Friday Q&A: Recovering From a Hip Fracture

Fractured Hip Before Repair

Fractured Hip After Repair

Q: This info most helpful, but could you give me info on Yoga after fractured hip repair? My doctor said I did not need a total hip replacement because I have strong bones, no arthritis and no osteoporosis (do have osteopenia). He is saying no yoga for 4 mos., so bones heal completely OR I could end up having to have a total hip replacement. Appreciate any advice. Thank you 

A: We received the above inquiry about Nina’s recent post All About Hip Replacements and Yoga. Nina’s immediate response was spot on: "Will forward this to Baxter. But keep in mind we can't give specific advice to you without seeing you in person. Hope you understand that! Also, there is a lot of yoga that doesn't involve asanas that you could practice in the meantime: Savasana, pranayama, meditation, studying yoga philosophy, etc."

I should begin by clarifying that Nina’s post All About Hip Replacements and Yoga was specifically looking at the use of yoga for total hip replacements, which are usually elective procedures done mostly for those with severe arthritis of the hip joint. Our writer is in a different boat, having apparently suffered a recent hip fracture, presumably following a fall of some sort. In the face of acute trauma such as this, there are any number of possible ways an orthopedic surgeon might repair a fractured hip, depending on where the break is on the thigh bone and whether the bones are lined up or displaced. For example, my mother fell and broke her thigh bone a few years back while gardening, and because of the location of the break and the offset alignment of the two parts of the bone, a metal rod with teeth—which looked like a comb with only five teeth—was used to keep the two parts of her femur bone together as they healed. So, no total hip replacement for my mom, either! However, she still started limited physical therapy shortly after her surgery, which progressed in challenge as her pain subsided and she began to get stronger. 

As for our reader, first of all, I want to say that you should follow your doctor's instructions regarding yoga. But even if you have been warned off yoga by your doctor for now, it is likely that you, too, will be doing some sort of physical therapy in the meantime. So you could apply yoga mindfulness practices and yoga bodily awareness and focus to whatever exercises you are doing in and out of physical therapy. (But it actually might be worth the time to check in with your doctor and physical therapist regarding their understanding of yoga asana and its adaptability. After you educate them with an explanation of the wide variety of ways that yoga can be modified to meet the person where they are at, that they might revise their caution regarding yoga asana in the first four months.)

Next, because a common result of acute fracture of the hip is pain, you can also use yoga for pain management. In fact, one of the primary goals of physical therapy and rehabilitation after surgery is to reduce pain. So, leaving yoga asana out for now, I recommend that anyone recovering from a hip fracture use the other tools in our Yoga for Healthy Aging kit, especially practice pranayama and meditation, to assist in pain management. We’ve written extensively about this, so check out this post Yoga for Pain Management: The Big Picture, which provides an overview of the information we have on pain management: 

It is also common for those suffering hip fractures to experience fear regarding future falls, increased levels of stress, and/or increased rates of depression and anxiety. Again, yoga tools can be a very good adjunct to a more broad-based approach to these issues that your doctor may already have recommended. Here are some posts with helpful information.

Yoga for Anxiety: Yoga for Anxiety: The Big Picture

Yoga for Depression: Practicing Yoga for Depression: An Overview

Yoga for Stress Management: Stress Management for When You're Stressed

Practicing Yoga Mindfully (which could you could to doing physical therapy if you are not practicing asana): Coming to Your Senses in Yoga Poses 

So, even if you are recommended to hold off on doing yoga asana for a period of time following a hip fracture repair, you are now armed with a whole lot of information and tools that can help you on your road to recovery! 

NOTE: While it sounds like our reader may not be in the acute hospitalized period just following fracture repair, it is worth mentioning for others who may face this situation in the future that there is up to a 20% chance of complications following fracture repair surgery in adults over 65. This can include altered mental status, cardiac and vascular issues (such as irregular heart rhythms, heart failure, heart attacks, blood clots in the leg veins or to the lungs), as well as lung and gastrointestinal issues. The chances of these problems occurring is highest right after surgery while a person is recovering in the hospital. If you are already a yoga practitioner, your increased levels of interoception (the awareness of your internal body moment by moment) could clue you into potentially problematic changes that you should bring to the attention of your health care team as soon as possible. 

—Baxter

Subscribe to Yoga for Healthy Aging by Email ° Follow Yoga for Healthy Aging on Facebook and Twitter ° To order Yoga for Healthy Aging: A Guide to Lifelong Well-Being, go to Amazon, Shambhala, Indie Bound or your local bookstore.

