Ask An Expert

Urinary/Bladder issues and the Pelvic Floor

Question from a Student:

Since I had my second daughter I’ve been having bladder/urinary issues, and after a lot of reading and doctors’ visits I’m starting to think that at least one source of my problem is with the pelvic floor muscles. The reading I’ve done advises against Kegel exercises for the symptoms I have, as the problem is likely due to pelvic muscle tightness rather than weakness. Would you know or know how I could get advice for yoga routines to relax the pelvic floor muscles? I’ve seen a few exercises on YouTube but am kind of at a loss in terms of a routine that I could practice regularly and hopefully work toward some healing..”

Answer from Viki Boyko:

What are the bladder/urinary issues? Stress incontinence, urge to go to the bathroom? I would first look at taking time out to destress. Nothing makes urgency worse than feeling stressed. 10-20 minutes a day in a constructive rest pose –

– or legs up the wall or another pose that allows you to ‘let go’. If you are holding on to tension in the pelvic floor then you are probably gripping elsewhere too – the jaw? the low back? Is it possible to take a restorative yoga class? Even a few moments focusing on the breath moving through the body may help bring calm – especially where your exhale is longer than the inhale.

There are many muscles and ligaments around the pelvic floor neighborhood that can be helped by yoga stretches. Here’s are some that I might try, though I don’t know if you know what the poses are:

  • Arching and curling the spine (either cat/cow or lying down on your back with knees bent and feet on the floor). to ease and balance the low back and abdomen, both of which are attached to the pelvic floor.
  • Reclined pigeon pose to stretch the piriformis muscle which can be a culprit for pelvic floor tightness.
  • Inner thigh stretch – legs up the wall and take the legs into a wide straddle. Or lie supine with knees lifted over your hips. Relax the lower legs and feet and take your knees wide apart. Open and close the knees slowly with attention to your sit bones moving apart and together.

Keep the backs of the legs – calves and hamstrings stretched too. The lower extremity, hip, abdomen, pelvis, and spine are a connected kinetic chain, any dysfunction along this chain may cause overcompensation and dysfunction of other associated muscles.

Practice squatting. Sit less, walk more. What is caffeine intake? Caffeine can be a bladder irritant.
There are many different ways to effectively stretch and release that area.  I might be inspired to put a little video sequence together that you could use….gosh! Where to start!! Hope this kicks the ball off tho!

Viki

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Advice for working with people who have blood clots?

Question

Do you have any experience and/or what advice do you have for working with people who have blood clots? I have a student who was just diagnosed with a blood clot in her calf….last month! She’s on coumadin now, but is there more I should know/watch out for/avoid?

From Justine:

First off make sure she has permission from her doctor to do Yoga (often, the doctor will tell them what to avoid…..and, sadly, often they won’t!!) If she is on Coumadin and has been for over a month, my guess is the clot is diminishing. Make sure your student is doing the follow up appointments – they should be monitoring her until there is no sign of a clot. Movements in your chair class should be fine. The main risk here is the clot dislodging and causing a problem (this is a big risk, as the problem can be life threatening). My MAIN suggestion would be NO inversions where her feet are above her heart – so, no legs up the wall, or even on the chair just to play it safe…..we don’t want gravity helping to dislodge it. IF your student starts to feel deep pain in her calf – or more importantly higher up the leg – have her stop immediately, and call her doctor. I am not trying to scare anyone here – I am doing worst case scenario because I am a safety girl (extra points if you can name the movie Safety Girl comes from!!) Truly, there shouldn’t be a problem – I just want you to know what to look out for. Hope that helps……

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Do you limit your multi-level class size to keep students safe?

Question

I wondered if you had a limit in your classes or different classes according to health and activity level?

Since moving to a new studio In the past 6 months my classes have really grown. This is a good thing but also concerns me. I began with a few students, grew to an average of 12-15 in class now instruct up to 24 members. I have many levels of health in my classes. In order for my students to feel safe, as well as myself to care for this large of a population I have put a cap on my classes for no more than 20. Teaching these classes can be very draining since the demands are so high. I wondered if you had a limit in your classes or different classes according to health and activity level? I would love your advice.

Thank you!
Dannette L., 200 Hr RYT

Answer from Sherry

Thanks for your question. First of all, congrats for your growing classes! That means people are liking what you offer and coming back for more! A teacher’s dream!

All of my Chair and Gentle Yoga classes are mixed level so I understand when you say teaching these classes can be challenging for a Teacher if you are working hard at cueing and offering up movements and poses to accommodate every single student’s abilities. That is why I subscribe to the “Progressive” method of introducing poses to a group class. This means starting with the easiest and simplest version of the pose, and then building upon it with more options. I also continue to reinforce that the student needs to take responsibility for their own safety and only do what they feel comfortable doing, especially in a larger class.

As for capping the size of the class, I think you have to trust what you feel most comfortable teaching, and what the room comfortably accommodates. I have a Chair Yoga Library class that can have up to 40 people, row upon row of seniors who have very different physical abilities, and new people always coming in. I always start with the welcome and words of empowerment that they are just as involved in keeping themselves safe and strong as I am as their Teacher.

Now, if I had lots of students with very significant movement limitations and physical injuries and issues… it would be a completely different type of class. That class I would limit to 10-15 (space accommodating of course) and focus more on dealing with more of their specific limitations and offer movements that the majority of those students could do on their own.

I believe it is truly up to you and how you feel about limiting a class size. You surely have the right to do that as a Teacher to keep everyone safe. When you use the word “draining” then you have to trust that it IS draining for you and thus can lead to teacher burn-out should you continue to feel like you are on a vigil of caution the entire time you are teaching. You want to be sharing LOTS of Joy and having fun yourself. Otherwise… why do it?

I hope that helps! Keep up the great work as it surely appears your students LOVE you!
Blessings,
Sherry

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What resources or “extras” do you add to make your classes different & add connection & value

Question

Looking to learn here 🙂 I often use postcard quotes that randomly go on chairs I I take them back at the end of class but often they mean a lot to people & they ask to keep them or send them to a relative that’s going through a hard time.

I add a reading/meditation at the end of class, I am starting to add a chair yoga dance every few weeks.

I’d be interested in hearing more ideas, we can learn from each other.
Rachel Baer,
Chair Yoga Teacher in East Lyme, Connecticut

Add your suggestions here!

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Class Name and Description for a Mat/Chair Classes

Question

I teach several chair yoga classes a week, two at the same senior center. I just received the opportunity to start a new class there, still using a chair but more like a regular yoga class but with the chair. I am looking for advice for a class name, maybe adaptive yoga? And also ideas for a brief description so that people understand what it entails. Thank you
R.B.

Answer from Sherry

Hi! We have this type of class at the studio and we used to call it Adaptive Yoga, but now call it Mat/Chair Yoga. Reason being is that we found more of the Chair Yoga students willing to try this hybrid class out when it had the title of “Chair” in the class name.  We wanted to include both groups of students (mat and chair) and help them feel comfortable with using either for their Yoga class. Here is the description we use for this class.

