Lessons From The Heart: Feed Yourself First

image of three carved hearts

In my recent dissection experience, I spent some time handling a human heart. To literally hold someone’s heart in your hands is a humbling and awe-inspiring experience. Even though its owner had passed and the life force had left, the heart retained a poignant and palpable vibration.

Your heart is your lifelong companion. The medical community would say that we can begin to detect a heartbeat around six weeks; some yogis would offer that this fundamental pulsation begins from the moment that conception produces a unique vibration. The feeling of a heartbeat touches us deeply: babies rest their heads against against it to be comforted and lovers place their hands on it to feel a soulful connection.

More than just a physical organ, many cultures honor the heart as the seat of the soul. In Sanskrit, hridaya is the “spiritual heart,” in which atman (the soul) is believed to reside. The word heart has become synonymous with courage (from the French word coeur, or heart), as well as “soul, spirit, will, desire; courage; mind, intellect,” (retrieved from https://www.etymonline.com/word/heart).

The heart is composed of special muscles cells called cardiac cells. Not only will a group of these cells sync up together to pulse rhythmically, but they are also indefatigable. To appreciate your heart’s special capacity for endurance, try opening and closing your first fist 60 times in a minute and see what happens.

During the lab last week, I learned another wonderful fact about this magical organ: the heart feeds itself first.

The Coronary Arteries

Your coronary arteries (named coronary for their “crown” like wreathing shape) wrap your heart like delicate garden vines. Both the left and right coronary (you have two) connect to the aorta. You may know the aorta: it’s the blood vessel that connects from your heart and spirals freshly oxygenated blood up to your brain and out through your body. What you may not truly grasp about the aorta (I certainly didn’t until I saw it) is that it is massive. As in, bigger than either your esophagus or trachea, sometimes as big as both combined (average about 2.7 cm wide).

As the newly oxygenated blood whooshes from heart out into the aorta, the coronary arteries divert some of this formidable gush back to the heart directly to provide it with oxygen.

  • By Blausen Medical Communications, Inc. – Donated via OTRS, see ticket for details, CC BY 3.0, https://commons.wikimedia.org/w/index.php?curid=26986337

The Heart’s Invitation

The heart feeds itself first.

The human body has many lessons for us. By observing what is true in the body, we can be reminded of natural principles that our intellectual minds may have forgotten or obscured.

For example, many of us have been taught to believe that our own needs must come last; that self-care is an act of selfishness. We compromise our own resources – whether it’s getting enough sleep, taking the time to eat well, or sacrificing our personal time – in a kind but misguided attempt to be a good person.

In the coronary arteries, we can see that Nature offers us a different lesson: nourish yourself first. Ensure that you give yourself the energy and resources that you need to thrive.

The heart shows us that self-care doesn’t adversely affect the rest of the system: the coronary arteries are small vessels that do not impede the abundance of blood from supplying the rest of the body. In other words, a small amount of self-care can be profoundly nourishing. Your hour-long yoga class or twenty minute walk provide benefits that far exceed the time they take.

The heart also teaches us that your act of self-care is essential to the well-being of your entire system (in this case, your system may include your family, your friends, and your community). Ultimately, the rest of the body depends on the heart’s health to live. The “self-serving” aspect of the heart is a loving act that ensures that the rest of system thrives.

As you consider your own self-care, remember the heart’s lesson in compassion: feed yourself first. Then share the fruits of your vibrancy.

Yoga Practice for Back Pain

“So what brings you to yoga?”

“My back!”

So many of my students have started coming to yoga to help with their back issues – and for many, it’s helped! While there is no specific set of yoga postures guaranteed to fix an unhappy back, yoga can often help alleviating some of the triggers that lead to back pain. (Check out this article from one of my favorite physios: Is Yoga Really Good For Your Back.) Caveat: yoga is like any medicine: the wrong dosage for the wrong ailment and medicine can become poison. Dealing with injuries require patience and love. So if you have back pain, see your physio and make sure that the following exercises support your health.

Movement and exercise in general – whether you’re walking, lifting weights, rock climbing, or doing hatha – is good for you on so many levels that it’s almost like swimming in a fountain of youth. What yoga does very well in particular is facilitate low-impact mobility and stretching. The following poses help to both stretch and strengthen your back and hips.

1. Downward dog

Downward facing dog with assist

Downward dog is the ultimate happy back pose. When done properly, it puts the back into mild traction through the opposing action of the arms and legs. Now if you’re a beginner, or have really tight hamstrings, then I’m going to suggest that you do downward dog at your kitchen table. Put your hands on the counter, walk back until you make an “L-shape” with your body. Then press your hands firmly, stretch your chest towards your hands, bend your knees a titch, then pull your hips back into the center of the room. Actively pull yourself in two directions. Like you’re on the medieval rack, but this time it’s nice. What we’re going for here is some decompression through the spine. As a bonus, we get a hamstring and calf stretch. Hold for ten (long, slow) breaths.