Follow Baxter Bell, MD on YouTube, Facebook, and Instagram. For upcoming workshops and retreats see Baxter's Workshops and for info on Baxter see baxterbell.com.  

Excerpts from "Hip-Healthy Asana" by Charlotte Bell

by Nina

My post Interview with Charlotte Bell, Author of "Hip-Healthy Asana" introduced you to Charlotte and her latest book, Hip-Healthy Asana: The Yoga Practitioner's Guide to Protecting the Hips and Avoiding SI Joint Pain. And today I'm pleased to tell you that I can share some excerpts from the book with you! I chose three excerpts that I thought would appeal the most to our readers. The first two provide background information about Charlotte's reasons for writing the book and why stabilizing the hips is so important, but the third one is a full practice for stabilizing your hips. If you try this practice, I'd love to hear back from you about it.

So, let's start with the introduction to the book, in which Charlotte describes her personal reasons for writing this book and provides an overview of the basic goal of the book:


Here is Chapter 4: Stabilizing Your Joints, which discusses why it is so important to stabilize your joints rather than over-stretching.


Here is 10: Standing Your Ground, which includes a full practice for stabilizing your hips:


You can order Hip-Healthy Asana from Amazon, Shambhala Publications, Indie Bound, or your local bookstore.


Subscribe to Yoga for Healthy Aging by Email ° Follow Yoga for Healthy Aging on Facebook and Twitter ° To order Yoga for Healthy Aging: A Guide to Lifelong Well-Being, go to Amazon, Shambhala, Indie Bound or your local bookstore.

For information about Nina's upcoming book signings and other activities, see Nina's Workshops, Book Signings, and Books.

How Spinefulness Helped Improve My Upper Back

by Eve Johnson

The day I met my first yoga teacher, Wende Davis, she placed me in Right Angle pose (which some call Half Downward-Facing Dog pose) with my hands resting on the top of her upright piano and ran her fingers along my spine. When she came to my upper back, she tapped and said, “That’s where your work is.” 

And that’s where my work stayed for the next 29 years. In countless yoga classes, workshops, and teacher trainings, helpful fingers tapped my back in the same spot to bring awareness into my stiff and overly rounded thoracic spine. I was told that my tendency to round was genetic, but with practice I could slow down, or even stop, the increasing curve. The genetic part made sense because my mother and my older sister were both more rounded than me. 

So, in class and at home, I worked on it. I had a daily practice of chest openers. I studied backbends. Moving slowly and with focus, I learned to lengthen my spine and draw in my thoracic vertebrae. Eventually, I could change the shape of my upper back in a pose so it was less rounded.

After 13 years as a student, I started teacher training and eventually passed my Jr. 1 Iyengar certification. But helpful fingers continued to tap my spine. In deep forward bends, my back still humped. In candid photos I saw myself getting shorter and more rounded every year. And I used to feel upper back pain after long walks, hours of standing in the kitchen, and extended seated meditation. 

Then in March, 2016, I took a weekend workshop in Spinefulness (Spinal Mindfulness) with Jean Couch and Jenn Sherer in Palo Alto, CA, led there by Thea Sawyer’s excellent book Put Your Back at Ease. Jean is a former Iyengar yoga teacher, the author of the Runner’s Yoga Book. She’s also one of the voices you hear on the NPR story on healthy bending that Nina and Baxter have been writing about. 

For the first time, I learned why my back rounded and how to straighten it. I learned that posture is cultural, and that although every woman in my family had a rounded upper back, our genes weren’t the problem. Like all little girls, we had modeled our posture on our mother’s, and achieved the same results. 

I learned new habits: sitting with my weight as far toward my pubic bone as possible, turning my feet slightly out instead of keeping them parallel, releasing my chin, and elongating the back of my neck. More problematic, I had to unlearn habits, such as locking my knees when I stood and, most of all, lifting my chest. It was counter-intuitive, but true that when I stopped trying to sit up by lifting my sternum, I became straighter. 

Over those two days, my new alignment began to feel right. Sitting, I found myself in an unfamiliar state of equanimity, both elevated and relaxed, neither slumped nor on edge. Late on Sunday afternoon, Jean’s hands gently guided me into alignment. My spine lifted, my ribcage lengthened, and my back ribs moved up and forward. I had never before felt so light, or so clear. 

I’ve been back to Palo Alto four times since then, and am completing certification for teaching Spinefulness this summer. My spine has visibly straightened. I can avoid humping my back in forward bends. I no longer feel doomed to hunch over as I age. And I now rarely feel upper back pain after my long walks, hours of standing, and seated meditations.

