Advice on Practicing Yoga in Middle Age, Part 3

Here is part 1 of his responses, and here is part 2. More than 100 readers submitted questions about aging and yoga; because of the volume, not all could be answered. Some questions have been edited for length, and new questions are no longer being accepted.

HEADSTANDS AND GLAUCOMA RISK

Q. Given that I have been told by several ophthalmologists and a retinologist that the pressure system for the eyes is an independent pressure system and will not be affected by doing headstand, forward bends, etc., I would like very much to hear what your comments are regarding contraindications for practitioners who have elevated eye pressure. Thank you. — Kathy Shoemaker, Buffalo, N.Y.

Q. I would like to know more about inversions (specifically, headstand) and glaucoma. I am almost 51 and have been practicing yoga for 15 years or so, at least three times a week for the past five years. I have “borderline high” eye pressure and my doctors have never seemed too concerned when I tell them I practice headstand. I certainly do not want to have to give it up if I don’t have to, but I also don’t want to do anything that is likely to exacerbate things. Could regular headstand make my eye pressure worse? — Equilibrist, N.Y.C.

Q. I am 62. I have been practicing yoga since the age of 16. Is any yoga pose contraindicated for a narrow angle glaucoma condition? — BJT, Florida.

A. Kathy and Equilibrist, the nonchalant attitude of your doctors may harm you. A few years ago, to help resolve the conflicting claims about whether inversion poses can cause risky eye pressure levels in people with glaucoma, I had an ophthalmologist anaesthetize my eyes, and then I stood on my head. He then did tonometric measurements every 15 seconds. My intraocular pressure doubled from 15 and 14 to 29 and 28 within the first 15 seconds, and then stayed at that level for the pressures just held there at double their normal value for every variation I could think of over 25 minutes. In handstand the values went 10 to 20 percent higher still.

So for you two, and other yoga practitioners and teachers, it is unwise to adopt the “try it and let’s see” attitude about headstand or handstand with glaucoma because by the time you’re comfortable in the pose, it may be too late. Therefore, and this is for you, BJT, too, I believe headstand and handstand are contraindicated by wide angle and narrow angle glaucoma.

We then tried shoulder stand, and found that the intraocular pressures went up all right, but only half as much. The pressures in my right and left eyes went from 14 and 15 to 21 and 22, respectively. This may be because the jugular veins and carotid arteries are somewhat compressed in shoulder stand. Viparita karani, the restorative pose, actually lowered the pressures one point below their resting values. The literature confirms this.

I don’t have glaucoma. At that point in my life I had stood on my head for 30 minutes at least once a week for more than 30 years. I had a retinal image taken soon afterward: the blood vessels were totally normal. So the ophthalmologists you saw are probably right about the retinal vessels, but not about the intraocular pressures that are so critical in glaucoma. For more information and references please see “Intraocular pressure and inversion” on my Web site, Sciatica.org

BALANCE AND BREATHING

Q. Can you recommend a suite of yoga poses that concentrates on breathing and balance (easier to harder) for older yoga folks? Thanks. — Steve G., Baltimore

A. Steve G. of Baltimore, I would begin with the tree (vrksasana), breathing in as you raise your arms, culminating as your hands meet above your head, and exhaling as your arms come down, is a very good start. Use a wall behind you or a chair in front of you if you need it at first. You might follow this with warrior I (virabhadrasana I), inhaling as the arms rise. The downward and upward dog (adho mukha and urdhva mukha svanasana) are good, and reasonably gentle. Then you might try twisting poses like marichyasana and matsyendrasana, where your job is to try to equalize the inflation of right and left lung. Finally, headstand (mirsasana), also with suitable props, is another good balance and breathing posture. For every variation, exhale as you bring your legs down; inhale as they come up.

ARTHRITIS, DIZZINESS AND OTHER AILMENTS

Q. Is yoga good for people like myself who suffer from arthritis? If yoga is helpful, what do I need to be aware of to avoid injuring myself? — Cleo, N.Y.C.

A. Whatever else yoga does, Cleo, it stretches. Lengthening your muscles and tendons and expanding the range of motion of your joints has got to relieve the restrictions that arthritis imposes. Further, a 2008 metastudy published in the journal Nature confirms that the type of gentle exercise that yoga is (and Sunday football is not) liberates a potent endogenous anti-inflammatory from your muscles: PGC1-alpha. Because people make this protein in their own bodies, no one is allergic to it. PGC1-alpha actually reduces the inflammation that is at the heart of osteoarthritis, and for side effects, reduces the incidence of Alzheimer’s disease, diabetes type 2 and a host of cancers.

