Early in my career as a Yoga teacher I attended an international Yoga conference in Switzerland. Howard Kent, the founder of a British Yoga and health center, led a workshop called “The Hip Bone's Connected to the Back Bone.” Illustrating with charts and diagrams, he explained the musculoskele-tal system and how all its parts are tied together. Wanting us to experience the effects of that integration, he asked us to form a circle and walk around the room. After a few laps he said, “Now walk on your toes.” Well, as Yoga teachers we were in good shape, but pretty soon we started to notice changes. I expected the balls of my feet to start getting tired and my toes to begin feeling numb. Beyond that, I could feel my calf muscles and knees working harder. To keep my balance, I began to lean forward and look down, thereby changing the natural curve in my back and putting it under stress. After several laps, my body was feeling strained and I had to raise my arms for balance. I looked around the room and it was quite a sight—each person's posture from head to toe was dramatically affected by walking on their toes for just ten minutes. It was a dramatic illustration of how a small alteration in our body's position can have a major effect on its overall alignment.
Your body's alignment and mobility depend on the proper relationships between elements of the musculoskeletal system—the muscles, bones, and joints. Conditions that upset the delicate balance of the musculoskeletal system often manifest as pain in your back, neck, hips, or knees. To understand why Yoga's holistic approach makes sense and how it can help, you need to know a little about the structure of your musculoskeletal system. Let's take a look at your muscles, bones, and joints and see how they respond to Yoga therapy.
Muscles are the body's most abundant tissue, making up about 23 percent of a woman's body and 40 percent of a man's. There are three different types of muscle in the body: cardiac muscle in the heart; smooth muscle in blood vessels and other organs; and skeletal muscle, which is the type we move voluntarily. Along with tendons and other connective tissues, the skeletal muscles provide both stability and mobility, allowing us to hold ourselves upright and to move. These are the muscles we'll be discussing here.
Skeletal muscles provide movement through contractions, working in pairs. The muscle that contracts to provide the movement is called the agonist; its opposing muscle, called the antagonist, releases and lengthens during the movement. The practice of Yoga incorporates both the contracting and the lengthening of muscles. When you hold your arms out to the sides and bend them up at the elbow (in a classic “muscle man” pose), your biceps is the agonist, contracting and shortening; and your triceps is the antagonist, stretching and lengthening. When you relax your arms, both the biceps and triceps return to their resting lengths.
When you lengthen and stretch a muscle, it opens up space for the rich flow of blood it needs to be healthy. A muscle in good condition stays relaxed at its normal resting length until needed, and it has a greater ability to produce a strong and powerful contraction. An overly stressed muscle can remain chronically tense, restricting blood supply and diminishing its strength. Yoga works primarily through gently stretching and lengthening the muscles, thereby conditioning them to be both strong and supple.
The muscles govern the movement of the skeletal system, which is composed of bones, joints, and connective tissues such as tendons, ligaments, bursae, and disks. In Yoga philosophy, joint health is a primary goal because it both influences and reflects the body's overall health.
While a few joints in the body are immovable or slightly movable, most of the joints are “freely movable” and have elaborate structures. Their complexity is one reason they're particularly vulnerable to injury.
A joint is only as healthy as the muscles surrounding it. Relaxed, flexible muscles lead to a more mobile joint. Art Brownstein, M.D., author of Healing Back Pain Naturally,uses the example of a stream running through the woods. Picture a tree branch jutting out from the bank of the stream into the water. At the branch, the flow of the stream is impaired and you will start to see accumulation of debris. If you remove the branch, you will see the stream quickly return to its normal speed, and it will cleanse itself of the debris that had piled up. Like the unobstructed stream, an open, limber joint has good flow and a healthy, clean surface. A major benefit of Yoga is its contribution to maintaining healthy, flexible joints.
The remainder of this chapter encompasses the musculoskeletal disorders typically alleviated through Yoga therapy. Muscle, bone, and joint conditions can be caused by accident or injury, but most often they're the result of problems caused over time by such things as poor sitting posture, incorrect lifting, and even jogging on hard surfaces. Often when these problems are corrected, the corresponding pain diminishes. Many of the muscle and joint pains Westerners have come to expect as a normal part of growing older are not, in fact, inevitable and can be avoided or reversed with Yoga therapy.
“It's a miracle, Larry.” That was music to my ears, even though it was fifteen years after I had treated Robert, a respected screenwriter in Hollywood. He had come to me in desperation, a last-ditch effort to avoid surgery on his chronically aching back. Having seen every specialist in town from orthopedists to chiropractors, he was out of options and still suffering. His diagnosis was “a posterior bulging disk between L4 and L5.” In English, an intervertebral disk (a jelly-doughnut-like pad) in his lower back was bulging backward out of its normal position. It appeared that the pressure of the bulging disk on the nerves was causing pain and numbness in his back and down his right leg. I spoke to his orthopedic doctor, reviewed his diagnosis, and got the go-ahead to begin Yoga therapy. (Depending on the disk problem, certain types of bending and twisting can cause further damage. A regular group Yoga class, in which individual instruction is usually minimal, would have been a big mistake.)
Our one-on-one Yoga therapy treatments began with Yoga breathing to relax the back muscles. I added simple breath and movement patterns, avoiding forward bends and emphasizing gentle arching postures. We discussed his lifestyle, and he admitted spending hours at the computer in a slumped forward position. It was easy to adjust the level of his computer screen so his spine would be upright. The results were stunning. His pain quickly subsided as he responded to the treatment while diligently practicing his Yoga therapy routine twice a day.
After a few short months, Robert was able to attend my group class. He knew what to avoid and how to modify postures to fit his condition. Because he lived on the other side of town, he found a good Yoga center near him, and eventually I lost track of him. Years later, walking through the health club, I heard my name called. Grinning and shaking my hand, Robert told me he'd joined a weekly Yoga class and kept up with it, and his back pain had never returned. Even after all these years, he couldn't conceal his enthusiasm as he admitted he'd thought relief from back pain was an impossible dream.
Most people experience back pain at some point in their lives, and many miss work or even become disabled because of it. Perhaps 90 percent of people with acute back pain get better within a month. While for a number of people the pain subsides within a few months, others develop chronic back pain that persists for months or even years. This is the type of pain most likely to be relieved by Yoga therapy If you suffer from back pain, be sure to read the Yoga Prescription for Musculoskeletal Ailments and Yoga for the Back.
When we think of the back, we usually think first of the spine—a partially flexible column of bones and disks that extends from the base of the skull to the pelvis. It provides the torso's vertical support, and transfers the weight of the upper body through the pelvis and down to the feet. The spine also encloses and protects the spinal cord, a bundle of nerves connecting every area of the body to the brain. The spinal column is uniquely constructed to guard the spinal cord while also providing strong but flexible upper body support.
The spine is made up of vertebrae and their joints, each of which can move in six different directions. (That's a lot of movable parts, increasing the odds of something going wrong.) The vertebrae are bound together by two long, thick ligaments running the entire length of the spine as well as by smaller ligaments between each pair of vertebrae.
The uppermost section of the spine, the seven vertebrae of the neck, is known as the cervical spine. The middle section, made up of twelve vertebrae, is called the thoracic spine, which is the longest section of spine. The lower section is called the lumbar spine, which is the inward-curving small of the back that is made up of five vertebrae. The sacrum is both the base of the spine and the back of the pelvis. As the foundation of the higher levels of the spine, the position of the sacrum plays an important role in the overall alignment of your back. Tip the sacrum too far forward for too long, for example, and the curvature of the whole spine gets distorted and sends you running to your local Yoga therapist.
