferation (of new cells) phase. Here the body lays the scaffolding that will bridge the damaged tissues. The process in this phase of healing is called granulation. The body sends tiny tendrils of scar tissue across the breach to show the body where to lay the permanent tissue.

Granulation occurs around 6 to 14 days and the area immediately feels more stable. Pain and inflammation decreases and you start to feel better. There is a strong urge to return to normal activity around two weeks post-injury. This is where we make our biggest mistake.

We resume normal use of the area and the granulation tissue is not strong enough to bear the load.  I picture these granulation tissues like the tiny gossamer filaments of a spiderweb. Under normal use, the tender fibers tear and the body initiates the inflammation phase again.

If you can wait, if you can stop yourself, the next weeks of healing are the remodeling phase. Around three weeks after the injury, the collagen of the scar tissue laid during granulation matures and is constantly remodeled until permanent tissue is achieved. This process takes around 12-16 weeks, but some tissues can take up to 26 weeks to fully mature. Mark your calendar with these dates as points to check in with your own healing process. With this injury, you must limit end-range hip flexion for three to six months.

Enhancing Maturation

While most students can grasp this healing protocol, most of us forget to put in the time  to strengthen the support muscles of the back of the hip and the hamstring muscles and tendons. If we are going to prevent this injury from happening in the future, it’s imperative to also strengthen the tendons. A tendon is strengthened by loading the muscle and, thereby, the tendon.

I’m a big fan of Jules Mitchell’s progressive loading technique for healing PHT. Take your time with each of the phases of this loading technique. Give yourself a week or two with each exercise before moving on to the next. Remember the exercises can be done with your feet on an exercise ball, a chair, your coffee table or couch. You can also do all of the exercises in the Bridge Pose position and slowly move your feet farther away from the buttocks as your strength increases.

In addition to these tendon-toning exercises, you must immediately improve the way you use the muscles of your hip and the alignment of your body in one-legged postures.

Most of us under-utilize the deep six rotator muscles that stabilize in the hip and forget to fire the hamstrings to keep the body’s weight forward rather than hanging from the back of the hamstring tendons. I’ll go into the 26 postures from the Bikram series in detail below, but remember that the bones of the leg do their job best when they are lined vertically hip over the knee and ankle joints. The bones of the leg bear weight longitudinally much more effectively than horizontally or at an angle.

When the body’s weight is in the heel in a hip-flexing posture like Warrior 3/Balancing Stick, most of the body’s weight hangs from the tendon of the hamstrings muscles. When the leg is aligned vertically, the majority of the body’s weight is borne on the bones of the leg and the muscles and tendons of the leg simply stabilize your balancing body.

Can I heal my injury and still go to yoga?

Absolutely! Yoga benefits healing by increasing circulation throughout the body and giving you the opportunity to build muscular strength. If you’ve been overworking the hamstrings, I’m confident there are at least another dozen other muscles you can wake up and get them to do their fair share of the work around your body.

Increasing circulation speeds healing. We get the waste products out and the building blocks in. By increasing circulation you help your own body do what it does best: keep you healthy, active, and pain-free.

Your first rule of thumb in healing a sprain, strain, or tendinopathy: Don’t poke the bear. If you can feel it, you went too far.

I grew up in rural Vermont. We give directions like, “Turn left a half mile before the big, red barn.” That really is how you get to the Cabot Creamery, but sometimes you have to go too far a few times to figure out how to get there. The goal of the mindful yogi is to stop before you feel sensation: pain, pulling, stretching to the injured tendon. In the beginning, you’ll go too far a few times, but hopefully you’re a fast learner.

You have to stop the cycle of injury to the area. In biomechanics, this means no end-range hip flexion. Hip flexion refers to flexing or closing the joint of the pelvis/hip and the femur bones. In yoga class, this means no full forward folds for about a half year.

Healing and the 26/2

Please find below specific instructions to modify and/or moderate each of the Classic 26 postures.

Pranayama/Deep Breathing:

In Pranayama, you have an opportunity to practice strengthening the muscles at the back of the hip to prevent injury in the future. Stand with your feet together in front of a mirror. Side-by-side and touching or with a small gap in between for those with hip injury/pain. Look at your legs in the mirror. For most flexible people you’ll notice that the femur bones internally rotate and the kneecaps have a very slight inward cast as if you were going slightly cross-eyed.

Note: The more internally-rotated the thighs, the wider the gap will be between the knees. There are some students with a true “bow-legged” stance who will have a large gap regardless. This student is the exception, not the rule. Many students think they are naturally bow-legged when they just have weak hip muscles.

Internal rotation of the femurs is a prerequisite for a hyper-extended knee. If you can stop the femurs from turning inward, you will prevent the knee joint from moving beyond 180 degrees,effectively stopping hyper-extension.

The muscles that do this work are some of the deep six rotator muscles: the piriformis, the obturators, the gamellus, and quadratus femoris. They are also part of the base of the pelvic floor. These unsung heroes are some of the most important muscles that connect the legs and trunk. Take a look at them here. They’re very cool! Looking and seeing where the muscles insert and originate will help you understand what they do and how to find them.

Looking at yourself in the mirror, very slightly externally rotate your thighs. For some it helps to imagine you were turning the backs of your knees towards each other. What you want to see in the front mirror is a small movement of the kneecaps outward until they point straight ahead. It is a subtle, but visible movement. If you see gross movement, you’re trying to do it with your glutes.

Place your hands on your buttocks muscles. Relax them. Then place your first two fingers in the “gluteal fold” between your buttocks and the back of your thighs. Now contract there by trying to turn the backs of your knees closer together.

