The Research Question Asked
Can yoga help people manage substance use and addiction?

The research team searched several databases for previously published studies evaluating the effects of yoga on substance use. They included studies in their review if the study population was over 18, patients in the study had a substance use disorder, and the study evaluated the effects of a yoga treatment.

Results
Yoga treatments were generally associated with reduced substance use, decreased craving, and improved quality of life.

Conclusion
Yoga was an effective adjunct treatment to help populations manage substance use disorder and addiction.

Background
Substance use is a common way to deal with chronic stress, physical, and psychological pain. When we continue substance use, despite the negative consequences, our use can become a substance use disorder. That is the official medical term for what is sometimes referred to as substance abuse. The harmful effects of smoking, for example, increase the likelihood of lung cancer, emphysema, and other diseases. However, that is not enough for many smokers to quit the habit. Aside from the addictive qualities of nicotine, one reason for this is that the substance is legal, like alcohol, rather than a controlled substance, such as opioid painkillers.

One arm of treatment, then, for substance use disorder is finding a healthy way to mitigate the pain they’re experiencing. Some smaller yoga studies found that yoga was a useful complementary treatment for managing substance use disorder specifically. More generally, yoga has been shown to reduce anxiety, stress, PTSD, and other experiences that often occur alongside chronic physical and emotional pain.

However, one issue with older yoga-related research is that very small study populations were often used. More recent research has tried to address that issue. For those reasons, the researchers on the study we summarized here chose to conduct a review study examining all individual studies that evaluated the effects of yoga on various populations experiencing substance use disorder. However, they elected to conduct their review on more recent research published during or after 2013.

Research question
Can yoga help people manage substance use disorder and addiction?

Research methods
The research team searched several databases for previously published studies evaluating the effects of yoga on substance use. They searched MEDLINE, EMBASE, Cochrane Library, SCOPUS, and PsychINFO databases. The researchers used the following keywords for their search: yoga, alternative treatment, substance use, addiction, drug dependence, alcohol use, and combinations of those terms. They included studies in their review if the study population was over 18, patients in the study had a substance use disorder, and the study evaluated the effects of a yoga treatment.

Results
Eight individual studies were included in the larger review study. Generally, across the smaller studies, yoga treatments were associated with reduced substance use and improved quality of life.
More specifically, studies reported the following effects:

Reduced PTSD symptoms (2 studies)
Decreased stress
Reduced anxiety (2 studies)
Decreased pain
Decreased craving
Greater likelihood to quit among smokers (2 studies)
Improved mood
Increased mindfulness

Why is this relevant to yoga practitioners?
Substance use disorder and addiction are notoriously difficult to manage. Often, underlying those issues are struggles with other mental health challenges such as stress, anxiety, and PTSD. Whether we are or have experienced a struggle with substance use, we likely all periodically experience those underlying issues of stress and anxiety. Having a consistent yoga practice can help ameliorate some of the physical and emotional challenges we all face in life. If we have positive tools that both improve our psychological outlook as well as physically support feeling better, we’re less likely to reach for harmful ways to deal with the life stresses we experience.

Conclusion
Participants in the studies examined generally reported that yoga reduced mental health symptoms such as stress and anxiety. Specifically, multiple studies found that yoga was associated with reduced cravings and a higher likelihood of quitting smoking. Yoga was also associated with positive experiences like improved mood and improved mindfulness. This suggests it could help reinforce positive behaviors as part of managing substance use disorder and addiction.

Twisting is part of our normal and natural range of motion. It’s an important part of our functional movement. Maintaining a healthy and mobile spine has physiological benefits, too, because our spine houses our spinal cord. But despite the benefits of twisting, our range of motion in this plane is often limited. Just try to turn your head to the right and then to the left. You’ll probably notice that your movement feels a little stiffer in one direction than the other. Twisting in yoga is a core range of motion, too. I consider twists to be one of the five main categories of postures. This is the category of postures that probably gets the least amount of attention, however. In this article, we’ll try to rectify that. We’ll dive deeper into what makes a twist work and look at the benefits and cautions for twisting.