2. Hamstring stretch

Supta hasta padangustasana. That’s a mouthful.

Yes, this old chestnut! The hamstrings can sometimes pull your pelvis under, which puts your spine in an unhappy position. Stretching them out can help relieve some of this pull through the back line of your body.

Pictured is my favorite way to do this stretch, because your spine is supported by the floor. That’s nice. Use a strap (or tie, or towel) around your foot. Keep you right hip anchored down and REACH through your heel to STRETCH the back of your leg. Hold for 2 minutes. Yes. 2 minutes. Set a timer. To the get maximum impact out of this, add a little quad work and really try to straighten your leg.

3. Figure four/ thread the needle

mild version
deeper version

Figure four stretches your outer hips, which can often get tight and cranky.

your outer hip muscles: glute max, medius. Minimus is hidden under there, as is piriformis.

Either these muscles are weak and cranky because you haven’t been using them enough, or they are tight through lots of use (that’s my joggers, hikers, bikers). So if you haven’t been strengthening these guys, I’ll suggest that you may want to visit your friendly personal trainer or physio and see if they’re working the way that they should.

4. Locust

A little back strengthening is in order! Locust pose strengthens your spinal extensors. And the good news is, there’s a variation for everyone. Use a strap (or leave your hands unbound) if you have any shoulder issues. Reaching the arms forward is more challenging; this this with discretion. Also, this is a rather low-key, strengthening backbend; “bigger backbends” aren’t better and in fact may not work for all bodies. Do five sets, holding each repetition for 3-5 breaths. You will feel your back engaging, but if you feel any sharp pain, choose a more moderate version or leave your legs down.

5. Back stretch, child’s pose

Nom nom. Rest your hips back on your heels and BREATHE into your lower back. If this is too intense or hard on your knees, take happy baby instead:

Basically, we’re looking for a stretch that gently widens and spreads your back. (If you’re more flexible, a rag dog forward fold can also fit the bill). I like happy baby because it also helps to open up the adductors (groin) muscles.

Conclusion

Functional fitness is about small daily acts. It’s about showing up every day – even if it’s just for 10 minutes – and taking care of your body. This is a perfect little wind down for the end of the day, or a good mid-afternoon stretch (I don’t recommend stretching in the morning; we’re too tight from sleeping). Also, join me on Do Yoga With Me (it’s free!) for some practices that can support back happiness.

Five tips for Practicing A Yoga Headstand Safely

Sirsasana, king of the asana!

Sirsasana and Sarvangasana (shoulderstand) have gotten a bad rap in the past few years. Teachers have become worried about placing pressure on the head and neck – and with good reason! The neck is not meant to bear the weight of the entire body, and certainly not when it’s crooked at a 90 degree angle (which is why you must always prop yourself in Sarvangasana! But that’s for another post).

Sirsasana is a doozy of a pose. Practiced correctly, it is both invigorating as well as calming. However, to protect your neck, you need to keep a few essential guidelines in mind.

Align Your Neck

Your neck should be in its natural, neutral alignment, that is, it needs a slight lordotic curve to be safe. Your neck is happiest when weight can be distributed evenly across the discs. Make sure that the spot where your head meets the floor is at the crown of the head, so you are neither tucking or overextending your neck. If you have a long neck, prop your arms up with folded blankets so you’re not crunching your neck (see video).

Use Your Arms

That said, don’t put weight on your head! Put the weight into your forearms and press them down like a crazy person. Your shoulder girdle should bear the weight of the pose, not your neck. Pay attention to the weight in your forearms, particularly when you’re coming in and out of the pose. You’ll usually get excited and distracted by the entrance and dismount. Move slowly enough so that you can pay attention and press your forearms firmly down.

Have Your Own Back

Recruit the power of your upper back to stabilize your shoulder girdle (see video). If you can’t get your upper back to stay in, then you’re not ready to take your weight up. Work on getting your upper back more into your body until you stabilize your shoulder girdle to create the necessary stability to support your body weight. It’s perfectly fine to stay in a dolphin headstand until you can walk the feet in without the back “falling out.” Yes, I know hamstrings can be an issue.

Use Those Legs!

Activate your legs. Don’t let them just hang there like dead weight, yo! Use your legs to pull your weight up. Squeeze your legs together and go up, up, up. And don’t be impatient to get your legs off the wall; the wall is a sacred friend and will help you find proper alignment.

Be Patient

Sirsasana is an elegant, quiet pose. Getting up into the pose may require patience and tenacity. If you become agitated or anxious while trying it out, then back out. Sirsasana is a pose of control rather than exuberance (handstand is a bit more exuberant). And your weight is on your neck. So no kicking up or wild movement. And in case I haven’t been clear, use a wall. You have enough to think about without worrying about doing a somersault! See this video for step by step instructions.

