Busting other yoga myths with biomechanics

Unlike some of the improbable myths that the gals over at Smarterbodies take on in their new ebook Exposing Yoga Myths, yoga teachers could be forgiven for their misconceptions about demands placed on joints and muscles in common balancing asanas. In fact, nobody was more surprised at what is actually happening than Dr. George Salem, lead researcher for the Yoga Empowers Senior Study (YESS). Dr. Salem is Director of the Musculoskeletal Biomechanics Research Laboratory, Director of the Human Anatomy Program, directs the Exercise and Aging Biomechanics research program; and is Associate Professor in the Division of Biokinesiology & Physical Therapy at the University of Southern California.

In the study that is the subject of this post, Dr. Salem and his team used standard biomechanical analysis (joint moments of force and EMG measurements of muscle activation patterns) to examine physical demands placed on older persons, average 70 years old, performing three common variations each of Vrksasana (Tree) and Uthitta Hasta padangustasana (single leg balance).  Here’s what they discovered.

Vrksasana (tree pose)

Because it can become confusing, use this key for translating beginner, intermediate, and advanced vrksasana. You can see a visual here.

  • beginner = toes of non-stance leg touching the floor; hands on wall
  • intermediate = only stance foot touches ground; hands on wall
  • advanced = only stance foot touches ground; no wall support

They hypothesized that the beginner variation, which was done with toes on the floor and heel against the inside of the shank (lower leg) of the stance leg and using a hand on the wall for support, would be the least physically demanding . The intermediate variation, which had the entirety of the foot on the stance shank, but still holding the wall, would be more physically demanding. The advanced variation, which was classic vrksasana, with foot on shank and no wall support would be the most physically demanding. They hypothesized that the increase in physical demands would be linear. They were wrong.

Progressing

What they found was that there was a large increase in demand going from tree with the toes on the ground and wall support (beginner tree) to tree with the foot off the ground and wall support (intermediate tree). And there was not much change at all between having or not having wall support, when only the stance foot was grounded. Providing wall support doesn’t lessen demand nearly as much as lifting the toes from the mat.  This suggests that more time may be needed practicing the beginner variation before transitioning to the intermediate variation. Because older persons have diminished strength and balance, reduced joint range of motion, and a greater prevalence of osteoarthritis, some variations of what are seemingly appropriate asanas may place them at risk for musculoskeletal and neurological pain and injury. And while increased muscle loading may improve strength and endurance, excessively high joint moments of force may lead to damaging loads to joint structures and exacerbate osteoarthritis and other pathological joint issues.

Recommendation: In working with older persons in vrksasana, when they are ready to progress from the beginning variation, have them keep their toes on the floor and move away from the wall, rather than having them lift their toes while staying at the wall.

Hip Strength

Another finding was that advanced tree and intermediate tree (both with non-stance foot off the ground) were nearly identical in the physical demands of the lateral hip musculature aka abductors aka gluteus medius. Thus, there appeared to be no adaptive benefit to stepping away from the wall, when you are already balancing on one leg (toes of non-stance leg not on the ground). Thus, for students who feel safer holding onto a wall, they are gaining as much improvement in strength and endurance as those not holding the wall. Strong abductors are associated with better balance and reduced fall risk.

Recommendation: Let your students know that holding onto the wall does not undermine hip strength and will  effectively assist them in achieving better balance, decrease fear of falling and performance anxiety in class, and build confidence. 

Knee Safety

A really important finding has implications for students with knee issues. Intermediate and advanced tree pose increases loading of joint structures. Unfortunately, such loading characteristics are associated with knee osteoarthritis and joint pain, thus could exacerbate preexisting conditions. Importantly, and in contrast to commonly held conceptions, the use of a wall for support during these variations of Vrksasana does not offer protection for the knee joint.

Recommendation: For senior students with existing knee problems, suggest they stick with the beginner version of Vrksasana.

Uthitta Hasta Padangustasana (single leg balance)

Follow this key, when visualizing the beginner, intermediate, and advanced variations of padangustasana. Here is a visual.

  • beginner = extended leg supported on blocks
  • intermediate = extended leg supported on chair
  • advanced = extended leg unsupported aka supported by the strength of the student

Progressing with Props…maybe not

Again, researchers were surprised, when their hypotheses were not supported. It turns out that extending your leg onto a chair is not much of a progression over stepping onto a stack of blocks, although it appears quite a bit more demanding. (I interject that there is likely more balance anxiety for some older students to place their leg on the higher chair.) The real progression comes with the advanced variation, which uses active mobility – you holding your own leg up. What is striking to me is that while the leg may be higher on the chair, the effort is larger in the advanced variation – even though the leg is barely off the ground (see link to visual) because the student is generating internal force (muscle force) rather than relying on external force (chair) to assume the posture. It matters how you get there. It matters how you stay there.

Hamstrings

In the advanced variation, co-contraction of the hamstrings and quadriceps occurs, stiffening the joint and increasing stability, however, this increased loading may exacerbate existing knee osteoarthritis symptoms.

Recommendation: For senior students with existing knee problems, suggest they stick with the beginner or intermediate variations of Vrksasana.

Ankles

This study found Padangustasana to be an excellent posture for improving plantar flexor (think rising up onto the ball of your feet) strength and performance, which is associated with balance and postural control, gait, and fall risk in older persons. However, it’s not until students are confidently performing this one legged balance that they appreciatively load the plantar flexor muscles.  This asana is also excellent for ankle inverter strength (think sole of the foot facing in towards the midline of your body), which, like strong plantar flexor muscles, is critical for balance but also in agility and walking proficiency.

Recommendation: encourage your appropriate older students to work towards the advanced variation o Uthitta Hasta Padangustasana for improving ankle strength and agility.

Conclusions

This study’s biomechanical insights provide evidence that can be used by yoga instructors, when selecting modifications for their older students.

Here are three points to remember:

  1. Posture variations that have long been considered introductory may actually induce higher demands at some joints and planes of motion, than pose variations considered advanced.
  2. Pose variations can produce forces that are in the opposite direction of those generated during the classical variation.
  3. Use of props, such as a wall, to reduce contraindicated joint loading may have little or no effect.

As a yoga and movement teacher, my biggest take away is that there are few well-designed studies in the area of biomechanical forces and yogasana. In fact, the authors’ state that this is the first study to quantify the physical demands of yoga pose variations, using biomechanical methodologies. I will continue to seek more research like this so that I can replace time-honored ideas about what I think or what I’ve been told might be happening in yoga with what is actually happening in yoga.

The Physical Demands of the Tree (Vriksasana) and One-Leg Balance (Utthita Hasta Padangusthasana) Poses Performed by Seniors: A Biomechanical Examination. Sean S.-Y. Yu,  Man-Ying Wang,  Sachithra Samarawickrame,  Rami Hashish,  Leslie Kazadi,  Gail A. Greendale, and George J. Salem. Evidence-Based Complementary and Alternative Medicine. 2012.  http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3437689/

Namaste, Michele

Strong At Any Length

I write today about paradigmatic shifts in yogasana – an evolution in three acts – inspired by three teachers, whose work I’ve been deeply studying and with whom I’ve been privileged to train in vivo. Having multiple teachers is an exercise in blessings and curses and maddening dissonance. I am constantly reconciling and reconvening the experts in my head. I call a summit of this brain trust at least once a week, usually on Facebook, where I am then schooled by my smart(er) colleagues and their respective adepts. This is a mashup of what I’ve come to understand from these bodysmarties and how I’ve integrated their wizardry into my movement and life practices.