What’s in this article?
Anatomy of a twistThe spine
Pelvis and hips
Shoulders
What restricts or prevents twisting?Muscles
Fascia
Bones
TechniqueStanding twists
Seated twists
Binding
Proportions
Breathing in a twist
Building more complex twists
Issues, cautions, and injuries SI joint pain and low back pain
Low back pain
Hip pinching
Disc herniations
Anatomy of a twist

First, let’s talk about where twisting in yoga happens in our body. The ideal twist happens primarily in our spine. In contrast to forward bending, where I say that the pose is about ⅔ hip flexion and ⅓ spine, an ideal twist is something more like ⅔ spine and ⅓ or less hip or pelvic movement. Within our spine, we can get more specific. The shape of the vertebrae, the way they fit together, and the directions that they glide at the facet joints are different in each section of the spine.

The spine
Remember, we can divide the spine into three broad sections: the cervical spine (neck), the thoracic spine (mid-back), and the lumbar spine (lower back). There are seven vertebrae in the cervical spine. The thoracic spine has 12 vertebrae. And there are five vertebrae in the lumbar spine. While there are some intermediate shapes of vertebrae where each of these sections transitions into the next section, generally, the vertebrae are shaped differently in each section. Because of their shape and the orientation of the facet joints where they meet, the vertebrae in each section of the spine have an easier or harder time gliding in a way that allows a twisting motion. 
 

In the lumbar spine, the facet joints are perpendicular to the sagittal plane. When we twist, the facet joints quickly start to bump into each other. For that reason, we have a very small range of motion in the transverse plane (twisting) in the lumbar spine. Our range of motion in twisting in the lumbar spine is just a few degrees in either direction. However, in the thoracic spine, our facet joints are oriented roughly parallel to our back (coronal plane). So we can twist much farther in our thoracic spine before restriction occurs.

We have to remember that the thoracic spine has ribs associated with it and therefore the tension of the ribs will eventually restrict gliding of the facet joints. That assumes that the ligamentous structures surrounding the facet joints haven’t stopped movement already. For that reason, most of our twisting in the thorax happens from our thoracic spine. The shape of our cervical vertebrae allows our head to move easily in all planes. So, we can easily rotate our head right and left if there are no myofascial restrictions preventing it.

Pelvis and hips
Although an ideal twist happens mostly from our thoracic spine, our pelvis and shoulders are still involved in the twisting motion, at least tangentially. How much the pelvis or shoulders contribute to twists in yoga depends on the pose we’re doing and our particular body.

Our hip joints are ball-and-socket joints, so they allow rotation. Where our spine meets our pelvis is at the sacroiliac joints (SI joints). A very small amount of gliding occurs at these two joints. So, we can create some part of a twisting action from our hips and the connection of our pelvis to our spine. As you likely know, the SI joints are also prone to issues. That’s important to know when you are assessing twisting in yoga. Depending on the pose and the person, you may or may not want to allow, restrict, or encourage twisting to happen in different areas of the body.

Shoulders
Our shoulder girdle can also be part of our twisting action in yoga, particularly when we add binding to a posture. When we place our shoulder on the outside of our knee, or even put our hand on the floor to support us in a twist, we tend to use these connections as leverage. That leverage has an impact on how much twisting we do from the thorax and how much pressure or force we can or want to create in our thoracic spine. This is often why binding in a twist can make it harder to breathe. With the binding as leverage, the force and pressure through the rib cage increase.

What restricts or prevents twisting?
Muscles
At a minimum, twisting in yoga involves our whole torso. So, tension in just about any muscle group along our torso can impact our ease in twisting. Those muscles could especially include the intercostals, internal and external obliques, erector spinae, deep spinal muscles/paraspinal muscles like multifidus, and latissimus dorsi. The interesting thing about twists is that, because of the nature of the movement, we are always lengthening muscles along one side of our body while shortening/contracting muscles on the other side. So the same muscles may be part of twisting us into a posture on one side and resisting further twisting from the other side.

Fascia
Tension in layers of fascia on our torso can also restrict twisting. An example of that is the
thoracolumbar fascia that is integral with our latissimus dorsi and wraps around our back. Keep in mind that fascia is continuous not just with the muscles but also with the bones themselves through the outermost layer of connective tissue on the bones (periosteum). As a result, the connective tissue on the ribs (not technically fascia) is integrated with the intercostals and the sheet of connective tissue on both the inside and outside of the rib cage. All of which are firmly held with just connective tissue.

Bones
Finally, remember that each vertebra is also attached to a pair of ribs. That means the articulations of rib to vertebrae need to be mobile. The joint capsule that surrounds that articulation (more connective tissue), and the muscles that we’ve mentioned that also cross that joint, need to have movement available to them or they will also potentially restrict twisting in yoga. Then there is the rib itself. As a fairly rigid bony structure, the ribs will also restrict our twist at some point during the motion. After all, they are designed to protect what is inside them (heart and lungs). At some point, too much movement would start to create trouble for those very important structures.