On the left is my photo from March, 2016. Notice that my knees are locked and my belly protrudes. Also, my thighs are well ahead of the line, and my upper back rounds behind the line. On the right is my photo from January, 2018. I still have a long way to go, but my weight has moved to my heels, my knees are soft, my belly doesn’t stick out and my thoracic spine is longer and straighter. 

In the yoga classes I teach, students whose upper backs have always humped in forward bends are learning to elongate. Other students report that chronic tightness in their quads and hamstrings has released, and sore backs, knees, and feet all improve. What’s the secret? What technique could possibly be so universally helpful? Spinefulness teaches us to align our bodies in their most efficient relationship with gravity, as we did when we were toddlers and as some people in less industrialized cultures still do. 

We all know that a building can’t stand if one of the columns curves at the base, and that a bridge will collapse if its supports don’t transfer its weight efficiently into the ground. But, we rarely remember that human beings are physical structures, in essence a bridge that walks. People who live in industrial societies are almost universally out of line with gravity. Starting about the age of three, when we begin to imitate the adults around us, we take our pelvis, our center of gravity, forward of the gravitational line. Modern pelvis-forward posture is a result of many influences, including baby seats that curve infants into a C-shape, bucket seats in cars, soft couches that encourage us to round our backs, and a culture of sitting for hours at a time, with our buttocks tucked under and our spines rounding. 

And then there’s fashion. Before 1920, many more of us stood in alignment. Then came the flappers, who made it cool to stand with the pelvis forward. Decade by decade, that trend has continued and intensified.

Even Steve McQueen, the coolest of all, can’t escape the consequences of sitting back on the buttocks: a rounded spine with head thrust forward. 

Once our center of gravity is off-center, every joint in the body has to compensate. To balance our forward pelvis, our upper body moves back and rounds. To complete the counter balance, our head moves forward. With the pelvis forward, we take more weight than nature intended into our feet and knees. When we sit, we tuck our buttocks under. Our back rounds into a C-shape, and our head juts forward.

This means that the weight of our bodies no longer moves through our bones. Instead we decommission the bones and depend on our muscles to hold us up. But bones evolved to bear weight. Muscles evolved to move the bones. (An exception would be the deep core muscles closest to the spine.) So when we ask our muscles to hold us in an out-of-balance position, the result is tense, gripped muscles—a tension we are so accustomed to that we rarely feel it until it reaches the point of pain. 

Because we spend most of our waking hours out of balance, either sitting or standing, no yoga practice, however faithful, can possibly undo the rounding. Even two hours every day is no match for 22 hours of off-balance posture. (Yes, Spinefulness teaches us to sleep in alignment, too.) As Jean Couch likes to say, “you can turn the lights on and off, you can turn the heat on and off, but you can’t turn gravity off.”

So how do we find our healthiest relationship to gravity? We imitate people who live in balance. They have a short, sharp arch low in the back and an elongated, almost straight spine. They also have bones that stack—with pelvis, spine, and ankles all in one line—and soft, elastic muscles.

Standing with weight in heels and pelvis back 

Letting pelvis hang forward,
creating a zigzag line in the spine 

The first step is to sit on our bones and relax.

How to Sit

Sitting with Spinefulness entails the “figging” motion that Nina and Baxter have written about in their posts Life-Changer: Bending Over Differently and Time to Rethink Standing Forward Bend. Sitting is, of course, a variation of bending, so the instructions are much the same. As you sit down, you bend your knees and allow your pubic bone—the place where Adam and Eve wore their fig leaves—to move between your legs, going both down and back toward the wall behind you. Ideally, you sit with your weight falling into your pubic bone. But correcting misaligned posture is a process, and for most of us, sitting forward on the sitting bones is enough to start with. Once we rotate the pelvis forward, we’re able to form our natural arch at L5/S1 (just above the top of the sacrum, where it connects to our lower spine, the lumbar) We also immediately deepen our lower spinal curve, the lumbar curve, above the natural arch. 

Next, seated with your upper back touching the back of your chair, relax your buttocks. Then relax your upper body, letting your sternum and your front ribs descend. (If you’ve spent a lifetime trying to lift your chest to stand up straight, you might feel like you’re slumping.) To feel longer and lighter, you need to lengthen your spine. The Spinefulness solution is a “chair hitch”: 

1. Pull your feet back toward you, so you won’t be tempted to lift from your legs. Hold on to the sides of the chair and push down. Without lifting your pelvis or the front of your chest, draw your lower belly toward the small of your back and up. 
2. Once you have your maximum lift, curl back, with your chest still down, to place your upper back on the chair. Relax your shoulders and lift your head. 
3. In a successful chair hitch, your back will connect to the chair higher than before you started. Check that your buttocks are still relaxed, and your chest is still soft. 