CLASS DESCRIPTION:

People of all ages may be dealing with some form of physically-debilitating conditions, arthritis or other types of joint pain and/or physical weakness. This Yoga class is designed for those students living with such symptoms. Learning how to strengthen and stretch muscles surrounding sore and stiff joints can promote improved comfort and stability. Working with breath and mindfulness brings to life our Yoga spirit. Modifications are taught for all poses with the goal of giving the student a true personal practice. Students are welcome to use a chair and/or Yoga mat with modifications being offered for each. GENTLE/OPEN LEVELS

Why Movement Helps

A regular yoga practice can increase muscle strength and endurance, proprioception, and balance, and the emphasis on mindful movement through a full range of motion can be particularly beneficial for arthritis sufferers. Additional beneficial elements of yoga include breathing, relaxation, body awareness, and meditation, which can reduce stress and anxiety and promote a sense of calmness, general well-being, and improved quality of life.

 

Namaste,

Sherry

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How Does Yoga work with students who have Stenosis and other disc issues?

Question

I am beginning a new gig soon for folks 60+. Very excited to share all I’ve learned from you! One student asked how yoga would work as she has stenosis and other disc issues.

Thanks!
Gail

Answer from Justine

With central and foraminal spinal stenosis, back bends can trigger pain and spasms due to compressing the nerves. Forward bends open the foramen and spinal canal and give relief – I always say with deeply bent knees when standing, and always look for a forward tilt of the pelvis and sacrum so that the spine and sacrum are tilting the same way to avoid hinging in the lumbar spine, which can compress the intervertebral discs. If she has disc damage, back bends are usually more healing – so it is a bit of a catch 22. Let pain be her guide – any ‘uh-oh’ pain, come out. Mild movements linked to breath, as though she is breathing directly into the area of pain, can be profoundly helpful – it doesn’t take huge movements to get great effects 🙂 Twists can be risky – no leverage…..but using her core strength to rotate her body around the axis of her spine (even if it is just a very small movement) can be helpful – like ‘flossing’ between the vertebrae and bringing in circulation and space.Lateral bends are helpful as they stretch the quadratus lumborum – which when tight can compress the vertebrae and foramen and increase pain.

Stenosis is very similar to osteoarthritis – it is the location of the excess bone growth that makes it stenosis. I always say use heat to relieve pain – ice and cold can make it worse.

I hope that helps. Please feel free to reach out with any questions 🙂

Much love,
Justine

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What are suggested movements for a student who as Psoriatic Arthritis?

Question:

I have a student who was diagnosed with Psoriatic Arthritis about 35 years ago. She has had both wrists fused and reports that the pain in her hands is getting worse due to increased reliance on them. I want to offer her sequences that will help her strengthen her arms and hands without stressing the wrists or finger joints, and that will hopefully reduce the pain and stiffness she feels. She does a nice modified dolphin using the chair, but i am at a loss to support her when we are doing wrist movements. I want to give her things she can work on at the same time. Any suggestions? Thank you!

Answer from Justine

I am assuming she had both wrists medically fused, and the bones did not fuse on their own.  She needs to keep the joints in the hands healthy and increase circulation throughout the hands. I would focus more on that than on strengthening, as it sounds like her hands are getting enough of a workout. Gentle movements linked to breath – start with hands in a loose fist, on inhale (one hand at a time!) open one finger, one knuckle at a time, on exhale close one finger, one knuckle at a time. Do 6-10 repetitions on each side (she can alternate hands if she likes). Also, opening the hands on inhale as wide as is comfortable, sustaining the stretch for a moment or two, and gently relaxing the hands as she exhales.
The first exercise of linking breath to slow movement can be done very slowly (have her do it throughout the day as well) and is a nice option when your class is doing wrist exercises. The other thing she could work on is cactus arms, drawing the shoulder blades together strongly on inhale, then bringing hands and elbows together in front of her on exhale…..just to keep her rhomboids strong for better thoracic spine and shoulder girdle alignment. I would also think stretches to keep her chest open, particularly pec minor, would be helpful to avoid compression on the brachial nerve plexus as it goes through the chest to innervate the arms.
Lastly, abhyanga oil massage on the hands (everywhere if you can get her to!) to hydrated the tissue in the hands. Sesame oil would be best as it has a warming quality to it.
I hope this helps!
Much Love,
Justine

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Have you taught Chair Yoga (with a standing part of class) to people with serious sight impairments or who are blind?

Question

Have you taught Chair Yoga (with a standing part of class) to people with serious sight impairments
or who are blind? I teach part-time at a nearby VA and we are going to integrate some students like this into my
regular class. Most are over the age of 60 and several use walkers and scooters so they have mobility impairments too.

I liked the idea of a separate class but my Supervisor wants to try to integrate them due to our budget.
They will have a “Coach” with them. There are 4 students coming into my class and there are 2 coaches.
(Currently the regular class is very small, another reason we are thinking of having them join this class.)
Apparently the coaches are accustomed to touching the students to help them with a balance class they take.
We typically don’t touch the veterans due to PTSD etc.

Any thoughts or recommendations?

Thank you,

Linda C.

Answer

From Sherry

Hi Linda!  SO wonderful to hear from you!  I am copying two lovely Chair Yoga teachers who have experience teaching Chair Yoga to the blind.  Paula and Cheryl!  I will have them weigh in on their thoughts to this issue, and then I will add my few comments as well.

Thanks for reaching out!  I agree with the concern of not touching someone who is blind with PTSD. I have several blind people intermingled with my wheelchair classes and when they are present.. I always make a very concerted effort to speak very clearly with lots of detailed instructions. I watch them to ensure that they seem to be connecting their movements to my instructions.  Periodically I would say “great job Sylvia!” so that they know I am watching out for them.

Cheryl…Paula?  Can you let us know what you think?

Thank you beautiful ladies!!

From Paula Montalvo

Thanks for including me in this subject. I taught Yoga to visually impaired adults at the Braille Institute in La Jolla for about 5 years. I can agree with everything Sherry advises.

It requires a great deal of detail in describing every posture and you may even find that some postures have too many details to use.

I made it a practice to rarely touch a student, and if I did, I would be sure to ask permission before doing so.

I also liked to comment on how well they were doing, mentioning names as much as possible.

Most of the postures were done seated in the chair, and when we stood up I was very clear that they were to hold on to the back of the chair.

I am sure they will enjoy yoga very much and it won’t be long before even the most severely impaired students will be smiling and looking forward to your class.

Love, Paula

From Cheryl Gary

I have been teaching at The Center for the Blind for over 9 years. Most are seniors, with a few younger students.

I agree with Paula and Sherry regarding the clarity of language. I do also practice with eyes closed, as a lot of us do in our own practice, everything I’m attempting to do with the class. I try and keep language simple, not too detailed.  Changing obvious words of “looking over your shoulder”, to “turning your head in the direction of”, etc.  I also reference seeing themselves from the inside out, being an “internal observer”, something we all practice, but that they can “see”.

As so many of my students are in varying stages of “sightedness” only one or two are completely blind, even if they don’t suffer from PTSD, they are all in stages of some anger (at their bodies) and fear. I always state in the beginning of class that I may walk around and possibly gently guide them if I see they may need it, and ask them to raise their hands if they do not want that.

I still stumble often over descriptive words, and am dyslexic, and they love to catch and correct me. Helps me know they are listening!  Humor is really important!!! And I supply them lots of reasons, at my expensive, but in fun, to laugh.

Chair in front of chair is necessary in my class for standing postures. I am in a general purpose room with long tables and lots of chairs. So I have to be creative in structure and found making linear style lines of students serves the dual purpose of more space, and safety with the back of the chair from the person in front, an accessible place to hold on to for standing if needed.

Many of the students are handicapped as well. Alternatives are given, and anything we do standing, which is not always part of a class, those students can do sitting.

