Shoulder injuries are common among yogis, but they don’t have to be. Here’s how to care for your shoulders, not tear them down.

Trish Jones knew trouble was brewing when her right shoulder began to throb during her favorite yoga class. The 29-year-old was no stranger to such pain. She had suffered from unstable shoulder joints for years. Her doctors call it “multidirectional instability,” but Jones refers to it as “having loose nuts and bolts.” So loose that in 1995 she had [read more...]]]> A great article on caring for your shoulders in yoga class,  from Yoga Journal.

Shoulder injuries are common among yogis, but they don’t have to be. Here’s how to care for your shoulders, not tear them down.

Trish Jones knew trouble was brewing when her right shoulder began to throb during her favorite yoga class. The 29-year-old was no stranger to such pain. She had suffered from unstable shoulder joints for years. Her doctors call it “multidirectional instability,” but Jones refers to it as “having loose nuts and bolts.” So loose that in 1995 she had surgery to stabilize her left shoulder. Last summer, when pain began to gnaw at her other shoulder, she couldn’t shake the feeling that it was in trouble, too.

Still, Jones kept practicing Ashtanga three times a week at a studio near her home in Alexandria, Virginia, in hopes that the pain would work itself out. That is, until her right shoulder dislocated in Vasisthasana (Side Plank Pose). “Luckily, I knew exactly what happened, so I went out into the hall and popped it back in,” she says. Still, the incident served as a wake-up call. She knew the way to dodge a second surgery was to figure out how yoga could build up her shoulder strength without aggravating the instability.

After her injury, Jones switched to a restorative yoga practice and sought advice from yoga teachers, physical therapists, and doctors. Two weeks later, she was back at the studio. Under the close supervision of her teacher, she modified every pose in the Ashtanga primary and second series to spare her shoulder. They jettisoned all weight-bearing asanas, like Adho Mukha Svanasana (Downward-Facing Dog Pose) and Chaturanga Dandasana (Four-Limbed Staff Pose), and took an easy-does-it approach to shoulder openers, like Marichyasana I (Marichi’s Twist I.) “It was a much different practice than the typical first series,” Jones says, “but it wasn’t in my best interest to stop practicing altogether.”

Although Jones was eager to build strength in the damaged joint, she knew the only way to thwart another dislocation was to perfect her alignment. So she analyzed her shoulder position in every pose. To prevent rounding forward in the front of the shoulders, she started each asana by widening her collarbones. To protect the back of the joints, she made sure her upper back was engaged, with the bottom tips of the shoulder blades drawing together and down. Soon, these shoulder adjustments became a meditation in themselves.

As Jones found out, yoga can be a boon to the shoulders, but it can also be a bust. While an intense yoga class can leave your shoulder muscles a little sore the next day, you shouldn’t steamroll past any sharp or throbbing pain in the joint during or after practice. If your shoulders start to gripe whenever you roll out your mat, it’s time to tune in and figure out what’s going on before you do more harm than good. If your shoulders are free of trouble, don’t be overconfident: Now is the time to protect them from future injury. Either way, your shoulders will thank you, and your yoga practice will be stronger.

How it Works

Shoulder problems shouldn’t be shrugged off. In 2003 (the latest year for which numbers are available), nearly 14 million Americans visited a doctor complaining of a bum shoulder. Joint instability, like Jones’s, is one of the most common ailments. Others include impingements, rotator cuff tears, and arthritis.

Athletes often suffer disproportionately from shoulder injuries because the various repetitive movements stress the joints, says Jeffrey Abrams, an orthopedic surgeon in Princeton, New Jersey, and a spokesperson for the American Academy of Orthopaedic Surgeons. “In other countries people play soccer, but here we like to ski and play golf and tennis, all of which are hard on the shoulders.” Jones is a typical example—when she was younger she played basketball and tennis and loved rock climbing. Now she puts her shoulders through their paces in Ashtanga.

But there’s another factor at play—the natural structure of the joint. “Shoulders are designed for mobility, not stability,” says Roger Cole, Ph.D., an Iyengar-certified teacher in Del Mar, California, who teaches workshops on shoulder safety. The mobility allows for an astonishing range of motion compared to that in the hips—if you have healthy shoulders you can move your arms forward, back, across the body, and in 360-degree circles. But the relatively loose joint relies on a delicate web of soft tissue to hold it together, which makes it more vulnerable to injury. (The soft tissue includes ligaments, which connect bone to bone; tendons, which attach muscle to bone; and muscles, which move and stabilize the bones.)

The main ball-and-socket joint is also quite shallow, adding to the flexibility but putting the joint at risk. Abrams likens it to a basketball sitting on top of a plunger. (The basketball is the head of the humerus, or upper arm bone, and the plunger is where it meets the scapula.) The rotation of a big ball on a little base makes the shoulder mobile.

When the soft tissue around the joint is strong and toned, the system works flawlessly. But factor in years of repetitive roundabout movements, like throwing a baseball, swimming, or even stretching the arms overhead in yoga, and shoulder ligaments can overstretch and lose elasticity, like worn rubber bands. Plus, as muscles age, they lose tone, making it even more likely that the ball will slip off the plunger at some point. The best way to stay out of a sling? Be diligent in your quest for proper alignment and build balanced strength around the joint to create stability.

Check your Alignment

Sounds easy enough, but here’s the hitch: Perfect shoulder placement in yoga can be elusive. For starters, unless you practice yoga in a mirror-lined room or have eyes in the back of your head, it’s tough to know what your shoulders are up to. To make matters worse, poor posture is habitual. If your shoulders slouch, slump, or cave all day long, you can’t help but bring a few bad habits into the yoga studio. “I see a lot of students with shoulders that slope, turn in, and jut forward,” says Mitchel Bleier, a senior certified Anusara Yoga teacher in Rochester, New York. “If those misalignments are maintained during yoga practice, especially during weight-bearing asanas, the risk of a shoulder injury goes up dramatically.”

Therefore, weight-bearing poses, such as inversions, require extra vigilance. Inversions are safe for the shoulders, Cole explains, but they are best performed with precise alignment.

The first step in understanding correct shoulder alignment is to start simply, by exploring Tadasana (Mountain Pose) and Urdhva Hastasana (Upward Salute). Here are Bleier’s alignment instructions for his students in Tadasana: First, lift your shoulders slightly so they line up with the base of your neck. Simultaneously, draw the heads of the arm bones back, toward the wall behind you. Keeping a slight curve in the back of your neck, draw your shoulder blades down toward your waist. Your shoulder blades should lie flat on your back, instead of winging out. Feel your chest rise, but resist the temptation to pinch your shoulder blades together—doing this will only compress your spine. Instead, keep the bottom tips of your shoulder blades pressing into your back and spreading. If you want to feel deliciously supported while doing this, try the Strap Jacket.

Reaching your arms overhead is a little more complex, but once you learn to do it correctly, you can apply the same principles in poses such as Downward-Facing Dog, Plank, or Adho Mukha Vrksasana (Handstand). Before you sweep your arms up into Urdhva Hastasana, it’s important to rotate your arm bones externally and move them down so the head of the arm bone is in the socket. This will strengthen the muscles on the back of the rotator cuff (the infraspinatus and teres minor), which are typically weaker than the front, and it will spare the supraspinatus, which can get pinched between the edge of the scapula and the head of the arm bone when the arms lift. If the tendon is pinched repeatedly, it wears and frays like a rope. Eventually, what begins as a mild irritation can progress to a severe injury, such as a tear.

Once your arms are straight overhead, you don’t have to pull your shoulders down quite so firmly, because that will inhibit your ability to reach up. To get the maximum reach safely, start in Urdhva Hastasana and spread your shoulder blades away from each other. As your shoulder blades wrap around toward the front of your rib cage, you should have more space to really lengthen up. The tops of your shoulders will lift slightly, which is OK. Just don’t let them bunch up by your ears. Now keep your shoulders in place and press your palms up toward the ceiling. Feel familiar? This is similar to the placement for Handstand.

Counteract Misalignment

Once you’ve mastered the ins and outs of proper alignment, you should be ready to build the strength to maintain it. And therein lies the rub. Done correctly, yoga poses strengthen the shoulders, but in order to do them correctly and maintain proper alignment, your shoulders have to be strong. Of any yoga pose, Chaturanga Dandasana (Four-Limbed Staff Pose; exemplifies this—if you’re not strong enough to keep your shoulders in their proper place, you leave yourself wide open to injury.

The most common misalignment is to collapse the chest and allow the heads of arm bones to drop forward toward the floor. You’ll know this is happening if your shoulder blades poke out instead of lying flat on your back, or if the fronts of your shoulders are sore the next day. This can strain the front of the rotator cuff and can also build strength unevenly, making the front of the rotator cuff stronger than the back. Over time this imbalance will pull the arm bone forward, contributing to a vicious cycle of misalignment.

To counteract this, start in Plank Pose, and as you move into Chaturanga Dandasana, see that the heads of the arm bones stay level with the elbows. Try not to let them dip down. (Practice at home in front of a mirror.) If they drop, you need to build more strength around the whole rotator cuff. To do that, practice Chaturanga with your knees on the floor and the Supine Sleepwalker Pose.

You can also practice what Cole calls the anti-Chaturanga, or Purvottanasana (Upward Plank Pose). “Purvottanasana stretches most of the muscles that Chaturanga strengthens and also strengthens opposing muscles,” Cole says. It’s one of the poses Trish Jones credits for helping her escape another shoulder surgery. “My rotator cuffs are stronger since I’ve adopted Purvottanasana into my practice,” she says. Finally, stretch the front of the chest by doing Setu Bandha Sarvangasana) (Bridge Pose), Sarvangasana (Shoulderstand), and Matsyasana (Fish Pose).

Strengthen and Stabilize

To stabilize the joint and reinforce the rotator cuff, you’ll also need to focus on your supraspinatus, the muscle that helps you lift your arms out to the side. More specifically, the supraspinatus engages during the first 30 degrees of lifting the arms. Once your arms are shoulder level, your deltoids hold them up, which won’t strengthen the rotator cuffs. To strengthen the supraspinatus, practice standing poses where you reach the arms out, such as Trikonasana (Triangle Pose) and Virabhadrasana II (Warrior II). Hold the poses for five breaths and bring your arms down and back up between each pose.

Once you feel ready—meaning, the head of the arm bone isn’t slipping around and the joint is free of pain—toss a few weight-bearing poses into the mix. One of the best ways to build strength around the rotator cuff is to move slowly from Downward-Facing Dog out to Plank and back again. Just be careful not to let the upper back hyperextend and sink toward the floor in Downward-Facing Dog, which, according to Jean-Claude West, a kinesiologist and master manual therapist, can compress the joints. “Maintaining width in the upper back keeps the shoulder girdle active and the shoulder joints stable as you approach Plank,” he says.