With the chair hitch technique, you use your abdominal muscles to pull the bones of your low back toward the back of your body. This means that the bones are better able to stack, with your body weight transferring down the flat, thick bones at the front of the spine. Imagine the spine as a column, and then see the exaggerated curve that many of us have in our lower backs. With the lumbar spine forward, the bottom of the column is no longer in line with the top. And without support, the top of the column sinks. When the bones of the low back move back in place, the upper spine feels light. It becomes longer and more mobile. 

Take a look at the two spines below. In the 1911 example, the bones of the low back rise almost vertically from the short, sharp arch at their base. The upper back is also less curved. It lines up with the lumbar vertebrae, the support bones of the bow back. In the 1992 example, the bones of the upper back sit so far behind the lumbar, that they lose the support of the bones beneath them.

In the spine on the right, the more stacked vertebrae are able to support the thoracic spine in the upper back. In the spine on the left, there’s no support for the upper back. (From Thea Sawyer’s book Put Your Back at Ease, used with permission.)

The way we spend our days shapes our bodies, which can be bad news if your job requires long periods in a chair. The good news about Spineful sitting is that once you “fig” and relax, your sitting time can actually help relieve back pain, and improve your posture. There’s a catch, of course. Spinefulness is an awareness practice and awareness is fleeting. So you will still catch yourself slumped in a C-shape with your shoulders around your ears and your head craned forward towards a computer screen. But now you’ll know how to fix it. 

Changing Our Habits

Perhaps the most difficult part of Spinefulness is to undo our ideas of good posture and stop lifting the chest. We’ve all been reminded countless times to “stand up straight,” meaning pull the front chest up and the shoulders back. Sadly, the longer you’ve practiced yoga, the more likely it is that lifting your front chest feels natural and good. We’re so used to the strain it causes that we no longer feel it— at least until we’ve been taught to relax. 

But lifting the front chest shortens the back and takes us out of our most efficient relationship to gravity. The spine evolved to bear weight through the vertebral bodies, the front part of the spine. When we lift the front ribs, we pinch the lower back and transfer weight into the spinal processes at the back of the spine. And once we’ve lifted the front ribs, it’s impossible to lengthen the spine.

True length in the spine comes from keeping the front ribs drawn toward the spine and from lengthening the back and side ribs to our full extent. Once that length is present, the elongated upper spine, the thoracic, is free to move towards the front of the body.

How Does Spinefulness Fit with Yoga? 

In a word, seamlessly. Using Spineful alignment in my asana practice brings new ease into my poses. Twists are freer. I can access my upper back better in backbends, which makes them less stressful for my lower back. And because I can now lengthen my spine more effectively, my forward bends are less curved.

This probably shouldn’t be surprising. For one thing, Spinefulness has deep roots in yoga. In 1959, Noëlle Perez, the Parisian genius who did the research that underlies Spinefulness, became one of BKS Iyengar’s earliest European students. She continued to study with him into the 1970s, and eventually published Sparks of Divinity, a collection of his teachings. Noëlle struggled with pain, particularly in Headstand. And she credits Iyengar’s advice with giving her the first clue to what became her life’s work.

“Walk behind Indian women and observe them closely, copy them,” Iyengar told her. “When your shadow matches theirs, you will have made progress.”

In India, before the onslaught of western culture, a relaxed, aligned way of sitting, standing and walking used to be close to universal. I like to think that when I bring my body into its best relationship with gravity, I too am making progress. 

If you are interested in learning more about Spinefulness, you can experience Spinefulness with Jean Couch this summer in Vancouver, Canada, where she will teach a weekend immersion course July 7 and 8, and a 30-hour intensive July 9 through 13. For more information, go to yogaon7th.com. If you live in the San Francisco Bay Area, you can contact Jenn Sherer, at spinefulness.com and check out workshops at spinefulness.com/workshops.

Eve Johnson is an Iyengar Yoga and Spinefulness teacher based in Vancouver, Canada. She owns and teaches out of Yoga on 7th studio in Vancouver. Eve’s focus has always been on encouraging her students to develop a home practice. Until an intense bout of Spinefulness training intervened, she wrote the My Five Minute Yoga blog, subtitled “friendly advice for growing a home yoga practice.” She plans to return to blogging soon. In the meantime, she’s relishing the constant opportunities for practice that Spinefulness provides.

Subscribe to Yoga for Healthy Aging by Email ° Follow Yoga for Healthy Aging on Facebook and Twitter ° To order Yoga for Healthy Aging: A Guide to Lifelong Well-Being, go to Amazon, Shambhala, Indie Bound or your local bookstore.

