Poses, Props and Modifications for a Lifelong Yoga Practice

Some of the most famous images in yoga are of a silver-haired and wrinkled B.K.S. Iyengar in an advanced posture just a few years before his death well into his nineties, or a pink lipstick-wearing Tao Porchon-Lynch displaying incredible feats of flexibility before she passed away earlier this year at 101. While most of us see these images and shake our heads, lamenting our own muscle flexibility lost and aches gained over the past decade, they teach us a great deal about the practice itself.

Yoga, as most of us know, was not intended as purely a physical exercise, but rather a holistic practice comprised of eight limbs, culminating in samadhi. In this way, yoga lends itself to being accessible through the many stages of life and the necessary modifications that result. While many forms of exercise and sports can be so physically demanding that they either frequently lead to injury or are difficult or unsafe to practice as we enter a new life stage such as pregnancy, injury, illness or old age, yoga asana – and especially therapeutic variations – has a response to each of these. 

Here are some common poses, props and modifications to address some of the most common challenges that arise in the course of adulthood and ways to leverage the asana practice as a healing mechanism.

Chair yoga – Whether due to challenges with balance, restricted movement, or for clients just beginning a yoga practice, chair yoga is a starting point. So many common asana poses – twists, Warrior series, triangle, backbends, forward folds and more – can be modified to be done from a chair, whether seated or standing behind it and using it for support. All you need is a firm, steady folding chair. You can start to build strength in the chair and then eventually explore poses without using it.

Walls – As we age, the risk of falls increases. The National Council on Aging reports that one in four Americans over the age of 65 will fall each year, often resulting in the need to be treated in the emergency room. Thus, cultivating balance is critical. For clients who struggle to maintain balance, whether because of vertigo or ageing, the best modification is to find the steadiest prop possible and use that for practice – think the wall or floor. These props do not move no matter what, so should be used in poses that can challenge the balance. Think keeping the big toe on the floor during tree pose, or leaning back into a wall for triangle pose.

Yoga for low back pain – Low back pain is the second leading cause of missed work, second only to the common cold. Nearly all of us have awoken at one point or another with a stiff or sore lower back, not knowing what to do about it. The tricky part about low back pain is that its causes are many, and its treatments are just as diverse. Certain causes, like a ruptured disc, ask us not to forward fold, while others, such as sciatica, call for spinal twists. The key, if you are experiencing low back pain, is to visit a physician who can order tests and examine you to assign a proper diagnosis to your pain, and from there, you can work with a yoga therapist to ease your symptoms. Dr. Loren Fishman is a great resource on yoga for low back pain and has contributed greatly to the field of therapeutic yoga through his work.

Patience – Over time, the connective tissues that hold together our muscles and bone structure can dry up and become brittle. A key practice to maintain flexibility, which helps enable pain-free movement in the body and prevent common injuries, is yin yoga. Yin involves holding stretches for three to five minutes, getting deep into the connective tissue, to keep it healthy and supple. Interestingly enough, yin does not require deep flexibility to begin with, but rather asks us to stretch only to about half of our full capacity and utilize props to keep each pose supported, making it a sustainable practice for varying stages of fitness. That’s why you’ll be encouraged to bend your knees slightly in a yin-style forward fold or to back out of the most intense version of a posture to achieve lasting results over time.

These are just a few of the most common challenges we face as we age, and ways to modify, support, and explore them in the yoga practice. Finding a skilled yoga therapist to work with can help you find more ways to adapt your asana practice to your changing needs as you age.

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Hannah Slocum Darcy is a yoga teacher and a student at Prema Yoga Institute. She specializes in accessibility and adaptive practice for many life stages and scenarios.

From Lip-Synching “Om” to Leading Chants: One Yogi’s Sound Therapy Journey

Music and I have always enjoyed a pretty fraught relationship.  I have long been something of a screech owl blundering amongst a watch of nightingales, forever surrounded by the musically gifted but unable to join in their chorus without causing amusement or, more often, wincing.  It’s been my dubious fortune, as someone who literally cannot sing in key, to be a kind of magnet for people with perfect pitch (although I am, at least, consistent: my college roommate—a violist— used to stare at me in a kind of appalled awe as I sang along with the radio.  “It’s uncanny,” she’d say, “you are literally always exactly a quarter step down.”)  I can’t tell you how many times I’ve had people express appreciation when I sing harmony on “Happy Birthday”—I’ve learned to stop telling them that I’m trying to sing the melody.