Breathe work is the most important part of the class.  Gives them a chance to collect themselves and let go of the struggle to just have gotten there that day. I always offer the option of just doing that during class. Give lots of kudos for where they are, where they have come from, to be there.

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Advice for working with people who have blood clots?

Question

Do you have any experience and/or what advice do you have for working with people who have blood clots? I have a student who was just diagnosed with a blood clot in her calf….last month! She’s on coumadin now, but is there more I should know/watch out for/avoid?

From Justine:

First off make sure she has permission from her doctor to do Yoga (often, the doctor will tell them what to avoid…..and, sadly, often they won’t!!) If she is on Coumadin and has been for over a month, my guess is the clot is diminishing. Make sure your student is doing the follow up appointments – they should be monitoring her until there is no sign of a clot. Movements in your chair class should be fine. The main risk here is the clot dislodging and causing a problem (this is a big risk, as the problem can be life threatening). My MAIN suggestion would be NO inversions where her feet are above her heart – so, no legs up the wall, or even on the chair just to play it safe…..we don’t want gravity helping to dislodge it. IF your student starts to feel deep pain in her calf – or more importantly higher up the leg – have her stop immediately, and call her doctor. I am not trying to scare anyone here – I am doing worst case scenario because I am a safety girl (extra points if you can name the movie Safety Girl comes from!!) Truly, there shouldn’t be a problem – I just want you to know what to look out for. Hope that helps……

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For Osteoporosis? Is a Chair or Mat Yoga Class Better?

Question

How do we, as teachers, learn about all these conditions and know what type of Yoga poses will help or not? We get a lot of questions in our email box from teachers who want to ensure they are keeping their students safe in their Gentle, Senior and Chair Yoga classes. Most of our students are 50+ and we all know too well the health issues that can start to manifest around this time of life and beyond.   It is mind-boggling, intimidating and frightening at times.

Answer

Take for instance – Osteoporosis.  We cringe at the thought of doing anything that will cause a bone fracture in our students. We may have students in our group classes with Osteoporosis or Osteopenia (predecessor to Osteoporosis) and we, or they, may not even know it. So, how do we keep our classes safe for everyone?

During one of our “Ask The Yoga Therapist” workshop sessions, the subject of Osteoporosis came up.  A teacher asked whether a Mat class or a Chair class is better for someone with this condition.  Justine addressed this issue… and you may be surprised by her answer.

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A Student is Complaining about Pain in the T-Band area

Question

I have a senior client complaining about pain in what looks like the T-band. What would recommend to get into that area? I was concerned to recommend rolling on a roller as that might be to intense. Also thinking we could do a set with a rubber bands (lying down) above the knee and pulling top leg away from the bottom (or do this standing – pulling left leg away from right.- against a wall).

Answer from Justine

I don’t have any experience using hand therapy putty……but I just googled it and it looks like it would be great for strengthening the hands. I wonder if it can be cooled in the fridge or freezer, to help with inflammation in the hands??

As far as pain in the IT band area – did your client describe the pain? I’m hoping it is a dull ache, and there is no nerve type pain. I agree with not using a roller – too intense and could damage the tissue. IF your client can do a supine, symmetrical twist (both knees bent) that may be a way to stretch it slightly, in addition to the strap stretch with the leg extended toward the ceiling (client on back, opposite leg could be kept bent to limit stress) – bring leg toward you and take leg 6-8 inches across body. To get the breadth of the IT band, this could be done with internal and external hip rotation as well. It can be intense – so have them back out to a place where it is stretching, but doesn’t feel violent.

I’m gonna share a little story that I think would really help. A couple of years ago I was having pretty intense IT band pain on my left side – most likely because I sit in easy pose ALL the time, including on my couch. Then, I went to Mexico in December and got really tan. I got home and my skin was SO dry. So….for vanity’s sake, I got special ‘Vata’ massage oil from Banyan Botanicals to help with my skin. I was doing Garshana (body brushing) and Abhyanga (body oiling) every day. After a couple weeks I noticed a wonderful side effect – the IT band pain was gone. GONE! After it hurting for over 6 months. (Apparently, vanity isn’t always a bad thing!!) The brushing helps move the lymph, and the oiling nourishes the tissues.

The special Vata oil is good, or there is another oil for muscles and joints called Mahanarayan oil (

https://www.banyanbotanicals.com/shop/category/herbal-massage-oils/

) Or your client could use organic sesame or olive oil (not coconut oil as it has a bit of a drying effect). When rubbing it in, picture it saturating all the tissue down to the bone, even including the bone…..and your client can gently massage around the IT band edges too….doing it herself so she can not press to the point of pain. She could also google an image of the IT band and see if she can find the attachment and insertion points in her own body and rub there….loosening the ends will cause relief in the whole band.

I attached a PDF with direction on how to do Abhyanga and Garshana. I hope this helps!!

Love,
Justine

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How Does Yoga work with students who have Stenosis and other disc issues?

Question

I am beginning a new gig soon for folks 60+. Very excited to share all I’ve learned from you! One student asked how yoga would work as she has stenosis and other disc issues.

Thanks!
Gail

Answer from Justine

With central and foraminal spinal stenosis, back bends can trigger pain and spasms due to compressing the nerves. Forward bends open the foramen and spinal canal and give relief – I always say with deeply bent knees when standing, and always look for a forward tilt of the pelvis and sacrum so that the spine and sacrum are tilting the same way to avoid hinging in the lumbar spine, which can compress the intervertebral discs. If she has disc damage, back bends are usually more healing – so it is a bit of a catch 22. Let pain be her guide – any ‘uh-oh’ pain, come out. Mild movements linked to breath, as though she is breathing directly into the area of pain, can be profoundly helpful – it doesn’t take huge movements to get great effects 🙂 Twists can be risky – no leverage…..but using her core strength to rotate her body around the axis of her spine (even if it is just a very small movement) can be helpful – like ‘flossing’ between the vertebrae and bringing in circulation and space.Lateral bends are helpful as they stretch the quadratus lumborum – which when tight can compress the vertebrae and foramen and increase pain.

Stenosis is very similar to osteoarthritis – it is the location of the excess bone growth that makes it stenosis. I always say use heat to relieve pain – ice and cold can make it worse.

I hope that helps. Please feel free to reach out with any questions 🙂

Much love,
Justine

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What can be done about Foot Cramping while doing Yoga?

Question

I had a client complain of foot cramping when doing some stretch poses in yoga of a cramping feeling in her feet. I have been told or read somewhere that dehydration and not enough potassium could be the culprits. Do you have any other insight or link to information I could learn more about this topic towards provding my client with something to consider learning or doing?

Answer from Justine

So many people have this issue…..including me! You are so right – dehydration is an issue, one thing you might suggest is starting her day with a glass of warm water with lemon – I do half room temperature and half almost boiling, this will help hydrate the tissues better. Not having enough potassium as well as magnesium is also a problem,there is a great supplement called ‘Calm’ that you make into a drink (doesn’t taste bad!!) that helps not only this, but will improve sleep, here is a link to what it looks like – most health food stores should carry it. (have her start slow as it can also make the bowels loose, the directions will warn her!)

It is also important to keep the calves stretched as those muscles turn into connective tissue in the feet – loosening them will help everything down the line. Here is a link to a class, start at about 24:30:  It will take you through a version of tadasana where you rise up on the toes (forcing circulation to the feet) to warm up, followed by a stretch of the foot with a block at the wall. WARNING: IF she has pins surgically put in the feet this is a no go!!