Technique
Standing twists
Establish your base in the feet
Standing twists have the same foundation as any other standing pose, your feet. So it makes sense to start there. Without a stable base underneath you, it’s hard to work more specifically with restrictions to twisting in yoga. In standing twists like revolved triangle and revolved side angle, take a look at your feet. Set your feet up in a way that you feel balanced and steady before you start to twist. If you’re having difficulty balancing, try a shorter length (front foot to back foot distance) and a wider width (distance from left to right between the feet).

The pelvis
After you’ve established your base (your feet), the next important piece as we make our way up the chain is the legs, and then the pelvis. In standing twists, our hamstrings, lateral gluteal muscles, and lateral hip rotator muscles can all be part of restricting where we can go in the pose. This is because the movement is part forward bending and part twist. Tension in your hamstrings can affect how your pelvis is oriented. And tension around your hips can affect the position of your pelvis and ultimately how much twisting in yoga is available. It can also affect where you’re twisting from, whether that’s more from the hip joints or more from the spine. Opening the hips can especially have an impact on standing twists.

Giving up one thing for another
As we’re putting together the pieces of our standing twists, it’s important to remember that twisting is a whole-body movement. All of the pieces that come together to make a complex standing twist, like revolved side angle for example, may not be accessible right away. In the short term, as you are learning and evolving your standing twists, you may have to give up one thing for another.

In revolved triangle, you might want to connect your hand to the floor, but in order to do that, you may have to let your pelvis rotate a little bit. If you want to prioritize keeping your pelvis squared to the front of the mat or parallel with the floor, then you may not be able to reach your hand to the floor initially. Neither of these options is right or wrong. The key here is to consider which option would best serve you or the student you’re working with.

 
 Debunking the myths
There are a few cues that come up specifically related to standing twists. One in particular that comes up frequently is the myth that your feet, heels, or insteps should be lined up in poses like revolved triangle and revolved side angle. Realistically, that very narrow base doesn’t work for most practitioners. If your hips are at all tight, you aren’t going to be able to balance as easily on that narrow base, and it’s going to restrict movement at your pelvis because the tissues will already be lengthened just to maintain that position.

Consider your intention in the yoga pose. Is it to work on twisting? Then broaden your base in a way that makes it feel stable to you. That allows you to take your focus off of just staying upright and balanced, and instead put your focus on the twist. Additionally, check that your feet aren’t crossed. That means, if you draw a line from the front of your mat to the back, ideally your right foot will be a little to the right of that line and your left foot will be a little to the left of that line

Seated twists
When we’re seated, our base is no longer our feet, it’s what we’re sitting on. Because our spine sits on top of our pelvis, our pelvic position can influence how much twist we can find in our body. It can even affect how much of our arm is available to bind. If we take a posture like Marichyasana C or ardha matsyendrasana, for example, a strongly posteriorly tilted pelvis will take our spine with it. That’s going to effectively take our torso away from the knee that we’re trying to twist around. In contrast, if we take our pelvis more toward a more neutral position, we’ll be closer to our knee, making both twisting and binding easier.

Binding
Binding is the action of wrapping our arm or arms around, usually our knee or leg, to then connect to the floor or connect our hands together. It’s the last step in some versions of standing or seated twists. It builds on the other pieces of setting up our twist. First, we have to set up our pelvis in a way that brings our torso as close as possible to the knee or leg we want to bind around. Getting your torso to your knee is essential, whether you are binding a standing twist like revolved side angle and trying to get your hand to the floor, or wrapping your arm around your knee in a seated twist like binding Marichyasana C or D. The closer we are to what we want to bind around, the smaller the distance we’re trying to cover as we wrap around it.

The armpit to knee relationship
That brings us to the second important part of binding, which is establishing our armpit to knee relationship. The more firmly connected we keep our armpit area to the surface we’re trying to bind around, the easier it will be to bind. The closer we get our armpit to our knee, the more of our arm we have to work with as we’re trying to rotate it around and make a connection, either to the floor or to our other hand.

