Anxiety and depression in isolation. 

The lockdown of our communities during the Covid-19 Pandemic can be particularly difficult for those who suffer from symptoms of anxiety and/or depression. The loss of social connection, structure and routine and physical outlets can worsen the symptoms for those already struggling with these conditions or precipitate the onset of them in those who may have never experienced them in the past. To help keep this at bay maintaining a regular yoga practice is more important than ever. 

Social isolation is a health risk.

Social isolation can have as big an impact on our health as smoking or obesity and increases the risk of premature death. Research has also demonstrated links between isolation and depression, poor sleep, cognitive decline and even impaired immunity. 

Exercise withdrawal can induce depression.

Even for those who haven't previously experienced depression or anxiety, the cessation of their usual physical activity can precipitate the onset of symptoms. Research from the University of Adelaide has shown that for regular exercisers it can take just three days of inactivity for symptoms of depression to present. These findings confirmed an earlier review that found exercise withdrawal has negative consequences for mental health.

Active people are happier people. 

Yoga improves symptoms of anxiety and depression.

A group of people with Major Depressive Disorder (MDD) participated in a clinical trial assessing different 'doses' of yoga. The high dose group took three 90 minute yoga classes per week with four 30 minute homework sessions per week for twelve weeks while the low dose group did two 90 minute classes and three 30 minute homework sessions per week. After twelve weeks both groups had  "reduced symptoms of depression and anxiety and increased feelings of positivity". 

 The social bonds of yoga.

While yoga itself has an effect on the physical and emotional wellbeing of the practitioner, yoga also has a positive impact on the feeling of connection and trust that a group experience when practicing together. Research shows that the steepness of a hill is judged to be less difficult when you are walking up the incline with a friend than when you walk it alone. Things just feel easier when we do them together.

The power of synchronised movement.

Synchronised movement has a powerful effect on groups. Whether it is dancing to the same steps (think Nutbush CIty Limits), marching on parade or doing a group yoga class the effect is unifying. This effect has been shown to increase cooperation and other prosocial behaviours (things like helping, donating and sharing) from those who participate in synchronised activity such as yoga. This comes about through the feeling of one-ness that we experience when we move in unison with others. 

But my yoga studio is closed!

While it isn't perfect, a home practice can offer opportunities (reduced commute time) and an opportunity to connect with yourself and with your studio and maybe even include your family. Or maybe not if you live in my house....  The are a lot of benefits including:

 Keeping your activity levels up.

Engaging in a home practice during a difficult time can certainly help keep your activity levels up. As well as the physical benefits there are upsides to creating space for yourself, allocating time to engage in an activity designed to look after your wellbeing. 

 Is online yoga a viable alternative?

While studios are closed (hopefully not for much longer!) there are a wealth of options for keeping up your practice up while in isolation. From youtube videos to yoga apps there are many options for a wide variety of practices.

YOME has a huge array of videos embracing many different yoga styles from Bikram to Power Yoga. Yoga with Adriene is a youtube powerhouse and has great beginner videos and also offers short practices and there are a dizzying array of apps available. Down Dog is offering totally free access to their app until July 1st 2020 (no credit card required!).

 Virtual Yoga.

But if you want to get the benefits of your yoga practice on your health and wellbeing AND you want to get the social and emotional benefits of practicing with others try looking into virtual classes. Check to see if your local studio is offering classes via Zoom or other group platforms and join them. Or search online using an app such as MindBody to see if you can schedule a virtual class with another studio. Instagram Live has a multitude of classes and options to try. (*Zoom yoga class Image thanks to Instagram). 

No it's not the same as going to the studio, but it is a way to connect, to get your workout in and reach out to others in the same boat. Plus, it's a lot harder to give up halfway through a class when you have a real life teacher encouraging you and your regular fellow classmates practicing alongside you. 

Wishing everyone health and happiness until we can get back to a studio!

 Namaste,

PS If you want to set up a hot room at home for your Hot Yoga practice check out my blog here.