Also, my latest addiction is to garshana (dry brushing the body, or she can do just the feet) followed by Abhyanga – oiling the feet or whole body. This gets nutrition to the tissues and will help keep them from being to stiff. Special reminder, learned the hard way – don’t rush through it, treat it like self care and self love We are all worth that special time 🙂 Here is a link to more info on it by one of my teachers. Remind her to start slow, if she can only do her feet – that is wonderful….then, as she gets more used to adding it into her routine she might expand to the whole body. It takes some time, but it is so worth for so many reasons!

I hope these help!!!

Justine

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Guidance for a Student with Hyperextended Knees

Question

I have a client that appears to hyperextend her knee. I am working to support her being more aware and building up the strength in her quads and glutes. Is there anything else you would add?

She is only in her 30’s and the doctor has told her she has arthritis. The doctor didn’t do any testing or make suggestion about her posture or referral to see a physic therapist. I encouraged her to go back and get a referral to a specialist to support her in getting a proper diagnosis and referral to appropriate specialist who can help her.

Answer

From Sherry

From my perspective, I find I hyperextend my knees when I am leaning forward in a Tadasana position. I feel my knee jamming. So for me it is postural positioning more so than an anatomical issue. I would look at her posture from the side view to see if you notice an alignment issue. It can be that her knee joint is hyper mobile and it can go back into that hyperextended position very easily. So for her, she would have to consciously find the knee position that is less straight legged but with a micro bend to keep her knee safe. My two cents.

Back to Justine…

From Justine

I agree with Sherry on the microbend of the knees, while telling her to also lift her kneecaps by engaging the quads. Triangle is also VERY easy to hyperextend the front knee, really keep a bend in it and lift the kneecap (when I started Yoga my knees hyperextended badly, and I didn’t have the strength to lift my kneecaps, those days are over!) It would behoove her to really build the musculature around the joint synergistically – like chair or half chair while squeezing a block between her knees – better yet, chair against the wall – she doesn’t have to bring the femur parallel to the floor, she can work up to that – and be very mindful of her alignment so the knees stay stacked over the ankles. Isometric holds like that will also increase synovial fluid into the joint.

I’m glad you urged her to get a referral to a specialist!

I attached a document with knee poses in it. The first one is great for working with tracking (have her be mindful of her alignment), increasing circulation to the musculature of the leg and getting synovial fluid into the knee and hip. The second one is an example of chair (if her knee tends to give out, have her near a wall just in case). The last one is AWESOME! This one helped me to heal my own knees – it will traction the knee joint to create more space, as well as synergistically strengthening the musculature around her knees. The osteoarthritis is most likely toward the front of the knee as that would get more compressed with the hyperextension.

Legs up the wall is great (for so many things!!) – it slows the circulation to the legs down, and when she comes out the increased circulation brings white blood cells too which will help with removing toxins and inflammation. It is similar to icing – however, with osteoarthritis I think icing is too much (unless it feels good to her – I hate it!) If she does ice, follow with heat. Applying oil to the knees, abhyanga style, would also be very beneficial.

You may also want to suggest she look into turmeric, SAMe or Boswellia as supplements to help with joint pain. Lemongrass essential oil also works really well applied topically.

Those are my thoughts, hope it helps!

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Leg Cramps when Doing Yoga

Question

I had a client get cramps in her feet while doing gentle seniors mat yoga class. I was just wondering if you had any quick remedies should this happen again or what could have caused it. We were doing warrior 2 pose.

Answer from Justine

Those foot cramps are no fun!! Generally speaking, make sure your student is drinking enough water, dehydration can cause those cramps. I also suggest people look into using a supplement called ‘Calm’ which is a powder you add water to and it is high in Magnesium – works like a charm! (Make sure to suggest they check with their doctor about adding a supplement) For a quick fix – sometimes you squeezing the foot on the top and the bottom, compressing it so to speak, will help the cramp go away. I also attached a pose to stretch the musculature and connective tissue in the feet. Should work as a quick remedy (won’t be fun!) – and would be a good thing for your student to add as a daily practice to keep the feet limber.

Hope that helps!
Justine

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What are the Forward Bending Guidelines for a Herniated Disc?

Question

For a herniated disc, modifications include forward pelvic tilt. It was my understanding that the pelvis should be rolled back to straighten the lumbar spine to alleviate pain in that area. Please clarify this for me.

Answer from Justine

There is a running joke in the Yoga therapy world that every question can be answered with ‘It depends.’ Used to drive me crazy when Gary Kraftsow would answer that way…..but I can’t tell you how often it comes out of my mouth when I mentor my Yoga therapy students!!

With a forward bend (standing or otherwise), the pelvis should be tilted forward so that the sacrum is moving in the same direction as the lumbar spine – otherwise there is a hinge point in the lumbar spine which puts added, undue stress on the anterior portion of the intervertebral discs, adding to the posterior pressure on the disc – which could cause a bulge or cause an already bulged disc to herniate. (Note: seated forward bends are riskiest to the lumbar spine, as the hips are fixed so any brunt of the movement will go into the body) Generally speaking, lumbar discs tend to bulge posterolaterally (to the back, slightly to the side of the spinal cord) which is why we don’t want that undue pressure on the anterior portion of the disc. (I have a disc that bulges straight back to the cord – rare, because the ligamentum flavum is strong and usually prevents that slippage. Lucky me!)

However, if a disc bulges forward (usually from an bad accident or a crazy, wild, extreme Yoga back bend, unfortunately – I’ve only worked with one like that in my career) then that pelvis rolling back to lengthen the back to lengthen the lumbar would be more appropriate when standing to release posterior pressure on the discs and bring the nucleus of the disc more centrally aligned, rather than pushing forward.

As far as tucking, or rolling back the pelvis – it depends! If someone is standing in tadasana, and has an overly lordotic lumbar curve (sway back if you will), then rolling the pelvis back will help to elongate the lumbar curve and bring the spine more into balance. However, a standing forward bend would still necessitate the forward movement of the pelvis to keep the spine from hinging. I find tucking the pelvis more structurally beneficial to people with severe lumbar osteoarthritis or spinal stenosis, as it lengthens and slightly opens the posterior aspect of the vertebrae, allowing more room for the nerves as they exit the spinal column.

The hamstrings can be a major culprit it pulling the pelvis into posterior rotation in a forward bend, which is why it is safer to bend the knees if there are tight hamstrings (I instruct everyone to bend their knees, at least the first few forward bends, to take the hamstrings out of the equation and stretch the musculature of the low back. Stretching the hamstrings while supine, with the back completely supported by the floor, is a safer option).

Keep in mind, I also work with pretty sever injuries and tend to always go for the safest common denominator!

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Pose Option Sciatica for People who Cannot Do Seated Pigeon

Question

I need suggestions for poses addressing sciatica for seniors who cannot get down on the floor and who cannot cross their legs. Figure 4 Pose is not an option AND they require walkers.

Answer from Melanie

Check out the options that Melanie Starr, Yoga Vista Academy Certified Chair Yoga Teacher, came up with!

Answer from Justine

Those are great options from Melanie!

One thing they could do, to get the piriformis to fire, is stand on both feet – hold on to walker, chair or wall for balance – bring the weight more into one foot. With the other foot, on exhale externally rotate the hip turning the toes outward, inhale return to neutral. Repeat several times to increase circulation to piriformis. Do on both sides. Sit back down in chair, lift one knee up toward chest (or set sole of foot on block) and move knee toward midline of body to gently lengthen piriformis. Then practice Melanie’s option with the side of the foot on a block and external rotation of hip.

