Friday Q A Blue Feet

Blue Village by Marc Chagall

Q: I have a question about blue feet. I have vascular issues so my feet often have blue patches. When I do legs up the wall, my feet begin to look pretty normal. One on my Yin students commented that her feet turned blue during legs up the wall. She said the color was scary but she felt fine. What’s going on here—circulation/lack of O2? Is it something to worry about? Are inversions bad for her?

A: In general, we are pretty keen on supported inversions, such as such as Legs Up the Wall pose (Viparita Karani), because they are beneficial for stress management and circulation in general. But when your legs are upside down in Legs Up the Well pose, your circulation is certainly affected. 

Because your legs are above your heart, there is a down-hill gravity pull on the oxygen-depleted blood in your veins that assists in returning blood to the right side of your heart. But that same orientation challenges the blood in your arteries to pump blood uphill towards your toes against gravity. Some of the symptoms we sometimes get in doing the pose for 10 minutes or more, such as tingling in the feet or that falling asleep feeling in the feet and legs, may be due to the challenge in getting the blood uphill in your arteries. In both you and your student’s case, however, you are not experiencing negative symptoms, just noticing color changes to your feet. 

The most common reason for people to notice blue vessels or patches on the feet and ankles is varicose veins. If that is the vascular issue you have, then doing Legs Up the Wall may be helping the blood that gets pooled in your veins return back to your heart and at least temporarily eliminating the color blue. Your pose is helping your circulatory system, and that is a good thing. 

In the case of your Yin student, I cannot say for certain without evaluating her in person why her feet may turn blue when in the pose. Because she is not having any unusual symptoms while doing the pose, it may be a benign sign, and may be related to the uphill challenge of getting oxygen-rich blood from the heart via the arteries up to her feet, or her feet could simply be getting cold. She could try slightly bending her knees for a minute or so when the color change happens and see if normal color returns for a while; this is a modification that often helps with numbness and tingling that occurs for many people in the pose, but would be worth trying in this case as well. Another idea for her would be to stay in the pose for a few minutes until her feet are blue and then bend her knees into crossed legs position and touch her feet. If they are cold to the touch, she could simply wear socks when doing this pose. 

As to whether inversions are ultimately good for her or not, without much more information, I cannot comment. I will mention that there are a few rare conditions that cause color changes in the extremities, Buerger’s disease and Raynaud’s disease, but both are associated with noticeable symptoms and would likely prompt anyone with them to get evaluated by their doctor. If your Yin student has any worries about this, encourage her to get checked out. If you want to know more about these two conditions, see:

Raynaud’s disease: http://www.mayoclinic.org/diseases-conditions/raynauds-disease/basics/definition/con-20022916

Bueger’s disease: http://www.mayoclinic.org/diseases-conditions/buergers-disease/home/ovc-20179160 

—Baxter

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Friday Q A Creaky Knees

Q: I just started working with a student who has a lot of issues with her knees, and also has a total hip replacement. Whenever she flexes her knees even the smallest amount while weight bearing they make this loud creaking noise. What is the cause of this and how should I work with her from a yoga standpoint?

A: The sound that joints make when they move can often be scary. When do we need to be concerned about these sounds? Whether or not we should ignore them is the crux of this question and our medium of exploration is asana.

It would seem that if you asked this question to a physician or other health practitioners, you would probably get an answer that sounded like this (now remember I now have my physical therapist’s hat on). Often sounds in knees are called crepitus. Crepitus may show up suddenly with no associated pain and it may be persistent every time the motion is performed. These joint noises are considered “benign” because there is no associated pain. Some theories of what causes these sounds (and the medical term is cavitation) are that when the knee joint moves there are changes in joint pressure in the synovial fluid. The changes in joint pressure cause tiny bubbles of gas to form slowly in joints. When these gas bubbles burst quickly, they make a popping sound similar to when you pop bubble wrap. The myth that states that these joint sounds will lead to arthritis is not medically proven.

Okay, so now let’s explore the sounds a bit more. Remember, the ends of the bones in the knees are covered with cartilage. This cartilage protects the joints as we bend and straighten them. If this cartilage becomes worn or frayed, the normal and smooth sensation that accompanies knee motions can become rough, leading to catches or popping sensations. If the cartilage becomes severely damaged, severe painful catches and swelling can occur.

Another cause of joint noise is the snapping of tendons or scar tissue as they are stretched slightly as they go over a prominence around the knee joint and then snap back into place making that popping sound. Again, medical opinion is that there is no harm with this knee popping as long as it isn’t causing pain, and it will not put you at risk or make you more prone to injury.

Finally, sounds in the knee may be due to small fragments of cartilage or other tissue that move freely around the joint, and these small bodies can cause complaints of popping and catching although they are most often associated with pain with movement or loss of movement due to catching.