Those are the muscles we seek. Feel the way those muscles deeply contract underneath your fingers. Still having trouble? Ask your yoga teacher or a pelvic floor physical therapy specialist to help you find those muscles. Finding and strengthening and increasing the flexibility of those muscles will not only help with your ass pain, it’s also going to help you stop peeing your pants when you jump on the trampoline.

Pranayama deep breathing is your chance to practice contraction of those muscles so you’re ready later when we try to balance on one leg.

Pro tip: During Pranayama, contraction should be softened on the inhale and deepened on the exhale in rhythm with the natural movement of your pelvic floor.

  • Exhale breathing: pelvic floor, deep hip muscles, and abdominal wall contract.
  • Inhale breathing: pelvic floor relaxes and abdominal wall inflates.

Half-Moon pose:

In Half Moon, we continue to work on engaging the deep rotators. In this pose, you’ll create the contraction and hold it the entire side. Relax. Engage. Start left side. Repeat for the back bend.

Pro tip: Can you feel your hamstrings muscles engage, too? The hamstring and calf muscles are important counteraction of the strong quadriceps muscles at the front of your thigh. The traditional “lock the knee” cue means a Battle Royale between the muscles that extend and flex the knee. If both sides are equally contracted, you have a very stable standing leg.

Hands to Feet:

Pump your brakes, big time. This posture centers around complete end-range hip flexion. We are trying to fold the pelvis down completely to the thighs. Remember your rules? No end-range hip flexion for 3-6 months.

Mind the warm-up in this posture. Simply move the hips side to side. Some teachers have added a cue to their class to “Bend into the right knee. Bend into the left,” or “Walk in place.” Bending the knees applies a tremendous amount of compression to the hamstrings tendons and should be avoided in any case where the yogi has a history or suspicion of PHT. Do you remember the stat from the beginning? That’s 80% of the people in class. In other words, that cue is inappropriate for the general public.

There are two approaches to this posture with a PHT. Some teachers will tell you that you MUST bend the knees. There is no science-based evidence to prove this assertion is true. Depending on the location and severity of the injury, one may work better than the other for you.

  1. Straight legs: Keeping the legs and spine straight, slowly walk your hands down your thighs or to the floor until your body makes a 90-degree angle. Press your hands against your thighs to create traction along the spine. Stop at any point you begin to feel pulling on your granulating injury.
  2. Bent knees: Bend your knees and lower your upper body toward your thighs. If you are asymptomatic here, you may reach around and grab your heels. Proceed to depth with caution. Do not straighten the legs completely until the maturation process is complete and your injury does not bother you at any time.

The one absolute no-no is to come down into a forward fold with straight legs and then bend your knees. Imagine the hamstrings muscle like a rubber band that is attached above the hip joint and below the knee joint. When you flex the hip, it pulls the rubber band tightly over the hip and knee joints. If the tendon is already compressed against the ischial tuberosity and you bend your knees (picture yourself plucking the rubber band), you will increase the load and compression to the tendon and aggravate the injury.

Either bend your legs before you flex the hip or keep the knee straight and only flex the hip to tolerance. This same principle will apply in Standing Separate-leg Stretching, Standing Separate-leg Head-to-knee, and Paschimotthanasana.

Awkward pose:

Awkward presents another opportunity for you to practice the action of contracting the deep muscles at the back of the hip. I like to picture those muscles like a great big hand holding me from the outside of the hip on the thiPosterior Pelvisgh bone (the greater trochanter of the femur) to the bottom of the pelvis where you sit (your ischial tuberosities, pictured right). Imagine that hand, those muscles, pulling the femur and pelvis together, and closing or stabilizing the back of the joint.

When you sit down in Part One, instead of flaring your pelvic floor backward, try to pull the back of your hips together. It almost feels like you could pull your pelvic bones together. Again, it’s a small movement. If your knees fly out, you’re using your butt. If your tail tucks under, you’re using your psoas. Try to create a sensation like are lifting above the hip flexion, rather than sinking back into it. The movement of the deep hip rotators are subtle, but strong. Repeat this action in Part Two.

In Part Three, most yogis naturally engage the deep six on the way down. It’s how you keep your spine straight. If you’ve been pitching forward to come up, it’s because you’re under-utilizing these hip muscles on the way out. Before you come up, imagine you could pull your two ischial tuberosities (sitting bones) together as you lift your pelvic floor. You’ll have so much strength and control on the exit that it feels like you’re riding out on a geyser.

Eagle pose:

Don’t be surprised if you can’t hook your toes or sit very low in this one with a PHT. Depending on the location of the injury, the internal rotation required by the femur to hook the toes beneath the standing-leg’s calf muscle can twist and pull on the back of the leg enough that it can irritate the hamstrings attachment. Cross the legs and make sure you’re asymptomatic during the posture. Don’t poke the bear.

If it feels okay, go for it!

Standing Head-to-Knee pose:

Just like your teachers told you back in your first class, your standing leg is the most important part of this posture. For at least a couple of weeks, practice next to a side mirror and watch your body’s alignment. It requires the same engagement we did with double legs in Pranayama and Half Moon of that hand-like set of muscles of the back of your hip. Before you even shift the weight, engage the posterior hip muscles and stabilize your leg.

Look at yourself in the mirror from the side. When you stand on one leg, does your hip joint hang behind your ankle joint? Close the gap between the greater trochanter of the femur and the back of the pelvis/sacrum to keep your weight forward. See below. The picture on the left shows support from the muscles at the back of the leg and hip. The photo right shows a relaxed posterior hip and weight in the heel.