DIY Hot Yoga Studio at home.

As many of us have been forced to deal with serious withdrawals from our hot yoga addiction without access to the hot room I decided this week to set up my own temporary hot yoga studio (with minimum expenditure). This way I can practice from home until the enforced isolation comes to an end we can all run at full speed back to our beloved hot yoga studios. I set mine up in the spare room this week complete with temperature gauge for a total of $73.99 and have achieved a consistent 40 degrees celsius for my home practice. If you had to buy all of the items on the shopping list below it would cost you $143.99 to start from scratch. (Obviously this doesn't include the possible increase in your electricity bill but I figure my sanity is worth it!).

What you need for your home hot yoga room?

Shopping List

Items already on hand:

• Curtain/blind (or use a towel)
• Draught excluder (or use rolled up towel)
• Yoga Mat
• Yoga Towel (try The Archer!)

Step One - Windows and blinds

1. First step, close up any windows and if you can use a blind that has a honeycomb structure as they are more effective at maintaining the room temperature. Mine is a cheap one from Ikea that was already in place so no outlay there. 

Step Two - Declutter the space.

2.  Next, as much as possible try to declutter the space. Think minimalism. The more crowded the room with furniture, stacks of boxes or baskets of washing etc the harder it is for the warm air to circulate - not to mention it isn't that good for you to try and practice yoga surrounded by piles of stuff! If this is your bedroom then just do the best you can but if you are lucky enough to have a spare room then clear it out!

Where would you prefer to practice?

Step Three - Turn up the heat.

3. Heating!! My experimenting and research resulted in a two pronged approach. Firstly an electric oil 'fin' heater is good at heating a room but tends to need a while to be effective and doesn't move the air around so this goes on for my baseline heat and then I've an electric fan heater placed to blow through the oil heater fins to circulate the hot air from the oil heater in conjunction with its own heat. 

From left to right. 1. Electric Oil Heater - similar one available from Kmart $35. 2. Electric Fan Heater from Big W $39 and 3. My home set up.

We already had the oil heater and bought the fan heater this week from Big W. I find if I heat the room up around 2 hours before I practice it gets to 40 degrees celsius and stays there.

Step Four - Block any draughts.

4. Stop any cool draughts by using a draft excluder to block any air that may come in through gaps under doors. You can get them from Spotlight for around $12 or just roll up some towels for zero cost like I did!

Left: Yoga towels rolled up to block draughts. Right: Sausage shaped draught excluder from Spotlight.

Step Five - turn up the humidity

5. All the heating might make your room feel hot but also make the air a bit dry. Introduce a little moisture with a humidifier. These can be cheap and cheerful like this one from Amazon that I bought for $29.99 or spend a little more for a bigger more efficient unit. 

From left to right 1. Small aroma diffuser for use as humidifier from Amazon 2. Beurer humidifier from Harvey Norman (images not to scale!).

While these will help the air be a little less dry in your hot room this isn't exactly precision heating and it is unlikely you will be able to perfectly replicate the precise heating and humidity of the studio you practice at home.  One low tech way to measure the humidity in the room is to place a few ice cubes in a glass and put the glass in the room. Leave it for a few minutes and when you come back check if the glass has some condensation forming on the outside. If it does't you might need to think about adding some moisture to the air. 

Read the room temperature!

If you have a temperature gauge handy then put it in the room. I have this one that I found at a local $2 shop. It actually cost $5.... 

From left to right: 1. Temperature before heating the room at around 22 degrees celsius. 2 After heating the room for approx. two hours the room was at 40+ degrees celsius. 3. Temperature Humidity Gauge available online from Ebay for $8.99

Finally, Mirror, Audio, Mat, Action!

I had this mirror leaning against a wall that I had planned to put up a while ago (when I got time) that I bought from Big W for $19 but you could use any mirror that you have handy. I've been using youtube videos by a variety of teachers using my mobile phone. To avoid overheating the phone I have connected it to a bluetooth speaker and left the phone outside. I had this already but you can buy them from lots of places relatively inexpensively - Target has them for $12.