Yoga for the Terminally Ill

by Erin Collins

Study of the Sky at Sunset by Eugene Delacroix

“But I don’t know how to die.” An acquaintance of mine recently told me of her friend who was diagnosed with stage 4 cancer and given a prognosis of just a few months to live. Accepting this reality, she simply stated that she wasn’t quite sure how to “do death.” 

As humans, two things we all share are breath and death. Although we’d all like to practice a full sequence of asana at the age of 92, the reality for many people, even with a healthy lifestyle, is that disease and death often come knocking before we expect or desire. So to practice yoga for healthy aging, we have to also practice yoga for healthy dying. We have to be able to face our mortality realistically and to talk about death and dying openly. And for those who are terminally ill, your yoga becomes less about the physical practice of asana (although there are some recommendations at the end of this post for poses that may bring some benefit), and becomes more about the contemplative nature of yoga. This contemplation of death can allow us to live more fully as we talk about it with our friends, our family, and our community. We can turn to yoga philosophy to help us in our contemplation of ourselves and our mortality. 

Clinging to Life (Abhinivesa) 

In yoga sutra 2.9, Patanjali writes that “abhinivesa is the automatic tendency for continuity; it overwhelms even the wise.” Abhinivesa is sometimes translated as “a wish to continue” or “a wish to live.” As humans, we have a natural inclination to cling to life—to the status quo—and to avoid the subject of death. Freedom from abhinivesa, then, could be the goal of yoga practice during this phase of life. Finding freedom from clinging to life as we know it is how we can use our yoga to face our mortality. 

In the practice of yoga, we can practice dying over and over again. This practice can give us the perspective to let go, to be at peace with the impermanence of our physical body, and to build a relationship with the many subtle layers of our being. Each breath is gone at the end of the exhalation. Each pose, practiced with determination, with effort, with focus, dies as soon as we move to the next. 

And in the end of our practices, we spend time in the pose of a corpse (Savasana), the ultimate practice of surrender, of transition, of letting go of ourselves as a physically active being and slowing ourselves to explore our true, subtle nature. And yet, we know that each time we lie in Savasana, we will wiggle our fingers and toes and we will return to the day’s chores and to whatever is next in our day, our week, our year. We may come to a seat and spend a few minutes in meditation, contemplating the practice, investigating our inner world. And this is where yoga for the terminally ill begins to aid us in facing our mortality as we can face the idea that at some point, we won’t reawaken from Savasana. Yoga is an opportunity to embrace healthy dying. 

Self Study (Svadhyaya) 

I recently watched, and highly recommend, the Frontline Documentary "Being Mortal," which takes a personal journey with surgeon and author Atul Gawande, telling the stories of some of his patients and their families as well as challenging viewers to reexamine how we think about death and dying. One of the most striking takeaways for me was the idea of naming your priorities. This list of priorities becomes especially important as we age, for an important component of healthy aging is acknowledging and embracing our mortality. 

Studying the sutras, and practicing the niyama syadhyaya, self-study, allows you to face your own beliefs about death and is an opportunity to name your priorities and realize what is most important as you face the last stage of life. Start by imagining you have six months to live. Make a list of what is most important to you in this scenario. Then, if you have three months, how does the list change? With only one month to live, what is most important? What is your “bucket list”? By investigating in your own true self what has the most value, you can declutter your mind and prioritize how to spend your time. When you have a list of priorities, you can more easily communicate with family, with friends and with your medical care team. You can more easily face an imminent death with a focus on the quality of life in the present time, as it unfolds, and direct your care needs to allow you to be comfortable and able to live in reverence and study of yourself. 

Who am I? 

We can see a terminal diagnosis as the worst news ever or as a harbinger of what is still to come. We may start to explore the idea that we are more than just a physical being who practices yoga on a mat. Yoga allow us to explore the subtler realms of our being. In Ravi Ravindra’s translation of Patanjali’s Yoga Sutras, he mentions a conversation with Krishnamurti in discussion of sutra 2.9: 

“The real question is ‘Can I die while I am living? Can I die to all my collections—material, psychological, religious?’ If you can die to all that, then you’ll find out what is there after death. Either there is nothing; absolutely nothing. Or there is something. But you cannot find out until you actually die while living.” 

This is the ultimate question across all beliefs and practices: Am I more than this body, this breath? To further explore this question, our practice can involve studying some of Patanjali’s eight limbs of yoga: 

Satya (truthfulness) from the yamas: To be honest with ourselves about the truth of our mortality. 