You might think of the spine as running in a straight line down the middle of the back, but only if viewed from directly behind. Seen from the side, the spine is curved, with each spinal section having its own characteristic curve: the cervical (neck) and the lumbar each curve toward the inside of the body, and the thoracic and the sacral each curve toward the outside (Figure 1).
The spinal curves are important to the structure of the body, acting as a kind of shock absorber and a balancing mechanism for the torso. Distorting the curves, either by increasing or decreasing them, can have negative effects for our overall health. Since the back's proper alignment is paramount, one of the primary goals of Yoga therapy is to restore and preserve the proper curvature of the spine.
The back also consists of a complex musculature, which is tied in with the muscles in your head, arms, and legs. Different muscles in the back can be affected by muscles in other parts of the body. For example, the hamstrings (the back of the thighs) pull on the bottom of the pelvis in a way that tends to affect the lumbar region of the spine. If your hamstrings are tight, they can exert such a tremendous pressure on your spine that they can literally flatten the normal lumbar curve. People with occupations that involve sitting in one position for long periods of time, especially taxi and truck drivers, often have back pain that can be helped by loosening up the hamstrings.
While most back problems are musculoskeletal (related to muscles, bones and joints, tendons and ligaments), back pain can also be caused by kidney infections, ulcers, gastrointestinal distress, reproductive organ problems, other internal organ disorders, and even cancer. For this reason, if you experience severe or persistent back pain, it is imperative to receive a diagnosis from a physician. If tests have confirmed that your back pain is not caused by an underlying organ problem or disease and you are not in an acute stage of pain, then starting with a Yoga therapy program is appropriate and will most likely bring relief.
By far the most common back pain is lower back strain. The pain may start suddenly after heavy lifting or twisting, but the structural weakness was most likely set in place long before, through your patterns of movement or as a result of an accident or injury. Women may first notice back pain in pregnancy, and dads can feel lower back strain after carrying their children. If you sit at a desk for long hours leaning forward toward a computer, if you often wear high heels, or if your job involves heavy lifting, you're a prime candidate for lower back strain.
Herb was a retired seventy-three-year-old movie producer and pianist who had suffered from serious lower back problems and terrible posture since adolescence. As he aged, his back pain worsened, but he had found no relief through traditional medical channels. Easily the stiffest man I had ever treated, Herb had compounded his back problems by playing the piano with poor posture for years. I started by giving him routines specifically targeted for back and neck problems. He was diligent about his daily Yoga practice, and as his symptoms gradually improved, I updated his program to keep up with his progress. Within six months, Herb was engaging in a daily one-hour program and was symptom free after more than fifty years of chronic back problems.
While acute back pain usually heals within a month or two, chronic back pain is less responsive to medical and chiropractic solutions. The good news is that chronic low back pain can usually be managed or eliminated by regular practice of simple Yoga therapy techniques, such as in the Lower Back Routine outlined in this chapter.
Another type of back pain is the result of damaged disks. A normal, healthy spine has a wide range of motion, and the intervertebral disks play a big part in this extraordinary flexibility (Figure 2). You know those jelly-filled doughnuts we're not supposed to eat because they're so fattening? They look a little bit like our inter-vertebral disks. Made of a tough outer ring that surrounds a gel-filled pocket, a disk is positioned between each pair of vertebrae in your spine. Like little shock absorbers, they cushion the vertebrae and soften the forces created by movement such as walking and jumping. You may have heard the term “slipped disk,” layperson's language for what's technically called a herniated disk. The disk doesn't really slip, but its outer ring gives way so that the gel inside bulges out from between the vertebrae and can press against the spinal nerves.
Disk problems usually cause acute pain and require medical attention. Symptoms of disk disorders commonly include numbness or tingling sensations in the legs and feet, or sharp, immobilizing pains in the back. Note: If you have a disk problem, or if you haven't obtained a diagnosis but you have these symptoms, be sure to consult a physician before starting any Yoga practice. If you have acute pain, begin Yoga only with your doctor's approval.
Most disk problems heal on their own over time; however, the pain may be so debilitating or long lasting that your doctor may suggest surgery. Unfortunately, there is no guarantee that back surgery will eliminate the pain. Yoga therapy can be helpful with many disk problems after the acute stage has passed, as long as your doctor feels the movement will not exacerbate your condition. If your doctor approves, follow either the upper- or the lower-back routines described in this chapter, depending on the location of your pain. Remember, if any of the movements increase your pain—stop. Practice only those postures that enhance your feeling of well-being, and do them gently.
Another common contributor to back pain is stress. Many of us are familiar with that tight, tension-filled ache in the neck or shoulders that just yearns to be rubbed or dunked in a hot tub. And someone suffering from undue stress might bend over to pick something up and develop a back muscle spasm, and not be able to get up. Many studies have been performed to investigate the powerful mind–body connection, confirming that our mental stress does influence our muscles.
If you've been in a car accident or suffered an activity-related injury, your back may be feeling the pain for months or even years afterward. Sometimes the pain leads to dysfunctional movement patterns—that is, you compensate for the pain by adjusting your sitting, standing, or walking posture. This puts your body even further out of balance and can lead to other problems in your back, neck, or hips. The tension in the injured area may leave it feeling chronically “tight” and lacking flexibility. The tightness may interfere with healing by preventing good circulation in the injured area. Since Yoga therapy addresses these problems, it can be a great help in treating injury-related back pain. A carefully practiced Yoga therapy routine, such as the back routines given in this chapter, can help or even completely alleviate the back pain. Your Yoga practice may also help you correct any dysfunctional movement patterns or postures you have developed, a crucial step toward healing.
Of all the joints in your body, your knees may be the most susceptible to pain or injury. Our knees are subject to numerous stresses as we go about our daily lives, walking, lifting, and kneeling. When we go all-out in high-impact activities such as jogging, skiing, or playing basketball, we're asking our knees to perform above and beyond the call of duty, especially when we twist and turn, stop and start, or jump. Pain in the knee is usually a direct result of these daily and extraordinary stresses, either from an injury or simply from excessive wear and tear over time.
Cartilage is found in the knee in three places: under the kneecap, on the ends of the femur and tibia, and in the joint itself Abnormal wearing of the cartilage can be caused by trauma or overuse of the knee. Cartilage can be torn by forcefully rotating the knee beyond its endurance. Pain can vary from mild to severe, and there may be swelling.
When the tendons are injured and become inflamed, it is known as tendinitis, which can be quite painful. It is usually caused by a repetitive motion that over-stresses the tendon; “tennis elbow” results from the repeated swing of the tennis racket over weeks, months, or years. Tendinitis of the knee is sometimes referred to as “jumper's knee,” since the high impact of jumping strains the tendons. Pain is usually mild during normal activity but severe when the tendon is being overused, such as in high-impact aerobics or running. The extreme version of tendinitis is a ruptured or torn tendon, which most often occurs in older people whose tendons are weaker and less elastic. When this happens in the knee, it's quite painful and makes bending or extending the leg difficult.
Car accidents and contact sports are often responsible for ligament injury, when there is a direct blow to the knee area. These injuries are also commonly caused by sudden twisting motions, as in the quick stop–start of basketball. Ligament sprains, strains, or tears usually cause pain, swelling, and difficulty walking; often, the knee will buckle and there will be a popping sensation.
When the cartilage of the knee degenerates and gradually wears away, it is known as osteoarthritis. It's usually caused by excess stress on the joint over an extended period. (Be sure to read the more detailed explanation of arthritis in the next section.)