But now let’s address this teacher’s question. She states that the student “has a lot of issues with her knees, and also has a total hip replacement.” Well, “a lot of issues with her knees” is pretty vague, but after a hip replacement it is probably that this student’s mobility has been limited for quite some time. When hips are in pain, it significantly changes how we walk and stand. Our physical abilities decline and we become much more sedentary. So we have the surgery to fix the main limiting problem but our body has to learn how to move again without the fear of causing the pain that we had for such a long time prior to surgery.

I would recommend that you first look at your student in Tadasana (Mountain pose) to get an idea how she distributes her weight on her feet and her knees and whether her kneecaps (patellas) are facing in the same directions. Looking for asymmetries in her knees and feet will help you learn what might need to be addressed in her asana practice. I also would watch her walk, and see how she moves in space and how easy and smooth her walking is. I would also assess her balance.

Of course, knowing her hip limitations and restrictions is paramount before she begins an asana practice, and if she herself doesn’t know, she may have to either give you permission to call her surgeon. or you can ask her to call herself (but be specific in the questions she has to ask).  As to her particular practice limitations, I might start her practice in a chair first so she can learn how to move her body with support. By having her practice in a chair, you can figure out if moving her knees in sitting has the same effect on the knee noise as loading her knees (standing in weight-bearing positions). Next, have her progress to standing poses but only with small, partial knee bending not full bending, seeing if there is a point that no noise occurs in the movements. She can work this way until she is ready to move onto the full poses.

—Shari

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Friday Q A This Class May Not Be Good for You!

Fir Forest by Gustave Klimt

A reader left this question on our post What Your Yoga Teacher Really Wants to Know:

Q: What if you're a fairly new teacher and someone shares something of the above with you but you don't really feel confident in providing a modification. Like you think, "Yikes! was it x posture or y pose that someone with her condition shouldn't do?" Or "Gosh, I can't remember which poses are contraindicated for that condition!" Have you ever told a student he/she couldn't participate after hearing something they're dealing with?

A: As many of my recent teacher training graduates tell me, this situation comes up all the time for new teachers, or teachers who have not been trained to work therapeutically with problems their students may have. And although there is no one answer on how to address such a dilemma, several responses come to mind, all of which I have used when I was a newer teacher. 

First off, you can be quite honest with your student and explain that you are not well versed in their particular issue but that they can certainly take your class that day if they feel comfortable listening to their own body’s feedback and backing up when they, the student, feel they need to. This does not guarantee that your student will not still get into some troubles, but you are at least honestly letting them know your limitations and openness to them being in class. 

Some students actually have been working with their health conditions and yoga already, so it is worth asking for them to briefly share with you what they know about their condition. Has their healthcare team given them any physical restrictions to observe? Have they been told by other yoga teachers how to modify for their condition? The new teacher then gets an on-the-spot tutorial, and may feel much more willing to have the student participate in the day’s class! 

A new teacher could also tell the student they don’t know specifically what to offer them today but then propose to look up the condition and have some options available in class next time or for a private session (if you are comfortable doing privates). Also, you could encourage them to skip class today and return on a date when you think you will have the needed info, just to be on the safe side. It’s not a bad idea to reiterate that you are most interested in giving them as safe and beneficial an experience as possible in class! 

Then, there is the rare instance when someone shows up for class with a serious issue you don’t know much about, for example, a serious neck issue, while you do know that the class you will be teaching that day includes several poses that will likely be inappropriate for them, such as poses in which students would be bearing weight on their necks. I think that if modifying the entire practice for the student is beyond your budding skills, in these truly infrequent situations, it is proper to state that the class you are about to teach is really not safe for them to do today, ask them to stop up front for a refund, and, if possible, recommend another class for them to try or give them an opportunity to meet for an individual session if you feel you can get some helpful information together to share with them. 

In some cases, it may be the particular style or level of yoga that you are teaching is not appropriate for a person with certain challenges. For example, lets say you are teaching a relatively athletic class and the student has a condition that you don’t know how to accommodate, like acute recovery from heart attack, Fibromyalgia, or Carpal Tunnel Syndrome, to pick just three from our lists in What Your Yoga Teacher Really Wants to Know, you will be doing them a favor if you let them know that your class really isn’t really the best one for them. (Some people have been told that yoga will be beneficial for their condition and then head off to their nearest class, without ever having received an explanation of the different types yoga and which kinds are suitable for someone with their particular needs.) 

I am sure there are other scenarios that may allow the new teacher, in the most transparent and compassionate way possible, to navigate this inevitable situation. If you have had a similar experience and want to share what worked for you as a teacher, or what worked well for you as the student on the other side of this situation, please leave a comment or send an email.

—Baxter

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Friday Q A Neck Pain and Fear

Q: I read of yoga for back pain, but little about neck pain. I've been in PT for months, with good ideas about posture/extension/alignment, etc. And now I'm in a series of skillful massage targeted to the neck muscles...but such stiffness in spite of it all! Did yoga for years, but not lately (still active!) I'm wary of yoga that my pain might be exacerbated. I'm 52. My work is varied, with some hours at a desk but broken up with people interaction. Thanks for your counsel!