But speaking of perfect pitch, my personal euphonic albatross: do you know what percentage of the world’s population has perfect pitch?  Less than eleven percent.  Here is a partial list of the people in my life who have (or had) perfect pitch:

·      My husband
·      My best friend
·      My college roommate
·      My late father
·      My uncle
·      My paternal grandfather
·      My paternal grandmother
·      A seemingly endless parade of my students
·      You get the picture 

Music has a bit of a complicated history in my family: my father’s father, the son of a bandleader, was a ragtime piano prodigy who was forced to tour the Orpheum Circuit with his father from the age of six.  At fourteen years old he quit the band, left home, and eventually became a surgeon and, later, a psychiatrist.  He married a woman with a stunning soprano voice in the style of Jeanette MacDonald, and together they raised four children absolutely devoted to music.  My uncle is one of the very few people in the United States who has made a living playing professional tenor saxophone over the past forty years. 

Many people my age grew up with fathers obsessed with jazz, and I would stake my late father in a jazz trivia contest against any one of them—his knowledge was beyond encyclopedic, beyond obsessive—jazz was, I think, his literal best friend.  NPR’s “The Art of Jazz” played on multiple radios throughout the house every single weekend of my childhood.  My father would often interrupt me or one my sisters from our Shrinky-Dinks or Sweet Valley High books to point at the stereo demand, “Who’s that on trombone, girls?”  It was never someone easy to recognize, like Tommy Dorsey or J.J. Johnson, it was always a hard one. “You mean to say you don’t know Miff Malone when you hear him?!”  Sorry, Dad.

There was also musical talent on my mother’s side. My maternal grandfather, who died when my mother was twenty, was a classic Irish tenor—although I never met him, I have a false memory of his beautiful rendition of Danny Boy, from hearing it lovingly referenced in so many family stories. 

It probably doesn’t help that I spent three years of piano lessons practicing on an out-of-tune piano before my teacher—a local Methodist pastor’s wife whose large family definitely had use for every spare penny—told my mother that she couldn’t, in good conscience, continue to take her money.  I joined Seattle Girls’ Choir in the fifth grade and, over the course of three years, came to tower over my fellow choristers as every girl in my training choir class was promoted to the Intermediate Choir except for me.  Eventually, the choir director echoed my piano teacher in gently suggesting to my mother that I be redirected in my interests, perhaps towards watercolors, or volleyball, or ikebana, or literally anything other than music.

All of which is to say, I am not, at this point in my life, confident about my musical abilities.  While I enjoy many kinds of music deeply, and have always found music and dancing to be a direct channel to spiritual connection, I avoid singing in front of others, and freeze up instantly when a musical instrument is put in front of me.  So you can imagine my reaction upon discovering, during the first day of my Sound Therapy training at Prema Yoga Institute, that by the end of the weekend I was expected to chant while accompanying myself on the harmonium.  Outwardly, I nodded enthusiastically.  Inwardly, I panicked.

Ironically, I am not afraid to use my voice—I taught vocal technique for actors for years at various acting schools and studios in New York City, including the Musical Theatre studio at NYU, where I was, I think, the only non-singer in the building.  The technique I taught, developed by Kristin Linklater, teaches actors to undo the maladaptive muscular habits that prevent them releasing their sound fully and expressively while speaking.  The technique is often referred to a “freeing the natural voice,” and—especially in the beginning—“ugly” sound is not only allowed but actually encouraged.

But I had never encountered “ugly” sound in yoga.  At that point, the only sound I was really familiar with in the yoga world was kirtan: a division of bhakti yoga often involving melodic call-and-response chanting, generally led by a yogi playing a harmonium.  I had attended large kirtan sessions where my imperfect voice could be masked by blending into the wall of sound, and found them to be ecstatic experiences.  But the idea of leading a kirtan myself—of being responsible for the sound element of a yoga class—was beyond daunting: it seemed actually impossible.  How could I expect a class to echo my chanting when it would almost certainly be off-key?