Many yoga poses build arm strength by requiring you to push away from the floor—poses like Downward-Facing Dog, Handstand, and Urdhva Dhanurasana(Upward-Facing Bow Pose)—but few demand that your shoulder muscles pull against resistance, which is part of the reason the back of the rotator cuff gets so weak. One way to build oomph in the back of the shoulders is to engage in activities that require pulling, like swimming or even pull-ups, says Cole. On your yoga mat you can practice poses that require pressing the back of the shoulder joint against the floor, such as Jathara Parivartanasana (Revolved Abdomen Pose), or on a stable part of the body, such as the front leg in Parivrtta Parsvakonasana (Revolved Side Angle Pose).

Finally, create balanced flexibility by practicing poses that require an inward rotation of the shoulder, such as Gomukasana (Cow Face Pose), Marichyasana III (Marichi’s Twist III), and Parsvottanasana (Side Stretch Pose). “If you feel a pinching sensation when you rotate your shoulders inward, you are probably irritating a tendon or other connective tissue,” Cole says, “in which case, let the scapula wing out a little bit.” (Don’t practice these poses if you have a history of dislocation or shoulder instability.)

Although these practice tips are meant to keep your shoulders free of injury, when it comes to pain, it’s important to remember that there are no guarantees in yoga or in life. “Injuries can be a wonderful blessing; they offer us an opportunity to learn, to grow, and to be able to help others,” Bleier says. “We all have asymmetries in our bodies; there is no perfect way for the body to be, and if you have pain, it’s just your body’s way of asking you to examine what you’re doing.”

If anyone has learned that lesson, it’s been Trish Jones. “My shoulder pain has taught me to slow down and take my yoga practice back to basics,” she says. “The journey has been a humbling one, but I know I’m better for it.”

The Shoulder Strengtheneing Sequence.

Supine Sleep Walker

This movement not only trains the heads of the arm bones to stay in the sockets during a wide range of movement but also builds well-rounded strength in the rotator cuff. Lie on your back with your knees bent and feet flat on the floor. Hold a yoga block horizontally between your hands and extend your arms up toward the ceiling. Draw the head of the arm bone into the shoulder socket so both shoulders press into the floor. Keeping the arms long, slowly lower the block overhead. As the block moves toward the floor, the backs of the shoulders may lift off the floor just slightly. But if the shoulders begin to bunch up by the ears, stop the block’s descent, realign the shoulders, and then continue to lower the block until it rests on the floor an arm’s length above your head. Now slowly lift the block back into the starting position while keeping your shoulders stable. Repeat up to 10 times.

Purvottanasana Upward Plank Pose

Purvottanasana counteracts the effects of Chaturanga by stretching the pectoralis major, pectoralis minor, and anterior deltoids. Sit in Dandasana (Staff Pose) with your hands several inches behind your hips and your fingers pointing forward. Bend your knees until you can place your feet flat on the floor. Exhale, press your feet and hands down into the floor, and lift your hips until you come into a tabletop position. Straighten your legs one by one and lift your hips still higher without squeezing your buttocks. Press the soles of your feet toward the floor. Lift your chest as high as you comfortably can. Keep the back of your neck long as you slowly drop your head back.

Jathara Parivartanasana Revolved Abdomen Pose

Lie on your back with your arms in a cactus position. Bring both feet off the floor and bend your knees until they are directly over your hips and your shins are parallel to the floor. Keeping your arms and shoulders pressing into the floor, exhale and lower your knees to the right. Don’t worry if your knees don’t come all the way to the floor. Instead, focus on keeping your shoulders grounded. Inhale and bring the legs back to center. Exhale to the opposite side. Repeat five times on each side. Keeping the back of your shoulders in firm contact with the floor strengthens the back of the rotator cuff, an area that’s commonly weak. This is generally safe to do if you’re recovering from injury because your body is well supported by the floor.

Standing Rotator Cuff Strengthener

This pose is similar to Jathara Parivartanasana but can be done from a standing position. Stand with your back to a wall. Raise your arms into a cactus position. Pull the heads of the arm bones back until you feel the upper back engage and press into the wall. Keep the tailbone tucked to avoid overarching the lumbar spine. Maintaining firm contact between your shoulders and the wall, and keeping your elbows bent at a 90-degree angle, slowly slide the arms up the wall. Ultimately, you may be able to touch your fingers overhead, but it may take time to get there. The key thing is to keep your shoulder blades flat against the wall. Repeat up to 10 times.

Strap Jacket

Getting the strap set up can be tricky the first time you do this pose, but it’s worth it. The harness supports and stabilizes your shoulder girdle by lifting the fronts of the shoulders up and drawing the bottom tips of the shoulder blades down.

Start in Tadasana and make a large loop in a 10-foot-long strap. (If you don’t have one, you’ll need to hook two straps together to create a big round loop.) Hold the loop behind you and put your arms through it, as though you’re putting on a jacket. Make sure the strap buckle is at the bottom of the loop, so you can reach back and adjust the length of the strap easily. The strap will pass over the tops of the shoulders and under the armpits.

Reach back and take hold of the part of the strap that is lying horizontally behind your neck. Grab this top part of the strap with one hand and pull it all the way down toward the floor. As you pull it down, the bottom part of the strap will pass over it and move up your back, creating a harness.

Reach behind you and twist the strap several times to help keep it in place. Now hold the dangling loop and pull down firmly. When the top part of the strap is pulled all the way down, it should be about hip level. The strap should roll your upper shoulders back and down while pressing your lower shoulder blades into your back. Don’t arch your lower back. Keep your legs and pelvis in Tadasana.

Stay here with your hand pulling down on the strap or, to go a step further, take a dowel or a broom and thread it horizontally through the bottom of the strap. Press your hands down onto the broom. Stay for at least 10 breaths.

SetuBandha Sarvangasana Bridge Pose

According to Iyengar-Certified teacher Roger Cole, when you clasp your hands behind your back in Bridge Pose, you stretch the muscles on the fronts of the arm bones, which makes it more difficult to lift your chest. For this version of Bridge Pose, you’ll use a strap around the ankles to help counteract this.

Lie on your back with your feet flat on the floor and hip-width apart. Your heels should be about six inches away from your buttocks. Place a strap around the front of your ankles and take hold of the strap, one end in each hand. Walk your hands down the strap, toward your ankles. Lightly shrug your shoulders toward your head and roll the heads of your arm bones back, rooting them into the floor. Keeping the backs of your shoulders pressed into the floor, pull on the ends of the strap and begin to lift your chest. Then, by pressing down through your legs and feet, lift your hips toward the ceiling. Lengthen your tailbone toward your knees. Keep pulling on the strap to encourage the heads of the arm bones toward the floor as you breathe and lift your chest.

Catherine Guthrie is a freelance writer based in Bloomington, Indiana.

My only comment on this article – awaiting moderation- was that I felt it was unclear which muscles she was referring to when indicating the “back rotator cuff.”  Seems that this about rhomboids and traps rather than infraspinatus.  If anyone has thoughts, do submit!  I’ll keep you posted if I get a response.

The Victorians had many names for depression, and Charles Darwin used them all. There were his “fits” brought on by “excitements,” “flurries” leading to an “uncomfortable palpitation of the heart” and “air fatigues” that triggered his “head symptoms.” In one particularly pitiful letter, written to a specialist in “psychological medicine,” he confessed to “extreme spasmodic daily and nightly flatulence” and “hysterical crying” whenever Emma, his devoted wife, [read more...]]]> A great article from the New York Times Magazine about the possible benefits that we actually derive from having the blues. Depression may not feel good, but maybe there’s a glimmer of a lining.

The Victorians had many names for depression, and Charles Darwin used them all. There were his “fits” brought on by “excitements,” “flurries” leading to an “uncomfortable palpitation of the heart” and “air fatigues” that triggered his “head symptoms.” In one particularly pitiful letter, written to a specialist in “psychological medicine,” he confessed to “extreme spasmodic daily and nightly flatulence” and “hysterical crying” whenever Emma, his devoted wife, left him alone.

While there has been endless speculation about Darwin’s mysterious ailment — his symptoms have been attributed to everything from lactose intolerance to Chagas disease — Darwin himself was most troubled by his recurring mental problems. His depression left him “not able to do anything one day out of three,” choking on his “bitter mortification.” He despaired of the weakness of mind that ran in his family. “The ‘race is for the strong,’ ” Darwin wrote. “I shall probably do little more but be content to admire the strides others made in Science.”

Darwin, of course, was wrong; his recurring fits didn’t prevent him from succeeding in science. Instead, the pain may actually have accelerated the pace of his research, allowing him to withdraw from the world and concentrate entirely on his work. His letters are filled with references to the salvation of study, which allowed him to temporarily escape his gloomy moods. “Work is the only thing which makes life endurable to me,” Darwin wrote and later remarked that it was his “sole enjoyment in life.”

For Darwin, depression was a clarifying force, focusing the mind on its most essential problems. In his autobiography, he speculated on the purpose of such misery; his evolutionary theory was shadowed by his own life story. “Pain or suffering of any kind,” he wrote, “if long continued, causes depression and lessens the power of action, yet it is well adapted to make a creature guard itself against any great or sudden evil.” And so sorrow was explained away, because pleasure was not enough. Sometimes, Darwin wrote, it is the sadness that informs as it “leads an animal to pursue that course of action which is most beneficial.” The darkness was a kind of light.

The mystery of depression is not that it exists — the mind, like the flesh, is prone to malfunction. Instead, the paradox of depression has long been its prevalence. While most mental illnesses are extremely rare — schizophrenia, for example, is seen in less than 1 percent of the population — depression is everywhere, as inescapable as the common cold. Every year, approximately 7 percent of us will be afflicted to some degree by the awful mental state that William Styron described as a “gray drizzle of horror . . . a storm of murk.” Obsessed with our pain, we will retreat from everything. We will stop eating, unless we start eating too much. Sex will lose its appeal; sleep will become a frustrating pursuit. We will always be tired, even though we will do less and less. We will think a lot about death.

The persistence of this affliction — and the fact that it seemed to be heritable — posed a serious challenge to Darwin’s new evolutionary theory. If depression was a disorder, then evolution had made a tragic mistake, allowing an illness that impedes reproduction — it leads people to stop having sex and consider suicide — to spread throughout the population. For some unknown reason, the modern human mind is tilted toward sadness and, as we’ve now come to think, needs drugs to rescue itself.

The alternative, of course, is that depression has a secret purpose and our medical interventions are making a bad situation even worse. Like a fever that helps the immune system fight off infection — increased body temperature sends white blood cells into overdrive — depression might be an unpleasant yet adaptive response to affliction. Maybe Darwin was right. We suffer — we suffer terribly — but we don’t suffer in vain.