 A: I understand why you might be afraid of doing yoga again but I want to reassure you that starting to practice again will be beneficial for you in so many ways. I currently have a student with a lot of physical challenges and chronic pain from prior surgeries. She has told me so many times that even though her body may not be able to move the way she wants it to, when she wants it to do something, she finds that “yoga is good for my mind. It makes me tune in and just listen to myself.” This individual needs a lot of modifications when she practices, but because she trusts both me and my co-teacher Bonnie, she is willing to try new things, "even when they are scary,” specifically because she knows she can stop WHENEVER she needs or wants to and we respect her decisions. We have a “circle of trust” in our class that is very valuable to both the teachers, the students and our assistants.

The great thing about yoga in my mind is the ability to stop whenever necessary. The practice is an internal dialogue not an external show. Sometimes we need to be reassured we can still do an activity but are afraid because it might hurt. Well, if something or an activity causes an increase in pain, then we have the ability to stop the action. Sometimes although our minds fear something when there really isn't a physical correlation between the fear and the action, we have to teach our mind not to fear the action. It is kind of like relearning to ride a bike when we have fallen off in the past and done some serious damage but now have the desire to get back on the bike. But where to start? With all activities it is helpful to imagine the activity first before attempting it. So, if you had some yoga poses that you used to do that gave you pleasure, start with those. I would set myself up in a position of comfort where I was warm and felt safe, and then I might mentally begin the practice using only my memory. After a while of envisioning the pose, I would try it just a little bit. If I felt scared that I was going to hurt myself, then I would stop and leave it and try again tomorrow.

If this type of mental re-entry into yoga doesn't work for you, then you might re-contact your teacher (if you had one) and ask to talk about your concerns about returning to a class. If you don’t have a teacher anymore, look for someone in your local area who has experience with working with individuals with neck injuries and discuss your concerns about re-entering a class. If that isn’t possible, look for a class either for people recovering from injuries or with a gentle focus, and, again, approach the teacher with your concerns. Going back to a class has to feel safe for you, and in order to feel safe you have to be able to trust the teacher to not make you do more than you are comfortable with. Don’t be afraid to be frank about your needs and to have the ability to keep yourself safe. If you still can't find a teacher who fits this profile, contact the International Association of Yoga Therapists and ask for a teacher in your area or near to you that you can work with. They keep a registry on file for all members.

And finally when you do begin to practice I would follow the motto of “less is better” because more than that might spiral you back into a flare-up cycle and put you off of yoga for quite a while. Poses that I particularly like when my own neck is feeling fragile are more passive poses like Viparita Karani (Legs Up the Wall pose) or a passive backbend over bolster with neck and head support. Active practice like standing poses with arm motions often make my own neck feel worse, so go easy on those. Learning to twist again without using arms for leverage also is important. I also like Chair Shoulderstand with a bolster under my upper back and no weight on my neck.

You mention only the physical aspect of asana but as you can see on many of the posts on our blog, that is only one small part of the practice of yoga. I might use this opportunity to re-visit some of the other limbs of yoga, especially some pranayama or basic breathing practices. The ability to fully breathe is a gift in learning to manage chronic pain and stiffness because it's like doing a massage from the inside out. I suffer from major neck issues myself, and I find that my neck will often let me know when I am overworked or overly stressed because the littlest things can set off my own pain cycles. There is no quick fix, but there are many pieces to the puzzle in learning how to manage ourselves in life.

—Shari

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Friday Q A Painful Shoulder

Q: I have developed a very painful shoulder issue. I finally stopped doing shoulder stand, down/up dog, and head stand. I instead switched to "western" solutions, rehab. I am finding that doing Yoga that is not modified for older bodies is dangerous. Is there a form of Yoga that does not require us to drink the Kool-Aid?

A: To answer this question more fully and accurately it would be helpful to know exactly what type of “painful shoulder issue” you have developed (diagnosis) as well as what your current “western rehab program” is like now.

As a physical therapist, when someone in pain comes to see me, I know it is important to try to pinpoint the MAIN area of dysfunction as well as the SECONDARY areas of discomfort. Sometimes the place that hurts the most isn’t the cause of the pain (like painful shoulder) but the pain may be coming from another area of your body. It is very common for neck pain to cause shoulder pain, poor postural habits definitely can cause and exacerbate shoulder pain. Non-ergonomic work stations and driving can also absolutely contribute to painful shoulder as well as recreational activities that you may do, such as rowing for crew, a lot of overhead home repairs, sleep positions and a bed that may be ready for replacement, significant pruning of trees in your garden, backpacking—I think you get the picture.