Happily, Jessica Caplan’s sensitive, inclusive teaching gradually made me feel more confident in my ability to lead a class in chanting over the course of the weekend. She also offered a variety of non-vocal ways to include sound in my yoga experience, whether as a teacher or as part of my home practice.  I came away with a practical understanding of what had been, before, a nebulous idea of the concept of sound healing.  I learned about the bija mantras’ relationship the chakras, and how to use them effectively in sequencing a chakra-centered class or private session.  I learned about toning and humming, and how the body responds to vibration and frequency.  (A useful maxim from the manual: “Sound is organized vibration.  Thus, organized sound can organize matter.”)  I was introduced to a variety of simple but powerful musical and percussive instruments (such as singing bowls, hand drums, chimes, and rattles) that I could accumulate and practice with in order to provide, for example, a soothing sound element during savasana, or an invigorating percussive element to a chi dance.  I also learned about the history of Indian sacred music.

Most transformative were the two immersive sound baths I experienced in the training, one a standalone experience and one incorporated into one of Dana Slamp’s incomparable restorative yoga classes. I also had the opportunity to create one myself, in conjunction with two classmates.  I don’t think I’ve ever experienced anything as simultaneously grounding and transporting as a sound bath conducted by Jessica Caplan.  The experience is hard to describe, and I would be lying if I said I left the class feeling as if I could instantly replicate what Jessica had created—she is, after all, a professional sound therapist.  But I did leave with confidence in the imperative of my curiosity to explore sound.  I have since started acquiring instruments to be able to create sound baths for my own students and clients, and have begun incorporating healing sound into my own yoga classes, and especially into my teaching of yoga nidra.  I can’t tell you how exciting it was to learn practical ways to begin including sound into my own teaching right away.

Another major takeaway for me was the incorporation of chanting and mantra in to my own meditation practice.  We learned several mantras and were each encouraged to select one that resonated with us and practice it for a week.  I was deeply moved by the Maha Mrityunjaya (“The Great Chant of Healing”) and continue to use it in my personal practice on a daily basis. Perhaps unsurprisingly, consistently chanting in my daily meditation practice has made me more confident in leading chants, and now I am more likely to begin or end a yoga class with Loka Samastah or Om Navah Shivaya, rather than my usual three Oms.  I use an app version of the droning chord created by a harmonium or shruti box (a sort of elementary version of a harmonium that I plan to add to my collection of instruments), so the students with better ears than mine have an accurate pitch to follow.  Surprisingly, though (to me, anyway), chanting nightly backed with an accurate drone has actually improved my relative pitch.

In PYI’s Sound Therapy training, I learned that sound itself can be therapeutic, not just what we conventionally think of as “music” or “singing”.  This was a major revelation for someone who has always thought of herself as musically challenged.  It is not an overstatement to say that the course opened new world of expression and devotion was opened to me through this course, both as a yoga teacher and as a practitioner. 

Prema Yoga Institute’s Sound Yoga Therapy Training runs from April 17th to April 19th.  More information can be found here.

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Molly Goforth is a yoga and meditation teacher and a student at Prema Yoga Institute. She specializes in accessibility and trauma-informed yoga teaching and practice.

Yoga Therapy for the Heart: Interview with Sonja Rzepski, C-IAYT

Sonja Rzepski is an IAYT-certified yoga therapist and graduate of Prema Yoga Institute’s Yoga Therapy Program. Sonja received her initial yoga teacher certification in the inaugural teacher training of Samahita Centered Yoga Institute in 1999, and originally studied Ashtanga yoga under Eddie Stern. Sonja teaches the Yoga Therapy for Cardiac Care course for PYI; in addition, she was the lead yoga therapist for the Northwell Lenox Hill Cardiac Care Yoga program, whose work was chronicled in a recent study published in the Annals of Clinical Cardiology entitled The Yoga Meditation Heart Connection—A Pilot Study Looking to Improve Women’s Heart Health, which demonstrated a meaningful connection between yoga and meditation practices and improved well-being and decreased depression rates in female cardiac patients, as well as other benefits.

I recently had the opportunity to sit down with Sonja and ask her about her work with cardiac patients as well as about yoga and heart health in general.  What follows are excerpts from that conversation.

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Molly Goforth: Can you talk a bit about how you came to your specialization in cardiac care? 