Act One by Ray Long: The Bandha Yoga Codex: Using Reciprocal Inhibition, Muscle Isolations, Co-Activations, and Facilitated Stretches in Yogasana

I have devoured Ray Long’s books and had the great fortune of a weekend workshop with him in Vancouver. It was through his teachings that anatomy ceased being abstract, non-contextual, and tedious rote memorization. His beautifully rendered books brought anatomy to life through methodical application of stretching physiology to yogasana.  His MO is to define the position of joints in a pose, identify prime mover muscles (agonists) and their corresponding stretchers (antagonists), and use stretch reflexes – muscle spindle, reciprocal inhibition, and golgi tendon organ to facilitate muscle extension. Where I find him most masterful is in cuing how to isometrically contract a muscle using directional cues like “press the hand onto the floor to contract serratus anterior” or “the cue for engaging these muscle together is to press the sole of the back foot into the floor and [isometrically] drag it toward the back side of the mat.” I wish all yoga teachers cuing isometric contractions would read Ray’s books and learn clear, sensible instructions instead of what can sometimes come across as vague, mystifying directives.  After learning of Jules Mitchell’s work, I started using Ray’s cues for muscle contraction not to facilitate reciprocal inhibition (ie contracting the quadriceps to further stretch the hamstrings), but instead I use his money cues to isometrically contract the stretching muscle, thereby increasing strength at the end range of motion, which, it turns out, is what actually increases flexibility.

I have read and recommend the following books by Ray Long.

The Key Muscles of Yoga: Scientific Keys, Volume I

The Key Poses of Yoga: Scientific Keys, Volume II

Yoga Mat Companion 1: Anatomy for Vinyasa Flow and Standing Poses

Yoga Mat Companion 2: Anatomy for Hip Openers and Forward Bends

Yoga Mat Companion 3: Anatomy for Backbends and Twists

Yoga Mat Companion 4: Anatomy for Arm Balances and Inversions

Act Two by Katy Bowman: Neutral Pelvis: How I Learned to Stop Using My Back to Stretch My Hip and Other Lessons in Honoring My Boundaries.

I’ve already written my primer on Katy Bowman on this blog. Most relevant here is Katy’s brilliant teachings on forces, loads, visible and invisible boundaries, and errant joint motions. Let me try to explain. In yoga, your body is subject to various forces, but of primary importance is how you position your joints in relation to each other. These forces are experienced as loads on your tissues. Regardless of the yoga lineage or alignment system you follow, your alignment markers are tools for helping you establish and maintain visible boundaries in your postures. Consider reverse warrior pose. If you maintain 90 degrees of flexion in your front knee as you laterally flex your spine, you will receive a different stretch than if you lose some of that flexion in your knee as you move into the pose. Try it. Circumventing your visible boundaries, as in the reverse warrior example, will not get you what you want in the pose – in this case, a stretch in the lateral trunk muscles.

When you disregard or have no visible boundaries (alignment markers) you are probably not stretching what you think you are. If alignment points (for example “90 degree flexion in knee in reverse warrior” or “shoulders stacked over wrists in cat/cow”) are your visible boundaries, what, then, are invisible boundaries? They are hidden forces, like errant joint positions, that undermine your alignment. Take the pelvis. In Katy’s system of Restorative Exercise, a neutral pelvis is one, where the  pelvic bones and pubic bone are in the same plane perpendicular to the floor. These visible boundaries (alignment markers), when honored, assure that you are stretching your hip flexors vs. overextending your back. Try this simple test. In a standing position, put your pelvis in neutral (Katy’s post linked to above gives a great visual). Remain upright (don’t fold forward into a Vira 3 variation), extend a leg behind you as far as you can. Notice that in order to get the leg that far back, your pelvis had to tilt forward and you contracted the muscles in your lower back. You used your back to stretch your hip flexors. Now try it again, this time keep your pelvis neutral while you extend your leg. This movement was much smaller and did not involve your back at all. This is your true range of motion in your hip flexing muscles. You can apply this same concept to prone postures like Dhanurasana (bow) or Salabhasana (locust). There is nothing wrong with involving your back, if you are aware that you are doing it and desire the accompanying lumbar extension and compression. If, however, you compress your spine each time that you only meant to extend your hip, then you are using your back to do the work of the muscles that should be stretching your hip.

Act Three by Jules Mitchell: Strong at Any Length: A Yogi Turned Biomechanist Turned Yoga Stretching on its Head

I have a nerdy girl crush on biomechanist Jules Mitchell. Me and about a gazillion other yoginis. The crush is strictly science based. I am a former research librarian, whose idea of a good time is to sit at home on Friday night with a stack of research papers. Jules wrote her masters thesis on the science of stretching and she turned the world of yoga on its head (not to be confused with the king is dead kind of headstand). She slogged through hundreds of research articles trying to confirm what she thought she knew about yoga stretching – that it makes muscles longer. What she discovered is that increases in range of motion are not biomechanical, but neuromechanical – yoga doesn’t lengthen muscles, it merely increases your nervous system’s tolerance to stretch further.  This is a ridiculously oversimplified explanation of Jules’ epic, paradigm shifting, game changing, head exploding thesis. But you are in luck, because she blogged about her research along the way and you can read about it. Start with her seminal post on tissue mechanics. If you want a concise distillation of Jules’ conclusions, read Jenni Rawlings’ post Stretching is in Your Brain – another smartypants to whom I am most grateful.

Two ways that Jules applies what she learned about the relationship between strength and flexibility inform my own practice. I was introduced to the idea of training active range of motion initially by Katy Bowman.

  1. Train active range of motion
  2. Strengthen at your end ranges of motion via muscle contraction

Training active range of motion in yoga simply means that you use muscle control to get into and out of a posture. If you have to leverage one body part with another or use your hands to lift your foot/leg into position, you are “placing” yourself into a position that you are not strong/flexible enough to get into organically. When you do this, you bypass your neurology and the tax for that “deeper” pose is that you no longer provide optimal muscular stability to your joints and you are in danger of stretching your connective tissues to permanent deformation or failure.  It is when you are in an active range of motion that you increase strength and flexibility.

For instance, in the seated spinal twist ardha matsyendrasana, instead of leveraging your elbow against your knee to twist your torso, you could simply use the core musculature of your trunk to twist. Try this,  keep your hands on your shoulders and twist using only your core muscles. If you need a hand on the floor behind you for support, make sure you are not leveraging the twist further with that hand.  Notice how far you are able to twist. This is your active range of motion. Now place your opposite elbow to the outside of your knee and leverage to see how much further you can twist. The difference is your passive range of motion. At best, in passive range of motion, you are not getting stronger or more flexible. At worst, you have rotated into a range of motion that is not safe for you because you bypassed the brake signal your nervous system gave you in the active twist. It is your brain that stops you from twisting further – not short or tight muscles. This concept applies whenever you are twisting, but expecially think about losing the leverage in postures like parivrtta utkatasana (revolved chair) and parivrtta trikonasana (revolved triangle).