Usually yoga does not cause pain, but yoga done with structural instabilities and imbalances can exacerbate weak areas and make pain "appear" so we blame yoga for the problem. But the problem is bigger than yoga. My opinion as a yoga teacher and PT is that the teacher doesn’t fit the student to the asana; the asana is there for the student to explore and to find their own release and expansion. In an interview on the Yoga Dork blog Power Your Yoga: Creating Space for Exploring the Present Judith Lasater discusses this very point very eloquently. If you are an experienced student and you know that certain poses cause you difficulties, it is your responsibility to talk to the teacher before class and explain that you have this shoulder problem and if you need to modify a pose it is because you are trying to protect yourself from injury. If the teacher is not agreeable to this plan, then my advice is that you stop practicing with this particular teacher. Now if you are new to yoga and do not feel that you have the experience to modify poses in your class independently, you can ask whether it is possible for you to meet privately so the teacher can teach you ways to modify poses that cause you discomfort or pain.

I always tell my students that I would rather be interrupted in a class to assist a student with a modification than to have that student silently suffering—often their particular issue may also be felt by other students. But some people are too shy to speak up even though the class culture encourages this. (All yoga classes become their own mini ecosystems and there is an exchange and dialogue—not necessarily through words—continuously between students and teachers.)

There are certain rigidities in different styles of yoga that may be less amenable to students who are not all following the same instructions in class. In this instance it might be important for you to stop and reassess why you are studying this particular type of yoga or with this particular teacher. Sometimes it's not the style of yoga but the particular teacher that you may not resonate with. Again, no one can force you to do a pose that is painful or unsafe for you to do.

I would also recommend that you give the rehab professionals that you are working with pictures of the asanas that are currently difficult for you. They can then break down the poses biomechanically to target specific areas of tightness and weakness that are preventing healthy integrated biomechanics in the performance of the asana. 

The poses that you listed as having difficulty with (dog pose, up dog, shoulder stand, headstand) all involve significant weight bearing through the arms, cervical and thoracic spine. Downward-Facing Dog pose has many modifications that you can substitute for the “traditional” pose. For example, if your difficulty with Downward-Facing Dog pose is shoulder range of motion, then it might be better to go back to working with the preparatory position: on all fours, with appropriate shoulder stabilization, torso stabilization, cervical and thoracic neutral positioning and supportive abdominals BEFORE you push up into dog pose. If you are deficient in shoulder range of motion, you might want to practice Half Dog pose at the Wall (or with a table top) to work into stability at 90 degrees shoulder flexion first. Then return to the floor with preparatory Dog, progress to knees off the floor with rocking and then slowly work back into Dog pose using a chair first then returning to the floor. (This progression is difficult to explain without me actually seeing you and watching how you move.)

As to Shoulderstand, a lovely variation is chair Shoulderstand, which takes almost all the weight off the shoulders, and with a bolster under the shoulders, the head and neck are much less weighted. Headstand is a different problem because even with using a Headstander prop or two chairs to unweight your head and cervical spine, this pose puts a lot of weight into your shoulders. So if the problem is truly from your shoulder, I would recommend that you do not do Headstand until you are pain free or, if the studio where you practice has wall ropes, perhaps you can have your teacher instruct you on how to do the inversion without bearing with through your head or shoulders.

Good luck in your explorations!

—Shari

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Friday Q A Back Stretches and Inversions for Chair Yoga

This week, we have a follow-up question to our Friday Q&A on chair yoga (see Friday Q&A: Chair Yoga) from one of our readers who actually teaches a chair yoga class

Q: I teach a chair yoga class which cannot go to the floor for healthy aging. How can I do a safe inversion or back stretch that does not stress the osteopenic back?

A: If you teach chair yoga, many students are older or infirm and not able to transfer from standing or sitting in a chair to the floor, where you might have them do any number of reclining poses that could stretch the back or approach an inversion, like Legs Up the Wall pose (Viparita Karani). 

If by “back stretch” you mean a forward bending action of the spine, like in Standing Forward Bend (Uttanasana), in light of possible osteopenic or osteoporotic spine, you need to be careful with most forward folding positions (see What is Ostepenia and How Can Yoga Help?).  It is not hard to do a seated version, however, if that is what you are looking for. One of my favorites that is fairly shallow and would not create too much force on the vertebrae of the spine would involve placing a second chair in front of the first, facing it away from you. Then ask your students to tip as much as possible from the hips and place their crossed forearms on the top seat back of the chair in front of them. This is similar to seated forward fold we showed for our Office Yoga series (see Featured Pose: Chair Forward Bend).

If, however, by “back stretch” you are referring to a back-bending action, then there is a bit less concern of hurting the spines of students with OP.  In seated Cat/Cow pose, the Cow variation is a nice, easy backbend shape that most could do in the chair. (See Featured Pose: Chair Cat Pose.)

