Yoga Therapy for Chronic Pain

Millions of people live with chronic pain. Arthritis and back pain are probably the two most common forms, but others include everything from fibromyalgia to cancer. As yoga therapy grows in visibility, many of these people are likely to come looking for relief—and fortunately, yoga has much to offer.

Stress can exacerbate pain, whatever its cause. When you are feeling overwhelmed by stress, your pain tolerance may be lower. And, of course, a vicious cycle often ensues, since being in pain can be stressful. Yoga, as perhaps the best overall system of stress reduction ever invented, can help interrupt this cycle.

Asana

The physical postures of yoga can help relieve pain in a number of ways. The most obvious is the ability of a well-rounded yoga practice to lower stress levels. Stress makes muscles more likely to go into spasm, and muscle spasms are an underappreciated contributor to both acute and chronic pain. Indeed, in the case of back pain, it's tight, aching muscles (which can grip in response to even minor injuries to tendons, ligaments, or other connective tissue) that experts now believe cause most of the pain. 

The practice of asana, beyond its ability to induce relaxation, can be an effective way to relieve muscle tightness. In contrast to many other forms of exercise, yoga promotes both strength and flexibility in muscles. 

Asana can also be very helpful in conditions such as back pain and degenerative arthritis, where poor anatomical alignment and dysfunctional movement patterns are usually contributing to the problem. 

By teaching my students to engage muscles that aren't working properly, and relax ones that don't let go when they should, I can help them bring their bones into better alignment, relieving compression of joints and soft tissues. 

Unconscious muscular gripping can be a problem in a host of conditions ranging from headaches to carpal tunnel syndrome. By offering feedback to my students as they practice, I can slowly help them bring awareness to areas where they currently have little. 

In some areas, such as in the muscles of the face, simply pointing out the gripping may be enough to allow the students to let go. For other areas, such as in the hips or quadriceps, it can take years of steady asana practice to find significant muscular release. 

A regular asana practice can also improve sleep. Poor sleep can worsen pain and is thought to be a major contributor to the pain in such conditions as chronic fatigue syndrome and fibromyalgia. Be sure, however, to advise my students to avoid activating practices, such as backbends or vigorous pranayamas, too close to bedtime. Sensitivity varies among individuals, but generally it's a good idea to put a few hours between vigorous asana and sleep, and to balance active practices with a good dose of restorative and relaxing ones, especially when practicing later in the day.

Posture and Pain 

Posture can play a huge role in back pain, neck aches, carpal tunnel syndrome, and a variety of other conditions, and here again asana can be very helpful. 

In the modern world, where people spend a large percentage of their days sitting at desks or staring at computer screens or TVs, it's common to round the back and hold the head well in front of the spine. 

This C-shaped slump can compromise nerve conduction and blood flow to the arms, potentially worsening the pain of such conditions as carpal tunnel and thoracic outlet syndrome. This misalignment is commonly accompanied by an unhealthy internal rotation of the upper arms, further exacerbating the problem.

 
When the head is poised directly above the spine, it takes relatively little effort to maintain its position. But when you hold your head well in front of the spine, the muscles in the back of the neck and upper back get stretched and can become painful, which is one reason why neck, back, and shoulder tightness and pain are so common. Having to hold up a weight equivalent to a bowling ball all day can also contribute to fatigue, another common complaint, and another factor that can worsen the perception of pain. 

The particular asanas that improve posture will depend on precisely what you see when I examine the student. For those with the classic C-shaped slump—"Slumpasana," as it's sometimes called—gentle backbends are often therapeutic, though these

students may find them particularly difficult. 
Slumpers often fail to engage their rhomboid muscles between the shoulder blades and their back extensors in the thoracic region. Take care that when these students do backbends, they aren't overly arching their lumbar spines or their necks. 

Doing so allows them to give the outward appearance of bending backward without actually engaging those muscles that they either don't know how to use or prefer not to use. Without my guidance, they may be doing these poses in a way that not only won't help their problems but could end up causing pain in new places. 

You might have such students try Cobra Pose or Locust Pose, keeping the backs of their necks long and their gazes directed down at the floor to encourage them not to compress their cervical vertebrae. Also advise them not to strive to get as high as they can in these poses, which often happens at the risk of compressing the lumbar spine. Instead, have them stay closer to the ground while focusing on bringing movement into the area between their shoulder blades. 

While it may not look like much, the students are likely to report that doing the poses in this manner makes them work in a way to which they aren't accustomed—and that's the key to their benefit.