The best towel for hot yoga.

If you don't already have a great yoga towel try The Archer. Super absorbent, designed with your alignment and hot yoga practice in mind. Free shipping worldwide. 

 You are good to go! Put a sign on the door and get changed into your regular yoga clothes. Set a time to start class and go in 5 minutes before and be sure to keep yourself honest - work hard. Enjoy a nice long savasana at the end. 

Smile, you did it. 

Let me know how you get on and if you have any tips or hints or improvements in the comments below! Namaste!

Firstly, what a locked knee isn't. Let's cross this off from the start. Medically speaking a knee lock is what happens when your knee joint becomes stuck and won't move. Most often this is when a bone fragment, cartilage from a torn meniscus or other foreign body gets trapped within the knee joint. It locks and will not bend or stays bent unable to straighten. This injury requires medical attention and is definitely not what you want to do in standing head to knee pose! More about this acute injury here.

Secondly, simply pushing your knee backward as far as you can does not qualify as locking your knee. This is hyperextension of the knee joint. It may not cause you an acute injury but it is certainly not what you are aiming for in your hot yoga practice.

Knee Joint Alignment - Neutral Knee

In yoga, a locked knee refers to alignment of the knee to ensure the stability of the total joint. The bone structure alone is quite weak so we rely heavily on the surrounding muscles and ligaments to keep the knee joint stable. Instead of saying 'lock the knee' imagine replacing this phrase with 'engage neutral knee'. This, in a perfect world, would be your leg in a straight 180 degree line with the bones neatly stacked on top of each other. In reality we are all individual beautiful snowflakes and most of us have some level of hyperextension (how far past 180 degrees our knee joint extends)- on average up to six percent. You can read more about the normal range of hyperextension here. Aim for the 180 degree straight line minimising hyperextension and get ready to engage the muscles. 

Figure 1. Neutral knee. 

How do I lift my kneecap up?

The main job required of your kneecap is to protect the quadriceps tendon. This tendon extends from your quadriceps muscles and over the knee and down to your shin bone. It should glide smoothly straight up and down but can get pulled over to the side which causes misalignment of your knees. Look carefully at your knees in the mirror in class. Are they facing straight ahead? Now contract your quadriceps, the thigh muscles that 'lift' your kneecaps up slightly. Look again and check that your kneecaps aren't moving to the side at all but are still facing forwards. 

Contract all four quadriceps.....

If your kneecaps are sliding outwards slightly one way to keep them straight is when you hear 'contract your thighs' think 'contract all four quadriceps'. We have four quadricep muscles (hence quads!) and you need to engage all of them while maintaining your neutral knee position. The main thigh muscle or 'rectus femoris' is just one of the quads but it is a dominant muscle that is easy to contract so it tends to take over. Just contracting the rectus femoris will pull your patella to the outer side slightly. When you lock your knee work hard to engage all four quadriceps (see figure 2 below), the other three are the vastus lateralis, vastus intermedius and the frequently weak and underused inner thigh muscle - the vastus medialis. 

Figure 2. Muscle groups of the thigh.

....and your hamstrings.

The hamstring muscles at the back of the leg also connect your femur (thigh bone) to the tibia (shin bone) using three main muscles, the semitendinosus, semimembranosus and the biceps femoris. Contracting all of these major muscles in unison with the quadriceps is known as working 'opposing muscle groups' and helps maintain strength. This can reduce injuries and contracting all of them together with the quadriceps is what makes a locked knee. 

Lock the knee!

In the standing series Pranayama Breathing, Half Moon Pose (including the backbend), Awkward Pose (in the set up before you sit down) Standing Head to Knee Pose, Standing Bow Pulling Pose, Balancing Stick, Triangle Pose and Tree Pose contract your quadriceps and hamstrings, align your leg and lock everything in. Full muscle contraction. 

On the floor you still need to lock your knee. Specifically think about the Sit-Up, Cobra Pose, Locust and Full Locust. 