Because knee ailments and patients vary so much, so do their treatments. Your physician will make decisions on how to treat your knee based on the exact nature of the injury or condition, the severity of it, your health history, and your personal preference. Treatments for knee injuries can involve pain medication, physical therapy, exercise programs, applying ice, wearing a brace, limiting activity, or any combination of these. If your knee condition is severe, your doctor may recommend surgery.
The Yoga therapy routine for knees in this chapter is an excellent tool for recovery from a knee injury or disease, and it may be especially effective in rehabilitation from knee surgery to begin restoring flexibility to the joint and strength to the muscles. Be sure to work in conjunction with your physician and/or physical therapist to maximize your healing and avoid further injury.
If you normally approach exercise and sports with the “no pain-no gain” attitude, you might as well drop it right now. It's not going to help you, especially when you're dealing with a joint as vulnerable as the knee. I know all too well what can happen when we Westerners insist on tackling Yoga with a “just do it” mentality.
Twenty years ago, I took a month-long Yoga teacher training course at a remote ashram in southern India. The courses and meals were taught and served on the floor. One of the goals was to sit in the full lotus posture as much as possible, which was very easy for the Indians. Yoga postures were developed in India for people who traditionally used very little furniture, squatted daily for numerous reasons, and kept their knee and hip joints very limber. However, for a mid-thirties, ex-jock male from California, a comfortable lotus position is more of a two-year plan than a thirty-day intensive. Unfortunately, I let my competitive spirit get the best of me. One morning during meditation, I finally twisted my legs far enough to sit very painfully in the full lotus posture. Exuberant because I had reached “the goal,” I ignored the warning signs coming from my knee joints and eventually felt a deep burning in my right knee. After another few minutes I also felt a tearing sensation. I knew something was wrong, but didn't realize until I returned to the United States that I had torn the cartilage in my right knee. I tried for two years to fix it through Yoga and physical therapy but finally had to resort to arthroscopic surgery. Eventually, I was able to use Yoga therapy to assist in my post-op healing, and I've kept my knees healthy ever since.
The point to remember is that the Yoga perspective never involves increasing the pain as a means to an end. As you begin to apply Yoga therapy for recovery from your painful knee, listen to your body. Challenge but don't strain yourself. Don't push yourself into any Yoga posture that causes or increases pain.
If you're suffering from pain in your knees, it is crucial that you see a physician for diagnosis and treatment. People often seek help from a Yoga teacher or therapist when the pain first hits, but the time for Yoga therapy is not in the acute stage, which usually involves severe pain and inflammation. Once you are on the road to recovery and you want to enhance your body's healing process, you should get your doctor's okay before starting a Yoga therapy program. If you suffer from a painful knee, be sure to read the Yoga Prescription for Musculoskeletal Ailments.
Turn on the television any day of the week and you'll be bombarded by commercials aimed at arthritis sufferers. The message is that arthritis equals pain—pain that keeps us from playing the piano, enjoying a round of golf, or holding our grandchildren. Arthritis is so common in our culture that most people, including doctors, have come to accept it as a natural part of growing older. Even though arthritis is not life-threatening, it can steal away your quality of life, forcing you to limit or stop not only the physical activities you enjoy but those you need to get you through the day—like walking, dressing, and cooking.
About forty-two million Americans—nearly 20 percent of our population— suffer from some form of arthritis. A whopping 85 percent of people over age sixty-five show evidence of arthritis on x-ray, and half of those experience symptoms.1It has a huge impact on work and is second only to heart disease as a reason that people leave employment.
Arthritis has everything to do with movement, which is one reason Yoga therapy can be particularly effective for helping it. If you have arthritis, you may be so sore that you curtail your movements. When you don't move enough, your joints freeze up and become stiff, which increases the pain, making you even less likely to move. It's a vicious circle, and the longer it continues, the more functions you may lose. Movement also can be one of the causes of arthritis, particularly stressful or destructive movement patterns over time, and the pain of arthritis can be assuaged through the right kind of movement.
The word arthritis means “joint inflammation,” and there are more than one hundred arthritic diseases, each causing pain, swelling, and stiffness in the joints. The most common type is osteoarthritis. It's sometimes called degenerative joint disease, or wear-and-tear arthritis.
Osteoarthritis means that the joints have worn down over time. Repetitive overuse or injury causes cartilage to be destroyed, leaving the ends of the bone unprotected. The joint then loses mobility and becomes painful. You can get osteoarthritis in the joints of your fingers, feet, hips, knees, or spine; but it's improbable you'd have it in your wrist, elbows, shoulders, or jaw. Arthritic symptoms in these areas are more likely another arthritic condition such as rheumatoid arthritis.
Rheumatoid, or inflammatory, arthritis is the second most common type of arthritis. An autoimmune disorder causes your own antibodies to attack perfectly healthy joint tissues, causing extreme swelling, pain, and redness. The inflammation can jump like fire from one joint to the next, and even into organs. Unlike osteoarthritis, it causes pain and swelling in many joints and locations, not just a specific area. The inflammation is extremely painful and leads to permanent joint damage.
But arthritis affects more than just your joints—your muscles take a hit, too. The National Arthritis Foundation has determined from multiple research projects that much of the pain in a severely arthritic joint is from the muscles, not from inside the joint. Dr. Art Brownstein likens it to putting a cast on a completely healthy arm and leaving it on for a year. When you take the cast off, your arm would be rigid and sore, not because of the joints but because the muscles have atrophied. They'd be weaker, thinner, shorter, tighter, and stiffer. It would become very painful to use them. Similarly, arthritis makes you behave as if your limbs are in a cast unable to move, leading to atrophy, so the aching joint is compounded by aching muscles. Relief is impossible without proper exercise to move the joints and rebuild the muscles. If you have your arthritic knee replaced with a shiny new titanium model but you don't begin a regular stretching and exercise program, eventually your pain will be the same as it was before the surgery, because of those atrophied muscles.
Just because you have achy joints, don't assume you have arthritis. Overuse injuries can result in other conditions such as tendinitis, bursitis, or carpal tunnel syndrome. As always, get diagnosed by a physician before jumping to conclusions.
Of all the testimonials in this book, the one closest to my heart is from my own brother. Harold Payne is a well-traveled performing songwriter with extensive credits including more than hundred recordings by artists ranging from Patti LaBelle to Rod Stewart to long time collaborator, Bobby Womack. At age thirty-nine, Harold was diagnosed with ankylosing spondylitis (AS), a severe form of inflammatory arthritis with no cure. AS affects the spine by attacking the joints, eventually fusing them. It is sometimes referred to as “bamboo spine” and can also affect other joints, such as the shoulders, hips, knees, and feet.
Harold decided to use every resource possible to make the best of the situation. He tried chiropractic treatments, physical therapy, and water exercise in addition to regular Yoga therapy sessions with me and world-renowned Yoga master T. K. V. Desikachar. Under the guidance of a rheumatologist, Harold took nonsteroidal anti-inflammatory drugs (NSAIDs) to reduce pain and suppress inflammation. Another important factor was education from the Spondylitis Association of America.
As a result of his holistic Yoga Rx approach, sixteen years after diagnosis Harold is a role model for AS. He stands tall with good posture, does not need medication, and participates in regular group Yoga classes. He continues to travel and perform internationally and believes his positive attitude despite the illness has had a major impact on his health.
