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!

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.

Posture of the Month: Spine Time – June 2017

Happy June!

This month we have another awesome posture for you to work on.

 The Spine Twisting Pose
ARDHA-MATSYENDRASANA

Spine Twisting Pose.png

What is it??

  • 150-degree rotation of the spine,
  • all vertebra rotating 1-5 degrees from top to bottom.

The spine twisting pose has some great benefits for your body:

  • Increases circulation and nutrition to spinal nerves, veins, and tissues
  • Improves spinal elasticity and flexibility
  • Helps cure lumbago and rheumatism of the spine
  • Improves digestion
  • Firms abdomen, thighs, and buttocks
  • Strengthens back and abdominal muscles
  • Increases flexibility of the hip and shoulder joints
  • Prevents and heals herniated disc
  • Detoxifying
  • Helps arthritis of the knee and sciatica

Running Clean

Monday, April 29th, 2013. I’ll never forget that morning. I woke up hungover from the weekend’s drinking that always seemed to extend itself through Sunday night. I was defeated, broken, out of shape, and needed a change.

I wouldn’t find sobriety for another two years, but this day was the start of my path to positive change. I wasn’t ready to admit yet that I struggled with alcohol addiction, but I was ready to start taking better care of myself. I decided that morning to start eating better with the help of Weight Watchers and get in a more regular exercise routine. I chose the only exercise I really knew: running.

I immediately fell in love with running and, combined with a more health conscious diet, my drinking reduced to just a couple of times a week. I didn’t have enough “points” to drink the way I wanted. That, unfortunately, would change once I hit my goal weight which amounted to over 50 pounds of weight lost.

As the drinking increased, so did the running. I think I used it to sort of “justify” my habit. The two couldn’t harmonize forever and after a few short stints of sobriety, I finally was able to put down drinking on March 2nd, 2015. Now nothing could hold me back from running…or so I thought.

I ran so much that I started racking up marathons in different states and set a goal to run a marathon in every state. Everything was going great, but eventually all of the “pounding” caught up with me and I suffered a severe iliotibial band injury. When I went to physical therapy, the therapist told me I had the tightest IT band he had ever seen. I was completely sidelined and couldn’t even run a mile. I felt fine on an exercise bike, in the pool and even doing light strength training, but running was out. I was devastated.

Eventually, after months of therapy, I was able to get back to running, but it was never quite right. I had to completely cancel a race in Austin, Texas and the next couple of marathons after that were a real struggle. My times were high and the pain I felt in the last six to eight miles of each race was excruciating. I thought many times that I was running my last marathon.

After running through pain and enduring the best I could, one day my friend Elissa suggested I try this thing called Bikram Yoga. I’ll be honest, I knew nothing about yoga let alone this Bikram Yoga of which she spoke so highly. My vision of yoga was a group of people sitting around, stretching their pinky toes and lying on their backs for most of the class (ha ha). I had no clue just how amazing it actually is.

As it turned out, Bikram Yoga is one of the most challenging workouts I’ve ever done both mentally and physically. It was exactly what I needed.

I started out doing Bikram once a week as a stretch day. I felt absolutely amazing after every class. My body was healing, my mind was clear and I felt…longer. That’s the only way I can describe it!

One class a week soon turned into two and before I knew it, I was hooked. I now go to three to five classes each week. My body feels younger, cleansed, refreshed.

I just completed my eleventh marathon in eleven states two weeks ago. Not only did I complete it, but I broke my personal record by over two full minutes. That IT band injury? I don’t even notice it.

That Austin marathon I had to back out of? I ran it in February. It was #10. I even found a Bikram studio in Texas. And sobriety?

As I write this I am 811 days sober. I am so grateful for the life I have today.

Each and every day is a gift, and if I get to go to Bikram it’s even sweeter.

Before yoga, recovery from a marathon was a one to two week process. Now, I just go to class the next day and I’m pain free. It’s that simple.

Finally, I can’t say enough about Bikram Yoga Portsmouth. I absolutely love each and every teacher there. They all have an amazing gift for making me feel confident as I grow as a yoga student, yet making sure I continue to be challenged, pushing me just a little further at just the right time.