ANDY THOMSON IS a psychiatrist at the University of Virginia. He has a scruffy gray beard and steep cheekbones. When Thomson talks, he tends to close his eyes, as if he needs to concentrate on what he’s saying. But mostly what he does is listen: For the last 32 years, Thomson has been tending to his private practice in Charlottesville. “I tend to get the real hard cases,” Thomson told me recently. “A lot of the people I see have already tried multiple treatments. They arrive without much hope.” On one of the days I spent with Thomson earlier this winter, he checked his phone constantly for e-mail updates. A patient of his on “welfare watch” who was required to check in with him regularly had not done so, and Thomson was worried. “I’ve never gotten used to treating patients in mental pain,” he said. “Maybe it’s because every story is unique. You see one case of iron-deficiency anemia, you’ve seen them all. But the people who walk into my office are all hurting for a different reason.”
In the late 1990s, Thomson became interested in evolutionary psychology, which tries to explain the features of the human mind in terms of natural selection. The starting premise of the field is that the brain has a vast evolutionary history, and that this history shapes human nature. We are not a blank slate but a byproduct of imperfect adaptations, stuck with a mind that was designed to meet the needs of Pleistocene hunter-gatherers on the African savanna. While the specifics of evolutionary psychology remain controversial — it’s never easy proving theories about the distant past — its underlying assumption is largely accepted by mainstream scientists. There is no longer much debate over whether evolution sculptured the fleshy machine inside our head. Instead, researchers have moved on to new questions like when and how this sculpturing happened and which of our mental traits are adaptations and which are accidents.

In 2004, Thomson met Paul Andrews, an evolutionary psychologist at Virginia Commonwealth University, who had long been interested in the depression paradox — why a disorder that’s so costly is also so common. Andrews has long dark brown hair and an aquiline nose. Before he begins to talk, he often writes down an outline of his answer on scratch paper. “This is a very delicate subject,” he says. “I don’t want to say something reckless.”

Andrews and Thomson struck up an extended conversation on the evolutionary roots of depression. They began by focusing on the thought process that defines the disorder, which is known as rumination. (The verb is derived from the Latin word for “chewed over,” which describes the act of digestion in cattle, in which they swallow, regurgitate and then rechew their food.) In recent decades, psychiatry has come to see rumination as a dangerous mental habit, because it leads people to fixate on their flaws and problems, thus extending their negative moods. Consider “The Depressed Person,” a short story by David Foster Wallace, which chronicles a consciousness in the grip of the ruminative cycle. (Wallace struggled with severe depression for years before committing suicide in 2008.) The story is a long lament, a portrait of a mind hating itself, filled with sentences like this: “What terms might be used to describe such a solipsistic, self-consumed, bottomless emotional vacuum and sponge as she now appeared to herself to be?” The dark thoughts of “The Depressed Person” soon grow tedious and trying, but that’s precisely Wallace’s point. There is nothing profound about depressive rumination. There is just a recursive loop of woe.

The bleakness of this thought process helps explain why, according to the Yale psychologist Susan Nolen-Hoeksema, people with “ruminative tendencies” are more likely to become depressed. They’re also more likely to become unnerved by stressful events: for instance, Nolen-Hoeksema found that residents of San Francisco who self-identified as ruminators showed significantly more depressive symptoms after the 1989 Loma Prieta earthquake. And then there are the cognitive deficits. Because rumination hijacks the stream of consciousness — we become exquisitely attentive to our pain — numerous studies have found that depressed subjects struggle to think about anything else, just like Wallace’s character. The end result is poor performance on tests for memory and executive function, especially when the task involves lots of information. (These deficits disappear when test subjects are first distracted from their depression and thus better able to focus on the exercise.) Such research has reinforced the view that rumination is a useless kind of pessimism, a perfect waste of mental energy.

That, at least, was the scientific consensus when Andrews and Thomson began exploring the depression paradox. Their evolutionary perspective, however — they see the mind as a fine-tuned machine that is not prone to pointless programming bugs — led them to wonder if rumination had a purpose. They started with the observation that rumination was often a response to a specific psychological blow, like the death of a loved one or the loss of a job. (Darwin was plunged into a debilitating grief after his 10-year-old daughter, Annie, died following a bout of scarlet fever.) Although the D.S.M. manual, the diagnostic bible for psychiatrists, does not take such stressors into account when diagnosing depressive disorder — the exception is grief caused by bereavement, as long as the grief doesn’t last longer than two months — it’s clear that the problems of everyday life play a huge role in causing mental illness. “Of course, rumination is unpleasant,” Andrews says. “But it’s usually a response to something real, a real setback. It didn’t seem right that the brain would go haywire just when we need it most.”
Imagine, for instance, a depression triggered by a bitter divorce. The ruminations might take the form of regret (“I should have been a better spouse”), recurring counterfactuals (“What if I hadn’t had my affair?”) and anxiety about the future (“How will the kids deal with it? Can I afford my alimony payments?”). While such thoughts reinforce the depression — that’s why therapists try to stop the ruminative cycle — Andrews and Thomson wondered if they might also help people prepare for bachelorhood or allow people to learn from their mistakes. “I started thinking about how, even if you are depressed for a few months, the depression might be worth it if it helps you better understand social relationships,” Andrews says. “Maybe you realize you need to be less rigid or more loving. Those are insights that can come out of depression, and they can be very valuable.”

This radical idea — the scientists were suggesting that depressive disorder came with a net mental benefit — has a long intellectual history. Aristotle was there first, stating in the fourth century B.C. “that all men who have attained excellence in philosophy, in poetry, in art and in politics, even Socrates and Plato, had a melancholic habitus; indeed some suffered even from melancholic disease.” This belief was revived during the Renaissance, leading Milton to exclaim, in his poem “Il Penseroso”: “Hail divinest Melancholy/Whose saintly visage is too bright/To hit the sense of human sight.” The Romantic poets took the veneration of sadness to its logical extreme and described suffering as a prerequisite for the literary life. As Keats wrote, “Do you not see how necessary a World of Pains and troubles is to school an intelligence and make it a soul?”

But Andrews and Thomson weren’t interested in ancient aphorisms or poetic apologias. Their daunting challenge was to show how rumination might lead to improved outcomes, especially when it comes to solving life’s most difficult dilemmas. Their first speculations focused on the core features of depression, like the inability of depressed subjects to experience pleasure or their lack of interest in food, sex and social interactions. According to Andrews and Thomson, these awful symptoms came with a productive side effect, because they reduced the possibility of becoming distracted from the pressing problem.

The capacity for intense focus, they note, relies in large part on a brain area called the left ventrolateral prefrontal cortex (VLPFC), which is located a few inches behind the forehead. While this area has been associated with a wide variety of mental talents, like conceptual knowledge and verb conjugation, it seems to be especially important for maintaining attention. Experiments show that neurons in the VLPFC must fire continuously to keep us on task so that we don’t become sidetracked by irrelevant information. Furthermore, deficits in the VLPFC have been associated with attention-deficit disorder.

Several studies found an increase in brain activity (as measured indirectly by blood flow) in the VLPFC of depressed patients. Most recently, a paper to be published next month by neuroscientists in China found a spike in “functional connectivity” between the lateral prefrontal cortex and other parts of the brain in depressed patients, with more severe depressions leading to more prefrontal activity. One explanation for this finding is that the hyperactive VLPFC underlies rumination, allowing people to stay focused on their problem. (Andrews and Thomson argue that this relentless fixation also explains the cognitive deficits of depressed subjects, as they are too busy thinking about their real-life problems to bother with an artificial lab exercise; their VLPFC can’t be bothered to care.) Human attention is a scarce resource — the neural effects of depression make sure the resource is efficiently allocated.
But the reliance on the VLPFC doesn’t just lead us to fixate on our depressing situation; it also leads to an extremely analytical style of thinking. That’s because rumination is largely rooted in working memory, a kind of mental scratchpad that allows us to “work” with all the information stuck in consciousness. When people rely on working memory — and it doesn’t matter if they’re doing long division or contemplating a relationship gone wrong — they tend to think in a more deliberate fashion, breaking down their complex problems into their simpler parts.

The bad news is that this deliberate thought process is slow, tiresome and prone to distraction; the prefrontal cortex soon grows exhausted and gives out. Andrews and Thomson see depression as a way of bolstering our feeble analytical skills, making it easier to pay continuous attention to a difficult dilemma. The downcast mood and activation of the VLPFC are part of a “coordinated system” that, Andrews and Thomson say, exists “for the specific purpose of effectively analyzing the complex life problem that triggered the depression.” If depression didn’t exist — if we didn’t react to stress and trauma with endless ruminations — then we would be less likely to solve our predicaments. Wisdom isn’t cheap, and we pay for it with pain.

Consider a young professor on tenure track who was treated by Thomson. The patient was having difficulties with his academic department. “This guy was used to success coming easy, but now it wasn’t,” Thomson says. “I made it clear that I thought he’d need some time to figure out his next step. His problem was like a splinter, and the pain wouldn’t go away until the splinter was removed.” Should the patient leave the department? Should he leave academia? Or should he try to resolve the disagreement? Over the next several weeks, Thomson helped the patient analyze his situation and carefully think through the alternatives. “We took it one variable at a time,” Thomson says. “And it eventually became clear to him that the departmental issues couldn’t be fixed. He needed to leave. Once he came to that conclusion, he started feeling better.”

The publication of Andrews and Thomson’s 36,000-word paper in the July 2009 issue of Psychological Review had a polarizing effect on the field. While some researchers, like Jerome Wakefield, a professor at New York University who specializes in the conceptual foundations of clinical theory, greeted the paper as “an extremely important first step toward the re-evaluation of depression,” other psychiatrists regarded it as little more than irresponsible speculation, a justification for human suffering. Peter Kramer, a professor of psychiatry and human behavior at Brown University, describes the paper as “a ladder with a series of weak rungs.” Kramer has long defended the use of antidepressants — his landmark work, “Listening to Prozac,” chronicled the profound improvements of patients taking the drugs — and criticized those who romanticized depression, which he compares to the glamorization of tuberculosis in the late 19th century. In a series of e-mail messages to me, Kramer suggested that Andrews and Thomson neglect the variants of depression that don’t fit their evolutionary theory. “This study says nothing about chronic depression and the sort of self-hating, paralyzing, hopeless, circular rumination it inspires,” Kramer wrote. And what about post-stroke depression? Late-life depression? Extreme depressive condition? Kramer argues that there’s a clear category difference between a healthy response to social stressors and the response of people with depressive disorder. “Depression is not really like sadness,” Kramer has written. “It’s more an oppressive flattening of feeling.”