The bottom line on arthritis is that there is no cure. Once the disease gets started, nobody is sure whether it can be completely stopped in its tracks. However, contemporary scientific research and ancient Yoga philosophy both agree it's possible to slow it down and to ease symptoms enough to bring back your enjoyment of life. For an excellent in-depth resource, I recommend the book Preventing Arthritis by Ron Lawrence, M.D., Ph.D., and Martin Zucker. If you suffer from arthritis, be sure to read the Yoga Prescription for Musculoskeletal Ailments, and Yoga for Arthritis.
Both of the authors of this book were introduced to Yoga because of serious, long-term musculoskeletal pain. We tried numerous remedies without success and finally found lasting relief through Yoga therapy. We're each aware of many others with the same experience. So in our opinion, Yoga practiced properly and consistently is one of the best ways, if not the best way, to manage pain in your muscles, bones, and joints.
The benefits of Yoga for these ailments are numerous and in many ways unique among all types of exercise. The routines given in this chapter will relax your entire body with Yoga breathing and create a union of your body, breath, and mind. You will gently stretch and strengthen your muscles without worsening any existing pain. The asymmetrical postures will stretch each side of your body area separately, important because the strength and flexibility of the muscles on either side of the body are frequently uneven from long-term unequal use. Yoga promotes circulation to the injured area, while strengthening the muscles and loosening up chronic painful contractions.
The Yoga therapy routines in this chapter are designed not only to enhance the health of your muscles but also to improve the condition of your joints. Unlike other exercises that may continue to stress your joints, in Yoga you move slowly and gently, practicing postures that gently pull the joint surfaces apart. This is followed by postures that stretch and strengthen the surrounding muscles to support the joint. Yoga also works to correct improper movement patterns that may be causing joint pain, through repetition of the Yoga routine to establish a more healthy range of motion. The combination of stretching, strengthening, and correcting movement patterns increases joint flexibility, supporting healing and allowing pain to diminish.
Since many of us are at risk for muscle and joint problems at some point in our lives, the Yoga routines in this chapter can be used preventatively We especially encourage “weekend warrior” type athletes to practice the routines to reduce the risk of injury from tight muscles and unhealthy joints. People with osteoporosis can improve their balance and overall strength by practicing these routines, to reduce their risk of falls that can lead to bone fracture and subsequent debilitating pain.
While the positive effects of exercise on joint problems have been accepted in the Yoga culture for centuries, the idea is fairly new in the scientific community. Recently, researchers at Philadelphia's Hahnemann University and the University of Pennsylvania School of Medicine presented a paper suggesting that correctly performed Yoga may actually alter cells and protect cartilage tissue, preserving the function of joints.2 Various studies are under way to explore the medical basis for the link between Yoga and joint health.
In years gone by, if you had a knee or back ailment you were given strict instructions to stay off of it. But evidence since the 1980s has turned that advice on its head, with study after study proving that musculoskeletal ailments only get worse with inactivity. So now the old axiom “use it or lose it” is applied to most knee and back problems, and is especially true for those who have arthritis.
Numerous studies have now shown that the best way to prevent and treat arthritis is to keep moving. The U.S. Centers for Disease Control and Prevention released a report to counter mistaken recommendations in the past that persons with arthritis should not exercise because it would damage their joints.3Most physicians recommend a program of flexibility, strengthening, and endurance exercises, which together can improve your general sense of well-being, decrease pain, and possibly even slow the arthritic process. Yoga therapy is uniquely effective for recovery from joint problems because if you do it according to the instructions, there is no bouncing, no impact, and no pushing yourself beyond your limits. Yoga provides exactly the kind of movement an arthritic joint needs, and if your arthritis is severe, Yoga might be about the only exercise you feel you can do.
Yoga has another advantage specifically for rheumatoid arthritis, in that this disease appears to be worsened by stress. Several studies have shown that a program of exercise and stress reduction can greatly reduce the flare-ups of rheumatoid arthritis. A major study published in Rheumatic Disease Clinics of North America suggested that therapies focusing on calming the mind, relaxing the body, and improving general health considerably reduced patients' pain and may have even promoted healing of the arthritis.4
While there are reams of anecdotal evidence establishing the effectiveness of Yoga for musculoskeletal pain, a landmark paper titled “Asana Based Exercises for the Management of Low Back Pain” was the first to scientifically support it.5Conducted at the Indian Institute of Technology, the study involved patients with lower back pain who were given a series of Yoga postures to perform regularly. After six months, 70 percent of the participants reported significant improvement, with near normal mobility and absence of pain. Those whose back pain continued also admitted they had not practiced the Yoga regularly. The results of this study perfectly mirror our experience with patients suffering musculoskeletal pain: When they commit to a regular Yoga therapy practice, most find relief fairly quickly. If you apply Yoga's holistic approach, looking at all the factors in your life that could be contributing to your pain, you may find that your ailments will heal themselves better than you ever thought possible.
Develop a regular exercise program for overall fitness and cardiovascular conditioning. Avoid activities that cause intense pain.
Swimming or exercising in the water is an excellent way to complement your Yoga therapy routine. It will strengthen your muscles and keep you flexible, without putting pressure on your joints. An excellent resource for water exercise is The Water Power Workout by Robert Forster, P.T., and Lynda Huey M.A.
Cycling and walking are also good forms of low-impact cardiovascular exercise.
To avoid stress on your joints, aim for short but frequent exercise sessions.
Look at your patterns of moving and carrying. Be creative in finding ways to reduce stress on your back and your knee and hip joints: Use your legs when picking things up, use carts with wheels when possible, carry lighter loads, or simply get someone else to do the heavy lifting. Take frequent breaks in repetitive motion.
Decrease your sedentary time. If you are required to sit at a desk for many hours, take breaks at least once an hour to walk around. Instead of watching television in the evening, try taking a walk (as your pain allows).
If you're overweight, losing just ten pounds can significantly reduce the strain on your knees and back, relieving arthritis and other types of pain.
Eat a wholesome diet to increase your general sense of well-being, making sure to get plenty of calcium for healthy bones. You can get enough calcium by taking a supplement or including in your diet calcium-rich foods, such as dairy products, salmon, and dark green leafy vegetables. Keep in mind that Yoga therapy is best once you're out of the acute stage of pain. The Yoga routines in this chapter are excellent for chronic mus-culoskeletal pain problems and rehabilitation from surgery or an acute episode.
Talk to your doctor about using pain relievers and/or nonsteroidal anti-inflammatory drugs such as ibuprofen and acetaminophen. Make a serious effort to reduce the mental stress in your life, which often shows up as pain in your back or neck and which can exacerbate arthritis. Doing Yoga is a stress buster.
Wear low-heeled shoes that fit properly and give good support to help maintain your balance and leg alignment.
Glucosamine and chondroitin sulfate have been in the news lately being touted as arthritis remedies. Each is a natural substance found in and around cartilage. If you are diabetic or obese, you should stay away from glucosamine. We recommend you discuss with your doctor whether these supplements are appropriate for you.
Capsaicin, a component of red hot peppers, has been shown to provide arthritis pain relief when applied as a skin preparation. It appears to do more than just mask the pain, providing long-term relief from pain when used regularly. It is available in over-the-counter preparations, but should be used with extreme caution because even a miniscule amount in your eyes can cause severe burning and irritation.
Approach Yoga and any other exercise slowly, especially when joints are stiff or muscles are tight. Being too aggressive can make it worse.
Practice the appropriate Yoga therapy routine from this chapter. Start with two or three days a week, working toward five to six days a week.