Each person will be a little different. Exploration is key, guiding them verbally to go inside and notice any sensation of stretch. For some, lifting the knee in toward chest will give them a nice stretch to the piriformis. If they have a constant ache, and these moves don’t seem to work or help, have them sit in the chair, feet directly under knees – then have them repetitively ‘clench’ their butt cheeks (have fun with the cuing!!) This sounds weird, but it is amazing how it can ‘wake up’ the bottom and increase circulation to the whole hip/buttock area.

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Trouble with Feet and Ankle Position on the Tip-Toe Tadasana Sequence

Question

I had my husband do the “Tip Toe Tadasana Sequence” going up on tiptoe while standing and he found that difficult. I noted that his toes tip up rather than pressing into the mat when the heels come up. Even when I cued him to press his big toe pads into the mat..they still tipped up and he said he found that he was feeling like he was going to fall backwards. My husband’s in good physical condition. He has been working on getting his black belt before he turns 60 so the heat is on. He turns 60 in February but even if he gets it in his 60th year he will be happy. Any idea what’s going on there. He says he feels that he has week ankles. I think it’s something happening further up the movement chain. I would be interested to get your feedback on this.

Answer from Justine

That variation of tadasana is hard for a lot of people. My first suggestion would be to have him lift the heels ever so slightly, just a centimeter or two, to begin with, and over time he can increase the height. Secondly, I had one private client whose toes tipped up as well – in his case it was from nerve damage in his lower back that was affecting his toes (if that is the case I would suggest garshana (body brushing) and abhyanga (oiling) on his feet to stimulate and nourish the nerves). I would also suggest he put one hand on the wall to help steady his balance. If he has weak ankles, this pose is great for strengthening them – and that could also be causing the instability. Further up the movement chain (I like how you worded that!) I would make sure he is engaging his core as that helps a lot with balance (cue belly in, tailbone dropping slightly, sternum lifted). Finally, urge him to have a gazing point on the ground about 12 feet in front of him to focus on, that drishti will help dramatically if he has been looking around while practicing this pose.

Your husband may appreciate this story – one of the first times I did this pose I fell, literally, forward onto one of my teachers (I’m 6’3”, I’m sure she is still terrified!) – In my defense, it was a 6am practice….and, no one was hurt!

Justine

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Urinary/Bladder issues and the Pelvic Floor

Question from a Student:

Since I had my second daughter I’ve been having bladder/urinary issues, and after a lot of reading and doctors’ visits I’m starting to think that at least one source of my problem is with the pelvic floor muscles. The reading I’ve done advises against Kegel exercises for the symptoms I have, as the problem is likely due to pelvic muscle tightness rather than weakness. Would you know or know how I could get advice for yoga routines to relax the pelvic floor muscles? I’ve seen a few exercises on YouTube but am kind of at a loss in terms of a routine that I could practice regularly and hopefully work toward some healing..”

Answer from Viki Boyko:

What are the bladder/urinary issues? Stress incontinence, urge to go to the bathroom? I would first look at taking time out to destress. Nothing makes urgency worse than feeling stressed. 10-20 minutes a day in a constructive rest pose –

– or legs up the wall or another pose that allows you to ‘let go’. If you are holding on to tension in the pelvic floor then you are probably gripping elsewhere too – the jaw? the low back? Is it possible to take a restorative yoga class? Even a few moments focusing on the breath moving through the body may help bring calm – especially where your exhale is longer than the inhale.

There are many muscles and ligaments around the pelvic floor neighborhood that can be helped by yoga stretches. Here’s are some that I might try, though I don’t know if you know what the poses are:

  • Arching and curling the spine (either cat/cow or lying down on your back with knees bent and feet on the floor). to ease and balance the low back and abdomen, both of which are attached to the pelvic floor.
  • Reclined pigeon pose to stretch the piriformis muscle which can be a culprit for pelvic floor tightness.
  • Inner thigh stretch – legs up the wall and take the legs into a wide straddle. Or lie supine with knees lifted over your hips. Relax the lower legs and feet and take your knees wide apart. Open and close the knees slowly with attention to your sit bones moving apart and together.

Keep the backs of the legs – calves and hamstrings stretched too. The lower extremity, hip, abdomen, pelvis, and spine are a connected kinetic chain, any dysfunction along this chain may cause overcompensation and dysfunction of other associated muscles.

Practice squatting. Sit less, walk more. What is caffeine intake? Caffeine can be a bladder irritant.
There are many different ways to effectively stretch and release that area.  I might be inspired to put a little video sequence together that you could use….gosh! Where to start!! Hope this kicks the ball off tho!

Viki

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What are some Cautionary Movements for Knee Replacements?

From Justine:

Knee replacements can be full or partial. A full replacement would be the lower femur replaced with metal, top of tibia replaced (softer and with padding) and sometimes the underside of the patella. The person is usually in the hospital for 3-5 days and in Physical Therapy (PT) for 4-8 weeks- if you know them at the time of surgery encourage them to do the FULL time on their PT.

There are few restrictions on range of motion (ROM), however, it is very difficult to get full ROM back. A long term goal for knee flexion is 0 degrees to 120 degrees. Sometimes the person cannot do full extension – straight leg at 0 degrees, and some people don’t gain more than 90 degrees of flexion. I can’t stress enough how different results can be for various people.

Precautions:

  • Stop at ROM, don’t push.
  • Kneeling can be difficult, in some cases not at all.
  • NO rotation in the knee.

Post surgery

Tracking and functional movement patterns need to be worked with. Get in the pool and walk. Some people start to develop low back and SI joint pain – this is usually due to leg length discrepancy. I always encourage people to research the surgeon extremely well, and to discuss areas of concern. I think the leg length discrepancy is avoidable – but I had one client who was starting to get into distress during surgery and they had to rush to close up. The result was a leg length discrepancy and chronic pain in her back.

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What are some Cautionary Movements for Hip Replacements?

From Justine:

Hip Replacement: It depends indeed!! The MAIN thing you need to know from your student is what the doctor told them NOT to do, and go by that. AND, constant reminders of No Pain No Pain. They should not push through pain. With hip replacements, it depends on the approach (posterior lateral or anterior)….they are going more and more to anterior approaches, and that is not as complicated – the posterior/lateral approach requires the scar tissue from the cut to heal, as that is what stabilizes the joint. If any thing feels weird, have the stop immediately. I have had students with hip and/or knee replacements that you would never know if they hadn’t told you, and I have had students with VERY limited ROM (range of Motion). As far as the knee replacement – a goal is to get at least 90 degrees of flexion back, more can be attained, but it is against the clock as the scar tissue forms very quickly.

Here is an excerpt from an Yoga Vista Academy manual on Hip replacements: Hip Replacement Surgery

Two approaches – Posterior/Lateral and Anterior: Posterior/Lateral has traditionally been the most common, but is also the most unstable. Anterior approaches are done more often on younger, more active people and athletes. Recovery for healing avascular tissue (ie. ligaments) is one year. The scar tissue that forms around the joint helps bind the hip back together. In the posterior/lateral approach, the hip is dislocated and the ligaments are cut.

Precautions/Contraindications for Posterior/Lateral Approach.

• Can’t bend hip (flexion) past 70-90 degrees – even when sitting in a chair. You can dislocate the hip! For at least 3 months, sometimes forever.

• No hip adduction – taking the leg across the midline of the body. For at least 3 months, sometimes forever.