Even scientists who are sympathetic to what Andrews and Thomson call the “analytic-rumination hypothesis” remain critical of its details. Ed Hagen, an anthropologist at Washington State University who is working on a book with Andrews, says that while the analytic-rumination hypothesis has persuaded him that some depressive symptoms might improve problem-solving skills, he remains unconvinced that it is a sufficient explanation for depression. “Individuals with major depression often don’t groom, bathe and sometimes don’t even use the toilet,” Hagen says. They also significantly “reduce investment in child care,” which could have detrimental effects on the survival of offspring. The steep fitness costs of these behaviors, Hagen says, would not be offset by “more uninterrupted time to think.”
Other scientists, including Randolph Nesse at the University of Michigan, say that complex psychiatric disorders like depression rarely have simple evolutionary explanations. In fact, the analytic-rumination hypothesis is merely the latest attempt to explain the prevalence of depression. There is, for example, the “plea for help” theory, which suggests that depression is a way of eliciting assistance from loved ones. There’s also the “signal of defeat” hypothesis, which argues that feelings of despair after a loss in social status help prevent unnecessary attacks; we’re too busy sulking to fight back. And then there’s “depressive realism”: several studies have found that people with depression have a more accurate view of reality and are better at predicting future outcomes. While each of these speculations has scientific support, none are sufficient to explain an illness that afflicts so many people. The moral, Nesse says, is that sadness, like happiness, has many functions.

Although Nesse says he admires the analytic-rumination hypothesis, he adds that it fails to capture the heterogeneity of depressive disorder. Andrews and Thomson compare depression to a fever helping to fight off infection, but Nesse says a more accurate metaphor is chronic pain, which can arise for innumerable reasons. “Sometimes, the pain is going to have an organic source,” he says. “Maybe you’ve slipped a disc or pinched a nerve, in which case you’ve got to solve that underlying problem. But much of the time there is no origin for the pain. The pain itself is the dysfunction.”

Andrews and Thomson respond to such criticisms by acknowledging that depression is a vast continuum, a catch-all term for a spectrum of symptoms. While the analytic-rumination hypothesis might explain those patients reacting to an “acute stressor,” it can’t account for those whose suffering has no discernible cause or whose sadness refuses to lift for years at a time. “To say that depression can be useful doesn’t mean it’s always going to be useful,” Thomson says. “Sometimes, the symptoms can spiral out of control. The problem, though, is that as a society, we’ve come to see depression as something that must always be avoided or medicated away. We’ve been so eager to remove the stigma from depression that we’ve ended up stigmatizing sadness.”

For Thomson, this new theory of depression has directly affected his medical practice. “That’s the litmus test for me,” he says. “Do these ideas help me treat my patients better?” In recent years, Thomson has cut back on antidepressant prescriptions, because, he says, he now believes that the drugs can sometimes interfere with genuine recovery, making it harder for people to resolve their social dilemmas. “I remember one patient who came in and said she needed to reduce her dosage,” he says. “I asked her if the antidepressants were working, and she said something I’ll never forget. ‘Yes, they’re working great,’ she told me. ‘I feel so much better. But I’m still married to the same alcoholic son of a bitch. It’s just now he’s tolerable.’ ”

The point is the woman was depressed for a reason; her pain was about something. While the drugs made her feel better, no real progress was ever made. Thomson’s skepticism about antidepressants is bolstered by recent studies questioning their benefits, at least for patients with moderate depression. Consider a 2005 paper led by Steven Hollon, a psychologist at Vanderbilt University: he found that people on antidepressants had a 76 percent chance of relapse within a year when the drugs were discontinued. In contrast, patients given a form of cognitive talk therapy had a relapse rate of 31 percent. And Hollon’s data aren’t unusual: several studies found that patients treated with medication were approximately twice as likely to relapse as patients treated with cognitive behavior therapy. “The high relapse rate suggests that the drugs aren’t really solving anything,” Thomson says. “In fact, they seem to be interfering with the solution, so that patients are discouraged from dealing with their problems. We end up having to keep people on the drugs forever. It was as if these people have a bodily infection, and modern psychiatry is just treating their fever.”
Thomson describes a college student who was referred to his practice. “It was clear that this patient was in a lot of pain,” Thomson says. “He couldn’t sleep, couldn’t study. He had some family issues” — his parents were recently divorced — “and his father was exerting a tremendous amount of pressure on him to go to graduate school. Because he’s got a family history of depression, the standard of care would be to put him on drugs right away. And a few years ago, that’s what I would have done.”

Instead, Thomson was determined to help the student solve his problem. “What you’re trying to do is speed along the rumination process,” Thomson says. “Once you show people the dilemma they need to solve, they almost always start feeling better.” He cites as evidence a recent study that found “expressive writing” — asking depressed subjects to write essays about their feelings — led to significantly shorter depressive episodes. The reason, Thomson suggests, is that writing is a form of thinking, which enhances our natural problem-solving abilities. “This doesn’t mean there’s some miracle cure,” he says. “In most cases, the recovery period is going to be long and difficult. And that’s what I told this young student. I said: ‘I know you’re hurting. I know these problems seem impossible. But they’re not. And I can help you solve them.’ ”

IT’S TOO SOON to judge the analytic-rumination hypothesis. Nobody knows if depression is an adaptation or if Andrews and Thomson have merely spun another “Just So” story, a clever evolutionary tale that lacks direct evidence. Nevertheless, their speculation is part of a larger scientific re-evaluation of negative moods, which have long been seen as emotional states to avoid. The dismissal of sadness and its synonyms is perhaps best exemplified by the rise of positive psychology, a scientific field devoted to the pursuit of happiness. In recent years, a number of positive psychologists have written popular self-help books, like “The How of Happiness” and “Authentic Happiness,” that try to outline the scientific principles behind “lasting fulfillment” and “getting the life we want.”

The new research on negative moods, however, suggests that sadness comes with its own set of benefits and that even our most unpleasant feelings serve an important purpose. Joe Forgas, a social psychologist at the University of New South Wales in Australia, has repeatedly demonstrated in experiments that negative moods lead to better decisions in complex situations. The reason, Forgas suggests, is rooted in the intertwined nature of mood and cognition: sadness promotes “information-processing strategies best suited to dealing with more-demanding situations.” This helps explain why test subjects who are melancholy — Forgas induces the mood with a short film about death and cancer — are better at judging the accuracy of rumors and recalling past events; they’re also much less likely to stereotype strangers.

Last year Forgas ventured beyond the lab and began conducting studies in a small stationery store in suburban Sydney, Australia. The experiment itself was simple: Forgas placed a variety of trinkets, like toy soldiers, plastic animals and miniature cars, near the checkout counter. As shoppers exited, Forgas tested their memory, asking them to list as many of the items as possible. To control for the effect of mood, Forgas conducted the survey on gray, rainy days — he accentuated the weather by playing Verdi’s “Requiem” — and on sunny days, using a soundtrack of Gilbert and Sullivan. The results were clear: shoppers in the “low mood” condition remembered nearly four times as many of the trinkets. The wet weather made them sad, and their sadness made them more aware and attentive.
The enhancement of these mental skills might also explain the striking correlation between creative production and depressive disorders. In a survey led by the neuroscientist Nancy Andreasen, 30 writers from the Iowa Writers’ Workshop were interviewed about their mental history. Eighty percent of the writers met the formal diagnostic criteria for some form of depression. A similar theme emerged from biographical studies of British writers and artists by Kay Redfield Jamison, a professor of psychiatry at Johns Hopkins, who found that successful individuals were eight times as likely as people in the general population to suffer from major depressive illness.

Why is mental illness so closely associated with creativity? Andreasen argues that depression is intertwined with a “cognitive style” that makes people more likely to produce successful works of art. In the creative process, Andreasen says, “one of the most important qualities is persistence.” Based on the Iowa sample, Andreasen found that “successful writers are like prizefighters who keep on getting hit but won’t go down. They’ll stick with it until it’s right.” While Andreasen acknowledges the burden of mental illness — she quotes Robert Lowell on depression not being a “gift of the Muse” and describes his reliance on lithium to escape the pain — she argues that many forms of creativity benefit from the relentless focus it makes possible. “Unfortunately, this type of thinking is often inseparable from the suffering,” she says. “If you’re at the cutting edge, then you’re going to bleed.”

And then there’s the virtue of self-loathing, which is one of the symptoms of depression. When people are stuck in the ruminative spiral, their achievements become invisible; the mind is only interested in what has gone wrong. While this condition is typically linked to withdrawal and silence — people become unwilling to communicate — there’s some suggestive evidence that states of unhappiness can actually improve our expressive abilities. Forgas said he has found that sadness correlates with clearer and more compelling sentences, and that negative moods “promote a more concrete, accommodative and ultimately more successful communication style.” Because we’re more critical of what we’re writing, we produce more refined prose, the sentences polished by our angst. As Roland Barthes observed, “A creative writer is one for whom writing is a problem.”

This line of research led Andrews to conduct his own experiment, as he sought to better understand the link between negative mood and improved analytical abilities. He gave 115 undergraduates an abstract-reasoning test known as Raven’s Progressive Matrices, which requires subjects to identify a missing segment in a larger pattern. (Performance on the task strongly predicts general intelligence.) The first thing Andrews found was that nondepressed students showed an increase in “depressed affect” after taking the test. In other words, the mere presence of a challenging problem — even an abstract puzzle — induced a kind of attentive trance, which led to feelings of sadness. It doesn’t matter if we’re working on a mathematical equation or working through a broken heart: the anatomy of focus is inseparable from the anatomy of melancholy. This suggests that depressive disorder is an extreme form of an ordinary thought process, part of the dismal machinery that draws us toward our problems, like a magnet to metal.

But is that closeness effective? Does the despondency help us solve anything? Andrews found a significant correlation between depressed affect and individual performance on the intelligence test, at least once the subjects were distracted from their pain: lower moods were associated with higher scores. “The results were clear,” Andrews says. “Depressed affect made people think better.” The challenge, of course, is persuading people to accept their misery, to embrace the tonic of despair. To say that depression has a purpose or that sadness makes us smarter says nothing about its awfulness. A fever, after all, might have benefits, but we still take pills to make it go away. This is the paradox of evolution: even if our pain is useful, the urge to escape from the pain remains the most powerful instinct of all.

Jonah Lehrer is the author of “How We Decide” and of the blog The Frontal Cortex. This is his first article for the magazine.

This article has been revised to reflect the following correction:

Correction: March 14, 2010
An article on Feb. 28 about the benefits of depression misstated the name of a university in Australia where studies have been done on the subject. It is the University of New South Wales, not South Wales.

In the experiment, preliminary results of which were presented last month at the annual meeting of the Society for Neuroscience in Chicago, scientists allowed one group of rats to run. Another set of rodents [read more...]]]> November 18th, 2009
by Gretchen Reynolds, New York Times
Researchers at Princeton University recently made a remarkable discovery about the brains of rats that exercise. Some of their neurons respond differently to stress than the neurons of slothful rats. Scientists have known for some time that exercise stimulates the creation of new brain cells (neurons) but not how, precisely, these neurons might be functionally different from other brain cells.
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In the experiment, preliminary results of which were presented last month at the annual meeting of the Society for Neuroscience in Chicago, scientists allowed one group of rats to run. Another set of rodents was not allowed to exercise. Then all of the rats swam in cold water, which they don’t like to do. Afterward, the scientists examined the animals’ brains. They found that the stress of the swimming activated neurons in all of the brains. (The researchers could tell which neurons were activated because the cells expressed specific genes in response to the stress.) But the youngest brain cells in the running rats, the cells that the scientists assumed were created by running, were less likely to express the genes. They generally remained quiet. The “cells born from running,” the researchers concluded, appeared to have been “specifically buffered from exposure to a stressful experience.” The rats had created, through running, a brain that seemed biochemically, molecularly, calm.