 

When you round down to grab the foot, and again when you start to kick forward, your weight will attempt to shift back into the heel. Be vigilant with these hip muscles and focus on keeping the weight forward so you don’t strain your healing hamstrings attachment.

When you are holding the leg with the tendinopathy in your hand, it’s OK for you to kick the leg forward as the hip will only be at 90° of flexion. Since this injury happens frequently with flexible students, you may be very easily able to straighten the kicking leg and still be asymptomatic. If it does hurt to straighten the leg, keep it bent for the duration of the healing process.

For flexible students: as you begin to round the spine over the thigh and bring your elbows down, keep the movement in your spine. Don’t proceed to end-range hip flexion by laying your torso on your thigh as this will increase the stretching and compression of the hamstring tendon and aggravate the injury. If you can get your elbows below your calves without feeling pain or pulling, you are more than welcome to drop your head on your knee.

Proceed carefully. It doesn’t matter if you can’t do this posture for a year. It’s better than living in pain and not being able to sleep at night.

Pro tip: When standing on the injured leg, try to feel the hamstrings muscles contract. In this way, you’ll be contributing to strengthening the muscle and its attachment so the injury doesn’t happen again in the future.

Standing Bow pose:

Utilize all of the work with the deep hip rotators that you’ve been working on since beginning breathing. As you begin to come down in Standing Bow, you are increasing hip flexion and compression of the tendon. You may need to execute this pose in a partially upright position. Mind your end-range hip flexion and proceed to tolerance.

Be vigilant in Standing Bow about the quality of your standing leg and prevent the weight from sinking backward and the knee from hyper-extending. As soon as you sink back, you are loading a damaged support structure and will only drag out the healing process.

Can you go down when you’re standing on the side that’s not injured? Sure!

Balancing Stick pose:

Come down only as far as you are asymptomatic. It is likely that your body will only come down to something like a 45° angle from vertical, maybe even less. The work you get to do here is contracting the hamstrings muscles so that even as you begin to introduce stretching back into your hammies, you’re doing it from a place of support and strength rather than hanging into the back of the hip. When you are lifting the injured leg, concentrate on deep contraction of those muscles, building strength as you heal.

Standing Separate-leg Stretching pose:

We approach Separate-leg Stretching just like Hands to Feet.

  1. Keep a flat back and bend your knees until you can touch the floor. Be mindful of your injury and slowly press your knees back to tolerance.
  2. Keep your legs straight and walk your hands down your thighs as far as your body goes without pain.

Pro tip: Many students find it helps to have something to put their hands on like the top of their water bottle or even a yoga block. That way they can practice weight forward, contraction of the back, legs and hips, without being tempted to sink down deeper into end-range hip flexion.

Triangle:

The primary concern for the injured hamstring is when it is the bent leg. Students should not be encouraged to sit down if it feels like pulling or stretching to the hamstrings attachment. It’s okay to stay up high and move the arms. For some students it’s impossible to move the arms and torso without feeling the pain. Start from the first cue the teacher gives and proceed only as far as you can asymptomatically.

Standing Separate-Leg Head-to-Knee:

This posture should be approached like Standing Separate-leg Stretching and Hands-to-Feet. Depending on the spot of the injury and the sensation the yogi feels, choose optoin one or two.

  1. Keep both legs straight and round the spine down like a candy cane as far as you can go without injury or pain and hold it there.
  2. Bend your front knee and place your hands on the floor. From there, keep the leg bent and curl the spine up towards the ceiling.

In my own recovery, I found both sets gave me different sensations in my spine and hips so I would practice one in the first set and the other version in the second set.

Tree pose:

In most cases, people are asymptomatic in Tree pose. If it pulls to lower and rotate the thigh, don’t do it.

Toe Stand:

In some cases, clients are asymptomatic in Toe Stand. Great!

If the forward fold creates a pulling sensation at the point of injury, simply repeat Tree pose.

Wind-removing pose:

Wind-removing pose is comfortable for most students because the knee is bent and torque on the muscle and tendon is reduced.

In a few extreme cases the student may feel pain simply flexing the single leg up. There’s nothing you can do about this but wait. In that case is I’ve had students simply bend the hip to a 90° angle and hold there.

Cobra series:

All the Cobra series postures require contraction of the hamstrings and hip muscles. These contractions stimulate circulation to the muscle area and build strength in tissue structures. Give it all you’ve got!

Fixed firm:

Fixed Firm is generally unaffected by PHT.

Half Tortoise:

Most students are comfortable in this pose.

Rarely, you may have a student with a very serious injury who needed to do a version like what you’ve seen in some Vinyasa classes called Puppy Dog pose. In this position, the shins are on the floor hips directly above the knees at a 90° angle and then you walk the hands out in front and drop the chest towards the floor. This allows the student to maintain some of the spinal traction and shoulder-stretching benefits of the posture, without aggravating their injury.

Camel:

Camel is another opportunity to strengthen the hamstrings, hips, and buttocks muscles with the same principles as the Cobra series.

Rabbit:

Most students are asymptomatic in this posture. Proceed in depth to tolerance.

Head-to-Knee pose:

This is a sticky posture for most students with PHT. Some feel pain when the injury is on the straight leg, for others when it’s bent. In the beginning, most students should simply sit upright and set the legs. Then, lift the arms overhead creating spinal traction and  begin to rotate towards the side. Most students will not be able to grab the foot early on. Arms can reach up over head for spinal traction or be placed on the floor on either side of the straight thigh.