Figure 3. Floor poses that require a locked knee. 

One 'locked knee' does not fit all. 

During a Bikram Hot Yoga class how you lock the knee can vary slightly in particular in some of the stretching postures. In particular Hands to Feet Pose, Standing Separate Leg Head to Knee Pose and Head to Knee with Stretching Pose.  These postures require you to either start with a bent knee or to bend the knee in order to achieve correct form and work on locking the knee from there. It is more important to maintain the correct form than to lock the knee. The quadriceps should be the focus here and the hamstrings remain relaxed.

Standing Separate Leg Stretching Pose requires that you contract the quadriceps only, in order to relax the hamstrings and allow the stretch. This action is known as reciprocal inhibition, the process of contracting one muscle group in order to allow another group to relax.  

 Figure 4. Stretching poses require a modified locked knee with contracted quadriceps and relaxed hamstrings. 

Summary

Locking the knee means contracting all of the major muscles of the legs to tighten around the knee joint  and keep it strong and stable when in standing postures. Think 'neutral knee' with the bones stacked neatly, not flexed backward and then contract the all the muscles. Engage your glutes, keep your. core tight and keep your tailbone long. 

Yoga changes your body but have you considered how, if at all, yoga could change your brain? 

Grey Matter(s)

Research studies have found that people who practice yoga regularly have more grey matter volume than people who are matched with them in every other way but don't practice yoga - called matched controls (Villemure et al 2015). Grey matter makes up around 40% of your total brain volume (the other 60% being white matter) and it is mostly comprised of neurons (the nerve cells that transmit information to other cells). Your cerebral cortex, the crinkly outer surface of your brain is made of grey matter.

Figure 1. Transverse view of the human brain showing the cerebral cortex (grey matter). 

In fact despite ranging from only 1mm to 4.5mm thick, the cerebral cortex has 14 to 16 billion neurons packed into its folds (called sulcus or sulci) and ridges (gyrus or gyri). Covering the two halves (left and right) of the cerebrum the cerebral cortex is further classed into four regions or lobes. These are the frontal lobe, parietal lobe, occipital lobe and the temporal lobe. Also packed into your skull are your cerebellum or 'little brain' sitting just below your occipital lobe that also contains grey matter as does your brainstem connecting the whole shebang to your spinal cord.

So where do yogis stash their extra grey matter? And does having more of something always equal better? More weeds don't make a better garden. So does that extra grey matter, matter?

A Quick Lap Around the Brain.

Despite weighing only 2% of our total body weight, our brains use 20% of the energy we consume just to keep it ticking over. The surface area of the cerebral cortex is much larger than it looks and would cover 1500 to 2000 square cm's if you unfolded it all. It's also pretty electric, producing enough energy to power a light bulb. 

Figure 2. Bright Spark! Your brain produces enough energy to power a light bulb. 

The frontal lobe is home to our executive function, attention, reward, working memory, planning and motivation. Very useful functions like remembering to pay bills, knowing what to say (and what NOT to say) in a meeting, and deciding to go to yoga instead of staying home to watch Netflix. The parietal lobe is involved in spacial perception or proprioception, navigation as well as our sense of touch. The occipital lobe, despite being curiously located at the rear of the brain, is directly responsible for the visual processing, colour differentiation and perception of motion.

Figure 3: Regions of the brain including the cerebellum and brainstem. 

The temporal lobe holds long term memories, auditory processes (hearing) and the interpretation of visual stimuli such as what a facial expression means. The cerebellum helps keep us standing on one leg for standing bow, maintaining balance and coordinating movement (amongst many things) and the brain stem manages many of the critical things you do without thinking - breathe, swallow, digestion and reflexes. 

Yoga and Cortical Thickness 

One study, published in Frontiers of Aging Neuroscience, found women with an average of eight years of hatha yoga practice had more grey matter and greater cortical thickness than a group of matched controls. Cortical thickness is associated with cognitive preservation and cortical thinning is typically associated with ageing and declining cognitive ability. Grey matter volume is also positively associated with executive function (Laubach et al 2017). 