The Dangers and Myths You Need to Know....Hot Yoga!

In the town that I currently live in, I really can’t walk down the street without seeing at least one yoga studio. On top of that, every single yoga studio is a heated studio, meaning that all classes are done in a heated room with a temperature range from around 90 degrees to 117 degrees.  

I will not lie to any of you, I was a hot yoga junkie for a long time. That is, until I learned more about the effects of heat on the body when doing any sort of movement, albeit yoga or working out in external, extreme heat.

Hot yoga is a huge craze at the moment. It’s getting more difficult to find a studio that isn’t heated, and all modalities are taught in a heated environment from the standard Bikram to Vinyasa. I was a yoga teacher, having taught in heated and unheated environments, but having some other education has helped me learn more about what I was teaching. Hopefully the facts can help you make the decision yourself, whether yoga in external heat is your friend or your enemy.

External Heat and Body Heat

Hot yoga brings its own external heat source to heat up a room to around 100 degrees. But it’s important to mention that you produce your own internal heat when you exercise, and yes, you can consider yoga moderate exercise. Hot yoga uses static holds (and some flow), which means you are lengthening specific parts of the body depending on what pose you are in and then contracting other parts of the body to keep you stable, which means you are isometrically contracting the muscles that are keeping you stable.

How does your body produce its own internal heat? Several chemical reactions occur in the cells of the muscle tissue. These cells then release energy, which is in the form of heat. The rate of chemical reaction increases during muscle contraction thereby increasing internal heat of the body. This concept is important later on as we continue to talk about heat and its effects on the body.

Hot yoga pretty much gives you a heat-on-heat response, which can lead to heat exhaustion or even heat stroke. 
When internal heat rises, vasodilation occurs in the blood vessels in the skin and you begin to sweat to cool the body to keep the body within the normal range of body temperature. So you are sweating to cool the body down, you have an increase in blood flow, but the room is heated to over 100 degrees, therefore you have no way of actually cooling your body down, which can cause a disruption of internal body temperature.

How Things Go Wrong
The reason there is a disruption is because the body cools itself down in various ways, but the ones to focus on are conduction, convection, and evaporation.  
Conduction is exchange in heat with two objects in contact with each other, convection is exchange in heat between the body and air or water, and evaporation is the conversion of water from a liquid to a gas, a process that requires heat. When you are in the heated room, the reason it gets so humid is because several different bodies are sweating and the heat is trying to escape from the bodies because their internal temperatures are increasing.

So what happens when you are so hot in a hot yoga room, you can’t get out, and you begin to get sick?  

You may be starting to suffer from heat exhaustion. Your body keeps temperature homeostasis via a negative feedback system. This system is working during heat exhaustion, but in this scenario it can’t prevent an increase in body temperature above the normal level. This heavy sweating results in dehydration, decreased blood pressure, and increased heart rate. You may end up feeling weak, dizzy, and nauseated.

When feeling like this you must move into a cooler environment, but having been in many hot yoga studios, many yoga instructors either look down upon seeking relief or encourage students to stay in the room. If you ever have these symptoms you must get into an area of cooler temperatures to get the body back into homeostasis. If you don’t, it may lead to heat stroke that in most cases requires hospitalization.

The Myth of Sweating Toxins
Does your yoga instructor tell you that the sweating is good for you because you are releasing toxins from the body? Well, this statement is not 100% true. Most of what you are sweating is water, but there are other chemicals that make up sweat including salt, potassium, ammonia, and urea. True toxin elimination comes from the kidneys and liver, and some from the colon. 

Doing a ninety-minute hot yoga session and sweating to death is not releasing toxins. You really are just dehydrating yourself and losing only water weight. I hate the burst the bubble, but my statement is true to the facts of body’s biological systems. If you really want to eliminate toxins from the body, it's best to talk to your physician or purchase an over-the-counter liver, kidney, or colon cleanse made out of natural ingredients.

The Myth of Flexibility
There is a difference from muscular flexibility and joint flexibility. Your ligaments and tendons don’t get much blood flow, especially your ligaments. The reason for this is because your ligaments are in place to stabilize the joints. When you are in a heated environment, your blood flow increases making you feel like you are more flexible then you really are.  
Being in intense postures like virasana (pictured to the right) may be more difficult if the studio is unheated because your joints give a stoppage point in the knees, whereas when its heated, you may not feel that stoppage point and surpass your safe zone. 

Ligaments do have some stretch to them, but not a lot. The more you continue to stretch your ligaments in joint-heavy poses, the higher your risk for tearing a ligament, or stretching them to the point where your joints are not as supported. It’s important to understand that when ligaments stretch out they stay that way and cause joint instability.