For years, both in popular imagination and in scientific circles, it has been a given that exercise enhances mood. But how exercise, a physiological activity, might directly affect mood and anxiety — psychological states — was unclear. Now, thanks in no small part to improved research techniques and a growing understanding of the biochemistry and the genetics of thought itself, scientists are beginning to tease out how exercise remodels the brain, making it more resistant to stress. In work undertaken at the University of Colorado, Boulder, for instance, scientists have examined the role of serotonin, a neurotransmitter often considered to be the “happy” brain chemical. That simplistic view of serotonin has been undermined by other researchers, and the University of Colorado work further dilutes the idea. In those experiments, rats taught to feel helpless and anxious, by being exposed to a laboratory stressor, showed increased serotonin activity in their brains. But rats that had run for several weeks before being stressed showed less serotonin activity and were less anxious and helpless despite the stress.

Other researchers have looked at how exercise alters the activity of dopamine, another neurotransmitter in the brain, while still others have concentrated on the antioxidant powers of moderate exercise. Anxiety in rodents and people has been linked with excessive oxidative stress, which can lead to cell death, including in the brain. Moderate exercise, though, appears to dampen the effects of oxidative stress. In an experiment led by researchers at the University of Houston and reported at the Society for Neuroscience meeting, rats whose oxidative-stress levels had been artificially increased with injections of certain chemicals were extremely anxious when faced with unfamiliar terrain during laboratory testing. But rats that had exercised, even if they had received the oxidizing chemical, were relatively nonchalant under stress. When placed in the unfamiliar space, they didn’t run for dark corners and hide, like the unexercised rats. They insouciantly explored.
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“It looks more and more like the positive stress of exercise prepares cells and structures and pathways within the brain so that they’re more equipped to handle stress in other forms,” says Michael Hopkins, a graduate student affiliated with the Neurobiology of Learning and Memory Laboratory at Dartmouth, who has been studying how exercise differently affects thinking and emotion. “It’s pretty amazing, really, that you can get this translation from the realm of purely physical stresses to the realm of psychological stressors.”

The stress-reducing changes wrought by exercise on the brain don’t happen overnight, however, as virtually every researcher agrees. In the University of Colorado experiments, for instance, rats that ran for only three weeks did not show much reduction in stress-induced anxiety, but those that ran for at least six weeks did. “Something happened between three and six weeks,” says Benjamin Greenwood, a research associate in the Department of Integrative Physiology at the University of Colorado, who helped conduct the experiments. Dr. Greenwood added that it was “not clear how that translates” into an exercise prescription for humans. We may require more weeks of working out, or maybe less. And no one has yet studied how intense the exercise needs to be. But the lesson, Dr. Greenwood says, is “don’t quit.” Keep running or cycling or swimming. (Animal experiments have focused exclusively on aerobic, endurance-type activities.) You may not feel a magical reduction of stress after your first jog, if you haven’t been exercising. But the molecular biochemical changes will begin, Dr. Greenwood says. And eventually, he says, they become “profound.”

It can be difficult at first to access the subtle sensations of the psoas. Buried in the body, engaged in habitual patterns of holding (especially when you’re sitting or standing), and deeply linked to your emotions, the psoas is best approached with quiet attention, patience, and perseverance. Awareness is the first key. Like a flashlight that illuminates the contents of a dark closet, you can use your attention [read more...]]]> The internal awareness that develops through yoga is the most important tool for learning to release the psoas. And releasing the psoas will bring new freedom, ease, and structural integrity to your yoga practice.

It can be difficult at first to access the subtle sensations of the psoas. Buried in the body, engaged in habitual patterns of holding (especially when you’re sitting or standing), and deeply linked to your emotions, the psoas is best approached with quiet attention, patience, and perseverance. Awareness is the first key. Like a flashlight that illuminates the contents of a dark closet, you can use your attention to clarify and define each sensation in your core.

Constructive Rest Position

Rather than trying to instantly correct all the imbalances and habitual compensations you’ve developed throughout your life, we’ll begin by simply releasing the psoas in a posture called constructive rest position. In this pose, you don’t need to perform any muscular action to release the psoas. Gravity will do the work.

To take constructive rest position, lie on your back, bend your knees to about 90 degrees, and place your feet on the floor in line with your hip sockets, 12 to 16 inches from your buttocks. Be careful not to flatten or exaggerate the curves in either your lumbar (lower back) or cervical (neck) spine. Rest your hands and forearms on your rib cage, on your pelvis, or by bringing them to the floor as in Savasana.

Now that you’re in position, shift your awareness to the support of your bones. Begin by sensing the weight of your bones sinking down toward the floor. Take note of any part of your skeleton that feels as though it is suspended, any place where the muscular contraction prevents the bones from surrendering to the pull of gravity. As your psoas continues to release, the distribution of weight will start to feel increasingly even throughout your body.
Active Supine Stretch

Once you’ve begun to understand the skeletal position and internal sensations that accompany releasing the psoas, you can move on to more actively lengthening the muscle. Starting from constructive rest position and keeping both knees bent, bring your right upper thigh toward your chest. Gently hug your right leg toward your trunk.

Be very careful not to curl your pelvis up off the floor as you move your right leg; the pelvis should remain aligned with the trunk. Sensing into your flexed right hip and softening in the hip socket will help free the right thighbone.

You’re now ready to stretch your left psoas. Very slowly walk the left foot farther away from the hips. As the leg extends, keep your awareness on the front of the left hip socket, releasing any psoas tension you notice there. Once you begin to sense the psoas lengthening, follow the sensation all the way up the muscle to its attachment at the 12th thoracic vertebra, located behind the center of your solar plexus.

To amplify the stretch, push your right leg against your right arm as though you were gently kicking up toward the sky. At the same time, resist the push of the leg with your clasped arms. After a few moments, change sides. Don’t continue this pose if you experience pain or tension in your lower back. Instead, immediately go back to constructive rest position and relax, allowing gravity to release your psoas again.

The Ultimate Stretch

All variations of the lunge (sometimes called “runner’s stretch”) and Pigeon Pose are excellent for stretching the psoas, but for many students the best is a modified Pigeon Pose (Eka Pada Rajakapotasana). When you stretch one leg out in front of you and one behind you while keeping your pelvis stable, you isolate the stretch in the psoas and iliacus muscles attached to the back leg.

To come into this pose, start by kneeling on all fours. Swing your right knee forward onto the floor between your hands, releasing and rotating the right femur within the right hip socket, and bring your right buttock toward the floor. At the same time, extend your left leg straight back behind you. Make sure you keep your hips level and squared to the front. If necessary, place a firm bolster or pile of blankets under your right sitting bone to keep your pelvis level and supported. [Note from Rachel: please prop your hips up as much as you need. If there is any sensation in the front knee, come out of the pose. A gentle engagement of your adductors - imagine scissoring the inner thighs towards each other - can help stabilize the pose. Another variation that takes the front knee out of the pose entirely is a well-propped Hanumanasana, with the focus on stretching the back psoas rather than the front hamstring.] Don’t bring your right buttock to the floor by torquing your right hip farther forward or farther toward the floor than your left.

This posture stretches your left psoas. As you continue to extend back through your left leg, check again that you are keeping your pelvis facing squarely forward. If the pelvis torques, you’ll lose the psoas stretch, and you may also compress or overtwist the lower back. If you’re stretching properly, you shouldn’t feel tension in your lower back. The release and stretch should begin where your psoas crosses your hip at the front of the joint, and you should feel an upward extension through both the front and back of your trunk. The line of your body should form a continuous arc, with no abrupt angles.

Seated Poses

Now that you’ve discovered how it feels to release and lengthen your psoas, we’ll use a simple cross-legged posture to illuminate the proper use of the psoas in seated asanas.

Sit on a firm, folded blanket, with your feet and lower legs off the blanket. Bend your right leg and draw the heel toward your left inner groin. Similarly, bend your left leg and draw the heel toward your right shin. If either of your knees feels strained or if one knee is higher than the other, support that knee by placing a rolled towel or blanket or bolster under the knee or thigh.

Begin to notice where the weight of your torso grounds through your pelvis into the floor. Does most of your weight fall behind your sitting bones, or in front of them? If you sense your weight grounding directly through the bones, refine your questioning. Is your weight more on the front of the bones or the back? Lift your sitting bones off the blanket and pull back on the muscles of the buttocks, so that when you lower down again you shift more firmly onto the front of your sitting bones. See if this action provides a more effortless base of support for your spine, rib cage, and head.

To align your pelvis properly, you may have to raise your sitting bones by placing flat, firmly folded towels or blankets under your buttocks. When you get all your props placed correctly, you’ll be on the front of your sitting bones, with your knees lower than your hip socket. This relationship between knees and hips is critical in all seated postures because it allows your psoas to open at the front of the hip; in turn, this opening allows a release of tension throughout your legs and lower back. As the weight of the body releases down through the bones, it grounds into the earth, and a subtle sensation of support rebounds upward.

When your pelvis is stable and your skeletal structure is free to align properly, sitting feels effortless. You shouldn’t have to use muscular tension to hold yourself up—thrusting your chest forward or pulling your shoulders back to lengthen your trunk. If you feel as though your spine collapses without these actions, if your weight is still placed behind your sitting bones, or if your knees are still higher than your hip sockets, continue to add towels or blankets until you find the sensation of support that accompanies proper alignment.

If you still don’t feel this support even though you’re aligned properly, try shifting your weight slightly forward through your hip sockets until you feel a release at the core of your body. At first, this release may feel a little unsettling. You may even experience a subtle fear of falling. As the psoas lets go, you are shifting from a familiar feeling of controlling your posture with muscles to an unfamiliar feeling of relying on your skeleton for support. Since it’s new, the sensation may feel a bit scary—or you may feel relief as you let go of unnecessary muscular contraction.

Standing Release

Maintaining a released psoas can be challenging in standing postures. Biomechanically, standing on two legs is a very complex task, and many of us have developed habitual—but less than optimal—patterns of muscular contraction to help keep us upright. Fortunately, there’s an excellent exercise that allows you to discover what it feels like to relax your psoas while standing. Take a block or thick book and place it 12 to 16 inches away from a wall. Stand on the block or book with your left foot, supporting and balancing yourself with your right hand on the wall. Let your right leg and foot hang completely released. Gently swing this leg back and forth like a pendulum, taking care not to let the trunk bend or twist as your leg swings. (If your pelvis is torquing, you’re going beyond the released range of motion of your psoas.) See if you can sense the pendulum movement deep within your torso; it should begin at the very top of your psoas at your 12th thoracic vertebra, behind your solar plexus.