• If feeling funny deep in the joint – STOP.

• Supine twisting – ONLY with support between the knees and NOT past 90 degree hip flexion.

• No internal rotation from neutral.

Precautions/Contraindications for Anterior Approach Hip Replacement

• Precautions are opposite of the posterior/lateral approach.

• No extension of the hip joint, no abduction (moving leg away from the midline) and no external rotation – any combo of these can cause dislocation – one at a time is okay.

In regards to hip replacements, if you know the approach that was used physics will help you remember the precautions – for example, if the back of the hip was cut and someone pulls the knee to the chest, there will be pressure sent to the back of the hip risking dislocation. Always encourage your students to listen to their bodies first and foremost – and if anything doesn’t feel right, don’t do it! Back out immediately and rest.

 

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Yoga pose for a rib that keeps popping out of place

Question

I had a question from one of my students that stumped me? She continuously has a rib that pops out of place. The chiropractor is able to put it back in place. She is wondering if there is anything I could recommend that would allow her to strengthen this area to prevent this from happening?
Thanks!
John

Answer from Justine

I have had a rib pop out of place before – no fun!!

First of all, I would suggest she be very cautious with twists (especially leveraged twists…supine twists can be risky due to the leverage of gravity) as that can be a culprit in the rib popping out. As far as strengthening, I would suggest rolling bridge, moving both ways on exhale, coming down on two full exhales – so she can really slow the movement down. The other thing that would be great is prone back bends such as cobra – doing this repetitively, rising on inhale and coming down on exhale for 3-6 repetitions, then holding the pose for 6-8 breaths. This will help strengthen the spinal erectors and hopefully get that rib more securely in place. (side note – deeper back bends might irritate it)

You might ask her to do a little self study – does she happen to notice what poses cause the rib to pop out of place? Does she take a day or two off practice after the chiropractor puts it in place? Does she happen to know which rib it is, and which side of her body?

After it has popped out like that, it becomes more susceptible to doing it more easily. The chiropractor adjustment can be painful (I STILL remember that, 10 years later!) Once, I just happened to mention it to my acupuncturist and she did ‘cupping’ on it – one treatment it was back in place and it wasn’t painful. That might be something for her to try. (My recollection is that mine didn’t go out again after that….but my memory might be hazy!!)

There might also be fascia adhesions causing this to happen repetitively…..perhaps a therapeutic massage, MELT class, Feldenkrais or Somatics would help.

Those are my thoughts….I hope something is helpful!!

Please keep us posted!
Justine

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Why are Warrior poses not necessarily easy or appropriate for students with SI Joint issues or low back pain or disc damage?

Question

Why are Warrior poses not necessarily easy or appropriate for students with SI Joint issues or low back pain or disc damage?

Answer from Justine

I’m gonna break this down a bit…..Warrior 1 is an asymmetrical back bend, and with one leg forward and one leg back it puts sheer stress on the SI joints – so if someone is in acute pain in either SI it should be avoided. If they aren’t acute, then they could modify by having a shorter stance from front to back- to limit the nutation and counter nutation of each SI joint – as well as hip width alignment in the feet. Warrior I may not be bad at all for someone with back pain, depending on the cause, and it can be very beneficial due to the stretch it can provide for the psoas on the back leg. Warrior I is difficult for people with spinal stenosis as it is a back bend (which can trigger nerve compression and possibly cause a spasm, back bends also decrease the size of the spinal canal by up to 63%, in people with central spinal stenosis they are already compromised and this can create more pain and compression around the cauda equina portion of the spinal cord) – this can be modified by pushing the chest forward to limit the amount of back bend/extension in the lumbar spine.

As far as disc damage and Warrior 1 – it depends. The back bend may help the disc retract (a prone back bend is much more efficient), but if there is acute pain or a pinched nerve involved it should be avoided……pain can be the guide here. Due to the similar alignment in Warrior III, the precautions would be similar – most risky in this pose would be SI joint instability. As far as Warrior II, it can trigger SI joint issues. With other low back conditions, I would say that pain can be the guide…..and the pose can be modified by shortening the stance to see if that helps the practitioner. I hope this helps!

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Is it Safe for Seniors with Undiagnosed Osteoporosis to do Forward Bends?

Question

I just finished a module of my 500 hour YTT on Adaptations and we touched on seniors and osteoporosis.  My teachers said that we should assume that most seniors have some form of osteoporosis, and therefore avoid forward bending, focusing more on spinal extension in the upright position.  Taken from my manual: “There are a number of seniors with undiagnosed osteoporosis who should avoid forward bending at all.  Also, the most common area for spinal fracture in seniors is the front of the thoracic spine; rounding over in a forward bend can literally be the “straw that breaks their back”.”

Answer from Sherry

I so  love this question, because I have a very strong opinion about this topic.  Which is…. are we saying that our seniors can no longer bend for fear of fracturing their spines?  How fearmongering is that attitude?  What about if they dropped something on the floor, or have to feed their pet and bend down?  I find this “no-no-never” attitude about bending unrealistic and even counter-serving for our senior population. What we need to do is teach our seniors how to bend safely.

Check out this video for ways to keep safe forward bends for seniors.
I believe in education and empowerment of our Seniors. Yes, we must acknowledge that Osteoporosis is very common in this student community and be mindful of movements that can be precarious for this condition.  But, we have seen our share of students improve their bone density scores by practicing Yoga – so sprinkling in encouragement is just as important as offering caution.  It is a delicate balance each Teacher must learn and embrace. And I will end it with Justine’s wise words when asked “Should Seniors not bend?”…”It depends…!”
Here are a few more Academy videos that discuss this topic:

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What are the Forward Bending Guidelines for a Herniated Disc?

Question

For a herniated disc, modifications include forward pelvic tilt. It was my understanding that the pelvis should be rolled back to straighten the lumbar spine to alleviate pain in that area. Please clarify this for me.

Answer from Justine

There is a running joke in the Yoga therapy world that every question can be answered with ‘It depends.’ Used to drive me crazy when Gary Kraftsow would answer that way…..but I can’t tell you how often it comes out of my mouth when I mentor my Yoga therapy students!!

With a forward bend (standing or otherwise), the pelvis should be tilted forward so that the sacrum is moving in the same direction as the lumbar spine – otherwise there is a hinge point in the lumbar spine which puts added, undue stress on the anterior portion of the intervertebral discs, adding to the posterior pressure on the disc – which could cause a bulge or cause an already bulged disc to herniate. (Note: seated forward bends are riskiest to the lumbar spine, as the hips are fixed so any brunt of the movement will go into the body) Generally speaking, lumbar discs tend to bulge posterolaterally (to the back, slightly to the side of the spinal cord) which is why we don’t want that undue pressure on the anterior portion of the disc. (I have a disc that bulges straight back to the cord – rare, because the ligamentum flavum is strong and usually prevents that slippage. Lucky me!)

However, if a disc bulges forward (usually from an bad accident or a crazy, wild, extreme Yoga back bend, unfortunately – I’ve only worked with one like that in my career) then that pelvis rolling back to lengthen the back to lengthen the lumbar would be more appropriate when standing to release posterior pressure on the discs and bring the nucleus of the disc more centrally aligned, rather than pushing forward.