Once we have our pelvis, torso, and shoulder in place, our arm and hand may still not reach all the way to where we’d like to reach to. In this case, you can set up an intermediate stage of binding for yourself. If you’re trying to reach the floor, try putting a small block under your hand as an option. If you’re in a seated pose and trying to reach around your knee to connect your hands, try holding the ends of a small towel until you eventually have the flexibility to connect one hand to the other. Assemble your bind and consider intermediate steps to grow this process for yourself.

Proportions
Tibia versus femur length
Our proportions affect the specific relationship of our torso and limbs to each other. Let’s use Marichyasana C as an example. Imagine if you had a very long tibia compared to your femur, or the reverse, a long femur compared to your tibia. You could probably see how that would change whether your sit bone on the leg with the bent knee would easily or not so easily meet the floor. With a longer femur and shorter tibia, our sit bone on that leg would rest closer to the floor. With the opposite, a longer tibia and shorter femur, our sit bone would be more likely to float a little off the floor.

We sometimes hear teachers suggest that the sit bones should always be on the floor in Marichyasana C. If we think about how proportions could change where our pelvis and the top of our leg meet the floor, we can see how it’s unrealistic to expect that everyone’s sit bones are going to meet the floor. It’s one thing to have an intention of “trying to ground the sit bone” for the purpose of creating length through the spine. It’s another thing to say that everyone “should” have their sit bone on the floor.

Femur versus torso length
We can also look at the effect of the relationship between our femur length and torso length in Marichyasana C. If we have a long torso relative to our femur, then when we sit up tall, our armpit is going to be higher than our knee. This means we have to make some choices when it comes to binding the pose.

If we want to wrap our arm around our leg, we’re going to have to bend over a little bit to hook our armpit around our knee. If we sit all the way up, our arm will slide off. So, we have to choose which thing to give up in order to allow the other. Do we want to sit up as tall as possible, or do we want to make the connection with the bind? Neither is right or wrong. They will each create a different effect. We have to decide which effect is more of a priority for us in that particular moment.

Breathing in a twist
One of the most common questions about twisting in yoga is: Why is it so hard to breathe in a twist? The main reason brings us back to the rib cage, the bones themselves, as well as the myofascial connections. Remember, as we twist, the ribs are going to “deform” to a degree at their connection to the vertebrae and the sternum. This essentially loads the bones themselves with additional tension. This “deformation” makes it harder for the bones to move and be lifted by air moving into the lungs.

In addition to that is the fact that one set of muscles that we use to twist are also muscles that we use to breathe. When we breathe, the intercostal muscles help lift the ribs up and out to make space for our inhale. But when we twist, these muscles are lengthened on one side and shortened on the other side. Twisting in yoga adds tension to these muscles, and we can feel that as resistance when we try to breathe during a twist.

The key to breathing during a twist is finding that happy medium between effort and ease. Twisting will stretch the intercostals, the muscles between the ribs that we use while breathing. So, in the long term, twisting can help create and maintain space for us to breathe fully. But in the short term, it’s helpful if we can find that edge where we are feeling some restriction, relax as much as possible, and breathe into it. Simply repeating that process will help develop the capacity to breathe more easily in twists over time.

Building more complex twists
In the twisting category of poses, there are also examples of more complex twists, like Marichyasana D and pasasana in the Ashtanga practice. Marichyasana D is especially complicated because it combines a half lotus and a twist. In pasasana, we’re binding not just one leg, but both legs. Anytime we start combining patterns, things get more complicated. With more complex twists, start slowly and establish the basic pattern comfortably in your body. Then, be consistent and build more complex patterns a little at a time.

Often, what makes these poses so challenging is not twisting per se. It’s combining additional patterns that may already be challenging, like a half lotus, for example, with twisting. In that case, I recommend taking the pose apart to look at what individual patterns are combined to create the pose. Work on each individual pattern on its own, then, when you have facility with the additional patterns, you can combine them into more complicated poses.

Issues, cautions, and injuries
SI joint pain and low back pain
Remember that our sacroiliac joint (SI joint) is the place where our spine connects to our pelvis. The sacrum is originally five individual bones at the base of our spine that become fused into a single bone, the sacrum, as we age. Where each side of the sacrum meets the iliac bone on the right and left sides of the pelvis, we have a joint, the right and left sacroiliac joints.

As I’ve already discussed in this article, twisting in yoga happens from both the hip joints and the spine. And at the sacroiliac joint, we meet the joint that transfers force between the spine and pelvis. So it’s possible for shear forces to be directed into the SI joint depending on the particular relationship of the spine to the pelvis. Those kinds of shear forces tend to show up more often in students who already experience some laxity or dysfunction of the SI joints.