Many students will feel pain if they bend the knee and grab the foot or if they round down. It’s more important that the student is asymptomatic in this posture than that they get the spinal flexion. Help the student to explore different parts of the ranges of motion  in this pose to see what they can do without feeling the pain or aggravating the hamstring attachment. This pose needs to be modified on a case-by-case basis.

Stretching pose:

One of the most challenging aspects of this posture is the set-up cue to “walk the hips back right and left.” For some students this pinches the hamstrings tendon between the pelvis and the floor and can be extremely painful. This cue should be skipped in students who are symptomatic.

Choose the start bent or start straight approach for Paschimotthanasana. The major principle here is no end range hip flexion and no pulling or pain at the point of PHT.

  1. Bend the knees and hold the feet with the spine straight
  2. Keep the legs straight, flex the feet, and sit up straight.

Spine Twist:

Most students are asymptomatic here, but you may get a few who have pain when folding in the bottom leg. Treat these students like you would a knee injury. Keep the bottom leg straight, foot flexed, and across the top leg over the knee.

Khapalbhati:

The client should be asymptomatic.

As you can see, at least half of the postures in the series are unaffected by the hamstring injury and all of them can be modified to accommodate the student’s needs for however long it takes them to heal this injury.

It may also be worth it to look into how your diet can support your healing. One of the strongest indicators of healing is albumin levels in the blood. This is a protein that is critical in healing process. Low-protein diet should not be attempted while healing an injury. There is also some evidence out there that certain nutritional supplements can support muscle and ligament healing. Consult with your doctor, functional nutritionist or naturopath to get suggestions for those products.

In addition, if you are experiencing tendinitis or inflammation and pain, it may be helpful to add foods to your diet that help to decrease inflammation. The powerhouse most folks know about is turmeric with black pepper. It’s in lots of really delicious foods, so why not add it to your fried rice or your coconut curry soup? Google is a great place to find more foods to add to this list like green tea, salmon, and blueberries. Healing an injury is it just the process of getting your postures right, but getting your mind right, reducing stress in your life, and getting plenty of rest. Pain from an injury like this is a cry for help. What other places in your life do you need support?

sara-fixing-knees.jpeg

 

 

 

Sara Curry is a therapeutic Hatha Yoga teacher from Portsmouth, New Hampshire with over 15 years experience in the field. Right, she assists a student in activating her posterior hip muscles to prevent hyper extension. Look at that nice, straight leg!

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Will I pass out in hot yoga?

The short answer to the question is: it’s highly unlikely.

Many new students have heard horror stories about yoga classes so hot that people were dropping like flies and being carried out of the room. Most of these are embellished or frankly fabricated. Like any tall tale, there’s always a kernel of truth: usually survival stories from teacher training where they try to burn you down metaphorically so you can rise like a phoenix from the ashes. You won’t find that in a general public yoga class.

I sat down this morning and tried to count how many times I’ve seen people pass out in yoga. I couldn’t even fill up one hand. I’ve heard stories of more than that, but in 17 years of practicing and teaching Bikram Yoga, I’ve only seen three people “go down” in a class.

Pre-existing conditions

Pre-existing health conditions make some people likely to pass out. I had a student in class one time who was born with an unusually narrow carotid artery. After half moon, she leaned back against the wall and slowly slumped to the floor. As she came-to in class, she smiled and said, “I pass out all of the time.”

Be sure to tell your teacher if you have any health concerns that might make you more likely to pass out. They’ll show you where to take it slowly and keep an extra eye on you during class. This includes, but is not limited to: heart conditions, arterial abnormalities, dwarfism, history of syncope, diabetes, dehydration, anorexia nervosa, and the use of some medications.

There’s a profile for that.

There actually is a stereotype for passing out in hot yoga. Our prime candidate is usually a very thin, tall woman, around the age of 19, who hasn’t had much (or anything) to eat. She comes up from a deep backward bend or forward fold, goes grey and collapses. This tends to happen due to low blood sugar or low blood pressure. The same can happen occasionally to people who consume very little water as they won’t have enough available water in their kidneys or blood volume to produce sweat without a dramatic drop in blood pressure.

You can prevent this from occurring by fueling your body with healthy, but easy-to-digest, foods before class and drinking plenty of water throughout the day. Your body is a precision machine that can’t function with out gas and oil.

Leaving the room

One of the primary places people pass out is in the lobby just outside the hot room doors. Here’s why:

In class, the air temperature is hotter than your body. All of your blood vessels dilate and blood rushes to the skin to cool your body and maintain a stable body temperature. That’s your body’s prime goal: maintain homeostasis. Your eccrine sweat glands kick in to high gear and start producing a lovely, cooling sweat.

If you feel hot or uncomfortable in class, your first instinct is to rush out of the room and take a quick break. This action is confusing to the body. Suddenly, the air is 30 degrees cooler, and significantly cooler than your body temperature. To add insult to injury, your body is now covered with moisture that is evaporating rapidly and dropping your internal temperature. Homeostasis alert! The status quo is not being maintained!

The body will quickly constrict the blood vessels and shut down the action of your eccrine glands to make you stop sweating and prevent your internal temperature from dropping below optimal. This quick vasoconstriction slows circulation all over the body, even up to the brain. If it happens rapidly enough, the student can temporarily lose vision or event pass out.

The problem with passing out outside the hot room is that the floor is hard and there’s no one there to catch you.

If you feel dizzy and think you might pass out, the best idea is to sit down right where you are standing. Take a few deep breaths and even a sip of water. If you don’t feel better in a matter of minutes, flag down your teacher and they’ll walk you out to sit on the bench and cool off.