Or, have the students stand behind the chair, use the top back rung for their hands for balance purposes and do a gentle standing backbend from Mountain pose (Tadasana).

As for inversions, this may be a bit tougher. You could have them put their chairs against the wall, and if they still have good hip mobility of rolling the pelvis over the femur bones, you could do a Downward-Facing Dog version with the hands on the seat of the chair, walking the hips and feet back into this higher version of regular Downward-Facing Dog, but with a slight downward slant from hips to hands. Make sure they bend their knees as they walk forward towards the chair at the end of the pose, and rise up slowly monitoring for any lightheadedness or dizziness. (See Featured Pose: Downward-Facing Dog (Chair Version)).

And you could show the class how to do Legs Up the Wall pose on the ground, demonstrating it for them, and suggesting they try this at home in their beds, swinging the legs up the headboard side of the bed if the bed is up against a wall. I’d have them only stay for 2 minutes or so at first, as you will not be there to monitor them. Of course give them all the usual precautions regarding inversions and high blood pressure and glaucoma, as the older your crowd, these conditions are more common. I hope these suggestions give you things to consider. And armed with the information from our posts on OP, you can be creative in your approach to working with your chair yoga classes.

—Baxter

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Friday Q A Stretching a Tight Ankle

Q: I would love to get some information about how to get at this part of the ankle. I do a daily yoga practice but still have considerable tightness around the Achilles heel and the outside of it. I'm not sure but it could be from cycling. Standing poses aren't eliminating the problem.

A: Because your foot position in cycling is plantar flexion (keeping your foot pointing downward), it could be that your tightness in the area around the Achilles heel is indeed from cycling. But I think the first approach is not just to focus on the tightness of the specific region but instead to approach your body more globally.

While standing poses are typically taught to beginners as an approach to creating a foundation on which to build your yoga practice, learning how to execute the basic poses is just the beginning of cultivating body sensitivity and alertness. When addressing foot and ankle issues, it is important to differentiate where your weight is distributed in the standing poses and also to vary how you do the poses so as to not habituate your central nervous system to always doing the pose the same way.

Learning how to shift weight differently when your foot is not flat on the floor might also help encourage more ankle bending (dorsiflexion). So try using a slant board that you place under your foot in various positions as a way wake up parts of your foot and ankle that are “asleep.” Doing standing poses on the beach in the sand or on uneven outdoor surfaces might be a way to challenge ankle sensitivity, strength, and flexibility. Likewise, doing standing poses on softer surfaces, such as multiple sticky mats or on a couch cushion on the floor, challenges your foot and ankle muscles and would be helpful.

Next, you can stretch the two main parts of your calf muscles (the gastrocsoleus complex), as this might be very helpful to increase your ankle bending (dorsiflexion). 

To stretch your gastrocnemius muscles:

1. Start by facing a wall.
2. Step your right foot forward so it is a few inches from the wall (but not touching it).
3. Reach your arms forward and place your fingertips on the wall, about shoulder height.
4. Step your left foot back so your feet are in Warrior 1 stance, with your front heel in line with your back heel and your back leg turned slightly out (approximately 5 degrees). Keep both knees straight and both heels on the ground. 
5. Now, slowly bend your front knee just till you feel the stretch on your back calf and heel. Keep the heel grounded and try to bend the front knee a bit more, all the time keeping the back heel down. Do not bounce
6. See if you can hold the stretch up to 90 seconds. But be very conscious of not going too far too fast because you do not want to tear or rupture your Achilles tendon.
7. Repeat on the other side.

To stretch your soleus muscle, you can use the same pose as for gastrocnemius with one exception:

1. Start by facing a wall, and follow steps 2-4 from the previous pose.
2. Now keep your front leg straight as you gently try to bend your back knee until you feel the calf stretch in a different area. 
3. Again, see if you can hold the stretch up to 90 seconds. But be very conscious of not going too far too fast because you do not want to tear or rupture your Achilles tendon.
4. Repeat on the other side.

For stretching your heel cords, you could try a single leg heel drop off a block. Start by taking Mountain pose facing a wall with a block on its lowest height on the floor in front of you. Then, with your fingertips on the wall, step one foot onto the block. Now, move your heel back so it drops over the edge of the block, creating a gentle stretch. If you have stairs in your home you can do this by dropping one heel over the stair lip. You can vary this exercise by keeping your hip and knee straight as you drop your heel or by keeping your hip straight and bending your knee slightly.

Do not get discouraged with your standing poses, but I might recommend more comprehensive stretching of your:

• Hamstring muscles (backs of your thighs)
• Iliotibial (IT) band (sides of your thighs)
• Gluteal muscles (buttocks) and hip rotators (sides of the hips)
• Hip flexors (fronts of the hips) and quadriceps (fronts of the thighs)

I also might recommend getting a consultation with a health professional about your particular ankle mobility or stiffness. Sometimes some good old joint manipulation of a specific part of ankle joints does a world of good in helping you gain mobility. Then the yoga will help you maintain the strength and stability.