Here are a few more postures to try that exemplify the brilliant work of Ray Long, Katy Bowman, & Jules Mitchell.

Vrksasana – I  used my hands to pick up my foot and place it high up onto my inner thigh.

P1030104 (1)

In this second version of tree pose, I used the strength and range of motion of my hip and leg to place my foot on my thigh without using my hand and while maintaining Tadasana (no cheating my foot up by contorting my body in some other manner). You see, my brain stopped me from going further because foot high on the thigh is not a position that I ever got into on my own before beginning to train active mobility. The first time I tried placing my foot without using my hand, I couldn’t get my heel higher than my knee joint! I am living evidence that training in active mobility improves both strength and flexibility.

vrksasana_active

And how about the Bikram or Hot Yoga variation? A striking difference between passive and active range of motion. Not only does passive range of motion  make your shorter, it sometimes changes the color of your clothes. Just kidding.

Vrksasana_bik_passivevrksasana_bik_active

Utthita Hasta Padangustasana takes on a whole new look, when you don’t use your hand to bypass your neurology.

UHP_passiveUHP_active_xn2UHP_active_np

In the classic pose, first picture, I am in passive range of motion – I used my hand to lift my foot, much higher than I could get it there on my own. My lumbar curvature is AWOL and if I had a dog tail, it would be between my legs.

Notice in the second picture, that even though I used active range of motion to lift my leg, I am not wearing a neutral pelvis. By retroverting my pelvis (tucking my tail), thus thrusting my pubic symphysis further forward than my pelvic bones (anterior superior iliac spines) and unwittingly flexing my standing knee,  I am now using my back to do the work of my leg – in this case flexing my hip.

The third picture shows the most optimal posture, in that I am training active range of motion and keeping a neutral pelvis (you can tell by the bubbleness of my bottom and my lordodic lumbar curve), but look how low high my leg is now!??!

Parsvattonasana

And finally, I hack Ray Long’s excellent cuing and mash it up with Jules Mitchell’s love of eccentric, concentric, and isometric muscle action for strengthening at end range in one of my favorite asanas – parsvottonasana. In this pose, the front leg’s hamstring is eccentrically contracting (generating force while lengthening). Cue lifting the front heel, while keeping the knee straight, to contract the calf muscle. You have just added a concentric contraction (generated force) to a stretching muscle.  Try slowly lifting and lowering the heel a few times. Next, with just the slightest bend of your knee, firmly press the heel of the front foot into the floor and isometrically  “drag” the front foot towards the back foot (don’t actually move the foot). Because the heel is fixed in place, this action of trying to press the heel into the floor and play drag it backwards is the same muscular action that would be taken if you were trying to flex your knee and results in a contraction of your stretching hamstring – the exact recipe for increasing strength at your end range of motion.

I would be honored and humbled to receive critical comments from any of these teachers or anyone familiar with their work. Or anyone, really.

Namaste, Michele

In reply to a dead but long living king

I received quite a few comments, on my personal Facebook page, to my article on headstand. Below are my clarifying responses. While I don’t include the original comments from my FB friends, they are fairly obvious within the context of my replies.

Reply to W.

Fan or not, Hector’s study is hugely important to biomechanics literature as it relates to yoga and to yoga literature as it relates to mechanical considerations of asana. There is very little out there that looks at the mechanics of yoga postures and their mechanical consequences. Hector was not trying to prove that loading the neck was bad. She set out to determine how much load is happening, rate of loading, center of pressure, and neck angle; contextualize these findings within what we already know about spine mechanics (lots); and apply this to an increasingly popular and controversial yoga posture. It’s through this extrapolation that one might conclude (me in this case) that unnaturally loading the neck is not good and that sirsasana provides the type of loading known to cause chronic and acute injuries.

You make a great point about loading of the neck not being limited to compressive forces. There are indeed tensile forces loading our cervical spine via our musculature. Buried within the 100+ pages of Hector’s thesis, she references studies that look at the minimal forces shown to cause cervical failure. These force studies, in humans, must be done in cadavers for obvious reasons. So, to account for the activity of surrounding musculature that would be found in a living person, cadavers’ skeletons were anatomically restrained in order to simulate the stabilizing properties of neck musculature. What they found, surprisingly I assume, is that larger fractures and forces were generated. This indicates that muscular stability or restraint may not increase tolerance for higher loads. Other researchers found that age, gender, disease, endocrine function, congenital factors and arthritis all affect tolerance values for cervical failure. Coincidentally, she does discuss African wood bearers, who are practiced at carrying large loads on their heads. In one small study, 90% of male wood bearers exhibited cervical degeneration compared to 23% of the control group. Elimination of natural cervical lordosis was seen, which puts the spine into pre-flexion – a known condition for cervical failure under axial loading. In other studies, females carrying large loads of wood had more prolapsed discs, herniations, and listhesis than those with moderate loads.

Ethically, a clinical study that seeks to prove that neck injuries are caused by certain loads can’t and won’t be performed on living humans, so we have to rely on research studies with cadavers or retrospective studies like those with wood bearers – which may be the closest thing we have to proving cervical loads do indeed cause injuries. When I put all of this together – case studies,  biomechanical studies, anthropological studies with wood carriers, clinical studies  done on glaucoma & blood pressure, and all the anecdotal studies from yoga teachers and practitioners, the evidence is clear, if not overwhelming, that supporting more than 8% of your body weight on your neck is dumb. Even if you do strengthen your cervical bones and other tissues by loading, I can’t imagine you strengthen it over five fold. But, again, the studies have not been done, which is why Hector’s study is so important.

Reply to M.

Iyengar taught, in his books anyway, that the full weight of your body should be on your head in sirsasana. Fortunately, many good teachers, like you, instruct students to place little to no weight on their heads. This better protects the neck, but then you have to consider that most people have meager compressive and tensile loading histories in their shoulders and arms, outside of some planks and possibly pull-ups in the gym/studio. I suspect that loads produced in the shoulders & arms from headstand or handstand far exceed most peoples’ loading histories and capacities. Nobody has studied this that I’m aware of.

The context of fear and empowerment is so important to this discussion. In my early 20’s, I was diagnosed with panic disorder, which was layered on top of a history of generalized anxiety. At age 26, I began rock climbing and that was the beginning of the end of my battle with anxiety. Climbing for me was terrifying, but I persevered (main motivator being I was totally in love with the guy who was taking me climbing:) and through overcoming my fears of heights, hanging belays, run outs, and dynos, I overcame my fear of life. Climbing is inherently dangerous, but 99% of the danger can be mitigated by good choices. What I’m learning about headstand (and shoulder stand) is that even the best choices (alignment, good instruction, acquiring strength, etc.) may not protect you from accumulated damage from putting 50% or more of your body’s weight onto your cervical spine, unless you are levitating your head, which I suspect most people aren’t. Listening to your body and doing what is right for you, while in most cases is sound advice, may not override the truth of biomechanics when it comes to standing on your head.

Reply to J.