Even if you don’t pass out when you leave the room for a “break”, you do shut down the cooling process of sweating. When you return to the room, it feels even hotter and your body has to start all over from scratch acclimating you to the new environment.

Leaving the room should be reserved for the five Ps: pee, poop, puke, period, pregnant.

One reason new students leave the room is fear that there’s not enough air in the room. That’s a by-product of nervousness and the fight-flight-freeze response to the new environment/activity. Our air quality is carefully maintained by an energy-recovery ventilator activated by carbon dioxide sensors in the room to bring in plenty of fresh air. If you start feeling like you can’t breathe, take the same precautions as you would if you were going to pass out. Sit down and breath slowly through your nose until you feel better.

The heat is a tool, not a weapon.

Bikram Yoga classes are heated to 105 degrees and 40% humidity. These conditions allow for complete vasodilation and allow students to stretch their muscles with a reduced risk of injury. The heat has additional benefits like improved mood, reduction in body fat percentage, and decreasing the day-to-day detoxification load on the liver.

The temperature is not intended for a dramatic increase in internal temperature. On average, body temp increases about one degree in most practitioners. The heat is a tool to facilitate the healing process, not a weapon with which to beat your body into submission.

Give yourself time to acclimate

We live in New England. It’s only Bikram Yoga temps outside for about two weeks in August. Around the world, people live in the very same heat index as a hot yoga class year-round, but we’re not used to it. We know the human body can live in these temperatures, we just have to give it time to get used to it. It takes the average new yogi 10-14 days of regular practice to get acclimated to the hot room.

Your sweat comes from fluids in your blood stream. If you haven’t sweat much since August, your body won’t be ready to dump a quart of water out of your pores the first time. It will take a few classes of going slowly and sipping water as you need it for your body to figure out you’re going to do this regularly. Your kidneys have to learn to hold water and dump it back into your bloodstream, rather than into your bladder, so your blood volume stays stable. You have to learn when and how much to drink and eat to fuel your practice. You may notice you crave more salts as you add this sweaty practice in to your life.

The great news is that in a couple of weeks, you won’t be worried about the heat any more. You’ll be too busy working out how to balance on one foot.

sara toe prep

 

 

 

Sara Curry is a Bikram Yoga teacher from Southern Maine who has dedicated her life to helping people take control of their lives and their healing through the practice of yoga. She owns and operates Bikram Yoga Portsmouth with her husband, Jaylon.

 

Funk’tional Nutrition Podcast

I had the great pleasure of joining Kyle Maiorana and Erin Holt of the Funk’tional Nutrition podcast this week to talk about what role yoga can play in healing chronic pain and illness.

Both women are registered dieticians who work to help their clients develop personalized plans for health that cover all aspects of their lives. I have a tremendous amount of respect for the work they do and wait anxiously each week for the release of the next episode. Topics cover everything from healthy fats to good sources of animal protein, and from the benefits of CBD oil to understanding diet culture. They also host people in the fields of health and wellness to share their unique areas of expertise.

You’ll find the information in this podcast to be science-based and designed to help develop a life of health that supports all of the amazing things you love to do on a daily basis. In Erin’s words, “I don’t teach people how to diet. I teach people how to EAT.”

Our episode covers how this yoga works, back pain, chronic pain, yoga and autoimmune disorders, and much, much more. Take a listen here.

Funktional Nutrition Podcast 19

Is the hot yoga studio clean?

A couple of students expressed concerns about the cleanliness of the studio in our recent customer feedback survey. I’m here to address all of those concerns.
The main take-away that I want to offer with this post is: We’ve got you covered. All of your concerns are ours, too. We’ve been in this business for 16 years and your best interests are also ours. We are always working to offer the most effective, green, sustainable environment possible so that we can all thrive, together.
Is the studio clean? I’ll start to answer the first question with a question back: have you met my husband, Jaylon? He steam cleans our carpets at home for fun. At the end of a long, hard day, he just wants to mop the kitchen floor.
Jaylon Mopping
Jaylon after a 12-hour day at work
We employ an army of cleaners to keep the studio in top condition so that you have a beautiful, welcoming, and clean space in which to practice.
The studio and all of the flooring is cleaned every day. We have one cleaner whose job, twice a week, is to wash your sweat streaks off the walls. We have another person who cleans the air vents, fans, and moulding every single week.
As you can imagine, our bathrooms get a lot of use. That’s why we have cleaners to scrub the bathrooms, including the walls, every single day of the week. The shower curtains are changed three times a week and the bath mats are changed after every class.
Am I going to catch something? In sixteen years, we have never had an outbreak of anything at the yoga studio. We have never had students get or pass on foot fungus. We once had a student with MRSA practicing at the studio for four months without telling us. The number of students who contracted MRSA during that time is zero.
Why not? First, the studio is really clean. We wash down everything, frequently. Second, your sweat contains two natural and powerful antiseptic compounds: sebacid and the heavy-hitter dermcidin. In clinical studies, dermcidin is more effective at killing Staph than Lysol. It functions by actually ripping off the cell membrane to kill the cell, so it is not an antiseptic to which an organism could develop a resistance. Feel free to cover yourself with this free, antibacterial solution daily!
For all of my real germophobes, rest assured that you’re much safer in a hot, sweaty yoga class than you are opening the door to your doctor’s office or pushing a grocery cart.
In addition, we run an Odorox hydroxyl generator between classes and overnight. This product is the most advanced solution today for eliminating odors, decontaminating surfaces, and purifying the air that is both 100% green and safe for use around humans and animals.
Further, our Humidifall improves air quality and reduces our use of natural gas by increasing ambient humidity while simultaneously filtering airborne contaminants and destroying bacteria, viruses and fungi with a secondary UV filtration system.
We also diffuse doTERRA On Guard Protective Blend throughout the studio. This study shows a reduction of 40-90% in the flu virus dependent upon concentration.
 