—Shari

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Friday Q A Practice for All Seasons Rerun

Swimming Hole by Brad Gibson

Q: Practice and the seasons: Does your practice change with the seasons and if so how?

A: Where I live, there are seasons (though some people might argue differently), but rarely extremes of weather. But one summer day that was actually hot, I went to my regular Friday morning yoga class, expecting backbends because my teacher always teaches backbends the second class of the month. Our studio, though in a beautiful old building, had no insulation and very little climate control, with poor heating in the winter and no air conditioning in the summer, so it was unusually warm in the studio.

The teacher opened the class with a little smile, saying, “Today we’re going to do some nice cooling backbends.” Everyone laughed, because, of course, backbends are typically not at cooling. But guess what. We did do backbends, but our teacher modified his typical sequence so we did a cooler practice of stretches, passive backbends, and the less effortful, active backbends, rather than a “hotter” practice of standing poses and very active backbends.

That memory of that still makes me smile, but I bring it up today because I don’t necessarily change my practice with the seasons per se, but I’m definitely change my practice to fit the weather and the temperature in the space where I’m practicing.

Today is a cold and rainy day in Berkeley, California and my house is a little bit drafty, so I would incline toward an active, heating practice rather than a passive cooling practice. Trying to do, for example, a restorative practice in a cold room is not only very challenging because you get colder and colder the longer you stay still, but it is also not very effective, because being cold stimulates your nervous system, alerting your body and mind that you may in danger. So it’s very difficult to relax. On the other hand, the active poses warm up both you and the room quite nicely.

Likewise, being too hot is very stimulating for the same reasons; your nervous system warns your body and mind there may be danger. So when it’s hot, it’s a good time to do more passive and relaxing poses. Or, slowly work up to the active poses and take time to rest and cool down.

Naturally you don’t want to do only active practices all winter and only passive practices all summer, but as my teacher did that day, you modify any sequence by adding more cooling poses or heating poses to accommodate the climate, both outdoors and indoor. For your convenience, I’ve categorized the general groups of poses into Heating and Cooling.

Heating Poses:

• Sun Salutations
• Standing Poses
• Active backbends
• Headstand and arm balances
• Twists and abdominal strengtheners

Cooling Poses:

• Restorative poses
• Reclined poses
• Forward bends
• Supported inverted poses

Some other considerations: Your body is stiffer when you are cold, so that’s a time when you may need more stretching. When it’s hot and your muscles are more relaxed, you may not need to stretch as much. The weather also influences how physically active you are outside the yoga room. I also tend to be more physically active outside during warmer, drier months, walking, gardening, and so on. So to balance my body on more active days, I’ll focus more on poses that complement those activities (see Deciding What to Practice). During the rainy season when I spent more time in the house, I’ll naturally gravitate toward more active poses to compensate for being more sedentary. However, some people may spend the winter skiing (yes, I’ve heard tell of that) and the summer hiding out in an air-conditioned apartment (heard of that, too), so each person needs to find his or her own way with figuring out the best practice on a given day.

—Nina

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Friday Q A Foot Cramps

Feet of a Kneeling Man by Albrect Durer

Q: I'm having this ongoing cramping of the feet, mostly the arch during yoga classes. The cramping I experience happens is not flex, such as in seal or cobra or even in a kneeling pose where the top of my foot is on the mat. It's then I get the cramp in the upper arch of my foot. Each foot will cramp and sometimes both cramp at the same time. I've read about electrolyte balance and eating bananas and I have a pretty healthy diet and I practice yoga in a studio 5 days a week. I've been cramping almost from the beginning of doing yoga, about 2 years ago.

A: This is a common experience for most yoga practitioners, certainly when they first begin doing yoga asana but even over time. I know that both Nina and I have experienced this first hand, so we are empathetic to your plight! That said, before I make some recommendations for this reader, it might be nice for all of us to have a better understanding of what I jokingly refer to as “the deadly yoga foot cramp” (of course, no one has actually died from foot cramps, but, boy do they hurt!).

Basically, a cramp is a sudden and involuntary (you can say that again!) contraction of one or more of your muscles. In the case of your foot, the cramp is most likely in the smaller muscles that reside solely in your foot—the “intrinsic" muscles of the foot—but may also involve those that originate near the knee and end on one of the foot bones—the “extrinsic” muscles of the foot. 

Although not all of us experience foot cramps, most of us probably have experienced a muscle cramp elsewhere in our body, quite commonly at night in the calf (a charley horse). This can very painful until the cramp subsides. However, if weren’t for the pain and the muscle going offline temporarily, we wouldn’t likely even talk about muscle cramps! And, although when you are in the midst of a sudden foot cramp in class or at home, it seems like it may last forever, it usually resolves in seconds or minutes, especially if you come out of the pose you’re doing and do a little self-care to help things along. 