Svadhyaya (self-study) from the niyamas: To explore our own beliefs, fears, and desires about death. 

Asana and Pranayama: To alleviate anxiety, nausea, and pain, and other symptoms. 

Dharana, (meditation): To contemplate the questions “who am I?” and “what is next?” In meditating on our mortality in this way and getting to know the more subtle layers of our Self, perhaps the suffering and fear of impending death can be alleviated. Meditation and study on ideas presented in the Yoga Sutras helps us to see that our real self isn’t our body-mind (which is prakriti), but rather our higher Self, our eternal, unchanging soul (which is purusa). So, in facing mortality, we can maybe find comfort in the idea that our eternal, unchanging soul isn’t going anywhere. It is only the identity we have wrapped up in Annamaya Kosha, the physical body, that will dissolve. 

Another aspect of yoga philosophy that can be helpful is the Pancha Maya Kosha Model, which says that we exist in layers of being, or koshas. These layers of our being nestle one inside the other, sometimes depicted as Russian nesting dolls, although they may be more fluid and interrelated than that. One of the koshas that may be helpful to work with is Vijnyanamaya, or the Witness. Beth’s post The Koshas: A Yoga Model for Healthy Aging about the koshas describes it well: 

“Wisdom-Witness Level (Vijnyanamaya Kosha). The Witness is the lamp that illuminates all aspects of ourselves (persona and shadow) for integration and acceptance. When we are able to witness our thoughts, emotions, and behaviors without judgment, we are better able to cultivate and deepen our understanding of the sources that gave rise to our habits, patterns, and core beliefs and then consciously choose to make (or not make) changes."

In facing imminent death, the Witness level is strong, as many people embark on life review, reflecting on a life well-lived and a legacy to be left behind. Working with this level incorporates self-study (svadhyaya) and, as Beth mentioned, can allow for acceptance and integration of all we are, all we have been, and all we are yet to be as our true Self. 

Asana for the Terminally Ill 

The poses you can do will depend on your physical state of being on any given day. As you become weaker or more fatigued, listening to your body with satya (truthfulness) will be the most important practice of all. To aid in the practice of contemplation as described above, a few simple poses can be helpful: 

Savasana (Corpse pose): This asana is perhaps the most profound to practice because it invites us to let go allow for the felt experience, even if for a few moments, of the dissolving of our physical body (Annamaya Kosha). 

Find a comfortable place where you can come to a full reclined position, on a bed, on the floor, or in a recliner. Wiggle your body to allow for a relaxation of muscles and settling of the bones. Deeply inhale through your nose, and as you exhale, let out the sound “ha” for as long as you can. Imagine these breaths as your last. Allow your body to be at ease and your breath to follow that ease. There is nothing to “do” in this pose, so allow yourself to just be here, now. As your senses withdraw and your thoughts fade away, imagine your inner layers of being. In your practice of Savasana, the letting go of Annamaya Kosha allows you to get more attentive to your emotional and mental state (Manomaya Kosha). In letting go and relaxing deeply, the Witness layer investigates body, breath, and being, perhaps allowing you to feel Anandamaya Kosha, the Bliss body, the integration of the koshas.

Matsyasana (Fish pose): This asana opens the heart. For someone who is terminally ill or who is caregiving for another, supporting the spine with a bolster or rolled blanket under the spine will feel restorative. You can do this pose reclining on the floor, in a bed, or in a recliner chair. Place a blanket roll, pillow, or bolster lengthwise under your spine and let your arms open to the sides. If your shoulders are uncomfortable, support your arms on blocks or pillows. Inhale deeply through your nose, filling your chest with breath. Then exhale slowly and relax your upper body. As your body is supported, let your awareness rest in your heart. What does your heart want you to know about death? What comes up for you in your heart when you imagine your own imminent death? 

Balasana (Child’s pose): Depending on what is most comfortable for you, you can practice Child’s pose in one of three different ways: 

1. Classic Child’s pose, folding forward on the floor or onto a bolster? 
2. On your back, bringing your knees toward your chest 
3. In a bed on your side, drawing your knees as close to your chest as you are able. 

The cycle of life begins in this position in the womb. As your return to this shape from where you started, can you contemplate death as a return to the beginning? You have completed your cycle of life and are prepared now to welcome whatever comes next. Embrace healthy dying in this pose as you embrace all the layers of yourself.

Erin Collins is a Certified Hospice and Palliative Care Registered Nurse, End-of-Life Doula, and Yoga Instructor in Bend, Oregon. She has spent 11 years caring for patients battling cancer and 5 years offering compassionate nursing care for the dying.