As far as tucking, or rolling back the pelvis – it depends! If someone is standing in tadasana, and has an overly lordotic lumbar curve (sway back if you will), then rolling the pelvis back will help to elongate the lumbar curve and bring the spine more into balance. However, a standing forward bend would still necessitate the forward movement of the pelvis to keep the spine from hinging. I find tucking the pelvis more structurally beneficial to people with severe lumbar osteoarthritis or spinal stenosis, as it lengthens and slightly opens the posterior aspect of the vertebrae, allowing more room for the nerves as they exit the spinal column.

The hamstrings can be a major culprit it pulling the pelvis into posterior rotation in a forward bend, which is why it is safer to bend the knees if there are tight hamstrings (I instruct everyone to bend their knees, at least the first few forward bends, to take the hamstrings out of the equation and stretch the musculature of the low back. Stretching the hamstrings while supine, with the back completely supported by the floor, is a safer option).

Keep in mind, I also work with pretty sever injuries and tend to always go for the safest common denominator!

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What are the Guidelines for teaching Yoga to people with Rotator Cuff/Shoulder Issues?

Is it Safe for a Student with Scoliosis to Twist?

From Justine Shelton, AVI-Certified Viniyoga Therapist

I have to start the answer here with, it depends! Is the scoliosis an S curve or C curve? If it is a C curve, is it in the thoracic or lumbar spine? Are there any other co-conditions such as SI joint dysfunction or Lumbar disc damage? These will complicate the condition and add a whole new list of contraindications. IF there is lumbar disc damage, the combination of flexion with rotation while the hips are fixed (ie in the chair) is risky and could further damage the disc – if this is the case, have the person stay seated with the spine tall and do the twist using just core strength to rotate the axis of the spine. If there is SI joint dysfunction, and it is acute, then the same precautions apply. If it is not acute, keep the knees hip width apart to stabilize the SI joints (possibly squeezing a block between the thighs) and limit the flexion of the spine by placing a block on the floor to bring the ground closer. Make sure the students doesn’t use the floor/ground for leverage – twists should be deepened with core strength, not leverage (this is true for all of us!!)

If the scoliosis is stand alone, meaning there aren’t other conditions complicating the issue, twists can be very helpful in balancing out the asymmetry in the musculature on each side of the spine. That being said, ALWAYS let pain be the guide for the student – meaning, if pain is created come out – it is not worth the risk! No pain, no pain!  Axial extension and asymmetrical poses are great for working with scoliosis – axial extension being creating as much space in the spine from tailbone through the crown of the head – lengthening the axis of the spine. Asymmetrical poses work each side of the body independently, so the strong side doesn’t ‘take over’ for the weak side. That being said, asymmetrical poses including the legs (ie standing head to knee pose, Warrior I, etc.) put sheer stress on the sacrum and are contraindicated for SI joint dysfunction. However, standing in tadasana with one arm raised by the ear, on exhale going into uttanasana and on inhale rising (keeping the arm in line with the ear), repeating several times before holding the forward fold, will strengthen each side of the upper back independently while also working with the bio-mechanics of movement for the practitioner, then the hold allows for stretching the musculature more deeply.

It is important to know that what works for one person with scoliosis my not work at all for another. This condition manifests very differently in people, so there is no ‘one size fits all’ pose or practice for dealing with it. Be in congress and communication with your student – the more they tell you how things feel, the better you understand their body and how to serve them with Yoga. I love my students and clients, they are my greatest teachers!

From Leslee R., Gentle Yoga Teacher who has Scoliosis

I am happy to give my input but would definitely say first and foremost that every persons’ experience and reaction to various poses will be different with or without scoliosis.  The seated sun salutation feels wonderful to me and I have no discomfort with the side twisting movement.  As a matter of fact, it feels really great!  I am also comfortable doing the modified sun salutation standing as long as I keep my knees bent generously.

I am able to do most poses but may need to modify some of them. Poses that create discomfort or pain in my body are:

1.) half moon on the floor but I can do in standing

2.) twists lying on my back create pain on my left side ( my scoliosis in the lumbar rotates to the right) in my psoas and/or QL. My favorite twist for my body is the reclining twist on a bolster.  This is very yummy to me and I really relax and release in this twist.  I am also comfortable doing a gentle seated twist.

3.) Lunges are also not my favorite but with the modification of keeping the knee down and using blocks I am able to benefit without discomfort.

Pose that feel good and help my back if I overdue and create muscle tension or spasm are:

1.) Pelvic tilt

2.) Apanasana forward and back and circular

3.) Butterfly

4.) Supported Inversion on a bolster

5.) Tree pose

6.) Windshield wiping my legs while lying on my back, mat width apart

7.) Cat/Cow on hands and knees and also seated

8.) Lateral stretch over a bolster

9.) Child’s Pose with knees wide and arms at my sides

10.) Savasana with a bolster under my knees

I have an S curve scoliosis so the rotation is both in my thoracic and lumbar spine. As I said earlier , depending on the type of scoliosis and the degree of the rotation each persons’ reaction and experience to poses will vary.

I am exploring the side plank after reading the following article:

https://yogainternational.com/article/view/yoga-for-scoliosis-new-research-supports-the-benefits-of-side-plank

It’s a tough pose for me and I am not yet able to do the full extension of the pose.  I do it against the wall on my forearm instead of my hand and my top leg is bent on the floor for support instead of resting on the bottom leg.  (Hope this is clear)  There is a lot of controversy about whether is really helps or not and whether to do it on the convex, concave or both sides.  I do it on both but hold it for a longer time on the concave side.

I also incorporate somatics into my practice which I find beneficial.

Hope this is helpful.

Much love,

Leslee

 

 

 

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Where to get anatomical models?

Question

What brand are the articulated anatomical models Justine uses in her videos? I’ve looked at dozens of different ones online and haven’t found anything I like as well as the ones she uses, that show the muscles, nerves, etc. Do you have a source for those? (Yep, I know I’m talking about $$$.)

Answer from Justine

I think you mean the actual models (my anatomy toys, as I like to call them!!)

I was actually able to find  some of the ones I ordered in the history of my Amazon account.  Unfortunately, the price has gone up since I got mine 7 years ago……one manufacturer is GPI anatomical models  and another is Lake Forest Anatomicals

Here are the links:
Hip with the sciatic nerve, and some lumbar vertebrae – I probably use this one more than my spine model, it is great!

Knee Model 

Rotator Cuff Model

Spine with stand 

Of course, in looking at these, I found more I want!! Danger of the internet!

They are durable and last well – even passing them around a room of a lot of people handling them. They are starting to show some wear and tear, but they have help up great!

Justine

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I have a student with a DBS, an electronic brain stimulating device for Parkinsons. Any Advice?

Question

I have a student with a DBS decice, An electronic brain stimulating device for Parkinsons, and wanted to make sure I was not leading poses that might be dangerous for him. I can not find any resource on the internet about doing yoga or Tai Qi after the surgery. Do you have any advice?

Answer from Justine

I am so happy your student found you and Yoga! My student had a stimulator unit put in her lumbar spine for pain control, so a bit of a different situation. She has since had it removed due to needing an MRI and back surgery – but it sure helped her a lot!

Here is some info on the DBS device I found on the Mayo Clinic site – giving you some ideas as to what the surgery entailed and after effects:

https://www.mayoclinic.org/tests-procedures/deep-brain-stimulation/about/pac-20384562

You are so right about there not being a lot of information – I even googled DBS and movement limitations – nothing!! The main thing they are concerned about are not getting MRI’s or other electrical tests or working around high voltage. Oy! I’m sure they gave all those contraindications to your student. One thing I would suggest is to have your student ask their doctor about movement limitations and if there is anything that needs to be avoided.