After you swing the leg for a few minutes, step down from the block and see if your two legs feel different. You’ve released the psoas attached to the swinging leg, and most likely this leg will feel longer, freer, and more relaxed.

Now reverse your position and swing the other leg. This time focus not only on the leg you’re swinging, but also on the standing leg. Check to make sure you’re not leaning into the standing leg hip. Try to sense your weight passing directly down through your leg and foot and into the block. Even though this leg is now bearing weight, you can release the psoas by bringing your awareness to the front of the hip socket and softening any tension you notice there.

Tadasana (Mountain Pose)

Now let’s investigate Tadasana (Mountain Pose). Stand with your feet directly underneath your hip sockets, and conduct an inquiry of your sensations. Does your pelvis feel like a stable foundation? Is the rim of your pelvis parallel to the floor? You can check by looking in a mirror, or by placing your hands on top of your hips and following the pelvic rim around to the front of your body, checking to see if both hands are level. Do both your legs transfer weight equally? Are you grounding equally through both feet? If your answer to these questions is “Yes,” your psoas should feel released, and you should be able to sense gravity drawing your weight down through your bones. If your bones are aligned, you’ll feel a slight sensation of rebounding from the earth, just as a ball dropped to the floor bounces up again. This rebounding force creates a current of energy that aligns the body, flowing up through your spine and out the top of your skull. If your pelvis doesn’t feel stable and even, try returning to constructive rest position and the supine psoas stretch. After a few minutes of releasing the psoas and stabilizing the pelvis, return to Tadasana and see if you feel more balanced.

Vrksasana (Tree Pose)

Once your weight feels equal on both feet in Tadasana, focus on sensing your ankles. Shift your weight ever so slightly forward and back over your ankle joints until you find the place where they feel most released. At that point, your psoas is also most free to release and to assume its proper function as a guy wire for the spine. Moving with proper alignment from Tadasana into Tree Pose requires that you continue to sense this connection between your standing leg and your spine, even as you shift all your weight onto one leg and lift the other into the air.

When you’re ready, gradually shift from grounding your weight through both legs to bringing it all onto your right leg. A common mistake in this asana is leaning into the right hip, which can strain the hip ligaments on that side. Instead, balance your weight directly over the bones of your leg, allowing the hip socket to remain released and the right-side psoas to relax.

When you can ground your weight straight down through your right leg, without leaning into your right hip or locking your right knee, you can start to turn and lift your left leg. Begin by softening any tension at the front of the left hip socket, releasing the left psoas. Then rotate the thigh bone in the left hip socket, contracting the external rotator muscles located behind the hip. Once you’ve rotated the femur, lift your left leg, placing the sole of the foot as high as possible on the inner right leg. Again, make sure you didn’t lean into your right hip as you lifted the left leg. If necessary, place your hand on a wall or chair to help you maintain balance.

Psoas and the Arms

If you feel stable and aligned standing in Vrksasana, you can add your arms to the pose. Just as your legs should be able to move independently of your pelvis, your arms should be able to move independently of your shoulders. And, as with your legs, this independent motion can only occur if your psoas is released. To avoid contracting your psoas as you raise your arms, bring your attention to your solar plexus and the back of your rib cage. Melt any rigidity you feel in these areas. Aim to soften and widen equally across the front of your chest and across your back, especially in the area between your shoulder blades. If these regions already feel open, straighten your arms, rotate them outward, and sweep your palms up above your head. If you detect any stiffening in the area of your upper psoas, pause and take your arms a little lower until you can soften the tension you sense in this area. Bringing your arms over your head can challenge the release of the upper psoas where it attaches to the 12th thoracic vertebra, and it can also challenge your stability through your standing leg. To maintain ease at the core of your body, focus on sensing a downward release from the very top of your psoas. Feel your weight dropping down through your bones, even as your arms float up over your head.

If you have difficulty sensing this release, return again to constructive rest position, with your arms at your sides. After a few moments, fold your arms across your rib cage. With this extra weight, the middle of your torso will rest a little more into the floor; you will feel an increased release deep in your trunk as the top portion of your psoas lets go. Once you’ve identified this release, you can again investigate it in Vrksasana.

If you guessed C, you’re correct. Buried deep within the core of your body, the psoas (pronounced “so-az”) affects every facet of your life, from your physical well-being to who you feel yourself to be and how you relate to the world. A bridge linking the trunk to the legs, the psoas is critical for balanced alignment, proper joint rotation, and full muscular range of motion. In yoga, the psoas plays an important role in every asana. [read more...]]]> (A) A remote tribe in Papua, New Guinea. (B) A revolutionary computer operating system. (C) The muscle that is the key to your structural stability.

If you guessed C, you’re correct. Buried deep within the core of your body, the psoas (pronounced “so-az”) affects every facet of your life, from your physical well-being to who you feel yourself to be and how you relate to the world. A bridge linking the trunk to the legs, the psoas is critical for balanced alignment, proper joint rotation, and full muscular range of motion. In yoga, the psoas plays an important role in every asana. In backbends, a released psoas allows the front of the thighs to lengthen and the leg to move independently from the pelvis. In standing poses and forward bends, the thighs can’t fully rotate outward unless the psoas releases. All yoga poses are enhanced by a released rather than shortened psoas. (When you reverse your orientation to gravity in inversions, however, the psoas must be toned as well as released to maintain proper spinal stability.)

Whether you suffer from a sore back or anxiety, from knee strain or exhaustion, there’s a good chance that a constricted psoas muscle might be contributing to your woes. Getting in touch with this deeply buried muscle can be humbling at first. You may discover that you’ve been doing many poses by contracting your core, instead of relying on your skeleton for support and allowing your more peripheral muscles to organize around a toned but flowing and spacious center. But if you persevere, psoas work can add new insight, openness, and stability to your practice. Though your psoas may not be as easy to sense as your biceps or hamstrings, improving your awareness of this crucial muscle can greatly enhance your physical and emotional health.

Along with improving your structural stability, developing awareness of your psoas can bring to light fears long locked in the body as unconscious physical tension. Intimately involved in the fight or flight response, the psoas can curl you into a protective fetal ball or flex you to prepare the powerful back and leg muscles to spring into action. Because the psoas is so intimately involved in such basic physical and emotional reactions, a chronically tightened psoas continually signals your body that you’re in danger, eventually exhausting the adrenal glands and depleting the immune system. As you learn to approach the world without this chronic tension, psoas awareness can open the door to a more sensitive attunement to your body’s inner signals about safety and danger, and to a greater sense of inner peace.
Meet Your Psoas

To locate this powerful muscle, imagine peeling your body like an onion. The first layer is the skin; next come the abdominal muscles in front and the massive muscles of the sides and back. One layer deeper lie the intestines and another layer of back muscles. Continue peeling each layer until just before you reach your skeletal core: There in the center of your inner universe rest the psoas muscles. One on each side of the spine, each working independently yet harmoniously, the psoas attaches to the side and toward the front of the 12th thoracic vertebra and each of the lumbar vertebra. Moving through the pelvis without attaching to bone, the psoas inserts along with the iliacus muscle in a common tendon at the top of the femur.

A healthily functioning psoas provides a sensitive suspension bridge between the trunk and the legs. Ideally, the psoas guides the transfer of weight from the trunk into the legs and also acts as a grounding wire guiding the flow of subtle energies. Working properly, the psoas functions like the rigging of a circus tent, stabilizing your spine just as guy wires help stabilize the main pole of the big top.

In addition, the psoas provides a diagonal support through the trunk, forming a shelf for the vital organs of the abdominal core. In walking, a healthy psoas moves freely and joins with a released diaphragm to continuously massage the spine as well as the organs, blood vessels, and nerves of the trunk. Working as a hydraulic pump, a freely moving psoas stimulates the flow of fluids throughout the body. And a released, flowing psoas, combined with a stable, weight-bearing pelvis, contributes to the sensations of feeling grounded and centered.
Psoas/Pelvis Relationship

Think of your pelvis as the foundation of a balanced skeletal structure. For your pelvis to provide this stable base, it must function as part of the trunk rather than as part of the legs. Many people mistakenly think of their legs as starting at the waist, perhaps because so many major leg muscles attach to the pelvis. But skeletally and structurally, your legs start at your hip sockets. If your pelvis tilts forward or back or side to side every time you move your legs, the bones can’t bear and transfer weight properly. Your psoas will then be called upon to help protect the spine by stabilizing your skeleton. Since the psoas can contract and release independently at any of its joint attachments, it can compensate for structural imbalances in many ways. But if you constantly contract the psoas to correct for skeletal instability, the muscle eventually begins to shorten and lose flexibility.

Shortening the psoas leads to a host of unfortunate conditions. Inevitably, other muscle groups become involved in compensating for the loss of structural integrity. The pelvic bowl tips forward, shrinking the distance between the pelvic crests and the legs, and the femurs are compressed into the hip sockets. To compensate for this constriction, the thigh muscles become overdeveloped. Since full rotation of the thighbones can no longer occur in the hip joints, much of the rotational torque is transferred to the knees and the lumbar spine—a recipe for knee and lower back injuries. In your yoga practice, if you feel strain in your knees or lower back in seated and standing poses, your body may be telling you that you need to lengthen your psoas.

In addition to structural problems, shortening the psoas limits space in the pelvis and abdomen, constricting the organs, putting pressure on nerves, interfering with the movement of fluids, and impairing diaphragmatic breathing. Finally, by limiting your options for movement and by constricting your center, a shortened psoas decreases both your vitality and your connection to the sensations at your skeleto-muscular and emotional core.

Losing touch with your core can happen in myriad ways. You may be born with structural imbalances that eventually lead you to engage the psoas for support. All sorts of physical traumas can compromise the optimal, healthy functioning of your psoas: injuries to the pelvis or spine, surgery, broken bones and joint injuries in your feet and legs, even a torn ligament from overexuberant stretching in yoga. No matter what their source, muscular imbalances that compensate for injuries, overdeveloped muscles, and chronic muscular tension all add to structural instability that affects the psoas.

In addition, our living environment often does not support the proper use of the psoas. From car seats to constrictive clothing, from chairs to shoes that distort posture, many features of modern life curtail our natural movement patterns. In fact, a chronically tightened psoas may date back to your first steps. Baby shoes that constrict the foot, impair the movement of bones, or limit ankle mobility can alter a child’s skeletal balance and stifle psoas vitality. Other child-rearing paraphernalia can add to the problem. Rigid plastic baby carriers limit movement, eliminating the natural protection and give-and-take of a mother’s body, and playpens restrict the crawling essential for neuromuscular and skeletal maturation. Walkers give infants a false sense of stability, encouraging them to stand and walk before the bones are fully formed and ready to bear weight. Rushing development in this way teaches children to rely on their psoas muscles, rather than their skeletons, for support.