Subscribe to Yoga for Healthy Aging by Email ° Follow Yoga for Healthy Aging on Facebook and Twitter ° To order Yoga for Healthy Aging: A Guide to Lifelong Well-Being, go to Amazon, Shambhala, Indie Bound or your local bookstore.

Video of the Week: Dynamic X's and O's

In this reclined mini vinyasa you move between two shapes to strengthen your core and mobilize your hips and shoulders. (I learned this from my girlfriend, Melina Meza, who is a talented yoga teacher. See http://melinameza.com/ for information on her.)

Subscribe to Yoga for Healthy Aging by Email ° Follow Yoga for Healthy Aging on Facebook and Twitter ° To order Yoga for Healthy Aging: A Guide to Lifelong Well-Being, go to Amazon, Shambhala, Indie Bound or your local bookstore.

Follow Baxter Bell, MD on YouTube, Facebook, and Instagram. For upcoming workshops and retreats see Baxter's Workshops and for info on Baxter see baxterbell.com.  

All About Hip Replacements and Yoga

by Nina 

I’ve gotten a few inquiries lately regarding hip replacements. For example, I’ve been asked, “Can I do yoga after a hip replacement? (Yes.) And I've also been asked, “What poses can I do after a hip replacement?” (It depends on the type of replacement—see below.) So even though this is a subject we’ve covered in the past, I thought it was time to revisit it by providing an overview of the information we have on our blog about this important topic. Almost all of the articles we have on the topic were written for us by Shari Ser, who is both a physical therapist and yoga teacher with long-time experience helping others dealing with this surgery in both roles. 

I’d like to start by saying that when I hear people who have come to a point where they are seriously considering this surgery—because they can no longer walk well or the pain they are experiencing is just too unbearable—I always think of something that Shari wrote in one of her posts: 

“In my clinical experience I have never had a client tell me that he or she is sorry to have undergone this surgery. In all medical procedures, knowledge, mental and emotional preparation and conviction in your choice of action go a long way towards healing.” 

Also, in my post Interview with Charlotte Bell, author of "Hip-Healthy Asana", Charlotte discussed her own hip replacements by saying: 

"My hip replacements truly gave me my life back. I wouldn’t be walking today, let alone enjoying yoga practice, if it hadn’t been for my hip surgeries. Every time I find myself wandering the gorgeous landscapes in my adopted home of Utah, I feel grateful for the technology that helped me regain my ability to hike."

But if you, like me, feel that you are not yet ready and don’t want to be rushed, see this post that I wrote about delaying surgery, which I have had some success with: Delaying Joint Replacement.

Now for the links to the articles by Shari and others: 

1. In Total Hip Replacements and Yoga Shari provides background information about what a hip replacement is, why it might be necessary, and how to talk with your doctor about yoga and hip replacements BEFORE your surgery (because most doctors don’t realize what yoga entails as far as movements.). She also discusses how to talk to your doctor about your post-surgery yoga and gives advice about easing back into your practice. Anyone contemplating this surgery should read this post! 

2. In Friday Q&A: Modifying Poses for a Hip Replacement Shari provides details about the types of yoga movements that people with various types of hip replacements should avoid. I included illustrations of the movements. This will help you learn the anatomical terms that you need to understand to help yourself move back into yoga practice after surgery. 

3. In Friday Q&A: Physical Therapy for Hip Joint Replacement Shari answers the question: Can yoga be a form or alternative for physical therapy post-hip surgery as well? 

4. In Friday Q&A: Helping a Student with a Hip Replacement Shari answers a question from a yoga teacher about how to help a student with a posterior hip replacement. 

5. In Arthritis of the Hip Joint Baxter and I provide background about arthritis of the hip joint, the most common cause for the need for hip replacements. 

6. In Friday Practical Pointers: Who Should Avoid Certain Movements of the Hip Joint? Baxter discusses the various movements of the hip joints and provides cautions for those who should avoid or minimize them, including those with hip replacements. 

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Metamorphosis

by Jivana

Photo by Sarit Z Rogers

The monarch butterfly spends two weeks as a caterpillar before metamorphosing into a butterfly. Then it lives as little as two more short, yet magical, weeks in an ethereal dance before it dies. Amazingly, the monarch’s annual migration across all of North America is achieved over the lifespan of four generations. One monarch can only make a portion of the journey and it’s up to the next generations to complete it.

Are our lives much different? In the U.S., women can expect to live to the age of 81 and men to 76. In the grand scheme of things, those eight decades are the blink of an eye and are as fleeting as the life of the monarch. These few precious decades hardly seem adequate to figure out what we’re here to do. Is reincarnation, a foundational concept of yoga philosophy, our version of the monarch’s migration journey? Will future me’s complete my soul’s work? 