Let me know if you have questions by leaving a comment below. Happy inverting!

Love-hate relationship with wheel? A physiotherapist explores one reason deep yoga backbends may not work for some bodies.  

Managing a love-hate relationship with wheel pose

Wheel was always one of the poses that came easily to me in yoga. Despite my internally rotated hips limiting me in hip openers, I could do wheel and I could go as high as I wanted. However, as my yoga practice progressed through the years, I began to feel a vague whisper at the height of my wheel…something wasn’t quite right.

Soon after this, while at a power yoga retreat in Costa Rica, my instructor trialed an adjustment in which he did a very high cat pose under me to push me a little higher…unfortunately without asking me first about how I was feeling in the pose and whether I was open to the adjustment.

So impressed by the aesthetics of the pose, my fellow yogis asked me: “How did that feel?” I hesitated to be truthful as I didn’t want to put my teacher down, but quite honestly, it felt as if I had been pushed past the point of safety for my body.

Backbends are a key part of yoga practice.

They have many benefits including countering the flattening of lordosis (natural sway curve of the lower back) that slowly happens with prolonged sitting, stimulating the discs of the spine, stretching ligaments and muscles, and on an energetic level, opening the heart, as well as many more. There is, however, a point for some spines where going to end range and accessing the highest point possible may not be wise.

A little too much range of motion

As you are likely aware, the spine is composed of 33 vertebrae that sit in a curved-column. The upper 24 vertebral segments are separated by discs, attached by ligaments (soft-tissue bands) that move and glide on top of each other, while the lower 9 are essentially fused in most adults (the sacrum and coccyx). The 5 vertebrae that sit on top of the sacrum are referred to as the lumbar spine and this is where I will focus the discussion on backbends here.

Bodies that can do yoga, usually end up in yoga

Yoga tends to be self-selecting, especially in the more physically “advanced” yoga styles such as power yoga. In other words, the more flexible one’s body is, the more likely they are to enjoy and gravitate to those classes because the poses are more accessible to them than to others who don’t have that range available in their joints.

Flexible bodies have the genetic make-up to be able to do a wider variety of yoga poses. There is much to be said about dedication to yoga practice, however how far we will get to in many yoga poses will be largely determined by our genetics and body-type.

The other commonality is that flexible bodies, especially females, tend to identify this ability early on in life. Therefore, if we look at the young girls and women training for gymnastics and competitive dance, they will have a greater than average range in their joints. Their joints will go further than most people’s when pushed to the limit.

These body types may present with a weakness at the lower two segments of L4-5 and L5-S1 (the first sacral vertebrae. This manifests as the top vertebrae slipping forward on the bottom one (see diagram) and happens in end-range extension of the lower back, such as deeper backbends like upward facing dog, camel and wheel pose.

This type of instability is termed a “spondylolisthesis” and can present in varying grades. Grade 1-2 being more minimal and grade 3-5 being more severe. The more severe forms can involve a weakening and fracture of the back portion of the vertebrae, called the pars interarticularis.

Explaining the slip

A certain amount of spondylolisthesis is likely congenital and pre-existing in one’s body. As much as 5-6%  of the general population has pre-existing spondylolysis, many of whom will be completely pain-free.  

However, it is possible that when they begin an activity which stresses this instability through repetitive backbends, they begin to reinforce the looseness in the joint and force it into a forward position where it begins to cause impingement of nerves and stretch ligaments that can bring on feelings of back pain, numbness in the buttocks and legs, and even nausea due to stress on the nervous system and internal organs.

As we age, our joints naturally begin to become less elastic and viscose, the repetitive trauma that our spines have endured through these stresses may start to cause weakness and we may not feel as comfortable going as deep into backbends as we used to.

Common activities involving such repetitive backbends are yoga styles with repetitive vinyasas, gymnastics, and some styles of dance.

Then what?

In my practice as a physiotherapist in downtown Vancouver, an area where there is probably more yoga available than any other city in the world,  I often treat young women presenting with lower back pain during and after yoga practice that I believe is due to some of this instability (explained above) and a mild to moderate spondylolesthesis in their lower lumbar spine

Diagnosing a spondylolesthesis

If you are beginning to notice pain, stiffness or numbness in the hours or days following a practice involving deep back bends, or if these poses are causing you pain, there are tests that a skilled orthopaedic physiotherapist can do to assess you.

Most of the time, there will not be a need for imaging or tests unless a more significant slippage or fracture is suspected.

Managing spondylolesthesis: The good news

Most yoga practice can be adapted and modified to care for these instabilities.