If you’re experiencing SI joint pain in twists, experiment with how much you are twisting from your hip joints versus your spine. This essentially means let your pelvis move more during your twists, or purposely move your pelvis as part of your twist. Remember, the pelvis is moving at the two hip joints. So, moving your pelvis from your hip joints will put less pressure through the spine. This can often help alleviate pain at one or both SI joints during twisting.

Low back pain
Similarly to SI joint pain, general low back pain can occur for some students during twisting in yoga. The source is usually similar to what we see for SI joint pain. Shear forces can be directed into the low back depending on how your particular spine meets your pelvis. Because the shape of the vertebrae and facet joints in the lumbar spine doesn’t easily allow for much twisting, trying to force additional twisting through this area can also lead to pain.

Hip pinching
Hip pinching describes a sensation that students sometimes report in both standing and seated twists. This is a sensation that sometimes happens when students go deeply into poses like revolved side angle or Marichyasana C. I’ve spent many years helping students work through this issue. My best hypothesis for what is going on is a combination of contraction/shortening of the iliacus because the hip is flexed while simultaneously twisting. For some students, this can cause a sensation like something is being pinched deep in the front of their hip joint.

When this happens during a class, I will work with the student to directly palpate and lengthen their iliacus tissue. This usually solves the problem, at least in the short term. Keep in mind that it is also possible that something else is occurring. If you know you have a labral tear, for instance, you may get a small amount of relief from treating your own iliacus, however, you need to be more careful in this situation. When practicing on your own, you can do some self-palpation and exploration of your own iliacus to see if this is the source of the sensation you’re feeling. If it is, you can also work to lengthen this muscle through targeted lunge postures and other poses that open the hip flexors.

Disc herniations
With very significant herniations in the acute phase of the experience, people will most likely avoid yoga classes. But as they get further into the treatment phase of dealing with the herniation, they may want to incorporate yoga. Gentle twisting may be helpful if part of the cause is tight muscles, adding to whatever force has led to herniations. How much twisting in yoga is helpful versus potentially harmful is highly variable from person to person. Go slowly with small twists and be in communication with the student. The student is the best person to say whether twisting feels relieving or compressing. Additionally, allowing the pelvis to rotate more can help you find just the right amount of twist through the spine so that it’s not too much.

Conclusion
Twists in yoga require a complex series of relationships. They incorporate our whole body. While the spine is certainly the center of twisting, openness in our hips and shoulders also affects how easily we access twisting postures in yoga. We can make twists more complex by incorporating additional patterns like half lotus or by adding binding. But even basic twists help us maintain mobility in our spines.

Yoga as effective as strength exercises for osteoarthritis pain relief
 
 
 
    Share on PinterestYoga could help relieve knee osteoarthritis pain, new evidence suggests. Image credit: Pedro Merino/Stocksy.
Yoga is as effective for addressing knee pain due to osteoarthritis as muscle-strengthening exercises, according to a new study.
The new randomized clinical trial has also found that yoga may improve health-related quality of life and reduce depression in people with knee osteoarthritis.
Experts say that neither yoga nor strengthening exercises alone are likely to be the most effective way to help treat osteoarthritis knee pain, but can be elements of a broader treatment strategy.
Adverse effects from both yoga and strengthening exercises reported in the study were minimal.
 
Knee pain specialists use various therapeutic approaches for helping patients with knee pain due to osteoarthritis. A new study directly compares the effectiveness of two of those therapeutic approaches, yoga and muscle strengthening.
In a randomized clinical trial of 117 participants, yoga’s beneficial effect on knee pain was found to be “noninferior” to that of muscle strengthening after a 12-week study period.
Its findings appear in JAMA Network OpenTrusted Source.
The trial, which took place in Tasmania, Australia, involved individuals with a mean age of 62.5 years. Women comprised 72% of the cohort. Participants reported an initial moderate knee pain level of 53.8 according to the 100-point visual analog scale (VAS).
They were divided into two groups, one of which received yoga therapy (58 individuals), and one of which was treated with muscle strengthening (59 people).
The condition of participants’ knees was tracked in multiple ways. These included VAS, as well as the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) for knee pain, function, and stiffness. Neuropathic pain and global health assessments were undertaken, as were physical performance measures leg muscle strength tests.
Individuals were also questioned regarding their health-related quality of life and feelings of depression.
Individuals in the yoga group reported modest reductions in depression at 12 weeks compared to those in the muscle-training group, and improvements in quality of life at 24 weeks.
Yoga performed slightly better at 24 weeks for WOMAC pain, function, and stiffness, in the global assessment, and for scores in a fast-paced walking test.
There were no significant adverse effects reported for either yoga or strengthening exercises.
 