From a Yoga therapy standpoint, here are some thoughts:

  • I would be cautious about balance, suggesting having a hand on the wall just in case.
  • I would also be careful about inversions – even a forward bend where the head goes below the heart. Main precaution would be to go into and out of a forward bend very slowly to avoid dizziness. If he happens to have a headache that day, I would avoid inversions and large movements.
  • If he gets nauseous, sitali inhale (through rolled tongue or pursed lips) would be helpful.
  • I would think hand/eye coordination would be very helpful – and Sherry sure gives a lot of ideas for that in her training! Also, left brain/right brain activity – such as a chair class pose extending right knee while raising left arm over head and alternating sides.

Inviting your student to dialog with you can be reassuring for him, and very educational for you. I always tell my students (as I pepper them with questions!) that I am asking so I can better help them, and they can educate me to better help others as well 🙂 Truly, our students are our best teachers.

Do feel free to reach out any time, I am happy to help as best I can…..and, I can learn from you and your student as well!

Much love to you,
Justine

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What would you recommend as best practices for self care for the yoga instructor?

Question

What would you recommend as best practices for self care for the yoga instructor?

Answer from Justine

This is such an important topic, to be sure! Sherry and I spoke, and we will address it one way or another 🙂

In the meantime, some thoughts to consider as far as self care…..

  • Oftentimes, teachers’ own personal practice goes out the window….and it is so important to continue. There doesn’t have to be a long physical practice – 20 minutes a day will do……even if you can only sneak in a restorative pose or two!
  • Yoga Nidra helps me tremendously…..physically, but also mentally/emotionally. I prefer Richard Miller’s teachings….you can find guided Yoga Nidra with him here: 

    https://www.irest.us

      “Resting in Stillness” is my favorite.

  • Garshana and Abhyanga are beautiful self care practices…….I attached a direction sheet for it. You can also learn more about it on LifeSpa.com or BanyanBotanicals.com
  • When demonstrating poses, try to switch sides so that you don’t always demo on one side……that can cause body imbalances and sometimes injury.
  • If you enjoy taking other teacher’s classes, try to schedule that in….just like you would a client, to make it a priority to keep your practice and community in the forefront 🙂

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What resources or “extras” do you add to make your classes different & add connection & value

Question

Looking to learn here 🙂 I often use postcard quotes that randomly go on chairs I I take them back at the end of class but often they mean a lot to people & they ask to keep them or send them to a relative that’s going through a hard time.

I add a reading/meditation at the end of class, I am starting to add a chair yoga dance every few weeks.

I’d be interested in hearing more ideas, we can learn from each other.
Rachel Baer,
Chair Yoga Teacher in East Lyme, Connecticut

Add your suggestions here!

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Help for Trigger Finger

Question

In the last few weeks I have been having pain and a popping when bending the middle finger of the right hand. I mentioned it to my doctor and she said it was trigger finger. She told me to come back if it got worse. As I move through the davit gets less stiff and doesn’t get stuck.

I was wondering if this is something that has come up with yoga instructors. Is it the down dog or just years doing computer work that could give this grief. I am also now feeling the same feeling in the first finger left of the middle finger and the same fingers on the left hand.

I would really appreciate any help and or insight you could give? I have an appointment with a massage therapist coming up next week but should I see a physio or some other kind of specialist in your opinion?

Answer from Justine

I’m sorry you are having that pain! I use the Mayo Clinic site a lot to research conditions, they have a nice write up on trigger finger:

http://www.mayoclinic.org/diseases-conditions/trigger-finger/basics/definition/con-20043819

It is not necessarily from down dog, more likely from using your hands for the keyboard or gripping objects a lot…..cooking, baking, even holding the hair dryer and things like that. Give some thought to your daily life and what you think may be triggering it (pun totally not intended, but I giggled a bit anyway!) If you are on the keyboard a lot, remind yourself to stop every 15 minutes or so to stretch your hands out. I would suggest prayer pose, and then turning the fingers forward and then down…..using the breath like an internal flashlight, maybe even doing Sitali inhale (through a rolled tongue or like you are sipping through a straw) imagining you are drawing that cool air all the way down to your hands and fingers.

First and foremost, I would recommend garshana (dry brushing) and abhyanga (oiling) to help speed up the healing of your hand. (I attached a direction sheet on how to, just in case.) The brushing helps move the lymph (I recently hurt my knee, and the brushing helped move the inflammation so much quicker) For the oiling, you can use coconut, sesame, olive oil or a special one from Banyan for muscles, tendons and joints:

https://www.banyanbotanicals.com/shop/category/herbal-massage-oils/mahanarayan-oil/

(your YA membership will give you 20% off) Do you have the little bumps on your palm at the base of the affected fingers?? You want to really rub the oil into the area…the whole hand really, and I would do the forearms as well. Stretches for the forearms will help ease the pressure on the tendons in the hand. If you notice that you sleep with your fingers curled (I used to, and it aggravated osteoarthritis in my hands) try to be mindful of keeping your hands open….or, maybe use a brace like Mayo clinic suggests……

I would also suggest gentle movement linked to breath for your arm and hand: start with a bent elbow and loose fist, inhale as you extend the elbow, extend the wrist and extend each finger one knuckle at a time (or as best as you can manage!), as you exhale, close the fingers one knuckle at a time, as you bend the elbow and the wrist. Doing that a few times a day to help move prana to the area, and help apana move out of the area 🙂

I don’t think it is time to see a specialist….I think with some of this intervention it should heal up fairly soon. Mayo clinic suggests an NSAID….I would suggest turmeric as a supplement (as long as you aren’t on blood thinners, I don’t think so – but I always say that just in case) – it is anti-inflammatory and increases circulation. I would also ask your massage therapist if your forearms are tight……that can really add to the pressure in the distal tendons of the hands. You could use a wine cork to massage your forearms yourself (the bottle of wine might be helpful in and of itself!)

Those are my thoughts du jour! I hope this helps…please keep us posted.

Much love to you,
Justine (& Sherry too!) ❤

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My shoulder makes a popping sound, should I be worried?

Question:

I found your classes on line and love them. But, I was wondering if in a stretch your joints pop, is that causing damage? Does that mean a stretch is gone too far? My shoulders pop all the time and I don’t want to make them worse.

Answer from Justine:

In classic Viniyoga style, I have to answer with ‘It depends.’  If you are doing hip circles and here a ‘thunk’ that sounds a bit like a pop, it is often a ligament sliding over a bone – as long as it doesn’t hurt, there is nothing to worry about.  Sometimes a joint ‘pop’ is actually air/gas leaving the joint, also not necessarily a problem.  With shoulders, as they are the most mobile joint in the body with the widest Range of Motion (ROM) – what we have in mobility, we give up some stability.  If your shoulders are hypermobile and can pop in and out of the socket, you don’t want to let them pop out, as that will affect the stability of the joint…..keep the shoulder in the joint and don’t go into hyperextension, say in down dog (even with a chair) – meaning, keep your shoulders in line with your ears and don’t let the arms go into a plane behind your head. However, if your shoulders are popping, more like a crunchy sound, that may just be crepitus and scar tissue crackling. Be careful especially if the shoulders are popping in weight bearing poses.

Crepitus

Crepitus /ˈkrɛpɪtəs/ (also termed crepitation) is a medical term to describe the grating, crackling or popping sounds and sensations experienced under the skin and joints or a crackling sensation due to the presence of air in the subcutaneous tissue.

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