Personally, I feel like putting all my chips on reincarnation is a risky gamble. Seems like I need to make the most of the time I have here rather than bargaining on future lives which I know nothing about. So, I should do my best to figure out what I’m here to do. As a long-time yoga practitioner it seems like enlightenment (samadhi) is supposed to be my goal, but that seems like such an impossible feat. 

In his Yoga Sutra, Patanjali describes how to achieve the state of samadhi, which he simply refers to as the state of yoga. He goes on to describe at least six distinct levels of samadhi. Reading through them recently I began to feel disheartened, and to doubt myself and my ability. I know I’ve learned so much about myself through yoga, but without working towards samadhi am I just fooling myself?

As I practice longer I am noticing a few important things. I’m more aware of a split within my own mind: the part of me that’s thinking and the Witness or inner consciousness observing it all. Patanjali would describe this separation as the dance of purusha (spirit) and prakriti (nature). I often think of prakriti as the natural world around us, but it’s not so simple. Every part of our human birth, including our mind and emotions, is prakriti. The only thing that is purusha is atman, the soul. 

Most of the time I’m talking to myself, aren’t you? But who is talking and who is listening? The mind, part of prakriti, is talking to purusha, the Witness, as Patanjali’s Yoga Sutra explains. If so, then my stream of consciousness is some kind of endless prayer—a continual flow of sensory experiences, self-criticism, and internal fights with everyone who bothers me. It’s embarrassing to think of all this mind-stuff as prayer, and I sure hope God isn’t listening when someone makes me mad!

I usually think of yoga as union–bringing something together. But, really, it’s more about separation. Using my discriminating discernment to tease out purusha, my Essence, from the complexity of nature. So much of my time is spent in the rituals of daily life: eating, sleeping, etc. But, as I go through all these activities, part of me is separate, simply watching the outer activity. This witness seems unaffected by these outward experiences. It’s always there, listening and watching. In my meditation practice I try to create an opportunity for that inner witness, the eternal Listener, to move into the foreground for a brief moment.

This shift, allowing the Witness to move from background to foreground, is unnervingly powerful, and yet I’ve noticed that sometimes I avoid it on purpose. Some days it feels easier to focus on what I’m going to eat for lunch or to allow my mind to be lost in the endless blur of other people’s lives in my Facebook feed. But in the end, I know for sure that I’m supposed to find a way to bring that Witness into the foreground more and more. Perhaps that is the experience of samadhi?

When I allow that shift to happen the experience is beyond words. It feels like my sense of self steps forward in a bold way that quiets the noise in my head. My normal experience of the world changes. The feeling that I’m seeing through my eyes shifts to an experience of my eyes. It’s not always so peaceful or some spiritual cliché. In fact, it forces me to feel whatever emotions I’m having, which I don’t always want to do. But it always feels honest.

And if I’m being honest with myself, then I also have to admit that my inner life isn’t really so private. The connection between prakriti in my mind and prakriti around me is very strong. For example, the idea that I can just think whatever mean thing I want about someone else or even myself is a lie I tell myself. It’s not that other people can hear my thoughts—at least I hope not—but my intuition tells me that my internal struggle is bound up with everyone else’s. At least if I act as if my inner experience is public, then I will clean up my mind. 

Ultimately, I know that we are all looking for happiness of some kind and maybe samadhi is simply happiness. According to the yoga teachings, happiness actually comes from peace of mind and not from any external thing or other person. Peace of mind occurs when I allow the Witness to come into the foreground. In the Bhagavad Gita, Krishna says:

“There is neither wisdom nor meditation in an always-changing mind. Without a meditative, one-pointed mind, there is no peace. And without peace of mind, how can anyone be happy.” (2.66 Translation by Swami Satchidananda)

What a great question. Without peace of mind, how can anyone be happy? Ironically, I think that’s the exact opposite of what we’re taught in the West. We’re taught that external validation and material possessions will make us happy, and, sadly, my mind is still invested in those pursuits. I have to wonder why my mind allows itself to suffer when I know in my heart that samadhi is the answer. For now, I’m like a hungry caterpillar eating all the leaves. Hopefully someday the yoga chrysalis will transform me completely and allow me to spread my wings. 

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Follow Jivana Heyman on Facebook and Instagram  and see Jivana's Workshops and Trainings for upcoming workshops and trainings. For information on Accessible Yoga, see accessibleyoga.org and follow Accessible Yoga on Facebook and Instagram.