Each teacher is unique in their own way. I truly, honestly, don’t have a favorite. They all get a perfect ten in my book. Thank you Bikram Yoga Portsmouth for not only restoring me on this quest to run 50 marathons, but for giving me just one more reason to stay sober each and every day. For that, I am forever grateful.

PJ Donahue is a musician and drum teacher who lives in Seacoast New Hampshire with his wife and daughter, Molly. You can hear more of his sound here: sometimes there are moments that can inspire an entirely new artistic direction. That is the story of River Sister.

Bikram Yoga and Benign Positional Vertigo

A bout of vertigo can put the brakes on a lot of daily activity. Can you still practice yoga? Will it help? Will it make it worse?

As with most questions in life, the answer is, When in doubt, go to yoga.

I have suffered from motion sickness and periodic bouts of vertigo throughout my life. It wasn’t until my early thirties that an ear exam revealed I have Meniere’s disease, a genetic condition shared by my father and sister, and an explanation for vertigo at such a young age.

Practicing yoga has been a life-saver.

I cannot say classes with vertigo are easy or fun, but they are a path to feeling better for the rest of the day. To understand how to use your practice to help your vertigo, it’s critical to understand the main causes of Benign Positional Vertigo (BPV).

The otolith organs (utrical and sacculus) in your ear monitor your position in relation to gravity with a combination of fine hairs and tiny crystals. For different reasons, the crystals can occasionally get dislodged from these organs and find their way into semicircular canals that make up the vestibular labrynth. It is the out-of-bounds crystals in the vestibular canals that cause the nystagmus, nausea and dizziness that make up vertigo.

To get on track to feeling better, we must first get those crystals back where they belong. There are several techniques out there to counter BPV. The most popular for years was the Epley Maneuver, which I found effective about 50% of the time and works better if it is done to you by a professional.

In recent years, I discovered the Foster’s Maneuver designed by Dr. Carol Foster. This technique is simple to use and can be repeated until you feel better. It is easily assimilated right in the middle of class if you notice the vertigo returning. Please watch the technique in the video below.

What to do in class?

First, perform the Foster’s maneuver prior to class. Because it is ideally done in 15-minute intervals, it is best to do it about 5-10 minutes prior to the start of class. Before you do the technique, lie on your back and roll over to one side and sit up. Repeat on the other side. Note which side made you feel worse. This is the side you will turn your head to during the exercise.

When the class begins Prayanama, it may feel a little bit gross the first few times you drop your head back. If there are still free crystals, they are moving around. That’s why you may feel nauseated or a little dizzy. The exhale breath actually helps to bring the crystals to the back of the vestibular canals where you want them for the maneuver. Go slowly, but don’t skip over it. It will make you feel better in the long run.

Half Moon Pose is helpful in loosening all of the muscles you’ve been tensing since you woke up with vertigo. It’s good for your overall health, so participate. I often find I don’t have a lot of strength when I have vertigo, so don’t be surprised if it looks very different from your usual posture. Complete the lateral flexion (side bends) and the back bend, but skip the forward bend, Hands to Feet, for this class.

The backward bend of Half Moon is the same as the prep phase of the Foster’s Technique. Since the first forward bend in class is about 15 minutes after you did the first set of Foster’s, now is a great time to repeat it. From the back bend, keep looking up and come down to your knees and execute the rest of the maneuver from there while the class completes hands to feet.

In the second set, do not repeat the Foster’s Technique, but skip the forward bend.

Awkward, Eagle, Standing Head-to-knee and Standing Bow can be executed as usual, with one exception. If you have the ability to put your forehead on your knee in SH2K, don’t do that today. Keep your face parallel to the mirror.

Balancing Stick should be done to tolerance. Most people find they cannot come all of the way down to parallel. If you woke up with a full-fledged vertigo this morning, I’d recommend keeping your face parallel to the mirror for this class. This means you will only come down about halfway into the stick pose.

By the time we get to Standing Separate-leg Stretching, if has been about 15 minutes since your last Foster’s Technique. If you are still experiencing a little of that shaky-eye nystagmus, this is a good time to repeat it.