Isn’t your flooring breeding fungi? Our hot room flooring is Flotex Flocked Flooring by a green company, Forbo. This product was originally designed for nursing homes to be both non-slip and antiseptic. It is NOT carpet. Carpeting has loops and coils that catch skin cells and hair and liquids. Flocked flooring is short, straight bristles that cannot catch debris. It is 100% moisture-backed, so no sweat can seep under the flooring (like happens with wood, cork, and carpet). You can dump a whole bucket of water on Flotex and suck every last drop of it up.
Our flooring is vacuumed at least once every single day of the year. It is steamed with hot water extraction every weekend. We add melaleuca oil to the hot water to further enhance the antibacterial aspect of the process.
Why does it smell sometimes? We can control a lot of the things in the studio, but we can’t control the people. Sweaty people smell like sweat. We run the Odorox between classes to clear the smell, but if you’re in class and people start sweating, you’re going to smell sweat.
The sweat that cools you off comes from your eccrine glands and doesn’t really smell. It’s mostly just water. Clean bodies don’t smell strongly of sweat.
The sweat that does smell comes from your apocrine glands and does not significantly contribute to cooling. These are found mostly in the armpits and groin and this “smelly” sweat is where a large amount of our pheromones are excreted. Your apocrine glands are not activated during a hot yoga class, so if you smell a strong armpit smell, it’s usually from something that stimulated the system earlier in the day to produce these “communication” odors.
Some behaviors contribute to a stronger sweaty smell. For some, eating garlic, onions, or cumin creates a powerful smell the next day. Individuals who drink alcohol or smoke marijuana often have a strong smell of ammonia or “cat pee” to their sweat.
 
What can I do to help?
  • First, bring a yoga mat and towel large enough to catch all of your sweat. If you find there is a puddle around your mat during or after class, you don’t have a big enough towel or enough layers.
  • If you did leave a puddle, please be sure to use the mini wet-vac provided by the door to suck up your sweaty puddle. Your fellow yogis in the next class will appreciate it!
  • Please brush your teeth before the morning classes. The Saturday 9 am always complains about the “bad breath” smell from the 7 am.
  • Please refrain from wearing scented products like perfume, cologne, body spray, hair spray, and spray deodorant. One in five Americans has chemical sensitivity. This condition produces nuisance symptoms like stuffy nose and sneezing, in addition to more serious effects from exposure like hives, wheezing, and asthma. If you can’t live without your Axe Body Spray, just apply it in the car after you leave.
  • Bring home all of your sweaty items with you after class. We’ve all been yoga space cadets before. Take an extra moment before you go to look around and be sure you’ve collected all of your wet, sweaty things.
  • Towel off if you’re a massive sweater. Dripping in the shower line? Ask the teacher for an extra towel to stand on or towel off with it so you don’t leave a puddle in the lobby.
  • Come to class clean. You don’t have to shower before class, unless you smoke, wear perfume/cologne, or have a job that has a powerful odor. If you do, grab a quick shower so the people next to you can inhale deeply without worry.

Yours in sweat and service,

 

Sara

Practicing Yoga While Sick

Can I practice when I’m sick?

It’s a question we get at the studio often. As with most yoga-related questions, there’s no one-size-fits-all answer.

First and foremost, if you have something contagious, please stay home and keep it to yourself. We once had a student undergoing treatment for a persistent MRSA infection practicing at the studio for four months without telling us.

Lucky for all who were practicing at that time, our sweat contains powerful antiseptic peptides in dermcidin. The best feature of dermcidin is that it attacks the microbes’ cell walls, not something to which a microbe can develop resistance.

Can you guess how many students have contracted MRSA at our studio? You’re right. None. The sweat-effect is amazing and powerful. With that said, the chance of transferring a few microbes on the door handle as you leave just isn’t worth the risk.

As a general rule, we say, “From the neck up, come to class. From the neck down, stay home.”

If your symptoms are sneezing, post-nasal drip, cough, even a head ache, you should be okay to take class. If your symptoms include vomiting, diarrhea, fever, body aches, and chills, you’re probably better off in bed. Or at your doc’s office.

Why you should practice.

  • Circulation: The “miracle cure” of yoga lies in it’s direct stimulation of the circulatory system. Through tourniquet-like compression and release of tissues in the body, we encourage and improve the movement of blood through the body, helping the human body’s systems to do their jobs better. Chronic stress and lack of movement can limit circulation to “non-essential” systems like the digestive, immune, endocrine, and reproductive systems. Yoga helps to restore circulation to better-than-normal levels. This improves your ability to heal.
  • Lymph: One of our most important components of the immune system doesn’t have it’s own pumping mechanism. Our lymph nodes circulate lymph and white blood cells, filter invading microbes and mutant cells, and remove edema from the body. This powerful system only works if you move your body. Through postures that flex and extend the trunk and the hips, we directly palpate the lymph nodes and facilitate the movement of lymph throughout out the body. The great news is that this movement doesn’t need to be intense or strenuous to get the desired effect. Gentle movement is enough to produce benefits.
  • Breathing: Breathing exercises also have positive effect on the lymph nodes. Simple abdominal breaths where the belly rises and falls can move four times more lymph than chest breathing. Most common colds and flus also include symptoms that restrict the breathing or allow mucus to settle in the chest. The deep and rhythmic breathing practiced in a yoga class can help to keep the bronchi clear. Don’t be surprised if breathing exercises make you cough. It’s not necessarily a bad thing.
  • Decongesting: Chronic congestion can lead to ear or sinus infection. Postures that invert the head can help to drain the sinuses and eustachian tubes. Many students find postures like Rabbit or Separate-leg stretching cause a sense of clearing. For students with an active sinus infection, theses poses might be torture. The moist, humid air of a hot yoga class is the only place many students recovering from a cold or the flu can actually breathe for a few minutes a day.
  • Mood: Being ill, especially chronic illness, can do a number on your mood and outlook. Yoga has been shown to improve levels of the “happy hormones” like dopamine, GABA, serotonin, and oxytocin in practitioners. A preliminary study at Mass General in Boston shows a direct negative correlation between numbers of classes taken and reduction in depression symptoms. Not only will your hormones get a boost, you’ll get out of the house and be around a community of healthy people who can offer you emotional support and even a few laughs during your recovery.