I applaud you for recognizing your “youth” as a teacher and putting your student’s before your ego. I wish I had showed the same restraint. It took me a while before I realized that just because I can do a headstand, arm balance, etc., it doesn’t mean I have the maturity in my practice to teach it. And, for what is now paramount to me, it does not mean that I understand their impact on biomechanics well enough to be teaching them to students, whose movement and loading histories I don’t know well. I’m not sure, though, if “feeling good” is always a good marker for the safety of a posture like sirsasana. Much of what I’ve read in the case studies and in the personal stories of long term yoga practitioners discusses cervical spine injuries as more chronic or cumulative in nature – not of the burst fracture type – but of accumulated damage from unnatural loading on insidiously degenerating discs and bone density-compromised vertebra. Most of these practitioners “felt good” for those years they were doing sirsasana, until they didn’t.

Reply to H.

You are right; the Hector study did not look at duration in headstand as a risk factor for cervical injury. However, earlier studies of headstand related to glaucoma found that duration positively correlates to increased intraocular pressure. I would posit that greater duration would be associated with fatigue, thus disrupting ecological balance between arm/shoulder forces and head forces. Your advice to students not to kick their legs up in sirsasana, and to work on having the strength to weight ratio to lift them in a controlled, symmetrical manner, certainly aligns with Hector’s study. As for shoulder stand…. it is another posture that has not fared well in the medical literature…more to come.

Reply to a different M

Hector’s study showed repeated loading of the head and neck due to intrinsic bouncing and weight shifts between the arms and head. Unless you were completely levitating your head from the ground (were you?), it seems like you would be unable to completely remove loading forces from your neck. I  would love to hear your technique.

Reply to R**

I edited my post to say the following: “I’ve been in many yoga classes, where headstand was cued, but few of them came with warnings about headstand’s potential effects on glaucoma, detached retina’s, neck issues, or uncontrolled blood pressure.” I appreciate the feedback that helps me to clarify what I really mean.

** R is a former teacher of mine and has reached the Intermediate Junior I level in her Iyengar teacher training, which is frankly badass in the exquisitely rigorous training curriculum and testing process that is Iyengar (don’t let “intermediate” and “junior” fool you, this is a remarkable accomplishment). Originally, I said that I had never had a teacher give contraindications for glaucoma, when instructing sirsasana. R challenged me on this. I have taken classes/workshops from a handful or formally trained Iyengar teachers but it has been some years and I don’t recall these contraindications, but I don’t trust my memory either. However, in recent memory, in local and regional studios in the last year or so, I can remember specific times when the warning was not given, because I was listening for it. That is a more fair statement.

General reply to all

I wrote this article from a teacher’s perspective. But as a student/practitioner, I have a different relationship with the King. Ironically, I used sirsasana as a therapeutic exercise (protocol of Loren Fishman that I referenced in my article) after I tore my labrum from the bone and partially tore my supraspinatus showing off  in downward dog. I credit sirsasana with my near miraculous, almost full recovery.

Namaste, Michele

The King is dead. Long live the king.

The so-called King of all asanas aka salamba sirsasana aka supported headstand is one of the crowning achievements in yogasana. If you can perform headstand, you join an elite group of yogis. If you teach it, especially to a group of wide-eyed beginners, you are a yoga rock Goddess. Another teacher once bragged to me that, within some period of time (months? a year? I can’t recall), every student in her class was able to perform sirsasana. I taught it at one time too. Before I had any business teaching it. I continued to teach it after I considered myself qualified. What qualified me? The usual stuff – I regularly practiced it. I read and watched tutorials on the internet and in books. I learned from other teachers. I took a couple of workshops.  I taught headstand because I craved the status. I desired to impress. I delighted in being responsible and lauded for another person’s accomplishment. I never wanted to hurt anyone. I’d like to say that I didn’t hurt anyone. But I don’t know. There were no reports of injuries. But, then again, I’ve had students confide in me about injuries sustained in another yoga class, including one suffered from prep work and attempts at headstand, but these students never told the other teachers.

But here’s the thing. I thought that if I followed the cumulative wisdom of alignment in headstand that I, and anyone I taught, would be safe from injury. I thought that if I drilled the shoulder girdle prep work into my students ad nasueam (lift your shoulders! lift your shoulders! lift your shoulders!) and dampened my enthusiasm and that of my students by  patience, restraint, and slow, methodical prep work, it would be all good. I was wrong. I liken this King of all yoga poses to King Henry VIII, known for many things, but most notoriously for lopping off tens of thousands of heads during his reign. Nobody knows how many heads have been lopped off by King Sirsasana, because nobody is counting. OK, nobody has literally lost her head with this pose, but we do know that adverse events can and do occur with headstand and that they can be of a serious, life altering nature.

Here is what’s been written up  over the years in case reports in the medical literature and captured in a 2013 review article entitled Adverse Events Associated with Yoga: A Systematic Review of Published Case Reports and Case Series. Keep in mind that this is not an inventory or accounting of the actual number of adverse events caused by yoga. These are the very few cases, where someone experienced an injury or other adverse event directly attributable to yoga; and where that person was seen by a physician, who subsequently wrote about the event and published the case in a scientific journal. What is missing from the number of cases reviewed (76) are the potentially millions of injuries/adverse events that occur each year in the US alone, where over 15 million people practice yoga and pranayama regularly. There is currently no way of knowing how many of these events occur each year because studies large enough to provide a valid estimation have not been done. In the above review of cases, headstand was culprit in 10 of the 76 cases.

Adverse events attributable to headstand included:

  • Worsening of vision secondary to glaucoma; this 46 yo female yogi fully recovered in several months by avoiding sirsasana
  • Progressive pigmentary purpura – a rusty brown skin patch caused by leaky capillaries (tiny blood vessels) of the forehead; the treatment was topical corticosteroids and the clinical outcome for this 59 yo male was unclear
  • Bilateral orbital varices (bulging veins in the eyes) due to increased blood flow;  treatment and clinical outcome were unclear for this 62 yo female
  • Basilar artery occlusion aka a stroke; the 34 yo female yogi received inpatient treatment and physical therapy  and had not fully recovered one year later
  • Progressive optic neuropathy (nerve damage to the eye) secondary to glaucoma; the course of treatment and clinical outcome for this 46 yo female were unclear
  • Bilateral conjunctival varix thromboses or enlarged veins with blood clots in the eyes; the 60 yo male yogi had a surgical excision of the blood clots but the clinical outcome was unclear
  • Progressive optic neuropathy (nerve damage in the eye) secondary to congenital glaucoma; the treatment and clinical outcome for this 47 yo female yogi was unclear
  • Early glaucomatous optic disk change and visual field loss aka pathological changes in the eye accompanied by worsening vision; treatment for this 29 yo male yogi was avoiding inversions, which stabilized his eye status
  • central retinal vein occlusion aka eye stroke; this 55 yo male yogi underwent eye surgery, but did not recover

If I had glaucoma or a family history of glaucoma and a yoga teacher cued headstand without detailing why it would be contraindicated for someone with glaucoma, I would walk run, possibly screaming, from the room because at the very least,  teachers should know this universally agreed upon contraindication. I cringe to say it, but I’ve been in many yoga classes, where headstand was cued, but few of them came with warnings about headstand’s potential effects on glaucoma, detached retina’s, neck issues, or uncontrolled blood pressure. And then, confounding matters and tarnishing the shine I feel when I call my teaching style “Iyengar-influenced,” there is this, from B.K.S. Iyengar from his seminal work, Light on Yoga: “I have taught this pose to a lady of 65 who was suffering from glaucoma. Now she finds the eyes are completely rested and the pain in them is much lessened. Medical examination revealed that the tension in the eyeballs had decreased. I am mentioning this to prove the value of the correct head stand.” One could not be faulted in believing that a good teacher can align the bad away in sirsasana, even though numerous case studies, as well as full research studies, show that intraocular pressure rises in headstand and exacerbates glaucoma.