Sonja Rzepski: It honestly goes way back, because of my mom's experience of having a heart attack, and also my family history of heart disease.  I hadn’t been seeing my parents on a regular basis because I was living in New York City, and they were living upstate when my mother got a job opportunity in the city and I started seeing her regularly.  I noticed that she was looking sort of grey, that she had gained a significant amount of weight, and that she got short of breath easily, just walking down the block. I knew my grandfather had had a heart attack, and that my mother had a significant history of heart disease in her immediate family, as I mentioned.  So I asked her if she had been to the doctor, and she quite casually told me that she had seen her doctor recently and he had said that women couldn’t have heart attacks before menopause.  I asked her if he had done any tests, and she said no. My mother is an extremely upbeat, positive person, but her energy was low, and even though she was having chest pains, her doctor didn’t run any tests and put her on anti-depressants. He just didn’t consider heart disease to be a possibility for a pre-menopausal woman.

MG: I would say that’s unbelievable, but sadly, it’s not.

SR:  No, it’s not.  There is so much information regarding women and cardiac health, and how to prevent heart disease in women.  But regarding my mother, she was told it was indigestion, it was depression, it was anything but her heart.  The only reason she ended up getting an accurate diagnosis is that she happened to go to lecture given by a specialist in heart disease in women at NYU, and she found that she was checking all the boxes, so to speak, regarding her symptoms.  After the lecture she spoke to the doctor, and she ended up becoming a patient, but it took her months to get an appointment. By the time she was finally seen, she actually had a heart attack in the hospital, on the table.

MG: Oh, my God.

SR: She had 92% blockage at that point, and of course the anxiety of it all likely contributed to the cardiac event.

MG: Of course.

SR: Thank goodness she was in the right place.  I was flabbergasted, because it was my own mother and she had been so misdiagnosed for so long.  It became very educational for me; I started to go with her to appointments and I started to become fascinated at the work her doctor, Dr. Steinfeld, was doing.  I wanted to learn more and more, and I started to get more in depth and to apply what I was learning to my yoga teaching.

MG: And how did that progress?

SR: I worked with Dr. Rachel Bond and Dr. DeJesus, and I started working with their support group. They had a women's support group for heart disease and I started basically mentoring with a cardiologist and working with their patients. And thank goodness the doctors were very open-minded and generous.  I mean, I was getting amazing training right there in the hospital. So then it just grew and grew and we started a formal outpatient cardiac class at the hospital.  Our patients had had cardiac events or suffered from heart disease and were seeing the cardiologists, but were not in the hospital at that time. They would return for classes, and that's how this study came about. And then, through Prema, we were able to bring in Yoga Therapy students as mentees, to support the work and even eventually to teach.

MG: What a compelling personal story about how you came to specialize in Cardiac Care. Is you mother doing better now? 

SR: She's doing much better now right. Not only does she lead her own women's support group, she does about 20 to 25 minutes of her own yoga practice every morning.

MG: That’s so great.  Shifting gears a bit, can you speak to working in a hospital setting as a yoga therapist?  What were some of the challenges? 

SR: I think there are actually two great extremes. The cardiologists and the cardiac nurses who saw the results our yoga therapy work was having on their patients were incredibly supportive and bent over backwards to make sure that we had a lovely space to practice in and even supplied water and healthy snacks…they couldn’t have been more supportive. And then the flipside of that is the bureaucracy. Unfortunately, in a hospital setting, even though we're certified yoga therapists, it’s such a new field and with regard to the administration, there's a lot of red tape. When administrative medical professionals don't see the word “licensed” in front of yoga therapy…I’ll just say that there’s still some doubt about the profession, and mistrust, and need for more proof of efficacy. So when studies like ours are done, it’s incredibly important, because anytime you can cite a study it actually brings you that much closer to legitimacy in the eyes of the medical establishment.  Honestly, even to get our study approved took months and months and months, even though we had a bevy of cardiologists supporting it.

MG: That must have been frustrating.

SR: There is a lot of red tape, unfortunately. But our personal experience was always wonderful. Seeing the actual interaction between patients and doctors and nurses and staff on the floor was always fantastic.

MG: Did any of the study’s findings surprise you?

SR: In the upcoming Yoga Therapy for Cardiac Care course at PYI, we will study the Ayurvedic perspective of heart disease and how yoga therapy can address it.  We don’t have the time now to get into a discussion of the complexities of the Ayurvedic concept of doshas and how that relates to cardiac care,  but I can say that the extremely high-functioning, high energy people who would come into the room as patients in our cardiac yoga therapy study…it was often very surprising to me that they were so ready to embrace the practice of yoga and mediation. So one thing that I learned as a yoga therapist working with this population was how important it was to create that safe, sacred space wherever we were.  We would sometimes be in a beautiful room with a fireplace, and other times we would be in the auditorium and they would have to practice… I realized how important was to make the space as consistent and warm as possible, to create that impetus to relax and alter their energy to match the environment.  We tried to incorporate a spiritual element as well, with a singing bowl and playing music before we started, because yes, there was always a lot of energy coming into the room.