If you are feeling okay at this point, feel free to perform the posture, but keep your face up, above the horizontal plane. For flexible students, you may be able to achieve this by placing your hands on the floor and doing the posture with a flat back. If you are a little less loose in the hamstrings, do this with your hands on your thighs for support.

half way ssls

Triangle can be performed normally, but pay attention to how you feel. You may not be able to turn your head to the ceiling if it is making you sick, especially to your bad side.

So that you don’t reverse the good you’ve been doing with the Foster’s maneuver, please do not go down in Standing Separate-leg Head-to-knee. Setting up the arms and turning to the side is enough for today. Stretching your arms up and lengthening your spine is plenty of hard work anyway.

Tree Pose is not likely to present any problems. Go slowly in Toe Stand to see how far down you can go before the headache and nausea creeps back in. Again, try to keep your face parallel to the front mirror.

Once we get to the floor, it can be very difficult to lie on your back in Savasana with your head completely horizontal. Trying using a block or a rolled up towel to prop up your head to a position where can lie comfortably without the world spinning.

It is okay to perform Wind-Removing Pose with your head slightly elevated, but don’t tuck your chin strongly to your chest.

For the Cobra series the postures are generally helpful for vertigo, but you may need to start and finish the postures with your face parallel to the mirror. This would look like setting up Cobra propped up on your elbows or Full Locust and Bow with your chest already off the floor. On really bad days, I find I need to do the pregnancy version of Locust pose to stave off the nausea.

For the belly-down Savasanas, I generally find that propping my turned head up on two fists is enough lift to stave off the dizziness, but still feel able to rest comfortably. Your rolled-up towel from Wind-Removing would probably work fine here, too.

During the rest of the class, the up and down of each Savasana may be too much for your spinning head. Feel free to sit up between postures or lean against the back wall.

Fixed Firm should feel nice. Go slowly with dropping your head back until the vertigo is gone. Half Tortoise is not recommended until you’re feeling better. It’s really not worth it to try it and start the world spinning again.

Camel is another wonderful back bend that gets the crystals to drop back in the vestibular canals. At this point, it has been more than 15 minutes since your last Fosters maneuver. After the second set of Camel, you’re in the perfect position to whip down into another set. Rabbit should be avoided anyway, so you have a few minutes to do a good, long hold. Remember to hold each phase of the maneuver until the nystagmus stops.

Head-to-knee and Stretching can be performed to tolerance, as long as you don’t drop the head below the horizontal line.

Spine Twist can also be performed as usual, although you may find you need to move your head very slowly through the twist if it brings back the nystagmus.

For the final Savasana you may continue to use the rolled up towel to prop your head or you might find you are feeling well enough to test out a normal execution.

The most important part of this process is to move slowly and with awareness so you can discover what makes your body feel better or worse and stay within your physical limitations for today.

It is recommended with the Epley maneuver that you sleep propped up for the next 24 hours. It does not come recommended with the Foster’s maneuver, but I generally sleep with my head elevated for the next couple of days just to be sure it doesn’t return.

BPV can be initiated or exacerbated by low barometric pressure due to pressure sensitivity in the ear. In times of low barometric pressure, it will help to continue these recommendations both for class and for sleep until the pressure changes.

If you have any questions, ask your teachers for help navigating this difficult time.

sara and bella headstand

 

 

 

 

Sara Curry is the co-owner and Director of Bikram Yoga in Portsmouth, New Hampshire. When her vertigo is under control, she enjoys spending time upside down with her husband and two kids in Southern Maine.

 

 

 

I am Not Good in the Heat and Other Excuses

“I’d try hot yoga, but I’m not good in the heat.” I’ve heard that at least a hundred times or variations on the theme.

“I hate heat.”

“I can’t handle heat.”

“No, really, I hate the heat.”

“I tried it and I couldn’t handle the heat.”

I am the bearer of both good and bad news.

These are not reasons. These are excuses.

The good news is that now that you understand it is an excuse, you can take action. The bad news is that this is just an excuse and not a reason not to go to class.