While I have a macabre fascination with headstand-induced strokes and vision loss, my real interest lies in the biomechanics of sirsasana and potential or actual musculoskeletal injuries to the cervical spine.The weight of an average adult head is 7.5% of total body mass. Your cervical spine was designed to carry the weight of your head, or about 7.5% of your total weight. In headstand, as you will learn later, you ask your neck to bear upwards of 50% of your body’s mass. For example, I weigh 125 lbs, so my head weighs about 9 lbs. Thus, my neck has a loading history of hauling around 9 lbs give or take a hat. However, when I perform headstand, I potentially place more than 60 lbs of weight onto my cervical spine, which, again, has a loading history and capacity of 9 lbs or less. Vertebra are made of trabecular bone, which is the spongy variety and more prone to fracture. Loading beyond tolerance levels subjects your neck to the possibility of a burst fracture. Burst, in case you need reminding of its definition means “to break suddenly and violently apart, spilling the contents, typically as a result of an impact or internal pressure.” Not something you want associated with your neck. But a more likely scenario, detailed below, is the possibility of spinal cord compression by a compromised cervical spine.

What I found remarkable about these cases was that none is the type of musculoskeletal injury you might expect to find when you  hold the majority of your body weight on the fragile vertebrae of your neck. To an emergency room physician or orthopedic doctor seeing a headstand-related neck injury, it’s going to be a no-brainer. A neck injury, where you might expect one, is neither as fascinating nor case-worthy as, say, a pneumothorax (collapsed lung) caused by Kapalabhati or breath of fire. So, I went searching and found a few case studies that were not included in the 2013 review article. In one case, a 63 yo woman, who had practiced yoga for 30 years and had a daily headstand practice, presented with bilateral hand numbness. Imaging showed severe multilevel degenerative disc disease, spinal stenosis (narrowing of the spinal canal in which the spinal cord runs), and secondary compressive myelopathy with myelomalacia  aka compression of the spinal cord by the vertebrae. In another case, a 63 yo man presented with history of tingling & numbness in his finger and toes, weakness and stiffness in all four limbs, and frequency and urgency of urination. There was no history of trauma to his neck or back. For 25 years prior, he had done headstand daily. He, too, was found to have cervical compression of his spinal cord. While case studies are captivating, they don’t tell us that much. What I needed was a research study. What I found, was even better. I uncovered a Master’s Thesis completed in May 2012 by Rachel E. Hector from the University of Texas, Austin, entitled Sirsasana (Headstand) Technique Alters Head/Neck Loading: Considerations for Safety. I could not have dreamed of a better find.

Here is how the study played out. Three groups of 15 yogis practiced one of three variations of sirsasana. Variations occurred in the entry and exit  from the postures, while the actual holding of the headstand was the same for each group. Group 1 entered and exited sirsasana by lifting/kicking one leg up at a time; Group two bent both knees, then straightened them together; Group 3 extended both legs and lifted symmetrically, in a pike position. I present a sketch of the entry techniques from Hector’s thesis.

Three ways to enter/exit headstand

Three ways to enter/exit headstand

Participants performed their respective variations, holding for 5 breaths, while a force plate beneath them measured peak forces acting on the head and neck, loading rate of those forces, center of pressure, and neck angle in the frontal plane at C3 (cervical vertebra 3). The study study examined the weight-bearing responsibility of the head and neck – separate from the arms, which I found to be a critical parameter. You can read Hector’s thesis to learn how they rigged the force plate to eliminate interference by arm forces.

Highlights of the study revealed:

  • the average yogi loads the head with 30-50% of his or her body weight while performing headstand
  • Individuals entering the posture with legs extended and together (pike position) exhibited the lowest maximum and average forces during entry with over 75% of participants using this technique staying below the threshold of vertical loading known to cause cervical failure (image on far right)
  • Individuals entering the posture by lifting/kicking one leg at a time experienced the greatest forces on the neck, with more than one half of them experiencing forces above the loading threshold for potential cervical failure (image on far left)

If headstand is responsible for an unknown number of strokes, vision loss, and debilitating damage to the cervical spine, why is still practiced and taught in most yoga studios? I think the reasons can be complex and beyond my ability to articulate nuances of empowerment, sacrifice, injury, and redemption in yoga. The courageous, thoughtful, and frankly brilliant Matthew Remski, the most compelling writer on philosophical aspects of yoga injuries, explores these ideas in his heady WAWADIA Project . I can not recommend it enough. I’ll go further, you should pre-order a copy of his soon-to-be-published-but-not-soon-enough book (which was crowd-funded, no less), because it’s first printing will sell out.

While Matthew wades through the deep stuff, I’ll pluck the low hanging fruit and merely bullet a list of popular, but mostly unexamined, “medical” benefits of King Sirsasana, tidily summed up in this giddy, optimistic article 10 Awesome Medical Benefits of Headstand. Fortunately, there are practitioners out there like Dr. Kathleen Summers, another yogi doc, who writes in a fairly balanced three-part post about the purported benefits of sirsasana and some potential dangers,  addressing several of these claims.While some of them are reasonable and may be valid, most are unexamined. My comments are in brackets.

The 10 [so called] Medical Benefits of Headstand

  1. Relieves stress [possibly for some; for others, it will likely increase stress hormone secretion]
  2. Increases focus [definitely]
  3. Increases blood flow to the eyes [yeah, that thing about glaucoma]
  4. Increases blood flow to the head & scalp [uh, no; the body has a highly regulated, secure system that will not throw the brain under bus for folly or whim]
  5. Strengthens shoulders and arms [yes and yes; in fact, Dr. Loren Fishman, a world-renowned rehabilitation physician and long time yoga practitioner and teacher, in a small pilot study (10 participants), produced remarkable results using sirsasana and even sirsasana prep work to heal torn rotator cuffs.]
  6. Improves digestion [huh? what? digestion is a downward action; human physiology is designed to push food, urine, feces, menstrual blood, and babies down and out; this makes about as much sense as having a delivering mother stand on her head to improve the birthing process. Ugh.]
  7. Helps flush out the adrenal glands [really? please elaborate]
  8. Decreases fluid build up in the legs, ankles & feet [yes, it will increase venous blood return, but only while you are in the pose]
  9. Develops strength in the core muscles [yes; this is more likely with a controlled pike variation of entry and exit; but while stabilized in headstand, the same alignment applies as in Tadasana – neutral pelvis and ribs to bring the core musculature to its appropriate length for maximum force generation]
  10. Stimulates the lymphatic system [yes, but a better, safer way to stimulate your entire lymphatic system is whole body movement such as walking in alignment.]

When these master-blessed messages are perpetuated in books, magazines, videos, websites, and by a staggering number of teachers in countless studios, then you have potentially hundreds of thousands of people clamoring to honor the King, without a clue that sirsasana can be a very nasty ruler indeed. While it is possible to suffer a musculoskeletal injury in just about any yoga pose, the stakes for musculoskeletal AND other adverse events like stroke and vision loss are higher than most would be willing to wager – if only they knew.