Either emotional trauma or an ongoing lack of emotional support can also lead to a chronically contracted psoas, and thus to a loss of core awareness. If your fight/flight syndrome is triggered into constant arousal, eventually you lose contact with your inner world. One psoas workshop participant, for example, recalled her mother repeatedly admonishing her, “Look where you’re going, young lady.” Constantly receiving the message that her body couldn’t be trusted led her into chronic anxiety. She realized she literally watched every step she took, forcing her skeleton to sag under the weight of a drooping head.

As an adult, learning to consciously release your psoas can rekindle vital energies by re-establishing your connection to your body’s internal signals—your instinctual somatic wisdom. Releasing your psoas encourages this process by allowing you to trust your skeletal stability instead of holding yourself up by muscular effort. Sensing your bones supporting weight translates into a physical and emotional feeling of “standing on your own two feet.” With a properly functioning psoas, the bones bear weight, the muscles move the bones, and the joints connect the subtle energies of the body. Energy flows through the joints, offering a sense of continuity, like the string flowing through a pearl necklace that transforms it into something more than the sum of its parts. The psoas, by conducting energy, grounds us to the earth, just as a grounding wire prevents shocks and eliminates static on a radio. Freed and grounded, the spine can awaken.

Once you’ve learned to sense and release your psoas, you can apply these lessons to your yoga practice and everyday life. Keeping your psoas released during yoga practice liberates attention previously directed toward your contracted core, allowing you to sense more clearly the delicate balance of action between other muscle groups. And freeing your center creates a sense of relaxation and calm that can infuse all your activities. In his poem “Burnt Norton,” T.S. Eliot wrote a phrase that perfectly captures the inner stability and peacefulness that accompanies a properly functioning psoas: “the still point of the turning world.”

Core Awareness Podcast

Author of The Psoas Book, a guide to the iliopsoas muscle and its effect on the body, mind, and emotions (Guinea Pig Publications; P.O. Box 1226, Felton, CA 95018; www.guineapigpub.com), Liz Koch has taught psoas workshops for over 20 years. She lives in Felton, California, with her husband Jeff Oberdofer and their three children.

Roger Cole’s reply:

You should check with your doctor about your individual case, but standard medical advice for people whose blood pressure is controlled on medication is to engage in exercise and other healthy activities that a person with normal blood pressure would do. Therefore, it seems reasonable that you can safely introduce inversions if you do so gradually. In fact, inversions trigger several reflexes that temporarily reduce blood pressure, so theoretically, regular practice may enhance treatment of [read more...]]]> I have high blood pressure that is controlled by medication. Is it safe to practice inversions, particularly Shoulderstand and Headstand? —Diane Kane, Kirkland, Washington

Roger Cole’s reply:

You should check with your doctor about your individual case, but standard medical advice for people whose blood pressure is controlled on medication is to engage in exercise and other healthy activities that a person with normal blood pressure would do. Therefore, it seems reasonable that you can safely introduce inversions if you do so gradually. In fact, inversions trigger several reflexes that temporarily reduce blood pressure, so theoretically, regular practice may enhance treatment of your high blood pressure. Note, however, that people whose high blood pressure is not under control should bring the pressure down first by other means before practicing inversions.

First, let me explain how inversions affect blood pressure. In an inverted posture, gravity causes pressure to increase inside the blood vessels (arteries, veins, and capillaries) of the head and neck. The vessels of the brain and eyes are largely protected from this pressure increase because they are bathed in fluid—cerebrospinal fluid inside the skull and vitreous humor in the eyes—the pressure of which also increases during inversions: The pressure of the fluid pushing in on the blood vessel walls from outside counteracts the pressure of the blood pushing out on the vessel walls from inside.

Blood vessels that lie outside of the skull and eyes, such as those supplying the inner lining of the nose, do not have this protection. Instead, many are protected by local reflexes that respond to elevated blood pressure by contracting muscles in the vessel walls. This contraction prevents the vessel walls from being overstretched. If inversions are introduced gradually, you are in theory systematically strengthening the vessel wall muscles by challenging them to contract against greater and greater pressure.

How much blood pressure increases in the head during an inversion depends mainly on two factors: how far above the head the heart is, and how far above the heart the legs and trunk are. Therefore, a mildly inverted posture like Adho Mukha Svanasana (Downward-Facing Dog), which lifts the heart only a little above the head and does not elevate the legs, only increases pressure in the head a little. Supported Setu Bandha Sarvangasana (Bridge Pose, lying on bolsters, legs horizontal, feet at hip level) increases pressure in the head somewhat more because the legs and trunk are slightly above the heart, and the heart is slightly above the head. Salamba Sarvangasana (Shoulderstand) increases pressure in the head still more, because the legs and trunk are raised to their maximum vertical position above the heart, and the heart is raised somewhat higher above the head than in Setu Bandha. Sirsasana (Headstand) increases blood pressure in the head the most, because the legs and trunk are maximally elevated and the head is as far below the heart as it can get.

To safely practice inversions, I recommend that you introduce them over several months, starting with mild or partial inversions first, then gradually attempting steeper inversions, and moving on to Headstand last.

Roger Cole, Ph.D., is a certified Iyengar Yoga teacher and a research scientist specializing in the physiology of relaxation, sleep, and biological rhythms. He trains yoga teachers and students in the anatomy, physiology, and practice of asana and pranayama. He is based at North County Yoga Center in Solana Beach, California, and teaches workshops worldwide.

If you practice yoga, no doubt you’re aware of its health benefits. But like any physical activity, it’s not completely risk free. If you’ve been practicing for long, you or someone you know has probably pulled a hamstring, tweaked a sacrum, or experienced some injury while on the mat. Close to 9,000 Americans received medical treatment for yoga-related injuries in 2004 and 2005, according to the U.S. Consumer Product Safety Commission. Still, there are only two yoga injuries [read more...]]]> Avoid injuries on the mat with this practical guide to caring for your knees, hamstrings, and sacrum.  This excerpt from Yoga Journal.

By Roger Cole

If you practice yoga, no doubt you’re aware of its health benefits. But like any physical activity, it’s not completely risk free. If you’ve been practicing for long, you or someone you know has probably pulled a hamstring, tweaked a sacrum, or experienced some injury while on the mat. Close to 9,000 Americans received medical treatment for yoga-related injuries in 2004 and 2005, according to the U.S. Consumer Product Safety Commission. Still, there are only two yoga injuries reported for every 10,000 times it is practiced, according to American Sports Data.

Injuries can be great teachers. They invite you to uncover your yoga demons—misalignments or overzealous attempts to force your way into poses—and make corrections. But it’s smart to learn proper technique, especially when it comes to your inner knees, hamstring tendons, and sacroiliac joints. These parts are vulnerable to damage and take time to mend. But if you understand what causes trauma to these areas, it’s easy to adjust your practice to avoid or help heal injuries. Here’s a primer on each.

Inner Knee

The Road to Injury

Have you always found it difficult to get into Padmasana (Lotus Pose) and felt tempted to force your legs into the position to join your serene-looking classmates for meditation? If you are thinking of traveling down this road, please reconsider. You may have discovered that rather than leading you to the blissful land of the Lotus, pushing yourself in this way dead-ends with a sickening “pop” in the knee, followed by years of pain and limited mobility.

When you hurt your inner knee doing yoga, it’s usually because you’ve tried to force a leg into Padmasana or one of its variations. Sometimes the injury occurs after one or both legs are already in Lotus position and you attempt a pose that adds a back-bending movement, such as Matsyasana (Fish Pose), or a forward-bending movement, such as Ardha Baddha Padma Paschimottanasana (Half-Bound Lotus Seated Forward Bend).

To understand how Lotus can hurt your knee, visualize lifting your right foot up and placing it atop your left thigh. To get into this pose safely, your thigh will have to rotate outward about 115 degrees. For many of us, though, the thigh cannot turn out that much, either because of its bone structure or because tight muscles and ligaments inhibit its movement. If your thigh stops rotating but you keep lifting the shin and foot, you’ll bend the knee joint sideways, which will pinch the inner-knee bones together—the upper inner end of the shin-bone pressing against the lower inner end of the thighbone. Between these bones lies the medial meniscus, which is a protective rim of cartilage that pads the knee joint and guides its movement. When you lift your foot, you are using your same-side shinbone as a long lever. If the thighbone doesn’t rotate enough, you’ll apply tremendous pinching pressure to the meniscus—as if your shinbone and thighbone were a giant pair of pliers. Forcing this lift even moderately can do serious damage. Similarly, if you are in Lotus and your top knee is not on the floor, pushing that knee downward can apply enormous damaging force to the meniscus.

Prevent and Prepare

To prevent this injury, the first rule is to never force your legs into any Lotus variations—either by pulling the foot strongly upward, pushing the knee downward, or thrusting your body forward or backward. Don’t let your yoga teacher push or pull you into any of these poses either. Janu Sirsasana (Head-of-the-Knee Pose) and Baddha Konasana (Bound Angle Pose) can cause similar (though usually less severe) pinching of the inner knee, so practice them cautiously, too. Stop going deeper and back off if you feel pressure or pain in the knee. The structures that need to loosen up in these poses are all located around the hip area, so that’s where you should feel stretching or releasing sensations as you go deeper.

The safest way to practice Padmasana and related poses is to strongly rotate your thigh outward at the hip and not go deeper into the pose when you reach the limit of your outward rotation. This means that you’ll have to stop lifting your foot when your thigh stops rotating, so you may not get your foot on the opposite thigh. (Remember the upside: happy, functional, pain-free knees.) You can use your hands or a strap to help rotate your thighbone outward. Whether using your hands, a strap, or a cloth, if your knee ends up dangling in midair, support it with a folded blanket so you do not inadvertently force it downward as you turn the thigh outward.

The Path to Healing

If you have the misfortune of hurting your inner knee in Padmasana or a related pose, the first thing to do is leave it alone. You need to rest, ice, elevate, and compress it for a few days to reduce swelling and inflammation. If the injury seems serious, seek medical attention. It’s a good idea to reintroduce knee range of motion as early as you can by gently flexing and extending the knee to the extent possible. A yoga program for recovery needs to be individualized to your needs and supervised by a qualified instructor. But the general pattern is to promote alignment and strength with basic standing poses, such as Trikonasana (Triangle Pose) and Virabhadrasana II (Warrior Pose II). If necessary, support your body with a chair to take weight off the knee. In addition, increase range of motion by doing Virasana (Hero Pose) with the pelvis supported on a prop, and eventually reintroduce outward rotating movements like Baddha Konasana (and perhaps Padmasana) using a rolled cloth behind the inner knee.