Why you should stay home.

While we appreciate the concept of sharing-is-caring, when it comes to disease, we don’t buy it. If you have something contagious, please don’t share it with your yoga friends. Just like in school, if you’ve vomited in the last 24 hours, stay home and wash your hands a lot. Meningitis, MRSA, lice, TB, flu, strep, and stomach bugs are just a few of the highly contagious diseases you should enforce a self-quarantine over.

Next, we get into the questions. Are you a chronically over-scheduled person? Are you over-worked, under-slept, and over-trained? For some of us, the most compassionate thing we can do for self-care is to stay home, make a cup of tea, and binge watch Shameless on Netflix.

What about chronic illness and fatigue?

You sweet, suffering yogi. You have all of my compassion. I know how difficult it is to suffer day-after-day with no end in sight. Living with chronic disease and adapting your life to this “new normal” while simultaneous searching for answers and cures is exhausting physically, mentally, and emotionally.

In my experience both as a teacher of students with chronic illness and as a patient suffering from chronic fatigue, I don’t think you can afford to cut yoga out of your self-care routine just because it makes you tired and is hard.

At the request of my doctor, I cut yoga out of my life for one week during my recovery. I rested, ate well, walked, and took my supplements. Each day, I felt worse than the last. It was a wonderful wake-up call for me. When I returned to class, I didn’t feel good or strong. I wasn’t even able to string more than two poses together in a row. After class, I didn’t get the yoga high I was used to, but I didn’t feel as terrible as when I didn’t have yoga in my life.

Practicing yoga with a chronic illness requires a radical shift in how you view yourself and your practice. Yoga is a healing modality. Yoga has the ability to support your body, your mind, and your healing. It also has the power to deplete and exhaust you. The difference is in how you approach your practice.

The beauty of yoga is that you can tailor each class to your exact abilities on that day.

The first phase in my healing was the mental shift. It took a long time and a lot of work to ignore the voice in my head who said, “It doesn’t matter how you feel. Keep going.” That powerful voice of perseverance that had helped me through so many challenging times in my life, was now destroying my health. If I pushed too hard in class, I couldn’t do anything for the rest of the day. I’d get shaky and my teeth ached.

I learned to treat yoga as a “get to” (not a “have to”) and class-after-class struggled to let go of my long-held view of myself as someone who is strong, tough, and steady. I learned to use yoga as my therapy and to tread gently with my tenuous health and strength.

I heard from many specialists, loved ones, teachers, and friends during my recovery that maybe I should stop practicing Hot Yoga. I heard that Bikram Yoga was too Yang, too Pitta, too much internal fire. People told me it was a depleting practice.

Trying not to be pig-headed, I tried heeding their advice, but my experience did not match their hypotheses (which, I must add, were based on conjecture, not science). Luckily for me, at the same time I was suffering from Post-Viral Syndrome and heart damage, I also had two students with serious illnesses practicing by my side. One woman suffered from Chronic Fatigue linked to Chronic Lyme and another woman suffered from Adrenal Fatigue after major life stressors and breast cancer treatment.

We were all told the same things. Each of our doctors told us to stop practicing Hot Yoga. As each of us tried limiting our practice or cutting it out all together, we each returned to the hot room feeling no better and looking for answers. Not-practicing didn’t heal any of us. It didn’t calm our inner fire. It didn’t balance our Yang and promote healing. It just took away our yoga. I took strength from those women, my compadres in suffering, to continue on the path that felt right for me despite the unfounded advice of our physicians.

A good first step for yogis with chronic disease, chronic fatigue, lyme, adrenal fatigue and the like is to start by practicing only one set of each posture. For Type-A yogis, this will not be easy, so you’ll need to solicit help from your teachers. My teacher (husband) used to stop the class until I sat down. That was the kind of loving-firmness I needed to take my health seriously. It only took holding back the class twice for me to self-regulate.

When you reflect back on all of the “reasons to practice” when you’re sick above, they’re all aspects of healing that you need during chronic illness. You simply must be more gentle, kind, and less demanding of yourself. There is no way to bully your way through chronic illness.

You can use yoga as a tool in your compassionate healing.

Sara Toe Street

 

 

Sara Curry is the owner of a Bikram Yoga studio in Portsmouth, New Hampshire. She has been teaching yoga since 2003 after her recovery from herniated discs ignited a desire to share the healing power of yoga with others. She is also Vice President of Seacoast Area Teachers of Yoga in Action, a local non-profit making yoga accessible to at-risk and high-needs populations on the Seacoast of NH and ME.