So, I end by circling back around to the work of Rachel Hector (who, by the way, recently published her findings in the Journal of Bodywork and Movement Therapies) and leave you with my recommendations, based on her work, for practicing sirsasana – IF you still feel compelled to practice it. But first, let me be very clear about some contraindications and caveats.

Contraindications:

  • If you have glaucoma or uncontrolled blood pressure, do not practice sirsasana
  • If you have low bone density in your spine, do not practice sirsasana
  • If you have degenerative discs in your spine, do not practice sirsasana
  • If you suspect that sirsasana is injuring you, do not practice sirsasana
  • If you feel pressured by teachers, students, media, or your own ego to practice sirsasana, do not practice sirsasana
  • If you are 35 of older (the age range with the highest risk for disc degeneration), do not practice sirsasana, and if you do, do not practice it daily. While Hector’s study did not find age to be a factor (her study subjects ranged in age from 18-60), intervertebral immobility and disc degeneration come with aging. Large, repeated, asymmetrical loading onto immobile, degenerative cervical discs that are not designed to withstand 50% of your body weight can, as the cases studies highlighted earlier, cause cervical failure resulting in neurological damage to the spinal cord. This damage is cumulative. You may not know its happening until one day, you know it’s happened.

Caveats:

  • According to Hector’s study, the taller you are and the more you weigh, greater are the loading forces and loading rate applied to your neck
  • Men tend to have higher loading rates and maximum forces on the cervical vertebrae (largely explained by their greater weight), however, studies on male cadavers have consistently shown that males have a much greater loading capacity before cervical failure occurs. Are you one of the lucky ones?
  • The subjects in Hector’s study ranged in yoga and headstanding experience from 6 months to 20 years and that experience was not a predictor of any outcomes. It bears repeating: headstanding experience was not a predictor of any outcomes. Experienced headstanders, with as much as 20 years experience, had no added protection from negative cervical spine outcomes. This was the most surprising result of the study and possibly the most important to the yoga community. There is a perception that if you get hurt in yoga, it is your fault, that you were novice, or not practicing good alignment, or you weren’t ready for the asana you were attempting. Matthew Remski, once again, illuminates these perceptions brilliantly in a piece on headstand that inspired me to begin consideration of its risks. The darker side of this coin is that if you are experienced and in good alignment, you might think you won’t get hurt. But in reality, being experienced at headstand may not protect you and being inexperienced may not put you at greater risk for injury. I can’t quite wrap my headstand head around this, but it bears consideration.

Recommendations for practicing Sirsasana:

  • Enter with legs extended (no bend in knees) and lift, symmetrically, in a controlled manner. This method of entry measured the least amount of forces to the neck and occurrences of sudden changes in loading, as it loads the head and neck slower than the other methods. This method of entry requires more intense upper body activation and controlled loading – essentially a better strength to weight ratio that kicking one leg up at a time.
B.K.S. Iyengar in Sirsasana

B.K.S. Iyengar entering sirsasana

  • Exit the pose quickly, by allowing one leg to drop to the mat in a controlled manner. This method of exit, as opposed to the pike exit, appears to reduce over-flexion of the cervical spine upon exit. Flexion-compression, also called pre-flexion or axial loading, loads the cervical spine without is natural curve and is the most vulnerable configuration of spinal alignment, which can result in spinal injury due to buckling failure.

The king is dead. Long live the king.

Namaste, Michele

When alignment points are biomechanical

After my first yoga class with an Iyengar-certified yoga teacher, I was hooked. The  placement of body parts at precise distances from each other, the bewilderingly colorful cues like “pull your skin up from your heels to your waist,” the blankets, and bolsters, and straps, oh my! Increasingly nuanced alignment combined with meditation-inducing long-held postures resonated like no other practice I had experienced. And, later, as a teacher, those unwavering alignment cues provided me a hook, something to cling to, in those first years months, when I hadn’t a clue what I was doing or talking about in yoga.

In the intervening years,  I’ve learned muscle anatomy – which muscles are contracting, stretching, and stabilizing in which yoga poses from smart guys like Ray Long. I’ve been exposed to passionately informed writings on the latest research in stretching and muscle physiology via the likes of Jules Mitchell. I’ve dabbled in the writings of the great Tom Myers on the endlessly fascinating and surprising subject of fascial tissue; practicing and teaching in the style of those who try to apply this evolving fascial knowledge to the Yin style of yoga, namely Paul Grilley, Bernie Clark, and Sarah Powers. All of these body thinkers school and inspire me and are constantly confirming and opposing each others wisdom. It’s maddening! Enter the fray Katy Bowman. She updated my understanding and practice of Iyengar’s culturally-based yoga alignment with an alignment based in geometry, physics, and engineering. Her circular theory, via her Restorative Exercise™ program, goes something like this:

There is one position of the body that ensures optimal flow of electricity (nerve impulses), blood (oxygenated cell food), and lymph (cellular waste removal). This position also happens to minimize friction in the joints and compression in the vertebral discs. Using 25 bony markers to align joints relative to each other, and in the case of multi-articular joints like the spine, relative also to itself, you place your muscles in the optimal position for strength and yield, which equals the greatest amount of electrical flow, which equals the greatest amount force generation, which equals the greatest amount of blood flow to those muscles. The greatest amount of blood to the tissues equals the greatest amount of tissue regeneration. Tissue regeneration equals tissue health. Biologically speaking, our bodies have one, and only one job, and that is to make cells. Our muscles must be at the correct length for strength, yield, flow, and ultimately cellular regeneration. It is through alignment that we get our muscles to the correct length and so goes the circle.

What I like about Katy’s alignment markers is their universality. Everyone is distinctly shaped and sized but can use the same markers because the bony points are yours and are relative to yourself. This is infinitely more objective and discriminating than cues based on distances. To ask a class of 20 differently shaped/sized students to “jump your feet four feet apart”  is not an appropriate cue for most of the bodies in the room. My “four feet apart” at a height of 5’8 is going to look and feel very different from someone who is 5’1, who is going to look/feel very different from someone who is 6’4. The RE alignment points are based on Katy’s understanding of muscle force length or the length-tension relationship, whereas cues in the Iyengar  style, and subsequently most styles of yoga practiced in the US, were developed for another culture with different tissue loads, anthropometric dimensions, and very specific environments that are quite different from the way most Westerners spend their waking (and sleeping) hours.

So, have I abandoned Iyengar altogether? Absolutely not. My copies of Light on Yoga: Yoga Dipika and B.K.S. Iyengar Yoga: The Path to Holistic Health are dog-eared and consulted anytime I want to reference how the man, who is arguably responsible for the way Hatha yoga is practiced in studios worldwide, cued and presented a posture. But then, I use my filters of current body thinkers and that of my own body experience to update what I practice and teach.

Namaste, Michele

Modifying Utkatasana with Smart Alignment

In yoga, in exercise, in athletic training, we’ve always been told – and if we are teachers, trainers, or coaches – we’ve always instructed to keep your knees from going beyond your toes in lunge-type positions. It’s conventional wisdom. A knee that shoots out over your toes is no longer supported vertically by the bones of your lower leg and in this  compromised position, it is being asked to hold the weight of your pelvis, torso, and head. Your knee joint is not designed for this type of load. Yet. Yet, what do we do in Utkatasana aka chair pose? We send both knees out over the toes and amass the weight of our pelvis, trunk, and head onto not one but two unsupported knees. Two bad knees are better than one, I suppose.