Everyone assumes that yoga is good for rehabbing, but understand that yoga is simply another form of moderate exercise and you can still injure yourself.  

I personally believe that some yoga instructors do not receive enough training in kinesiology or anatomy and physiology to keep people safe, and if you add the heated element into the mix, it does have the potential to be disastrous - especially if someone is new to yoga all together. Understand, this is not to say all yoga instructors are this way. There are many excellent yoga instructors who teach in a heated environment and keep students safe, and if a student is showing signs of heat exhaustion the instructor immediately cares for the student. But unfortunately, not all yoga instructors are created equal.

For all of you athletes, keep yourself safe. Walk out if it’s too damn hot. Don’t surpass your sticking point. And lastly, do your homework. Find a yoga studio and instructor that are right for you.

Ref:This Articles from Amber Larsen

Yoga for Stress Study: You’re Never Too Old to Exercise

“We do not stop exercising because we grow old; we grow old because we stop exercising.”

The words of fitness-guru Dr. Kenneth Cooper serve as a much-needed reminder for those of us who have begun using our years as an excuse to avoid using our muscles. However, in case we needed an extra push to get out of our chair and on to the yoga mat, a recent study published in the journal Psychosomatic Medicine provides us with the evidence we asked for: according to researchers’ investigations, adopting a yoga practice doesn’t just keep us younger through maintaining physical fitness; yoga reduces stress chemicals directly linked to aging and age-related diseases as well.

Conducted by Janice Kiecolt-Glaser, PhD and associates at Ohio State University, the study examined blood-levels of cytokine interleukin-6 (IL-6), an inflammatory protein both before and after exposure to stressful stimuli. IL-6, triggered by stress, is linked to a whole host of debilitating age-related diseases ranging from arthritis to type-2 diabetes, heart disease, stroke and more.

The study participants, 50 women between the ages of 30 and 65, fell into one of two groups: half were expert or long term yoga practitioners, the other half were novices. After analyzing the data, researchers found that not only did the long term yoga practitioners produce less IL-6 in response to the stressors, they actually displayed lower baseline levels of the stress hormone as well—to a degree where the novice practitioners’ IL-6 levels weighed in at a full 41% higher.

In other words, not only did the regular yoga practitioners display a healthier stress response, they also enjoyed a greater overall state of physical calm and health than their counterparts in the same age and weight categories did.

Although our body’s stress response is a natural and useful function, too much stress or an overactive stress response can produce high levels of IL-6 can seriously undermine our health. With the constant weight of stress from our jobs, financial concerns, and other obligations on our backs, it’s no wonder that so many of us are fighting high IL-6 levels and the health concerns linked with them—diabetes, high blood pressure, and even cancer.

While doctors are working on developing anti-IL-6 agents as therapy against these major diseases, we can reduce our own IL-6 levels without a prescription: through a regular exercise program, such as yoga for stress, we can turn around our health—and turn back the clock.

Reference:

http://yogauonline.com/yogatherapy/yoga-for-stress-relief/yoga-for-stress-relief-practice/373072910-yoga-for-stress-study-y

Muscle Cramps

A cramp is an involuntary and forcibly contracted muscle that does not relax. Cramps can affect any muscle under your voluntary control (skeletal muscle). Muscles that span two joints are most prone to cramping. Cramps can involve part or all of a muscle, or several muscles in a group. 

The most commonly affected muscle groups are:
--Back of lower leg/calf (gastrocnemius)  
--Back of thigh (hamstrings)  
--Front of thigh (quadriceps) 

Cramps in the feet, hands, arms, abdomen, and along the rib cage are also very common. 

Everyone will experience a muscle cramp sometime in life. It can happen while you play tennis or golf, bowl, swim, or do any exercise. It can also happen while you sit, walk, or even just sleep. Sometimes the slightest movement that shortens a muscle can trigger a cramp. 

Some people are predisposed to muscle cramps and get them regularly with any physical exertion. 

Those at greatest risk for cramps and other ailments related to excess heat include infants and young children, people over age 65, and those who are ill, overweight, overexert during work or exercise, or take drugs or certain medications.
Muscle cramps are very common among endurance athletes (i.e., marathon runners and triathletes) and older people who perform strenuous physical activities.

--Athletes are more likely to get cramps in the preseason when the body is not conditioned and therefore more subject to fatigue. Cramps often develop near the end of intense or prolonged exercise, or 4-6 hours later.  