Here’s a few ways:

  • Practice a posterior pelvic tilt: tucking your tail posteriorly tilts your pelvis and helps to tighten and stabilize the lower few segments of the spine. Starting your backbends with a posterior pelvic tilt can help to protect you from shearing the joints.
  • Shift the focus in backbends up into the mid-back (thoracic spine): with all the sitting we do these days at computers and phones, shifting the focus on backbends you’re your upper back can help strengthen of the muscles there, taking some of the pressure off of the lower back.
  • Consider shifting to a style of practice that involves less vinyasas or sit a few out during your current classes.
  • Work on your abdominal muscles to counter some of the flexibility you have in your lower back. Having a tighter superficial core will allow you to better control your backbends and may help compensate for the increased range that you have in your back. Additionally, switching up your routine to include activities that strengthen your core muscles, such as pilates, may be beneficial. (A series of one-one pilates sessions prior to beginning classes if preferable).

These instabilities and the limitations they bring can be gifts in disguise. Yoga should, at it’s core, be about caring for ourselves and our bodies and developing a relationship where we can listen and understand the messages it is sending us.

As we age, so our practice must change and it is with this approach that we can still have a full, satisfying practice – even without deep back bends.

Is Yoga really good for your back?

I hear this question a lot as a physiotherapist. The people who ask me this question range from the skeptical gym rat to the seasoned yoga enthusiasts.

Generally speaking, my answer is yes!

In a 2016 review, yoga was found to be effective in reducing pain and disability, can be performed safely and may improve psychological symptoms. There is an increasing number of spinal problems now that we are tied to our phones and computers. In a 2006 review, the total costs for low back pain in the United States exceeded 100 billion dollars!

As someone whose job it is to improve body mechanics, I believe that yoga can be a positive practice – provided that practitioners know their body’s strengths and weaknesses.

Here are the top three reasons why yoga can be great for your back.

  1. Yoga improves your flexibility and mobility

Moving your whole body in all directions is essential in keeping your joints, muscles and nerves healthy. Learning where you are hypo-mobile (not very mobile) in your body can help you focus your yoga practice on improving your stiff spots. For example, a common stiff area is the thoracic spine, or mid-back. If you are stiff in your mid back, contracting your core more actively in a downward dog can help stiffen your low back and improve your mid back extension.

However, one potential drawback to yoga is that overzealous stretching can lead to injury. If you are already very mobile in an area, pushing further into your range of motion may not be functional or healthy. You can avoid this problem by differentiating where you are “hypermobile” versus where you are “lax”. Hypermobility is movement with control; laxity is movement without control. An example of laxity is a hyperextending knee (hyperextension may show up in standing poses, like triangle or pyramid). For those who are not aware of their own laxity, they might be tempted to push the joint past an optimal range of movement.

One easy way to know you are making already lax joints more lax is listen to your body. When you are pushing past your body’s limits, you may get a range of abnormal sensations like pain, pins and needles, or a sense of apprehension. These warning signs come when a joint is being pushed to the brink of damage or dislocation. Yoga is supposed to feel good. Trust your body’s sensations!

  1. Yoga makes your core stronger

Yoga is a great way to explore different movement combinations. For example, learning to maintain control of your pelvis while moving deep into a lunge is can create flexibility and fortify your core at the same time. Interestingly, strengthening your core can actually help reduce muscular tightness in another area. For example, working on stretching your hip flexors (the muscles that cross the front of the hip) can feel like an endless task. However, strengthening your abdominal wall with a neutral pelvis can actually help relax your hip flexors, thereby leading a stronger and more efficient body.

Breathing can also help you to strengthen your core. The diaphragm, your primary breathing muscle, is actually an intrinsic core muscle. Yoga’s focus on continuing to breath while you do movement can help you to strengthen your core complex. When you contract the pelvic floor while maintaining a flow of breath, the stabilizing muscles of your low back automatically fire. This combination of engagement can lead to gains in all aspects of your body.

  1. Yoga helps control muscle tension

It’s very common to hear that we hold tension in our body. It’s important to differentiate the words “tight” and “tense.” Being tight is a physical state of muscle shortening. However, being tense is actually a behaviour. Often stretching a tense muscle leads to no real gains and sometimes can lead to further tightening. Getting into the proper mindset of being present, breathing full breaths, and clearing your mind of distractions are all helpful in solving tension issues. One of my greatest lessons from yoga is being told that Savasana is the hardest pose in yoga! Simplifying all your thoughts to just yoga while you’re on a mat is hard. Yet letting go of distracting thoughts is essential when trying to relief muscle tension. All the more reason to consider the state of your mind and your focus the next time you are working through a stretch.

Yoga can undoubtedly be great tool to improve the health of your back. But like any other form of exercise, it’s important to know your body well enough so that you can work effectively and avoid injuries. A balance of challenging your flexibility and strength limits with listening to your body’s signals can lead to amazing results.