Yoga for the Back
Lower Back Routine
The following is a program for lower back strain, or for the rehabilitation of chronic back pain, similar to the one I devised for Herb. When you begin, do only Phase One postures, those marked with an arrow, for two to four weeks. This will take about twenty minutes. When you are ready for Phase Two, use all of the postures in the order they are presented. Phase Two will take about thirty minutes. Use Belly Breathing or Focused Breathing throughout. As you become more comfortable, you can incorporate the more advanced breathing technique called Victorious Breath. Ideally, practice the routine twice a day until your condition improves, then practice it once a day. When you feel your condition has subsided, you may cut down to three times a week.
Caution:This routine is not for anyone in acute or severe pain. If your pain is accompanied by other symptoms, such as numbness or weakness in your legs, it is advisable to check with your doctor before using this program.
Bent-Legs Corpse
This is the classic posture for relaxation of the mind–body. Bending your legs supports your back.
Lie on your back with your arms at your sides, palms up.
Bend your knees with your feet on the floor at hip width. If your head tilts back or if your neck or throat is tense, use a pillow or folded blanket under your head. Stay in the posture for 8 to 10 breaths.
Relax with your eyes closed.
This easy stretch relieves stiffness, misalignment, and discomfort in the lower back. You can also use it for compensation after back bends and twists. (Note: Knee to Chest is different from Knees to Chest, which appears elsewhere in the book.)
Lie on your back, with your knees bent and feet on the floor at hip width.
As you exhale, draw the right knee into the chest. Hold your shin just below your knee. If you have knee problems, hold the back of your thigh near your knee.
If it feels comfortable, slide your left foot and leg down slowly to their full extended position on the floor, keeping your right knee at your chest. If this causes discomfort, bring your left leg back into the bent-knee position.
Stay in this posture for 6 to 8 breaths. Bring both legs back to the bent-knee position.
Then repeat on your left side.
This simple arm movement gently stretches the muscles of the upper and lower back, working each side of the back separately, since so many back problems are asymmetrical, or one sided. It also promotes circulation to your neck and shoulders.
Lie flat on your back with your arms at your sides, palms down. Bend your right knee and place your right foot on the floor.
As you inhale, slowly raise both arms up and overhead touching the floor behind you, palms up. Pause briefly.
Exhaling, bring your arms back to your sides.
Repeat the arm raise 4 to 6 times. Then lower your right leg.
Bring your left leg to the bent knee position. Repeat the arm raise 4 to 6 times.
This exercise strengthens your entire abdomen, focusing on your lower abdomen below the navel.
Lie on your back with bent knees, feet on the floor at hip width. Place your arms at your sides, palms down.
Take a deep breath, and as you exhale, slowly push your lower back down into the floor for 5 to 7 seconds. You should feel your lower abs contracting and the curve of your lower back flattening.
As you inhale, release your back.
Repeat 6 to 8 times.
In these crunches, the emphasis is on slow, controlled movement. They strengthen and tone the abdomen, especially the upper abs above the navel. They also strengthen the inside of the thighs (adductors), the neck, and the shoulders.
Lie on your back, bend your knees, and place your feet on the floor at hip width.
Turn your heels out and toes in (pigeon-toed). Tilt your inner knees together until they touch.
Interlace your fingers behind your head, and hook your thumbs under the angle of the jawbone, slightly below the ears.
As you exhale, push your knees together firmly, tilt your pelvis toward your navel, and use your abdominal muscles to slowly sit up, keeping your hips on the floor. Go only halfway up, so that about half your back is off the floor. Keep your elbows wide and to the sides, in alignment with the tops of your shoulders, using your hands to support your head. Look toward the tops of your knees. Do not pull your head up with your arms.
As you inhale, slowly roll back down.
Repeat 6 to 8 times.
This posture can be used for compensation after abdominal exercises. It promotes circulation to the neck and the shoulders while strengthening and stretching the back, shoulders, hips, and thighs.
Lie on your back, bend your knees, and place your feet on the floor at hip width.
Relax your arms at your sides, palms down.
As you inhale, use your abdominal muscles to raise your hips halfway up. Pause. Then lift your hips as high as you feel comfortable. Do not go past halfway if it causes you any back pain.
As you exhale, bring your hips back to the floor.
Repeat 6 to 8 times, remembering to pause halfway up.
This stretch feels great on the hamstrings, and prepares the body for numerous sitting, kneeling, and standing postures.
Lie on your back with your knees bent, feet on the floor at hip width. Relax your arms at your sides, palms down.
As you exhale, bring your right knee toward your chest, and hold the back of the right thigh with both hands just below your knee.
As you inhale, extend your right leg up toward the ceiling, as high as feels comfortable. Do not force it—your leg does not need to be fully locked out. Keep your foot flexed. Bring your entire leg as close to your head as you can.
As you exhale, return your leg to the bent position, but don't return your foot to the floor. Keep your head and the top of your hips on the floor. If the back of your head tilts back or your throat tenses while raising or lowering the leg, place a pillow or blanket under your head.
Repeat the leg extension 3 to 4 times. Then hold the extended leg with your hands interlaced on the back of the thigh for 6 to 8 breaths.
Return both legs to bent-knee position with your feet on the floor. Repeat the entire sequence using your left leg.
This posture helps improve your overall balance and stability.
Start on your hands and knees with the heels of your hands directly below your shoulders, your knees at hip width.
As you exhale, slowly slide your right hand forward and your left leg backward as far as they will go on the ground. Pause briefly.
As you inhale, raise your right hand and left leg up as high as you feel comfortable or until they are both parallel to the floor. As you exhale, bring them both down to the floor, keeping them in the extended position.
Repeat the lifting motion 3 times; then hold in the lifted position for 4 to 6 breaths.
Repeat the sequence with your left arm and right leg. Return to the starting position on your hands and knees.
Sitting Cat
This is a gentle stretch for your lower back, helping it relax and loosen up any tension. It is often used as a compensation posture after back bends or back stretches, which is how it's being used here.
Start on your hands and knees with the heels of your hands directly below your shoulders and your knees at hip width. Look down slightly.
As you exhale, sit back on your heels. Relax in the posture and try to rest your torso on your thighs and your forehead on the floor. Do not force yourself beyond your comfort zone.
Repeat 3 times, then relax with your head down and arms in front (as in Step 2) for 6 to 8 breaths.
The Cobra increases flexibility to the lower back and strengthens the arms, chest, and shoulders. It opens the chest to promote a deeper breathing pattern.
Caution:If the Cobra causes any pain or discomfort, replace it with the Sphinx (described next). If both postures cause discomfort, leave them out.
Lie flat on your belly, legs at hip width, with the front of your feet on the floor. If you have lower back problems, it is important to separate your legs slightly wider than your hips and to turn your heels out.
Rest your forehead on the floor and relax your shoulders. Place your palms on the floor with your thumbs near your armpits and your fingers facing forward. Your elbows should be bent close to your sides.
Inhaling, engage your back muscles, push your palms down against the floor, and lift your chest and head, looking straight ahead. Leave the front of the pelvis on the floor and keep your shoulders dropped and relaxed. Push yourself as high as feels comfortable, keeping your elbows bent, unless your back is very flexible. To make this easier, move your hands farther forward. To make it more challenging, move your hands farther back.
Exhaling, lower your torso and head slowly back to the ground.
Repeat the lift 6 to 8 times.
Use the Sphinx if you are not ready for the Cobra. The Sphinx emphasizes flexibility of the upper back and strengthens the arms, chest, and shoulders. It opens the chest, promoting a deeper breathing pattern.
Lie flat on your belly, legs at hip width, tops of your feet on the floor.
Relax your forehead on the floor and release your shoulders. Place your forearms on the floor, palms turned down, near the sides of your head.