 
Osteoarthritis: Yoga is not a sufficient treatment by itself
Bert Mandelbaum, MD, not involved in the study, is the co-director of the Regenerative Orthobiologic Center at Cedars-Sinai Orthopaedics in Los Angeles. To him, the study nails down just one detail regarding knee-pain treatment.
Speaking to Medical News Today, Mandelbaum said that, “what we need to know is that [yoga’s] not going to hurt us, but it’s not going to be that robust for us [for treating] arthritis just by itself.”
“Yoga is a good exercise,” he explained, “and it could be utilized in a multiple-mode exercise regiment. Yoga is not going to hurt you. It’s an important part of an overall program that deals with aerobic conditioning, anaerobic conditioning, interval training, flexibility, and yoga, as well as strength training.”
Timothy Gibson, MD, medical director of the MemorialCare Joint Replacement Center at Orange Coast Medical Center in Fountain Valley, CA, also not involved in the study, further pointed out that with yoga being low impact, it “offers the ability to strengthen without aggressive movements in a joint that may be painful to move.”
For older patients especially, Gibson said, yoga can be a great help with balance and fall prevention.
“Yoga can be great for knee osteoarthritis symptoms,” orthopedic surgeon Pamela Mehta, MD, not involved in the study, also told us. “It helps with mobility and stretching, which can greatly impact pain.”
“I’m also not surprised that it had a greater effect on quality of life and mood — yoga is a fantastic mindfulness activity. That said, I don’t find that yoga alone helps my patients in the way this study suggests,” Mehta also cautioned.
How yoga compares to muscle strengthening exercises
Mandelbaum noted that osteoarthritis and its symptoms occur in a continuum along which symptoms tend to progress with time and age. As a result, a patient’s appropriate mix of therapies must be continually re-assessed and adjusted as the condition progresses.
“My view of this is to have something that is a controlled multimodal approach where we evaluate where you are in that continuum. Any prescription should be a combination of aerobic conditioning, and then also consider yoga and exercise training.”

– Bert Mandelbaum, MD
Each element in the response to an individual’s current condition offers a unique benefit to the mix, as is the case of the two modalities compared in the study.
“Yoga,” explained Mehta, “is fantastic for mobility, balance, and flexibility. It helps restore smooth movement in the knee and reduces stiffness, both of which help reduce knee pain from osteoarthritis.”
“Yoga also helps with mindfulness and can improve mental health in a way that exercises don’t. This has a huge impact on how we experience pain,” she added.
Strengthening exercises, as one would expect, work more directly on musculature. They, said Mehta, “are all about support and muscle balance. The muscles that surround the knee joint help the joint move smoothly as you bend, walk, and run.” This can be critical for pain relief.
“Stronger muscles, well-balanced against other leg and hip muscles, help stabilize your knee joint as it moves. This helps to reduce pain in a very functional way, ensuring your knee is moving how it’s supposed to,” Mehta explained.
Gibson pointed out that strength exercises can be handy because they require less instruction and supervision. Moreover, he noted, “having purely more leg strength improves function, especially with ascending and descending stairs.”
Different as they are, the two approaches exemplify how multiple modalities can complement each other, according to Mehta:
“Yoga and strengthening exercises are perfect together, so long as you don’t overdo either one. I always recommend to my patients to practice gentle yoga for mindfulness and mobility while building up their muscle strength with exercises.”

Background
Although the emphasis in many modern yoga classes is on the physical practice of yoga postures, Yoga as a philosophy is broader than that. Patanjali’s Yoga Sutras describe eight interrelated limbs of Yoga philosophy. The first two limbs, the yamas and niyamas describe personal and relational practices. Asana, or the physical practice of postures is the third limb.

As we move up the limbs outlined by Patanjali, they get less concrete and more subtle. Limb number four, pranayama, or breathing practices, is considered by many to bridge that transition between more concrete and more subtle practices. Some schools and styles of yoga that emphasize the subtle more than the concrete may focus more on limbs six and seven. Those are dharana (concentration) and dhyana (meditation).