On 15 Years…

Fifteen years ago today, the first hot, therapeutic, 26/2 class opened in Portsmouth at 9 am. Over 20,000 classes and tens of thousands of students later, the greatest compliment is that many of the students who practiced that first week in 2002 are still with the studio today.

Over the last few weeks, we’ve had an out-pouring of thanks and gratitude in cards and emails from students. You’ve shared your stories and your thanks for our time, our teachers, and our community. When the first card came in, I told Nel I didn’t know if I could survive two whole weeks with my heart on the outside every day.

Years ago, Ariel and Laura and I sat together in a teachers’ meeting and talked about creating community. In what type of place did we want to work and practice? What were the qualities of a yoga community that we admired? What kind of teachers did we want to make of ourselves?

At that meeting, all of the dreams and hopes and intentions we set were YOU. When I look around the studio before, after, and during class, all I see is everything we ever dreamed we could create together. You are my dreams come true.

We wanted to create a place where everyone felt safe to be themselves. A place where you were met each day with a smiling face. A place where you could come on your best day and your worst. Where you could practice the morning of your wedding and the day after your sister died. A place where sweat, tears, and laughter all belonged in the same room. A place where you could quietly do your practice or share your stories with others. A place where we lift each other up. A place we learn over and over again that we are all the same on the inside.

I had one of my most profound experiences of that unity, that Namaste, in a music class a few months ago during the chorus of Guns ‘n Roses, Livin’ on a Prayer. In the class were students from age 16 to 71, of all different political affiliations and religions, with massive income disparity and differing gender expressions and identities, of all different phases of health and wellness. In that room was everything that could divide us outside these hot room walls, but instead, 53 voices swelled in song together, “Oh! We’re halfway there. Oh-oh! Livin’ on a prayer. Take my hand and we’ll make it, I swear.” G-N-F-N-R. Bringing people together since 1986.

In the beginning, Laura and Ariel and I had to do the work of establishing that community ourselves. With each new student, we made sure they were okay. Gave them the low-down on acclimating to the heat and where to buy a cheap yoga mat. We talked to them about hydration and emotions coming up during camel.

One day, as I sat at the front desk at the old studio, I heard Dede’s voice over the top of the ceiling-less women’s room walls talking a new student through what she’d just experienced in class. “I felt like that, too, my first class! What you’ll need to do today is be sure to hydrate and if you wake up sore tomorrow, come to class. Don’t take a day off. You’ll feel so much better…” Holy crap. Our community was starting to wrap new students in welcome like we’d done for them. When you treat people with kindness and compassion, it ripples far beyond the initial contact.

Jaylon and I are overwhelmed by the out-pouring of love and gratitude from everyone this month, each week, last night. We want to be sure that we are clear on one point. We work our asses off. We love this community. It is our studio, our home, our life’s work, our passion. We give a lot of ourselves so that we can make this community a place you want to return to day after day, but none of that would matter if it weren’t for every single face that walks through that door. Every single person in this community is what makes it special. We are not the only ones working our asses off. Our effort is a reflection of yours.

I made me so proud to see the reception for each of our teachers at the celebration class when they stood to speak. In case you weren’t sure, they love their jobs and they love you guys. They think about you after class and do research on your weird knee problem and they notice when you’re having a rough day. They take their commitment to their work far beyond expectations. Of the dozens of teachers who have graced this podium, I am proud to call each one my colleague, my teacher, my peer, and my friend. From long-lost faces like Amy, Glenn, and Kirk to our newest additions of Lunny, Kat, and Todd.

We’ve reminisced a lot lately about the old days and the first students to practice here. My first class at BYP, I remember Nicole calling out, “Glicka, lock your knee!” Jonny P steaming carpets. Jamie taking pictures. Standing on Heather’s hips during camel. Taking class with Molly, Kristen, Monique, Amy, Cory, Teri, Jenn, Tim, Bill, Lolo, Spidey, Michelle, Maeghan, Julie, Norm, and Weezie. It’s amazing to have Wanda back after 12 years and that Chris came back after leaving for back surgery. We have spent so much time together through sweat, tears, middle fingers, and laughs. We have built a history that has bonded us as a community. We have lost members of our community and we have mourned together.

Those veteran yogis have built the foundation and the web that welcomes every new face into the family. I can’t list all of your names because there are literally thousands of people who have made an impact on this community. From Dick, Glenn, and Jack-in-the-back to Rachel, Jes, and Ainsley.

When I was pregnant with my second child, I thought, “How can I love this child as much as I love Bella?” My heart was already full of that sweet, little girl. When Judah was born (the day after that headstand picture), I realized how as my heart grew bigger to wrap him inside.

That’s how our community works. As each new student joins us, the community grows bigger to wrap them inside. We send each new student a postcard that says, “Welcome to the family!” and we mean it. Like it or lump it, you’re a part of our yoga family now. Life and years may carry you to and from the hot room, but we’ll always be here for you, whatever state you return in, to welcome you with sweaty arms.

Last night, as we celebrated with Nel’s Greatest Party Ever, we did all of the things. We laughed. We cried. We danced. We reminisced. We supported each other. We did the ultimate act of public intimacy: sweat-soaked, half-naked hugging.

As Elissa started to sing, and then Stef, and then Chris, my heart grew three sizes like the Grinch. If we can sing together. If we can cry together. If we can sweat together, then goddamn it, we can change the world together.

I have one request for you this week. As you go about your day and your week, is there any time you can bring a piece of this feeling to someone outside the studio? That your presence in their day made it the tiniest bit better? That they aren’t alone in this struggle called life?

I promise to do my part.

Love,

Sara