As you inhale, push your forearms against the floor, and lift your chest and head. Look forward and straight ahead. Your forearms and the front of your pelvis should stay on the floor. Try to keep your shoulders relaxed.
As you exhale, slowly lower yourself down to the floor.
Repeat the lift 6 to 8 times.
Prone Resting Posture
This is a relaxing posture, similar to the Corpse. Use it to rest your back after doing prone (lying on the belly) back bends like the Cobra or Sphinx.
Lie on your belly, legs at hip width with the front of your feet on the floor.
Gently place your forehead on the floor or turn your head to one side. Bend your elbows, and rest your forearms on the floor. Turn your palms down, and place them near the sides of your head.
Hold the posture for 6 to 8 breaths.
This posture strengthens the entire trunk, including the lower and upper back, neck, arms, shoulders, buttocks, and legs. It also helps build overall stamina.
Caution:Be careful not to strain your back when doing this posture. If necessary, use the options in Step 3 to make it less strenuous.
Lie flat on your belly with a folded blanket under your hips. Place your legs at hip width with the front of your feet on the floor. Rest your forehead on the floor.
Rest your arms on the floor along the sides of your body, palms down.
Inhaling, raise your chest, head, and right leg. If the pose is too strenuous, try just bending the leg at the knee. For an even easier variation, raise the chest without lifting the leg at all. To make the posture more challenging, raise both legs.
As you exhale, lower your trunk, head, and leg slowly to the floor.
Repeat the lift 6 to 8 times.
Repeat with your left leg.
Sitting Cat
Repeating this gentle stretch for the lower back will help it relax and loosen up any tension. (If you have knee or hip problems, replace the Sitting Cat with the Knees to Chest, described.)
Start on your hands and knees, looking slightly down, with the heels of your hands directly below your shoulders and your knees at hip width.
As you exhale, sit back on your heels and bring your head toward the floor. Work toward resting your torso on your thighs with your forehead on the floor, but do not force it. Only sit back as far as comfortable.
Repeat 3 times and then relax in the posture with your arms in front, for 6 to 8 breaths.
This gentle twisting motion promotes circulation to your back. It tones the abdomen and usually feels great to those of us with stiff backs.
Caution:Move carefully and slowly while executing a twist. If you experience any pain or discomfort, leave the twist out of your routine until you can check with your health professional.
Lie flat on your back, knees bent, feet on the floor at hip width. Place your arms straight out from your sides in a T, palms down, level with your shoulders.
Exhale and slowly lower your bent legs to the right side, turning your head to the left. Your shoulders and head remain flat on the floor, but your left hip will come off the floor. While in this position, your entire right leg will be resting on the floor; the left leg is on top of it and does not touch the floor.
Inhale and bring your bent knees back to the middle, placing both feet flat on the floor. Exhale and slowly lower your bent knees to the left, turning your head to the right.
Repeat, alternating legs, 3 times slowly. On the last repetition, hold to each side for 6 to 8 breaths. Then bring your bent knees back to the middle.
This posture relieves stiffness, misalignment, and discomfort in your lower back. It releases abdominal gas and relieves menstrual cramps. We are using it to compensate for the strenuous twisting of your back in the previous posture. (Note that Knees to Chest is different from Knee to Chest, which appears elsewhere in the book.)
Lie on your back with your knees bent, feet on the floor at hip width. Bring your bent knees toward your chest and hold on to the top of your shins, just below your knees, one hand on each knee. If you are having knee problems, hold the backs of your thighs, under your knees.
As you exhale, draw your knees toward your chest. As you inhale, move your knees a few inches away from your chest, rolling your hips to the floor.
Repeat 3 times and then stay in the folded position for 6 to 8 breaths.
Bent-Leg Corpse with Long Exhale
This is the classic posture for relaxation of the mind–body, with bent legs to support your back.
Lie on your back with your arms at your sides, palms up. Bend your knees with your feet flat on the floor, approximately hip width. If you like, place pillows or rolled blankets under your knees for comfort.
Close your eyes and relax. If your head tilts back or your throat is tense, use a pillow or folded blanket under your head.
Gradually increase the length of your exhalation until you reach your comfortable maximum. Repeat for 20 to 30 breaths, and then gradually return to your resting breath for 5 to 10 breaths before you get up.
This relaxation pose promotes circulation to the legs, hips, and lower back and has a calming effect on the nervous system. You can substitute it for the Corpse if you like. You will need a chair with a sturdy level seat.
Lie on your back with your knees bent, feet on the floor. Place the chair (with the front edge of the seat turned toward you) just in front of your feet. Lift your feet off the floor and lay your calves on the seat, with the front edge of the seat snugged into the backs of your knees. If your head tilts back, place a blanket under your head.
Cover your eyes with a towel or eye bag.
Gradually increase the length of your exhalation until you reach your comfortable maximum. Repeat for 20 to 30 breaths, and then gradually return to your resting breath for 5 to 10 breaths before you get up.
The following is a preventative program for the rehabilitation of chronic neck and upper back pain that can be used to prevent neck and back problems. When you begin, do this ten-minute routine for two to four weeks. When you are ready add the Phase One exercises from the Lower Back Routine for two to four weeks. The total routine should take about thirty minutes. When this is comfortable, you can use the entire Lower Back Routine instead. Use Belly Breathing or Focused Breathing throughout. As you become more comfortable, you can incorporate the more advanced breathing technique Victorious Breath. Ideally, practice the routine twice a day until your condition improves, then practice it once a day. When you feel your condition has subsided, you may cut down to three times a week.
Caution:This routine is not for anyone in acute or severe pain. If your pain is accompanied by other symptoms, such as numbness, tingling, or weakness in your arms, it is advisable to check with your doctor before using this program.
Seated Posture
This posture will be used for all the upper back and neck routines.
Sit comfortably in an armless chair, bringing your body slightly away from the back rest.
Let your arms hang down by your sides. Place your feet evenly on the floor at hip width. If your feet do not touch the floor, place a folded blanket or a phone book under them. Your thighs should be parallel to the floor with your knees and hips bent at approximately a 90 degree angle.
Place your hands on your thighs with your fingers toward your knees. Bring your back up nice and tall, and gently pull your head back until your ears, shoulders, and hip sockets are in alignment.
Hold for 8 to 10 breaths.
This simple arm movement gently stretches the muscles of the upper and lower back, working each side of the back separately, since so many back problems are asymmetrical, or one sided. It also promotes circulation to your neck and shoulders.
Start in the Seated Posture.
Let your arms hang at your sides, palms turned back. Look straight ahead.
As you inhale, raise your right arm forward and up overhead until it is vertical.
As you exhale, bring your right arm down to the starting position.
As you inhale, raise your left arm forward and up overhead. Exhale on the return.
Repeat 4 to 6 times, alternating arms.
Shoulder Rolls
Shoulder Rolls help increase the range of motion in your shoulder joints. Do them slowly, focusing on each part of the movement and coordinating with your breath.
Start in the Seated Posture.
Let your arms hang at your sides, palms turned back. Look straight ahead.
As you inhale, roll the shoulders up and back, as if you were doing a giant shrug.
As you exhale, drop your shoulders down.
Repeat 4 to 6 times.
Reverse the direction and repeat 4 to 6 times.
This simple movement gently works your upper back and opens up your chest.
Start in the Seated Posture.
As you exhale, join your palms in the prayer position, thumbs at the breastbone.
As you inhale, separate your hands and stretch your arms like wings to the sides at shoulder height. Your wrists stay flexed, your fingers pointing toward the ceiling and your palms facing away from you. Look straight ahead.