Although the foot cramps themselves are harmless, it’s worth taking a moment to consider what the cause might be, because in some cases, they may indicate a more serious underlying problem. 

Even though in many cases the exact cause of muscle cramps is unknown, for those who have them often there are certain typical causes. The National Institutes of Health (NIH) website has a pretty exhaustive list of possible causes, including some pretty serious underlying health issues, such as Parkinson’s disease, chronic kidney disease, and nerve damage. But for the average yoga practitioner, the most common causes include heavy exercise that results in overuse of muscles, dehydration, low levels of calcium and magnesium, hyperventilation, and pregnancy, especially in the last trimester.

How should you decide if persistent foot cramps need to be further evaluated by your doctor? According to the Mayo Clinic, you may want to have a more thorough evaluation with your physician if you have any of the following: 

• Severe discomfort 
• Swelling, redness, or skin changes in the leg or foot with the foot cramp 
• Muscle weakness in the leg or foot with the foot cramp
• Frequent occurrences of cramping
• Cramps that do not improve with your self-care 
• You can’t associate the cramps with an obvious cause, such as heavy exercise

Now we’ll briefly discuss some self-care techniques you can use when you are experiencing a foot cramp. This will be followed by information about what you can do to prevent future foot cramps.

Self-Care for Foot Cramps 

During an acute foot cramp, I have always found that coming out of the pose that is triggering it, and stretching and massaging the part of my foot that’s cramping seems to speed up the release of the cramp and my return to my practice. I often do the stretch described as number 3 below under warm-up practices or a High Lunge pose with the cramping foot as the back foot. 

Medical sources suggest the use of ice or heat, but I always find that the foot cramps resolve long before I am able to get to anything like that, so that suggestion would be for the more unusual and persistent forms of cramping.

Preventing Future Foot Cramps 

There are certain factors that put you at more risk of getting muscle cramps in the first place. They include advancing age, pregnancy, certain medical conditions, such as diabetes, and dehydration (which is also a cause of cramps!). Although the only one of these factors you can actually eliminate is dehydration (hydrate yourself!), if you have any of those conditions, stretching your muscles in sensitive areas before and after your yoga practice may help prevent future foot cramps. 

But, hey, wait a minute! Aren’t I already stretching my muscles simply by virtue of doing yoga poses? Well, a beginner might think such a thing, but experienced yoga practitioners know that many poses involve the contraction and strengthening of muscles to enter, maintain, and exit a pose. And, in some traditions, the poses are held for several minutes, probably enough time for a sensitive muscle to cramp and spasm. 

So, if you suffer from frequent foot cramps during your practice, you might want to develop a foot warm-up sequence to do before or/and after your regular class or home practice. A few ideas for a foot warm-up sequence:

1. Massage your foot by hand for a minute or so before activity.
2. In a seated or standing position, roll a tennis ball systematically between the sole of your foot and the floor to massage and release tension in the muscles of the foot.
3. From a kneeling position, turn your toes under and sit back on your heels with your hands on the floor in front of your knees or on your thighs to stretch the muscles and fascia on soles of the feet.
4. In Reclined Leg Stretch pose, place the strap on the arch of your foot and rock it side to side to massage the muscles on the sole.
5. Stand facing a wall, about a foot away, with your hands on the wall at chest level. Step one foot back about three feet into Warrior 1 position, and then bend the front knee toward wall to get a good calf stretch for your back leg.
6. When practicing standing poses, imagine your toes relaxing and releasing away from the balls of the feet, instead of clawing the floor.
7. For our reader and others who are experiencing cramps in a more unusual location of the feet, poses that stretch the tops of the feet, such as Hero pose (Virasana) and Thunderbolt pose (Vajrasana), or if it’s comfortable for you, Reclined Hero pose (Supta Virasana), might be helpful.
8. A note from Nina, who finds that in Cobra pose, if she activates her hamstrings, her feet don’t cramp! Thanks, Nina, and good to know! 

For most practitioners, foot cramps tend to become fewer and farther between with more consistent time spent out of shoes and doing yoga on a more regular basis. That said, I still get them on occasion, too, and have to actually take my own advice. Hope this information helps!

—Baxter

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Friday Fun Words of Wisdom from Chicago Cubs Yoga Teacher

by Nina

In Meet Darnell McDonald, Mental Skills Coordinator for the Chicago Cubs Darnell McDonald, mental skills coordinator for the Chicago Cubs, explained why meditation and simply being present give players a competitive advantage.

“You learn when you get to professional baseball that everyone is good. The separator is the seventh game of the World Series, the team that is able to execute under pressure, take off the autopilot button,” he says. “Everything we do, we do better in the present moment.”