I think it was also the weight loss that was actually a surprise to me, as well, because we were doing very, very gentle chair yoga and meditation primarily. But 37.5% of participants lost weight. What the study was really geared toward was dealing with anxiety and depression. And there was a very significant decrease in that, as well. So that was really affirming. It went from a rating of seven to 4.9. 

MG: That's incredible.

SR: Yeah it really is, over a relatively short few months. So that was great. But the weight loss is what really surprised me. And I think part of what made that possible was that the women started to really look forward to coming.  It really became a community, a place where they started to really enjoy talking together and sharing their stories, and the outlook shifted from coming in as a patient and really identifying with their disease to being a part of a support group in a community that was doing healthy, uplifting activity together.  So I really think that we may have had a lot to do with improving other elements of their lives, not simply depression and anxiety but also just their outlook on life: “Hey, I'm going to make more of an effort to get better, because my life matters.”

MG: Speaking of lifestyle changes, are there cultural factors in the U.S. that you feel contribute to heart disease?

SR: Unfortunately, (heart disease) is on the rise and it's the largest killer in the world. And there are quite a few factors cultural factors that contribute. We are becoming less active as a whole. More and more people are waking up, going from their car to work, sitting all day at their job, and going back home and sitting in front of a television. So in general we're becoming less and less active and we don't even realize it. Second, the quality of our food, especially in this country, is just getting worse. There's more and more fast food, but also, even when someone does try to make an effort eat more healthfully, the quality of our meat, the quality of our dairy…and that healthier food is more expensive, all of these factors are truly contributing to declining heart health.

And then there’s a really big one, and it’s stress.  It’s the fact that people are having to work longer and longer hours with worsening health care. And the attendant anxiety this causes, as in,  “Well, I don't want to even go to the doctor because it's going to cost (too much).” There are many contributing factors.

On the bright side, one thing I think is a wonderful value of yoga therapy is that it encourages the client or patient to look at the whole picture of their health, and the more mindful a person becomes, the more they start to care about what they're eating and realize that moving feels good and your life can be strong and healthy. Empowering the agency in their physical form and yet making choices to practice more loving kindness and towards others also highly affects the heart. And this is what I'm very excited about regarding yoga therapy for cardiac care: that we get to bring together all these categories for a healthy life.

MG: Sonja, in your opinion, who is this Yoga For Cardiac Care training for?

SR: First of all, whether you are a personal trainer, a fitness instructor, a yoga teacher or really anyone who is dealing with a population working on their own health, you’re going to obtain such a knowledge base of how not only to recognize the signs and risks of heart disease but also what is effective. Which breathing techniques. Which asana. What languaging is helpful that they can implement and put into their work, whoever they are: acupuncturists, anyone in the wellness field.  And I’d also say that anyone who is supporting a family member or friend with heart disease or anyone who is at risk for heart disease.

MG:
Are there any ways, having worked with women in the study at Lenox Hill, that you think about gender and women when you are thinking about cardiac care in yoga therapy, in addition to how important it is to raise awareness among women about paying attention to their heart health?

SR: You need to have support networks, that is really important to awareness. Because the way heart disease presents in women can be very different from how it presents in men.  So that is number one.
And then I think for women it is really wonderful and important to empower each other. Because very often, for women, it’s easier for them to help a friend rather than to help themselves. So getting them all together allows them to all help one another. And then there is a greater chance that change will happen.

MG: I love that observation: I think that’s a point that should really be amplified. Sonja, I am so looking forward to taking your training, and thank you so much for your time.

SR: You’re very welcome. 

Prema Yoga Institute’s Yoga Therapy For Cardiac Care course, taught by Sonja Rzepski, runs from March 27th-29th at Pure Yoga West. Registration opens February 27th.

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Molly Goforth is a yoga and meditation teacher and a student at Prema Yoga Institute. She specializes in accessibility and trauma-informed yoga teaching and practice.