As you exhale, join the palms again at the breastbone.
Repeat 4 to 6 times.
This exercise stretches your neck and upper back.
Start in the Seated Posture.
Place your hands on your thighs, palms down. As you inhale, raise your right hand up to eye level with the fingers pointing upward and your palm facing away from you. Hold your hand at a comfortable distance, as if you were looking into a mirror on the back of your hand.
As you exhale, bring your right hand toward you and place the palm on the top of your left shoulder. Turn your head to the left and down, watching your hand.
As you inhale, move your right hand away from your shoulder at eye level, with your arm extended with your elbow slightly bent. Keep going around the front and continuing all the way to the right. Follow your hand with your eyes, and stop the movement when your head is as far as it can comfortably turn to the right.
As you exhale, bring your hand back in front of you as in Step 2, then lower your hand down to the starting position.
Repeat slowly, alternating the right and left side, 4 to 6 times each.
This movement gently stretches your upper back and neck, while opening the chest and working the shoulders.
Start in the Seated Posture.
Place your hands on your thighs, palms up. As you exhale, raise both hands to eye level, palms facing you as though you were holding an open newspaper.
As you inhale, move your open hands forward, up, and overhead, keeping a slight bend in your elbows and your shoulders dropped. Follow your hands with your eyes and head. Stop when your hands are directly over your forehead.
As you exhale, bring only your chin down toward your chest.
As you inhale, bring your elbows back and apart from each other, turning your palms forward and flexing your wrists backward. Lift your chin off your chest and look straight ahead, pressing your elbows back.
As you exhale, round your back forward like a camel, bringing your bent arms forward so that they are in front of you. Keep a slight bend in your elbows. Your arms should be roughly parallel to the floor, with your arms and ears in alignment.
As you inhale, return to the starting position; then exhale.
Repeat 3 to 4 times.
This gentle twisting motion promotes circulation to your back and tones the abdomen and rejuvenates the spine.
Caution: Move carefully and slowly while executing a twist. If you experience any pain or discomfort, leave the twist out of your routine until you can check with your health-care professional.
Sit sideways on a chair with the chair back to your right, feet flat on the floor, and heels directly below your knees.
Exhale, turn to the right, and hold the sides of the chair back with your hands. If your feet are not comfortably on the floor, place a folded blanket or a phone book under them.
As you inhale, bring your back up tall, as if you were trying to touch the ceiling with the top of your spine.
As you exhale, twist your torso and head farther to the right.
Return to the starting position. Repeat the twist, gradually twisting farther with each exhalation for 3 breaths, but do not go beyond your comfort zone. On the last repetition, hold the twist for 4 to 6 breaths; then return to the starting position.
Repeat the same sequence on the opposite side.
This posture stretches your lower back and flexes your hips.
Start in the Seated Posture.
As you exhale, bend forward from your hips and slide your hands forward and down your legs. Hang your head and arms down, and relax in the folded position for 6 to 8 breaths.
Roll your body back up to the seated position.
Seated Relaxation with Long Exhale
Start in the Seated Posture.
Close your eyes and begin Belly Breathing. Gradually increase the length of your exhalation until you reach your comfortable maximum.
Repeat for 20 to 30 breaths. Then gradually return to your normal breath for 5 to 10 breaths before you get up.
The following program is for the rehabilitation of injured knees. If you have had a serious injury or you are in acute pain, you should talk with your physician before practicing Yoga therapy This routine takes approximately twenty minutes and should be practiced using Focused Breathing or Belly Breathing. Ideally, practice the routine twice a day until your condition improves, then practice it once a day. When you feel your condition has subsided, you may cut down to three times a week.
Bent-Legs Corpse
This is the classic posture for relaxation of the body and mind, modified by bending the knees. The bent knees add support for the lower back.
Lie on your back with your arms at your sides, palms up. Place pillows or rolled blankets under your knees for comfort.
Bend your knees with your feet on the floor at hip width. If your head tilts back or if your neck or throat is tense, use a pillow or folded blanket under your head. Stay in the posture for 8 to 10 breaths.
Relax with your eyes closed.
This calming posture flexes the hips and knees and promotes circulation to your lower body.
Lie on your back with your knees bent, feet on the floor at hip width.
As you exhale, bring your bent knees toward your chest and hold on to the back of your thighs, just above your knees. You should feel a gentle stretch in your lower back and hips.
As you inhale, move your knees away from your chest, but do not lower them all the way to the floor.
Repeat 6 to 8 times, then return your legs to the floor in the bent-knee position.
This gentle stretch loosens up your hamstrings and flexes your hips.
Lie on your back with bent knees and feet on the floor at hip width. Relax your arms at your sides, palms down.
As you exhale, bring your right knee toward your chest, and hold the back of your right thigh with both hands just below your knee.
As you inhale, extend your right leg toward the ceiling as high as you feel comfortable, continuing to hold your leg. Do not force it—your knee does not need to be fully locked out. Keep your foot flexed.
As you exhale, return your leg to the bent position. Keep your head and the top of your hips on the floor. Place a pillow or blanket under your head if the back of your head tilts back or your throat tenses while raising or lowering the leg.
Repeat the leg extension 3 to 4 times. Then hold your extended leg with your hands interlaced on the back of the thigh for 6 to 8 breaths.
Lower your right foot to the floor.
Repeat with the left leg.
This exercise strengthens and tones your abdomen, especially the upper part above the navel. It also strengthens the inside of your thighs (adductors) as well as your neck and shoulders.
Lie on your back, bend your knees, and place your feet on the floor at hip width.
Turn your heels out and toes in (pigeon-toed). Tilt your inner knees together until they touch.
Interlace your fingers behind your head, and hook your thumbs under the angle of the jawbone, slightly below the ears.
As you exhale, push your knees together firmly, tilt your pelvis toward your navel, and use your abdominal muscles to slowly sit up, keeping your hips on the floor. Go only halfway up, so that about half your back is off the floor. Keep your elbows wide and to the sides, in alignment with the tops of your shoulders, using your hands to support your head. Look toward the tops of your knees. Do not pull your head up with your arms.
As you inhale, slowly roll back down.
Repeat 6 to 8 times.
This simple exercise stretches and tones the insides of your thighs (adductors) and groin. It also helps bring circulation to the pelvis area and the lower back.
Lie on your back with your knees bent, feet flat on the floor 8 to 12 inches from your buttocks. Place your hands at your sides, palms down.
As you inhale, slowly open your legs wide toward the floor, and join the soles of your feet together. You should feel a nice gentle stretch in your inner thighs.
As you exhale, slowly bring your knees back together.
Repeat 3 times, then stay in the open position (Step 2) for 6 to 8 breaths. Then bring your knees back together.
This seated posture strengthens your thighs, the deep hip flexors (psoas), and the muscles of the legs that support your knees.
Sit on the floor with your legs extended in front of you and with your back up tall. Place a tightly rolled Yoga mat or folded blanket under your knees. Put your palms on the floor behind you with your fingers pointing toward your hips, or put your back up against a wall.
As you exhale, tighten your right thigh and flex your right foot. Point your toes back toward you, extending your right heel forward as if you were pushing against something solid. Hold for 5 to 8 seconds, continuing to exhale.
Inhale. Then slowly exhale, keeping your right leg firm and raising it until the right heel is just above the toes of the left foot. Hold for another 5 to 8 seconds, continuing to exhale. Don't force it, just raise your leg as high as possible. Keep your chest lifted and your shoulders dropped.