The fifth limb, pratyahara, however, is often left out of both practice and philosophical discussion in modern yoga classes. The author of the philosophical study that we summarized here was interested in why pratyahara often gets left out of modern yoga practice. She explored what it is conceptually to modern yoga practitioners, and what its role is in contemporary yoga practice.

Research question
What is pratyahara and how does contemporary yoga practice incorporate it?

Research methods
The author conducted an in-depth literature review on the concept of pratyahara. She researched its role in contemporary yoga. She then developed a philosophical hypothesis on how we might use the practice of pratyahara to understand ourselves and the world in new ways as well as orient towards social change.

Results
The author divided her findings into three categories. Those were: conceptual origins of pratyahara, pratyahara through contemporary ontologies, and pratyahara as resistance. More specifically, the author identified several themes and proposed some applications of pratyahara practice based on her in-depth exploration of the literature.

Based on the author’s findings in the literature, the concept of pratyahara could be summarized as a practice of withdrawing from the sense impressions left by the material world to move towards spiritual freedom from identification with material or sensory experience.

The author’s key findings and interpretation of the literature
Initial research suggests health and wellness benefits of pratyahara practice may include reduced anxiety, decreased stress response, and increased relaxation.
Pratyahara practices may also influence our orientation and perspective regarding how we experience our inner and external worlds.
The author describes a potential tension in modern postural yoga between the practice of withdrawing from sensory experience as part of broader yoga practice and using the idea of a particular sensory experience resulting from yoga (calm, peaceful) to commercialize and sell yoga.
Additionally, the author describes a conflict between the concept of pratyahara as the withdrawal of the senses and pressure from the yoga industry which idealizes a particular aesthetic as the material appearance of health.
The author proposes that engagement in pratyahara practices has the potential to provide a refuge from discrimination and/or pain that practitioners may experience in the external world.
Finally, the author also proposes that when thoughtfully applied, pratyahara practices could result in greater discernment. Through that lens, it could better enable practitioners to engage with social change.
Why is this relevant to yoga practitioners?
Most contemporary yoga practice centers asana practice. For that reason, it’s easy to get caught up in the achievement of postures and miss the wider experience of yoga practice. While yoga practice certainly offers physical health and wellness benefits, Patanjali’s Yoga Sutras suggest these are actually side benefits of a holistic yoga practice.

When we practice all of Patanjali’s eight limbs of yoga, we recognize the possibility of experiencing samadhi, a spiritual transformation where we recognize the oneness of consciousness and no longer see ourselves as separate. Pratyahara practice has the potential to support us on that path. It allows us to experience discernment and reduce our identification with immediate sensory experience. This in turn can support us in healing, as well as cultivate an awareness of when to thoughtfully engage with the world and when to withdraw.

 
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Conclusion
The author suggests that skillful pratyahara practice can allow for greater discernment. She suggests we could apply that to deciding when to withdraw from worldly experiences and when to engage with the world, specifically to support social change.

The Question:
Hi David. I have been practicing Ashtanga primary series for four years now and I still cannot do headstand. I am not able to lift up my legs as they feel very heavy. The best I can do is lift only one leg but I cannot support myself on my lower back to lift the other one and stay in the pose. I have worked a lot on strengthening my back muscles which are now much stronger but I still struggle to get through the headstand. Where am I going wrong?

The Answer:
Great question! Headstand is a very popular posture. There are a lot of people working on it who want to do headstand. So, one thing is, if you’ve been working on something—I don’t know that she’s necessarily been working on her headstand for four years, but it sounds that way, so let’s assume it for a moment. If you’ve been working on a particular posture and using a particular method or technique and it’s not changing, it’s possible that you need more time. It’s also possible that you need to change your focus, intention, or the technique that you’re using. It doesn’t fit you specifically. That may be the case here.

Typically, I like to see someone and see what they’re doing before I say that, but it would be my guess. It sounds like Rashi’s been working on strengthening her lower back, which is good. Of course, you do need a strong lower back.

Consider trying a new approach
I get the feeling that a lot of beginners in Ashtanga try to bring both legs up straight at the same time, which is a worthy goal. I would say that it’s not beginner. There are always exceptions to that. Some people can do it. It might depend on their proportions. It might depend on what they’ve done previously, what the strength of their upper body is, or their core. You know, it can happen, but when it can’t, you need to train it. You need to train those muscles and learn how to engage them in a way that can sustain or support both legs at the same time.