Laubach's study found the yoga practitioners had increased cortical thickness in several lobes in the left prefrontal cortex, an important area for cognitive control.

Figure 4. Yoga is associated with increased cortical thickness in the left prefrontal cortex.

Total cumulative years of yoga practice was related to increased grey matter in several areas, including the left frontal operculum (Villemure et al. 2015). This area, located in the frontal cortex is believed to be responsible for the motor aspect of speech, music perception, some hand movements and the very important task that keeps many a households in ongoing harmony, response suppression.  

Another study (Cole et al 2012) examined the connectivity of different brain regions and the relationship of that connectivity to cognition and intelligence. They wanted to understand if there was a "brain region that uses brain-wide connectivity as a central mechanism for supporting cognitive control and intelligence." They found that only the left prefrontal cortex global brain connectivity was able to predict cognitive control and fluid intelligence. 

Figure 5. Yoga practice is linked with improvement in working memory, attention, verbal acquisition and other areas of executive function.

Short term yoga practice also is linked to cortical thickness. A group of women experiencing first episode psychosis had a 12 week yoga and exercise (walking and cycling) intervention (Lin et al, 2015). The group demonstrated significant improvements in working memory, verbal acquisition and attention. Their cortical thickness also increased.

SUMMARY 

These studies look at different types of interventions and different yoga practices in different groups of people, so we can't conclude categorically that these results will be true for all people who do yoga. Consistently however, it appears that cortical thickness, a highly desirable quality for your brain, appears to increase in people with both a long or short term yoga practice. 

Cortical thickness is positively associated with a higher IQ (link here) so there is every chance your yoga will make you smarter! 

Furthermore one of the regions where grey matter increases in yogis, the left prefrontal cortex, is linked to cognitive control and fluid intelligence. It also has a big role to play in establishing positive feelings, being able to overcome any negative thoughts and feelings that arise and replacing them with a positive perspective. So if yoga gives you greater cortical thickness in that region - I'll happily take it! 

Check back in our next blog to read more about how other brain changes related to can impact on your every day life. 

Namaste!

PS. This is not an exhaustive representation of the published literature on yoga and the brain. I am not a neurologist, I am a yoga teacher with a strong interest in neuroscience and anatomy. I really encourage everyone to read more about this topic and feel free to ask questions in the comments section and I will endeavour to answer them in the next blog post. 

Have you ever looked down at your feet at the start of a hot yoga class when the teacher says ‘feet together nicely, heels and toes touching’ and wonder how on earth to make that work when your bunions protrude outwards and your big toes are pointing away from each other?

Figure (1). Bunions make it difficult to bring your feet together with your heels and toes touching. They also make it hard to wear a lovely pair of narrow pointy Jimmy Choo's but that's a different blog post. 

As my feet are quite anatomically diverse (yep, huge bunions) I’ve struggled with this instruction. Should I force my feet together? Or stand with my heels touching and my bunions touching which gives me a kind of awkward duck stance? Is it more important that my feet are together or that my feet are straight? Does it even matter? We come back to this instruction many times in the Bikram sequence, even in the floor series, and the question niggled away at me until I decided I would investigate it further. 

How do bunions occur?

Just like the yoga sequence, our foot has 26 & 2. Bones that is! Twenty six bones and two small sesamoid bones (pea sized bones that sit within a tendon) that run right underneath the first metatarsophalangeal joint (MTP). This where the first long bone of your foot (metatarsal) meets the first bone of the big toe (phalanx). The MTP is the joint that protrudes when a bunion occurs (6. in the below image). 

Bunions develop when the adductor hallucis muscle, the muscle that runs left to right underneath your toes (3. in the diagram below)) contracts and tightens. This tightening has the effect of dragging the phalanx bones (2. below) of the big toe towards the other toes and away from the straight position. The displaced MTP joint can get bigger and more painful over time (6). This isn't hideous or ugly. It's just your feet. Some anatomical issues plus or minus some hereditary predispositions. Be kind to them. 