As you inhale, relax your right leg and bring it back down to the starting position.
Repeat with the left leg, and then alternate 6 to 8 times on each leg.
Locust with Support (Modified)
The posture strengthens your hamstrings and the muscles that support the back of your knee and your buttocks. It is a nice stretch for your lower back.
Lie on your belly, with a folded blanket under your hips and rib cage to prevent hyper extending your lower back. Keep your legs slightly apart with the tops of your feet on the floor.
Place your forearms on the floor in front of you, parallel with each other, with your elbows aligned below your shoulders.
As you inhale, raise your chest to a comfortable level supported by your forearms, and then raise your right leg backward as high as comfortable.
As you exhale, bend the right leg, bringing your heel toward the buttocks, until your leg makes a right angle.
As you inhale, straighten the right leg. Repeat Steps 4 and 5, for 6 to 8 times. Rest for a few moments on your belly as in Step 1; then repeat the entire sequence with the left leg.
This posture is repeated in this routine to increase circulation to the hips and knees. It should feel great in your lower back.
Lie on your back with your knees bent, feet on the floor at hip width.
As you exhale, bring your bent knees toward your chest and hold on to the back of your thighs, just above your knees. You should feel a gentle stretch in your lower back and hips.
As you inhale, move your knees away from your chest, but do not lower them all the way to the floor.
Repeat 6 to 8 times, then return your legs to the floor in the bent-knee position.
Legs on a Chair
This relaxation technique uses a chair to improve circulation to your feet, legs, hips, and lower back. It has a calming effect on your nervous system.
Place a chair in an area where you have room to lie down in front of it.
Lie on your back with your knees bent, feet on the floor. The front edge of the chair's seat should be turned toward you, just in front of your feet.
Lift your feet off the floor, and lay your calves on the chair seat, with the front edge of the seat tucked into the backs of your knees. If your head tilts back, place a blanket under it.
Use Belly Breathing with a long exhale or the Healing Triangles for 20 to 30 breaths.
The following program helps manage the pain of arthritis. This routine is designed to increase circulation and range of motion in your joints. If you have arthritis in your knees or back, use the specific routines for those body parts, given earlier in this chapter. For arthritis of the hands, arms, and feet, use this routine. The program takes approximately twenty minutes and should be practiced using Focused Breathing. Ideally, practice the routine twice a day until your condition improves, then practice it once a day. When you feel your condition has subsided, you may cut down to three times a week.
Seated Posture
This simple seated posture helps relax your nervous system and link your body, breath, and mind in preparation for the subsequent exercises. You will be using this posture for much of this routine.
Sit comfortably in a sturdy armless chair, bringing your body slightly away from the back rest.
Let your arms hang down by your sides. Place your feet evenly on the floor at hip width. If your feet do not touch the floor, place a folded blanket or a phone book under them. Your thighs should be parallel to the floor with your knees and hips bent at approximately a 90 degree angle.
Place your hands on your thighs with your fingers toward your knees. Draw your head slightly back, centering it over your shoulders and your torso. Imagine a straight line running vertically from your ears, straight down through your shoulders and ending at your hips. Keep this line straight, but don't force yourself into any position that's uncomfortable.
Use Focused Breathing for 8 to 10 breaths.
This simple exercise can be energizing while improving the range of motion in your shoulder joints.
Start in the Seated Posture.
Let your arms hang at your sides, palms turned back. Look straight ahead.
As you inhale, raise your right arm forward and up overhead until it is vertical.
As you exhale, bring your right arm down to the starting position.
As you inhale, raise your left arm forward and up overhead. Exhale on the return.
Repeat 6 to 8 times, alternating arms.
Shoulder Rolls
Shoulder Rolls are often used in exercise programs, because they help the range of motion in the shoulder joints. Here we do them slowly, focusing on each part of the movement and coordinating it with the breath.
Start in the Seated Posture.
Let your arms hang at your sides, palms turned back. Look straight ahead.
As you inhale, roll the shoulders up and back, as if you were doing a giant shrug.
As you exhale, drop your shoulders down.
Repeat 4 to 6 times.
Reverse the direction and repeat 4 to 6 times.
This exercise increases blood flow and improves range of motion in your hand, wrist, and finger joints.
Start in the Seated Posture.
Keeping your right arm straight, bring it up and out in front of you to the height of your shoulder, parallel to the floor. Make a fist with the thumb side up, and tuck your thumb down into the fingers.
As you inhale, open the hand, and then stretch all five fingers as if you were trying to touch all the walls in the room at one time.
As you exhale, fold the hand back up, with the thumb tucked in.
Repeat 6 to 8 times.
Repeat with the left hand.
Do two rounds with each hand. After you are familiar with the sequence, use both hands at the same time for two rounds.
This simple exercise improves the range of motion of the wrist.
Start in the Seated Posture.
Bring your right arm and hand up in front of you to the height of your shoulder, parallel to the floor. Turn the palm of your right hand down and extend your fingers and thumb forward and close together.
As you inhale, bend your right hand at the wrist backward as though you were pressing your hand against a wall.
As you exhale, bend your hand down at the wrist to your comfortable maximum. You should feel a light pull all the way up your forearm.
Repeat 6 to 8 times.
Repeat with the left hand.
Do two rounds with each hand. When you are familiar with the sequence, use both hands at the same time for two rounds.
Wrist-Joint Rotation
This rotation exercise improves the range of motion of your wrist.
Start in the Seated Posture.
Bring your right arm and hand up in front of you to the height of your shoulder, parallel to the floor. Make a fist, with your thumb tucked into the fingers and your palm down.
Let your breath be free and begin to rotate your right wrist in clockwise circles 6 to 8 times, keeping your arm motionless.
Change directions and rotate your wrist counterclockwise 6 to 8 times.
Repeat the sequence with the left hand.
Do two rounds with each hand. When you are comfortable with the sequence, work both wrists at the same time for two rounds.
This exercise loosens up the ankles and feet, improving circulation and flexibility.
Sit on the floor comfortably with your legs extended in front of you. Place the palms of your hands on the floor behind you with the fingers pointing toward your hips or lean your back against a wall.
Flex your right foot back toward you so it sticks up at a right angle to the floor.
As you exhale, point your right foot and toes forward and down.
As you inhale, bring your foot back to the right-angle position.
Repeat 8 to 10 times for two rounds.
Repeat with the left foot. When you are comfortable with the routine, do both feet at the same time for two rounds.
Seated Ankle Rotation
Rotating the ankle increases its flexibility and blood flow.
Sit on the floor with your legs extended in front of you. Place a tightly rolled Yoga mat or folded blanket under your knees. Put the palms of your hands on the floor behind you with your fingers pointing toward your hips, or lean your back against a wall.
Flex your right foot back toward you at a right angle with the floor.
Let your breath be free and slowly rotate your foot clockwise at the ankle joint 8 to 10 times. Reverse it and rotate counterclockwise 8 to 10 times. Do two sets each, then repeat with the left foot for two sets.
When you are comfortable with the routine, do both feet at the same time for two sets.
This relaxation technique calms the nervous system, while increasing blood flow to the feet, legs, hips, and lower back. You will need a chair with a sturdy level seat.
Place a chair in an area where you have room to lie down in front of it.
Lie on your back with your knees bent, feet on the floor. The front edge of chair's seat should be turned toward you, just in front of your feet.
Lift your feet off the floor, and lay your calves on the chair seat, with the front edge of the seat tucked into the backs of your knees. If your head tilts back, place a blanket under it.
Use Belly Breathing with a long exhale for 20 to 30 breaths.