The human body has a tremendously efficient and responsive thermoregulation system. Except in cases of illness, it does a wonderful job of constantly adjusting to changing external and internal temperature changes.

Your body is no different than any of billions of humans on the planet.

All along the equator, humans live in climates with a heat index much higher than a Bikram Yoga class. People survive Texas in the summer. Just a few decades ago, most did it without air conditioning. You, too, could survive there.

“But I am a special case….”

My friend, John, has a spinal cord injury that severed communication with his sweat glands. He cannot sweat. He uses a spray bottle to mist his skin when he gets hot and the water causes evapotranspiration to cool his body, just like yours. John can do hot yoga. You can, too.

Being in a hot yoga class is uncomfortable.

It’s hard to do yoga. It’s hard to look at yourself. It is hard to feel a body you have been trying to ignore for decades. You are hot and you think you might suffocate. You think your body just can’t handle it. These are thoughts. That doesn’t make them reality.

The secret to it all is, you can do it. You can show up and learn to breathe and focus on your body and not your mind. You can acclimate to the heat and take it one breath at a time and become more comfortable in your body. You can learn to do what you can today and not what you think you should be able to do by now, goldangit! You can become more comfortable in this moment, even if this moment is uncomfortable.

“I am not good in the heat” is a phrase that means “I am not comfortable being uncomfortable,” and this is normal. The human brain is designed to avoid discomfort. Within a fraction of a second, your body can classify any sensation as one to avoid or to seek. Before you even have time to rationalize, your mind will lead you toward avoidance.

If you are chased by a tiger, Avoid! Avoid! Get away and get safe. If you don’t want to take out the trash, well, its time to learn to control the mind and get the job done.

Reason, logic and patience are all gifts of our higher brain function. We can use our brains to either help ourselves in the moment or to hurt ourselves. It is the self-awareness that yoga brings that helps us to experience the present moment and act from a place of understanding and reason.

This is one of the greatest gifts of a hot yoga practice. We train over and over, pose by pose, to pause and to breathe in conditions of challenge and discomfort. We learn to quiet the mind, control the breath and listen to the body. “Am I safe? Am I okay?” we ask our bodies over and over in class.

When the answer is yes, we induce neuro-plasticity and retrain our brains not to fidget, hold our breath, or increase our heart rate under stress. This is why, in scientific testing, yogis have shown significant reductions in the stress hormone cortisol. This is why so many yogis report that yoga “reduces stress” even though their lives are as stressful as others.

Here are some other excuses, parading as “reasons”:

  • I am too old.
  • I am inflexible.
  • I am too fat.
  • I can’t.
  • Yoga hurts people.
  • I have __fill in the blank__ injury.
  • I am tired.
  • I have __fill in the blank__ disease.
  • I don’t have time.
  • My family needs me.
  • I don’t know what I’m doing.
  • I can’t afford it.

These excuses are all of the exact reasons that you need to do yoga. These are all factors in your life that yoga will help you heal from or deal with. I have never met a yoga studio owner who wouldn’t accept work/study or trade for yoga. If you are truly too busy to do yoga, you had better get to class before you die.

If you have seen yourself in one of those excuses, it may have started a diatribe in your head against me and how I don’t know what I’m talking about or, worse, about you and what a loser you are to have made an excuse.

You are not a loser; you are a human. While I take responsibility for saying some things that may have made you uncomfortable, I am not sorry in the slightest. That’s my job. I have made a career of helping people find comfort in their lives through uncomfortable acts and facts. I paid for the mirrors, but you’ve gotta do the work.

The payoff of all of that work is big. Peace. Well-being. Freedom from pain. Health.

In the words of my teacher, “You deserve to have the best life. I feel cry when I say that.” I feel a little cry myself, now that you mention it….

sara headshotSara Curry is the Owner and Director of Bikram Yoga in Portsmouth, New Hampshire. She is Vice President of Seacoast Area Teachers of Yoga in Action, a non-profit that improves accessibility of yoga to traditionally under-served populations. She is also one of the creators of the Sober Yogis yoga and recovery program.