--Older people are more susceptible to muscle cramps due to normal muscle loss (atrophy) that begins in the mid-40s and accelerates with inactivity. As you age, your muscles cannot work as hard or as quickly as they used to. The body also loses some of its sense of thirst and its ability to sense and respond to changes in temperature. 

Cause:
Although the exact cause of muscle cramps is unknown (idiopathic), some researchers believe inadequate stretching and muscle fatigue leads to abnormalities in mechanisms that control muscle contraction. Other factors may also be involved, including poor conditioning, exercising or working in intense heat, dehydration and depletion of salt and minerals (electrolytes).

Stretching and Muscle Fatigue 

Muscles are bundles of fibers that contract and expand to produce movement. A regular program of stretching lengthens muscle fibers so they can contract and tighten more vigorously when you exercise. When your body is poorly conditioned, you are more likely to experience muscle fatigue, which can alter spinal neural reflex activity. 

Overexertion depletes a muscle's oxygen supply, leading to build up of waste product and spasm. When a cramp begins, the spinal cord stimulates the muscle to keep contracting.

Heat, Dehydration, and Electrolyte Depletion

Muscle cramps are more likely when you exercise in hot weather because sweat drains your body's fluids, salt and minerals (i.e., potassium, magnesium and calcium). Loss of these nutrients may also cause a muscle to spasm.

Although most muscle cramps are benign, sometimes they can indicate a serious medical condition. 

See your doctor if cramps are severe, happen frequently, respond poorly to simple treatments, or are not related to obvious causes like strenuous exercise. You could have problems with circulation, nerves, metabolism, hormones, medications, or nutrition. 

Muscle cramps may be a part of many conditions that range from minor to severe, such as Lou Gehrig's disease (amyotrophic lateral sclerosis), spinal nerve irritation or compression (radiculopathy), hardening of the arteries, narrowing of the spinal canal (stenosis), thyroid disease, chronic infections, and cirrhosis of the liver. 

Symptoms 
Muscle cramps range in intensity from a slight tic to agonizing pain. A cramping muscle may feel hard to the touch and/or appear visibly distorted or twitch beneath the skin. A cramp can last a few seconds to 15 minutes or longer. It might recur multiple times before it goes away. 

Doctor Examination:
During your appointment, tell your doctor about your medical history including details about allergies, illnesses, injuries, surgeries, and medications. 

Your doctor may ask you several questions. How long have you experienced cramps? Is there a family history of the problem? Do your cramps occur only after exercise, or do they happen while at rest? Does stretching relieve the cramps? Do you have muscle weakness or other symptoms? Your doctor may want to take a routine blood test to rule out diseases. 

Treatment:

Cramps usually go away on their own without seeing a doctor.

--Stop doing whatever activity triggered the cramp.  
--Gently stretch and massage the cramping muscle, holding 
   it in stretched position until the cramp stops. 
--Apply heat to tense/tight muscles, or cold to sore/tender muscles. 

Prevention:
To avoid future cramps, work toward better overall fitness. Do regular flexibility exercises before and after you work out to stretch muscle groups most prone to cramping. 

Warm Up 
Always warm up before stretching. Good examples of warm-up activities are slowly running in place or walking briskly for a few minutes.

Calf Muscle Stretch

You should feel this stretch in your calf and down toward your heel.

Lean forward against a wall with one leg in front of the other. Straighten your back leg and press your heel into the floor. Your front knee is bent. Hold for 15 to 30 seconds.


 
Do: Keep both heels flat on the floor. Point the toes of your back foot toward the heel of your front foot.

Hamstring Muscle Stretch

You should feel this stretch at the back of your thighs and behind your knees.

 

Sit up tall with both legs extended straight in front of you. Your feet are neutral — not pointed or flexed. Place your palms on the floor and slide your hands toward your ankles. Hold for 30 seconds.

Do: Keep your chest open and back long. Reach from your hips. Stop sliding your palms forward when you feel the stretch.
Do not: Round your back or try to bring your nose to your knees. Do not lock your knees.

Quadriceps Muscle Stretch

You should feel this stretch in the front of your thigh.

Hold on to a wall or the back of a chair for balance. Lift one foot and bring your heel up toward your buttocks. Grasp your ankle with your hand and pull your heel closer to your body. Hold the stretch for 30 seconds.

Do: Keep your knees close together. Stop bringing your heel closer when you feel the stretch.
Do not: Arch or twist your back.
Hold each stretch briefly, then release. Never stretch to the point of pain. 