With Smart Alignment in Utkatasana, your knees don’t shift forward when they bend, but instead, your lower legs remain near vertical and your untucked butt moves back. Thus, the weight of your hips, torso, and head is held not by your knees but by your hamstrings and gluteus maximus – the big guns.

The  functional benefit of engaging your hams and gluts is the role that they play in pelvic floor health. Who cares? You should. Symptoms of a weak pelvic floor can present at any age and include urinary incontinence, fecal incontinence, and organs prolapsing out of your vagina or anus.  Known as pelvic floor disorders, they effect both men and women, regardless of reproductive status.

Healthy gluteal muscles are what provide optimal length to your pelvic floor muscles, which run between your sacrum (lowest section of your spine) and your pubis aka “pubic bone.” Your pelvic floor muscles, when they are at  optimal force generating length, are long, taut, yet supple; and are in the perfect condition to help hold up your pelvic organs and allow you to open and close your bathrooming muscles. Your gluteal muscles keep your pelvic floor muscles at this optimal length by keeping your sacrum from counternutating, or moving your tailbone anteriorly toward your pubis. Unless, that is, you are not using them. If your tailbone moves forward – think butt tuck – it creates slack in the pelvic floor muscles, which signals them to contract to create tension to hold everything up and in. Your pelvic floor is not meant for long term force generation aka constant contracting. When it is constantly contracting, it does not become stronger, it becomes weaker. A contracted pelvic floor pulls your sacrum even more forward – a negative loop you want to avoid. Utkatasana aligned with the knees shooting over the toes is suboptimal alignment for using your butt muscles, thus suboptimal for your pelvic floor.

If you are regularly practicing Utkatasana, begin to use your posterior leg muscles as I’ve described. This will result in you essentially squatting each time, which is about the best thing you can do to ensure the long term health of your pelvic floor, because it is the best thing you can do build your butt. I can’t say it any better that Jonathan FitzGordon at CoreWalking Blog, when he wondered about disappearing butts “The butt, gluteus maximus needs to be big and strong. It should fill in your pants. That is the simplest way to describe it. The space between the belt and the hamstring in your pants should be full to exploding with a supple gluteus maximus.”

Classic Utkatasana

Classic Utkatasana

This is classic Utkatasana with the phantom yogini’s knees shooting forward. I tried to pose for this picture, but was not willing to sacrifice my knees for the cause. I won’t mention the rib thrust that is happening here. Nope, I won’t.

Utkatasana with Smart Alignment

Utkatasana with Smart Alignment

This is a smarter alignment for Utkatasana. Knee saving, butt firing, pelvic floor lengthening happiness. Note my neutral spine – it did not change shape from Tadasana, but retained its natural curvature. Note my lower legs – shins & calves are darn near vertical.

Utkatasana with lordosis and rib thrust.

Utkatasana with lordosis and rib thrust.

Sometimes, I see this presentation – knees forward, hyper lordodic spine, and rib thrust. If this were my student (actually she is) I would place my hands on her hips and guide her back until her shins are vertical. I would place my hands on her lower ribs and help her to rotate then down and in. That would likely resolve the lordodic lumber spine.

Utkatasana with butt tuck

Utkatasana with butt tuck

More often, however, i see this presentation – knees forward, butt tucked, flat lower back. Yoga teachers, this is what often happens when you cue to “drop your tailbone down.” This is a pelvic floor killa.

Utkatasana without external hip rotation

Utkatasana without external hip rotation

In this presentation, my external hip rotators are not firing, thus my knees knock together resulting in improper tracking which causes heat, friction, and eventual pain and degeneration of my knee joints. Ouch. This is fixed by externally rotating my hips so that my knees track forward in the same channels as my anterior superior iliac spines (ASIS) aka pelvic bones.

Utkatasana internal rotation of hips

Utkatasana internal rotation of hips

By bringing my feet together, it might appear that I have fixed my knees, but its a lie. If I introduced a proper external rotation in my hips, I would likely have a small space between my knees. As soon as my knees touch, the tendency to press into each other for support is there and that will take my knees into poor tracking, albeit less severe than the previous image.

Utkatasana with smart alignment

Utkatasana with smart alignment

Here I present knees that are safely tracking in the same channels as my pelvic bones due to the engagement of my external hip rotating muscles.

Utkatasana with smart alignment

Utkatasana with smart alignment

Namaste, Michele

Modifying Tadasana with Smart Alignment

This post is in the context of a common yoga posture that to non-yogis looks just like standing; thus the instructions given are applicable whether you are standing around in yoga or in the world.

Yoga’s Tadasana aka Mountain Pose is taught with a variety of cues. Yoga lineage, aesthetics, cultural postural influences, and the desire to capture a certain energetic expression are often woven together in what can be a confusing tapestry of instructions that differ from teacher to teacher, class to class. One teacher may tell you to contract your gluteal muscles, while the next says to relax your butt. Oftentimes yoga teachers don’t question why they give a particular cue or what it is good for. Often we give a cue because we learned it from another teacher or from a book, article, or website. Maybe it  made sense at the time, but in the interim, we’ve forgotten why. It could be that certain cues are part of a yoga lineage that we follow closely or let loosely inform our teaching. But I propose that most of the time, most yoga teachers have not given much thought to or challenged the wisdom of most of the cues they give. Bring it.

The cues you are about to read for Tadasana (or standing for non-yogis) are not from a yoga lineage or given to make you look or feel a certain way. They are based on my understanding of the optimal orientation of bony markers relative to each other and to specific planes of motion that have the greatest chance of putting your muscles at their best length for maximum force generation; and so that you optimize the flow of oxygen via blood to feed your cells, energy via nervous system to move your muscles, and cellular waste removal via your lymph system. In other words, they are alignment based.

When I cue yoga poses, I avoid giving specific measurements like stand with your feet 6 inches or two fist widths apart or four feet apart. A 6’4 person and a 5’2 person each having his feet 4′ apart is going to experience very different ranges of motion and loads relative to his height & leg length. When I can, I use distances that are relative to other body parts. For wide stances, when this is not possible or is arbitrary, I simply instruct to “take a wide stance” and then let the pose dictate the actual distance needed. An arbitrary cue for Virabhadrasana 2 aka Warrior 2 is to “step your feet wide so that they line up beneath your hands when your arms are outstretched.” If you offer this cue, I am curious why.

The following cues, from the feet up, list the body areaa, common cues, and an alignment-based cue that I’ll call “Smart Alignment,” because it is biomechanically informed. I try to provide a thorough but concise rationale for my instructions. Using these cues to position yourself in Tadasana and whenever you are standing is practice for aligning your body during movement for optimal flow.