Figure (2). 1. First Metatarsophalangeal joint (MTP) 2. First phalanx bone of the big toe. 3. Adductor Hallucis muscle. 4. Abductor Hallucis muscle 5. Midline of the foot 6. Foot with displacement of the MTP or bunion. 

Bunions tend to go hand-in-hand with over-pronation. Over-pronation happens when the muscle that runs along the arch under your foot (Abductor Hallucis) becomes overstretched and weak. When strong this muscle helps to pull your big toe back into a straight line however when weak it flattens down the arch as you bear weight on your foot and your foot rolls inwards as a result. "So what?" you might ask. Well, the flow on effect from this for the rest of your body can be big. 

When your feet pronate inwards, your tibia (shinbone) also rotates inward. This turns your knees towards each other slightly, which can lead to poor alignment and poor knee tracking, knee pain and hyperextension of the knee joint. Continuing up your leg your thigh bone and hip also rotate inwards and your pelvis tilts forward giving you a 'sway back' or lordosis of the lumbar spine. All because of those pesky weak arches.  

So, feet together or not?

Ah, no. When you have bunions, having your feet together will be unlikely to be a good starting position for you in class for any of the standing or balancing postures. If the midlines of your feet are not parallel then your knees will turn in toward each other. Your knees should face forward for best alignment. 

The image above shows very clearly the inward turn of the knees that leads to hyperextension of the knee joint and an over-reliance on the inside of the foot and big toe mound for balance when having your heels and toes together if you also have bunions.

Feet together nicely with bunions. 

The first step is to work on correcting the pronation and find your ‘neutral foot’ position.  One way to do this is perform ‘short foot’, an exercise (great video here) that works by contracting the underneath of your foot to strengthen and lift your arch. While keeping your toes on the floor, ‘scrunch up’ your arch like you are picking a tissue up with the bottom of your foot. This contracts the abductor hallucis and pulls your big toe back towards centre a little.  

Now keeping the arch in its upward position, lift all five toes of each foot off the floor. Maintain the arch height and feel the pressure beneath the big toe mound (probably quite easy to feel). Now equally find the same pressure underneath the small toe mound. Slightly harder isn’t it? Try to ground all four points of your foot in this order. One: under the outside edge of your heel, two: under the little toe mound, Three under the inside edge of the heel and lastly Four: under the big toe mound. Try to share the weight equally across all four points. 

Figure 6. Equal distribution points across the foot, starting with the outside of the foot can help find a neutral starting point for balancing

Foot Midline

Observe where your foot midline is. Typically this line runs from the centre of your heel (under your ankle) straight down your foot towards your toes. While keeping these two lines parallel to each other bring your feet together as closely as your anatomy will allow without losing the alignment or the arch activation or the weight distribution. It may look a little like you have your bunions touching and your heels separated. This is your feet together nicely position. It probably won’t look like anyone else, and that’s okay because you are a unique snowflake and have your very own special anatomical make-up!

But, don't just open your heels...

While these two pictures in Figure 7 look similar, closer inspection shows that above left the knees still track toward each other when the foot midline is extended. Whereas on the right, where the arches are active and neutral foot is engaged the knees face forward more. You need to really maintain the contracted arch and work on keeping the foot in neutral. This is really hard. It will feel like you are back at the very beginning of your practice again.

That's because you are. That’s yoga.

More information: if you want to read more about this subject, much of which informed my understanding of this condition in the context of yoga: A great article on preventing and relieving bunion pain by Doug Keller and another on yoga for bunions by Amber Burke. Doug Keller also has a terrific video and also a great video on how to prevent bunions from getting worse with Yoga for bunions. 

Namaste!

Disclaimer: I'm not a podiatrist or any other kind of foot specialist. If you have painful feet or need medical advice regarding your bunions then get in touch with the appropriate health professional. I'm a Bikram Method Instructor with a personal interest in anatomy and neuroscience and I researched this topic to improve my own balance and practice.