FROZEN SHOULDER

.

Frozen shoulder is an extermely disabling condition, presenting with and remitting shoulder pain and stiffness. This was well defined by Codman in 1934, who described the best classical diagnostic criteria still used to this day.

These were:
1. Global restriction of shoulder movement.
2. Idiopathic etiology.
3. Usually painful at the outset.
4. Normal x-ray.
5. Limitation of external rotation and elevation.

The classification of a primary idiopathic frozen shoulder may be primary or idiopathic.  This is a distinct pathological condition identified by global limitation of glenohumeral motion, with a loss of compliance of the shoulder capsule, with no specific underlying cause found.

A secondary stiff shoulder or secondary frozen shoulder, typically presents after injury or surgery.  It may also follow an accompanying condition, such as subacromial impingement or a rotator cuff tear.  

Diagnosis:
The diagnosis of a primary Idiopathic frozen shoulder is made on the basis of:

Age:  
Typically occurring in females more common than males, in the 4th and 5th decade. 

Pain: 
The pain is of a constant nature, severe, affecting sleep.  There is often a toothache pain at rest, with sharp pains with forceful movements. 

Loss of external rotation: 
The typical loss of external rotation is such that passive external rotation is <0 degrees from the sagittal plane.  A secondary frozen shoulder usually has restriction of external rotation, which is beyond 0 degrees (i.e. external rotation of 10 degrees as opposed to -10 degrees with a primary frozen shoulder).

Natural History: 
The natural history of a frozen shoulder has typically been described as passing through 3 stages.  These stages last for approximately 2 years.

Stage:
1. Freezing phrase:  
This is associated with pain and loss for about 3 months.
2. Frozen phase:  
This lasts for approximately 3-9 months, with pain at extreme range of movement and marked stiffness.
3. Thawing phase:  
This last for approximately 9-18 months, usually painless and the stiffness starts to gradual resolve at this stage.





Aetiology:
The frozen shoulder has been found to be more common in association with the following conditions: 
1. Diabetes (10-20% association).  There is a 2-4 times increased risk for diabetics of developing frozen shoulder.  Insulin-dependent diabetics have a 36% chance of developing it, 10% bilaterally and the condition is more severe in diabetics. 
2. Cardiac/lipid problems. 
3. Epilepsy. 
4. Endocrine abnormalities, particularly hypothyroidism. 
5. Trauma. 
6. Drugs 

Pathology:
The macroscopic appearance is that of thickening of the anterior capsule, particularly the coracohumeral ligament (CHL) and middle glenohumeral ligament MGHL).
Contracture of the capsular ligament restricts specific movements of the glenohumeral joint. These are:

• CHL = external rotation in neutral 
• MGHL = external rotation in mid-elevation
• AIGHL = external rotation in abduction
• Inferior capsule (ICS) = abduction in neutral rotation
• PIC = internal rotation
• PSC = internal rotation in abduction

Microscopically there are 4 stages: 
1. Inflammatory synovitis with capsule unaffected. 
2. Proliferative synovitis, which is hypertrophic. 
3. Maturation of the capsule, with reduced vascularity. 
4. Burnt out synovium with a dense scar appearance.

Treatments:
The natural history of frozen shoulder is not necessarily that of complete resolution.  The original quotation that most recover from frozen shoulder originates from Codman in 1934. However, he stated that most frozen shoulders recover compared to tuberculosis.  

Many studies have shown frozen shoulder not to be an entirely self limiting condition and most patients still have some restriction of shoulder movement on resolution of the frozen shoulder but no functional disability.

Non-Operative Treatment:
Studies on non-operative treatments for frozen shoulder have shown that Osteopathy,Physiotherapy improves range of movement but not necessarily pain relief.  

Steroid injections have a benefit for short-term pain relief only but no long-term pain relief. 

The treatment options range from:
1. Osteopathy
2. Physiotherapy
3. Chiropractor
4. Stretching Therapy
5. Healing Yoga
6. Stretching Exercises
7. Swimming
8. Aqua Fitness
9. Heat
10. Distention injections
11. Locally acting steroid injections
12. Open/arthroscopic capsular release

Surgery:
Early surgery has been shown to be of significant benefit for a faster recovery of pain, quicker recovery of function and earlier return to work.   


Conclusion:
Primary idiopathic frozen shoulder is an extremely disabling condition, which does pass through a typical 3 stage progression.  However, full recovery at the conclusion of the 3 phases is not common.  Early surgical intervention has significant benefits for those patients that are unable to cope with non-operative treatment.