Tadasana Alignment

How far apart should my feet be from each other?
Common cues: feet together, feet hips width apart, feet 6 inches fists apart; feet 2 fists apart
Smart Alignment: A smarter cue would be to place your feet pelvis width apart. This means to space your feet the same width as your pelvic bones. Your pelvic bones are sometimes called your hip pointers or even your hip bones, but those are misnomers as your hip is a joint made of your pelvis and femur and is located on the lateral side of your pelvis. Your pelvic bones are the “sharp” bones on the front of your pelvis that would poke into the floor if you were to lie on your belly. The bony markers for the feet are the centers of the front of the ankles.
Rational: When your feet are pelvis width apart, you are in the best position to build bone strength in your ankles because the force of gravity tracks vertically down your femurs. If your feet are closer together or further apart, you lose the vertical requirement of gravity to optimize bone density.

How should I point my feet?
Common cues: I rarely hear cues for how to point your feet in Tadasana, but know that some teachers instruct students to point their second toes straight ahead
Smart Alignment: A better cue would be straighten the outer edges of your feet. You can gauge this by stepping to the side edge of your mat and lining up the lateral edge of your foot along the edge of your mat. The edge of the yoga mat should align with your malleolus (lateral ankle bone) and bisect the center of the baby toe joint at its base (metatarsophalangeal joint). Place your other foot pelvic width apart and try to align it similarly, but without the advantage of having that straight line. A true geek would whip out a level…just sayin.
Rational: I go over this in detail in an earlier post on building a bunion.

How do I distribute my weight?
Smart Alignment: Shift all of your weight back into your heels
Common Cues & Rationale: I wrote extensively (for a blog, anyway) about common yoga cues and the rational for getting your weight back.

Do I squeeze or relax my quadriceps?
Common cues: Squeeze your quads; lift your kneecaps
Smart Alignment: Release or lower your knee caps aka stop gripping your quadriceps
Rational: If your quadriceps are gripping, squeezing, or contracting, your kneecaps will be lifted. Contracted quads not only draw the patella aka kneecap up, they also pull it back into the joint capsule causing increased heat and friction, which leads to joint degeneration. In yoga, there are occasionally times that you might benefit from the stabilizing effect of engaged quads – when you are learning to balance in one legged postures or balancey two legged postures like parivrtta trikonasana; or if you want to increase the stretch of your hamstrings in parsvattonasana, trikonasona, or prasarita padattonasana via reciprocal inhibition, a technique used to signal the stretching muscle to relax by contracting its antagonist muscle on the opposite side of the joint. But you should be able to fire the quads on or off (mostly off) at will. If you are not aware of what your quads are doing, then you may be damaging your knee joints. Most people are unknowingly gripping their quads.
**Please see FootLove Yoga Facebook page for video of lifting & lowering your kneecaps, then give it a try. If you are unable to lift your kneecaps, then they are already lifted, meaning you are already squeezing your quads. To help coax them down, get all of your weight back into your heels, bend slightly at the hips and try again.

What is a “neutral” pelvis? Should I squeeze my butt?
Common cues: Squeeze your butt; drop your tailbone; tilt your pelvis forward and back a few times and stop in the middle
Smart Alignment: Line up your pelvic bones and your pubic bone in the coronal or frontal plane. If you were to press your front side against a wall, these three bones of your pelvis would touch the wall; said another way, if you lie down on your back, your pelvic bones and pubic bone will be at the same height.
Rationale: This alignment maintains the structural integrity of the natural lordodic curve of your lumbar spine, optimizes hamstring length for maximum force generation, and provides an appropriate amount of tensioning in your pelvic floor muscles. When you retrovert or posteriorly tilt your pelvis, as often happens as a result of the well-intentioned cue to “drop your tailbone,” you compromise the natural curve of your lower spine, grip your quads, change the length of your hamstrings, and increase the likelihood of pelvic floor disorders.

What about my abs?
Common cues: draw your bellybutton towards your spine; engage your abs; engage your transverse abdonimus, suck your belly in
Smart Alignment: Lower or drop your ribs down and back/in so that the most prominent bones of your lower rib cage align in the frontal plane with your pelvic and public bones. Stop Thrusting Your Ribs!
Rationale: When you do this, you will feel and probably look a bit shlumpy. It’s ok. I will post soon on what that means and what you can do about it. A rib thrust is when you lift and push forward your rib cage. Imagine the way an Olympic gymnast lifts her chest and thrusts her ribs forward before she starts a routine. To do this, she simultaneously lifts her sternum aka “opens her heart” in yogaspeak (warning, a post is forthcoming on this misinterpreted and potentially harmful instruction) and pushes her rib cage forward, the combined actions of which rotate the top of the rib cage back, causing a shearing motion of the lowest vertebra of the thoracic spine to translate or shear forward on top of the uppermost lumbar vertebra. Unfortunately, the vertebrae are not designed for a shearing motion. A rib thrust puts your rib cage out in front of your pelvis, causing a non-optimal change in the lengths of the abdominal musculature and attendant change in interabdominal pressure, increased vertebral disc compression, and pelvic floor tensioning. It’s a cascade of ugly but is the predominant posturing of ribs in yoga. You Must Stop Thrusting Your Ribs.
The Good News: Ending rib thrusting is very challenging both physically (you’ve been holding this muscle pattern for years) and emotionally, because the result does not look like what you’ve always considered “good posture.” But here’s the silver lining. When your pelvis and ribs are aligned with their bony markers in the frontal plane, it puts your abdominal musculature at optimal force generating lengths which means they are constantly turned on and toned. If you align yourself in this way, you can say goodbye to crunches and other ab work that only seemed necessary because for most of your life you have not been firing your abs naturally by aligning your pelvis & ribs. True story.

Palms forward or not?
Common cues: turn your palms out
Smart Alignment: Externally rotate your shoulders
Rationale: I like to use Tadasana as an opportunity to externally rotate my shoulders, which gives the appearance of turning my palms out, but happens at the shoulders and instead of the wrists. Until you experience in your body what it means to externally rotate your shoulders, a good rule of thumb is when your shoulders are externally rotated your elbows point internally and when you internally rotate your shoulders, your elbows will point externally. Try it. In external rotation, the elbow pits and palms of your hands will face somewhat forward. If the backs of your hands are facing forward, you are likely internally rotated in your shoulders. Life most often puts our shoulders in internal rotation – computer use, driving, doing most things out if front of us – and leads to chronic muscle patterning in the shoulders. Externally rotating your shoulders brings back a lost range of motion.

How did this string get on my head?
Common cues: pretend you have a string attached to the crown of your head and its pulling you up (or some variation on the them); align your ears over your shoulders; lift your chin;
Smart Alignment: Ramp your head up/back.
Rationale: The easiest way to describe this is to visualize its evil twin Computerhead, which is a head that is constantly thrust forward, often coupled with a lifted chin. This causes chronic contractile tension in the back of your neck. The fix is simple. Without lifting your chin, slide your face back like you are making a double chin until your ears stack over your shoulders. Ironically, when you ramp your head up/back, you actually turn on the muscles in the front of your neck/throat, which until now have been locked long in extension and are thus weak and without tone. By making a (temporary) double chin now you could save yourself from a permanent one later. Once you get your head back, you may find that you have a habit of lifting your chin. If so, just let your chin drop a bit to bring the muscles on the back of your neck to optimal length. Dropping your chin will bring your natural eye gaze level with the horizon. A lifted chin, lifts your eyes, causing overuse of the eyeball lowering muscles.

Alignment, like yoga, is a practice, but one that can be done everyday, all day, anywhere.

Namaste, Michele