Padmasana (Lotus Pose), preparationSet up blankets to support your pelvis and right knee. Sit in Dandasana (Staff Pose) with both legs extended. Bend one knee and place a washcloth behind it. Keeping the knee firmly bent, grip the end of the cloth in one hand and pull toward your body and out to the side to open the inner knee and rotate the thighbone outward. Continue this rotation as you lift your heel with your other hand and place your foot high atop the opposite thigh, near the hip if possible. Note: Discontinue if you experience knee discomfort.

Virasana (Hero Pose), modificationAvoid pain in your knees by elevating your pelvis as high as is necessary with folded blankets. Align your heels directly under your outer hips (this is less stressful for the knees than the standard alignment of having your heels outside of your hips). Keep your knees slightly apart, with your thighbones parallel. Place your feet in line with your shins. Sit for several minutes daily. Gradually lower the props over a period of weeks or months.

Upper-Hamstring Tendons

The Road to Injury

Say that you’re a flexible yoga teacher. Each day you wake up and practice hamstring stretches, then demonstrate deep forward bends in your classes. When you notice a pain just below one of your sitting bones, you stretch it more, thinking that will promote healing. But when the pain increases, you decide to rest it. After the pain diminishes, you stretch again and reinjure the area. The pain comes back, and the cycle repeats. This process can go on for years.

The hamstrings are three long muscles that cover the back of the thighs. At the top of them, tendons attach all three to the sitting bones. A nagging sensation just below the sitting bone is caused by a tear in the upper-hamstring tendon, near where it connects to the bone (called the attachment). To stretch hamstrings in forward-bending poses like Uttanasana (Standing Forward Bend), you straighten your knees while lifting your sitting bones. Any time you stretch a muscle, it pulls on its tendons, creating microscopic tears in them. If you wait 24 to 48 hours between practice sessions, these tiny tears heal. But the upper-hamstring tendons can take longer to heal because they are poorly supplied with blood. When you don’t give your hamstrings time to rest, you set up a scenario for injury. Alignment can also be an issue. Teachers often tell beginners to lift their sitting bones in forward bends because beginners tend to round their backs in such poses, which can lead to disk compression and lower-back injuries. But people with loose hamstrings can lift their sitting bones so high that the tendon starts to wrap around the bone. This can weaken the tendon.

To recap: If you produce new tears in your upper-hamstring tendons faster than your body can repair the old ones, you’ll end up with an injury. If you rest and start to heal, the partially healed tissue may still be too weak to withstand the pose and you’ll tear it again, ending up with more pain than before. If you repeat this cycle often enough, scar tissue will eventually develop in the torn area—and rehabilitating scar tissue is typically a slow, difficult process. Often hamstring injuries that seem to occur suddenly are set up by a gradual weakening of the tendon over time, caused by overstretching and insufficient rest. The weakening can culminate in one powerful stretch that leads to injury.

Prevent and Prepare

To prevent an upper-hamstring injury, you need to approach straight-leg forward bends gradually and with awareness, taking any pain near the sitting bone seriously. Never force a forward bend (or any pose), and if you feel discomfort at or near the sitting bone while bending forward, stop stretching that hamstring immediately. If the discomfort recurs in a future practice, avoid any action that causes it for at least several days. This usually means you should avoid practicing forward bends over that leg or you can bend the injured-side knee in all forward bends. Bending the knee protects the hamstring tendons by taking some of the stretch off of them and giving them time to repair themselves before a significant injury develops. Reintroduce straight-leg forward bends on the affected side only when the discomfort is completely gone for at least a few days, and then do so gradually.

Another important preventive measure is to include plenty of hamstring-strengthening poses, such as Salabhasana (Locust Pose), Purvottanasana (Upward Plank Pose), and Virabhadrasana III (Warrior Pose III), in your asana practice. Building muscle strength also strengthens the tendons of these muscles. However, if you have an existing hamstring injury, be sure to introduce these poses gradually.

The Path to Healing

If your injury is new, especially if you experience a dramatic injury such as a sudden tearing sensation during a hamstring stretch, rest and ice the area immediately. Be sure to avoid stressing it in any way for several days before introducing any recovery exercises at all.

Recovering from an upper-hamstring tendon injury typically takes at least a year. There are different schools of thought on how to recuperate. Some people suggest that you avoid all stretching for about six weeks while slowly reintroducing very mild strengthening exercises such as tiny preparatory movements for Salabhasana and Dhanurasana (Bow Pose). You systematically build up strength over the next several months, eventually adding powerful strengtheners like Purvottanasana and exercises that combine strengthening and stretching, such as Supta Padangusthasana (Reclining Hand-to-Big-Toe Pose), against resistance. The key is to avoid any stretching that causes pain to the injured tendon while systematically introducing stronger hamstring-strengthening exercises, including those that strengthen the muscle in the stretched position, for several months. You shouldn’t reintroduce any maximum-power hamstring stretches, such as Paschimottanasana (Seated Forward Bend), for at least a year after your injury.

Uttanasana (Standing Forward Bend), modificationIf bending forward with straight legs causes pain below one sitting bone, you may have injured your hamstring tendon. To protect an injured hamstring, fold forward into Uttanasana while bending the knee on the injured side enough to eliminate any discomfort. This will give the tendon a chance to heal. Continue to stretch the hamstrings of the other leg normally.

Supta Padangusthasan (Reclining Hand-to-Big-Toe Pose), against resistanceDuring the later stages of recovery from a hamstring injury, you can build strength while stretching the hamstring muscles mildly in Supta Padangusthasana. Lie back on the floor through a doorway or in the corner of a room. Lift one leg at about a 60-degree angle from the floor and firmly press the heel against the door frame, holding for 10 to 30 seconds. Repeat 3 to 5 times.

Sacroiliac Joint

The Road to Injury

Suppose you’re one of those people who finds that yoga comes easily to you. You can bend into most poses without stress or strain. One day, while coming out of Janu Sirsasana, you notice that something feels a little off down where your lower back joins your pelvis. From that day on, you frequently have a nagging ache in that area. It’s usually more annoying than disabling, and periodically it goes away altogether, only to mysteriously reappear days or even weeks later. These are some of the symptoms of an unstable sacroiliac joint alternately moving out of alignment and back in again.

The sacrum is the bone that is shaped like an upside-down triangle at the base of the spine. On each side of the sacrum, a roughened surface makes contact with the corresponding surface of the left and right ilium bones, or the “wings” of the pelvis. These are the left and right sacroiliac (SI) joints. Strong ligaments hold the SI joints together to prevent the sacrum from tipping forward between the ilium bones. To get an idea of where your SI joints are, trace your thumb over the top rim of your pelvis on one side, moving backward until you find the rearmost bony prominence of the ilium (this is called the posterior superior iliac spine or PSIS). If it were possible to press your thumb forward an inch or two, deep into your body, you would be touching one of your SI joints.

Yoga students frequently develop a specific pain pattern that’s characterized by a dull ache over an area about the size of a quarter and is centered on the PSIS on one side of the body only. Sitting, forward bending, and twisting movements often make it worse, and back and sidebending can also be painful. Although not all experts agree and other injuries must be ruled out, many yoga teachers and health professionals believe that this pain pattern is caused by the misalignment of one of the sacroiliac joints.

According to one theory, yoga practice (especially if it emphasizes forward bends, twists, and poses that stretch the inner thighs) can loosen the supporting ligaments of the SI joints over time, until one side of the upper sacrum slips forward relative to the ilium on that side. Because the two irregular surfaces no longer sit properly on one another, pressing them together tightly (as occurs strongly while sitting) causes pain.

Prevent and Prepare

To prevent this problem from happening, be mindful of your alignment in different types of poses. In forward bends, be careful to move your sacrum and ilium forward as a unit. For example, in Janu Sirsasana, move into the pose by tilting the iliac crest (pelvic rim) of the bent leg forward toward the foot of the straight leg. This makes the ilium push the sacrum along so that the two bones move as one. When your ilium stops moving, don’t tilt your sacrum any deeper into the pose. Likewise, in twists, experiment with letting the pelvis turn along with the spine instead of keeping it fixed, so the sacrum and ilium move as a unit.

In forward bends, twists, and any pose that stretches your inner thighs, try contracting the pelvic-floor muscles. These muscles help hold the sacrum in place by pulling the sitting bones toward one another, thereby squeezing the ilium bones inward against the sacrum. Finally, strengthening muscles of the back with poses such as Salabhasana, and strengthening the deepest abdominal muscle (transversus abdominis) with pranayama practices such as Kapalabhati (Skull Shining Breath), help stabilize the SI joints.

The Path to Healing

If you already have a sacroiliac misalignment, the key is to adjust the joint back into its proper position and keep it there. Some health professionals know how to manually manipulate the SI joint back into place, but it often pops back out soon afterward. Therefore, it’s helpful to learn how to reset your own SI joint using asana techniques, but it’s best to learn these techniques from a qualified instructor.

The golden rule for SI-adjusting postures is that a correct pose should immediately feel good on the injured area while you practice it. Enter each pose slowly, and if it causes any discomfort near the PSIS, come out of it right away. Not all poses work for all people, but you need only a single one that works for you. Two examples of poses that help some people are the Salabhasana and Virabhadrasana I (Warrior Pose I) variations shown here. Either side of the Virabhadrasana I variation may be helpful.

Once you have learned to put your SI joint back into place, make sure it is properly located before each yoga practice and follow the preventive steps above to keep it there. At the end of practice, use your technique again, if needed, to firmly reset the joint. Some teachers find that taking special care to keep the SI joint in place at all times over a period of months or even years can make it more stable.

Salabhasana (Locust Pose), modificationThis pose may help stabilize the sacroiliac joints. Strap your ankles 8 to 12 inches apart. Lie on your belly with your arms alongside your body, palms facing up. As you inhale, lift your arms, legs, and chest up. Pulling the legs strongly outward against the strap may relieve sacroiliac symptoms; it contracts outer hip muscles (gluteus medius and minimus) that pull the ilium bones apart, temporarily creating a gap between the sacrum and ilium to give the sacrum the freedom to move back into place. Introduce this pose gradually and back off immediately if it causes discomfort.

Virabhadrasana I (warrior pose I), variationThis pose may relieve sacroiliac symptoms by putting asymmetrical forces on the joint. Move into it slowly to make sure it feels OK; avoid it if it hurts. Take a wide stride, bend your front knee, and place a block between your knee and the wall. Keep your front shin vertical, back knee straight, back heel lifted, and chest lifted. Shift your body weight and adjust the angle of your pelvis to find the position that feels best in your sacroiliac area.

Roger Cole has practiced yoga since 1975 and taught since 1980. He is a certified Iyengar Yoga teacher trained at the Iyengar Yoga Institutes in San Francisco and Pune, India. He teaches at Yoga Del Mar in Del Mar, California.