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Friday Q A Implantable Cardioverter Defibrillators ICD and Yoga

USNS Comfort by Marie Lossky
(@Marie.Lossky on Instagram)

Q: I recently had an Implantable Cardioverter Defibrillator (ICD) installed (mid-December). And now I'm trying to work out my yoga practice (I've had a yoga practice for almost 30 years, currently almost entirely Iyengar)—trying to figure out what I have to give up. I don't do Urdhva Dhanurasana and Headstand (this one because of slight carotid stenosis). I'm 72, and except for the heart issues my health is good.

I’ve been advised no Chaturanga because of possible engagement of chest muscles (don't want to stress those wires!). My cardio electrophysiologist says stretching is okay – but weight-bearing engagement of the chest is very bad. 

I'll be returning to class in a week or so. My teacher is fabulous (a student of Donald Moyer), but she's never had experience with someone with an ICD. We're going to learn together. 

Big question: What about Handstand? It's my favorite pose—maybe the best moment of my day. My brilliant electrician is worried about it—thinking it might be too much chest engagement. I see it more as bone, not so much muscle. I don't want to be stupid about it, though. 

A: Implantable Cardioverter Defibrillators (ICD units) are very small devices that work like the large paddled defibrillators used in hospitals, ambulances, and many public spaces. They shock a heart that is either not beating at all or is in a life-threatening rhythm back to a normal rhythm to prevent heart attack and sudden cardiac death. 

So for people who have documented dangerous heart rhythms, Implantable Cardioverter Defibrillators can prevent sudden death! The small unit is placed just under the skin on the front of the chest, and a wire attached to the unit is threaded into the heart muscle. It is this wire that is vulnerable to breaking or getting dislodged.

As always with questions that I get that are about a particular illness or disease, I cannot directly give specific advice to you about your asana practice and your ICD without working with you directly. However, there are a few aspects of this inquiry I would like to address. If your doctor (a specialist in the electrical systems of the heart and these devices) is correct that you run the risk of breaking the wire that runs from the implanted defibrillator to the heart, rendering it useless if you do a lot of weight bearing exercise on the hands that engage the chest muscles strongly, I’d take that to heart (sorry about the pun!). I recommend that you get a bit more information from your specialist physician to see if there is any leeway to do short holds or dynamic variations in certain poses versus simply not doing any weight-bearing engagement of the chest.

And if indeed dynamic or short and long holds are out, then you want to look closely at the poses you normally do and remove those that put you at risk for damaging your unit. That would essentially include all arm balances (including, for example, Crow pose, and yes, Handstand, Forearm Balance, Headstand, etc.) and other poses that engage the front chest muscles such as Plank, Forearm Plank, Side Plank, and arguably even Downward-Facing Dog, Upward-Facing Dog, and Bow pose.

I personally would also eliminate Shoulderstand because the position of the arms could put excessive stress on front chest tissues. Try safer substitutes for all these poses. For example, for the inversions, you can substitute safer inverted poses, such as Legs Up the Wall pose or using a Headstander device at the wall. And for Downward-Facing Dog pose, you could practice Half Downward-Facing Dog at the wall and for Upward Facing Dog pose you could practice Locust Pose or Cobra pose with arms bent and very little weight on the hands. 

Even though you may need to eliminate to some poses from your repertoire, I recommend that you continue regularly practicing a well-rounded practice. You will still reap all the physical benefits of strength, flexibility, agility, and balance that a balanced asana practice provides.

And if you are not already practicing stress management and equanimity practices, you should consider adding them to your regular routines. 

Stress management is important for those with ICD units because a common problem for people who have them is anticipatory anxiety over if and when the unit might discharge to reset the heart’s rhythm (shock you!). You can imagine how disturbing it might be to have a strong electrical discharge/shock suddenly sent into your heart without any distinct warning that it’s coming. In fact, anxiety and depression are reported in about a third of all people who have ICD’s placed. A 2014 study Psychosocial and Cardiac Outcomes of Yoga for ICD Patients: A Randomized Clinical Control Trial that looked at the benefit of a regular yoga practice on this anxiety issue found that those in the study group who did yoga for eight weeks experienced a decrease in shock-related anxiety and actually had fewer episodes of the ICD units firing off, lowered by about 30%.

And cultivating equanimity can help with you with making decisions about letting go of something you used to be able to do. As we have written about many times before, these sorts of changes and loss are inevitable. But is healthy and reasonable to experience sadness over or grieve the loss of something you used to be able to do, that you may have enjoyed and that even gave you a sense of accomplishment and competence. Using yoga to support equanimity, for example, practicing calming pranayama and meditating regularly, will help you emotionally rebalance more rapidly and have a healthier perspective on the relative importance of the loss. And this process—which we are likely to experience many times in our lives as we age—also opens up the door to remaining curious about what you can still do and what new things you can learn. 

Not sure what to do to cultivate equanimity? Check out Nina’s excellent post with many suggestions: 7 Ways to Cultivate Equanimity with Yoga.

—Baxter

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