Usually what I do—and I’m going to assume she’s not doing any kind of prep. I don’t know. Rashi didn’t say. So what I’m going to do is just break down the way that I typically teach it to people. I would likely do this with Rashi if I met her. One is, just let go of trying to do headstand with two legs simultaneously for the moment. It’s okay to go back there, but for the moment, stop. It’s clearly just not working.

Think about the patterns you want to train
You want to create a pattern of movement that is going to get utilized. In this case, there’s a particular pattern of learning how to control your pelvis that is typically missing. Again, I can’t say that 100% about Rashi, because I don’t know. I find it in handstand as well. So what I do in order to teach that and to build up that sort of—you know she talks about her lower back. There’s lower back and there’s the front lower abdomen, so it’s kind of like a core strength that needs to be created to do this.

So the way I do that is—you know with straight legs you have long lever arms. Right? There’s more weight further away from where you’re trying to move it. That makes it harder to move it. She alluded to this because she said, I can do one leg at a time, which means, what’s the other leg doing? It’s probably moved in. Okay? So, when the legs are straight, it’s going to be harder to lift them. There’s more weight. It means your body, relative to where your head and your forearms are—which we’ll talk more about—all of that needs to move further in the opposite direction of where your feet are, temporarily.

Set up your base
So, here’s what I do. Let me break it down for you. First of all, set up your hands. In my case, the center and maybe slightly back part of my head is what’s in my hands and the front top is what goes on the floor. That’s how my proportions work. That’s my default. I can do the top of the head. I can do headstand almost any way I want to at this point, but this is my default version. This is how I do it. You could have proportions that don’t lend themselves to this, so don’t assume that this is how you have to do it. This is just how it works for me.

So assume all that setup is in place. Remember, that foundation is built on elbows and forearms pressing into the floor which comes from your serratus anterior. That’s what moves the shoulder blades, which then move the upper arms toward the floor. Your forearms are connected to that so all of that goes into the forearms. There are places in the movement where that ends up giving up a little bit or becomes very difficult to maintain, which is okay temporarily. But, try to maintain it as much as possible.

Train the pelvic movement
So you set up that foundation and then you walk both feet in. And then you bring one foot in. This is the beginning of it. Now when you get to the point where you’re bringing in one foot and then the other foot, notice how you have to lean your body beyond your head and neck, just slightly, to get both feet in and up. And once you get to that point, that’s a hard place to hold it. If you can, hold it, but don’t let it be too compressive to your head and neck, especially if you have neck issues. This is a good place to hold because this is going to emphasize that strength in and around the “core” that you need to sustain when you do headstand.

From here—this is a very important part for me. The next movement is where the knees get lifted. How do they get lifted? They get lifted by the pelvis rotating. The pelvis does what is technically an anterior tilt. We’re upside down, so it might look weird to you, but it’s an anterior tilt of the pelvis. The pelvis moving brings the femurs with it. The femurs might move at the hip joint as well until the thigh is essentially parallel to the floor beneath it. This becomes easier to maintain because that pelvic rotation takes your center of gravity and aligns it more closely with the center of your foundation, which is your head, forearms, elbows, and all of that. This is what I would work on first.

Practice the pieces until you can maintain them
Forget the feet going up at this point. If you can do it, great. But, I would hold back from that. I would get up to this point, hold it for a few breaths, and then, very importantly, lower your knees back toward your chest very slowly resisting gravity. That is going to teach and train the muscles of the low back and any other muscle that would be included in doing that anterior tilt part. This is what most people miss. They try to lift their legs from their legs, rather than lifting their legs from their pelvis moving. This is a critical missing point that I see over and over again in headstand.

Skip the wall
You know, what do most beginners do? They go over to the wall or their teacher stands there and they just kick up. They bypass all of these muscles needed to do this on their own. That’s why I never use the wall with beginners. If they learn how to do it there, they’re going to rely on a wall. They’re going to kick too far usually to find that wall and then when you move them away from the wall all the same fear is there. There’s no strength to do it. So, you basically have to learn it again. So, just leave that out.

Go straight to learning how to do headstand properly from the beginning. Don’t be in a hurry, okay? If you’re very scared of being upside down, maybe there’s an exception. There’s an argument for allowing someone to go upside down just to get comfortable with that. Sure. But generally, from a technique point of view, I don’t put people on the wall.