Q. I am over 70 now and a couple of years ago I tried a yoga class. The result was a lot of dizziness from all the up-and-down motion involving my head. Any suggestions? — Ladas2, San Antonio

Q. I have situational vertigo and it is difficult to lower and raise my head when going through positions in yoga without experiencing dizziness. Do you have any suggestions?

A. Ladas2 in San Antonio and Carrie in St. Paul, there are tiny balls in the semicircular canals inside our inner ears (otoliths) that may degenerate or even disintegrate as we approach 80 or 90. There are two ways to go: a good physical therapist may apply the Appley Maneuver, which can miraculously change things for the better, or, you may try yoga meant for people who are less mobile; that will involve much less vertical movement. The sequencing of yoga poses is a subtle business; some teachers intentionally do all the standing poses together, and the same with sitting and lying down. If you want to start again, discuss sequencing with your prospective teachers.

Q. Dear Dr. Fishman, I am a very bendy person. I have been practicing yoga for many years and I am 53. I started having heartburn and there seemed to be no apparent reason. Two endoscopies and five years later, I started to think it could be my intense backbends. My doctor felt there was “no way” I could be back bending that severely. I sustained a neck injury which put my back bends on hold for a year and three months. The heartburn is gone. I have since ceased my intense back bends. Can back bends give one heartburn? — Rosie, Asheville

A. Back bends can indeed give you heartburn, just as forward bends can. If you want to return to them, do them five hours after eating anything, and begin slowly and carefully, watching for any symptoms to appear. When you’re in, say, Urdhva Dhanurasana, work mostly to bring your chest over your palms, not to arch the lumbar spine. One way to do this is to push your feet away from you without moving them. There are other methods to achieve a satisfying back bend: try a private lesson with checkups every month or so as you proceed.

Q. I have piriformis syndrome with sciatic pain ending in my lower right calf. I’ve tried MacKenzie exercises (a lot like up-dog). PT said to avoid yoga poses with flexion, which I did for a while, but now my low back is stiff and tight and I still have the sciatica. I practice yoga two to three times a week and can do most asanas, but my right hip and leg are weak, so balance poses on the right side are tough. Should I keep doing them to strengthen that side? Or does that increase the inflammation? — JJK, Chicago

A. In the syndrome JJK mentions, the piriformis muscle in the buttocks compresses the sciatic nerve, causing pain down the leg. But the advice he has gotten, avoiding forward bends and doing poses like the upward dog, are for herniated disc, not piriformis syndrome. In my opinion he should be doing twisting poses like the twisted triangle, parivrtta parsvakonasana, marichyasana and matsyendrasana.

Q. There has been some minimal research about the benefits of yoga in treating atrial fibrillation. Is it a viable option for improved control of arrhythmias? — Reno, Falmouth

A. Reno in Falmouth, a recent study published in the Journal of the American College of Cardiology, using yoga designed and administered by Joan White of Philadelphia, documented significant reduction in atrial fibrillation and other types of arrhythmias. Incidentally, or perhaps not so incidentally, several measures of anxiety also showed substantial (and significant) reductions.

Q. Hi – I am a yoga teacher in Boston. I was in a head-on collision that fractured my sacrum bilaterally through both sets of holes along with other spinal and rib fractures. Since I used yoga for my recovery I have many other people with injuries and conditions as well as older students who attend my classes. I have a student with right side stenosis, who has undergone surgery with spacers put in and L4 and L5 fused. She is in a lot of pain, and some of the exercises we do help but only temporarily. Would you have a suggestion for this or could you direct me to any of your books for some guidance? — Kim, Boston

A. Kim, I need a little more information to answer the first question: If your student patient’s pain is at the inner calf or top of the foot, it might relate to the fusion itself, and the spacers. In that case, a doctor should probably try epidural steroids, because yoga should not put pressure on the region of the fusion. If her pain is elsewhere, like the front of the thigh, then she might respond to yoga that does not bring forces to bear at L4-5, but farther up the spine. Upward facing dog, keeping the navel on the mat, might be the way to start, with further arching poses afterward in which the patient wears a lumbar corset. I’m thinking of poses like the locust, keeping the legs on the floor. For someone proficient in yoga, then forward bending in lotus or virasana can be combined with a pillow or two under the chest effectively, especially with arms extended and elevated.

Q. In practice for two years now. I have recently been diagnosed with cerebellar ataxia and secondary parkinsonism. Are there poses that will help dysmetria and intention tremor? The instructors at my studio have only responded “listen to my body,” which I do, but can give me no specific guidelines so I might try and retrain my brain, especially the cerebellum. My physicians are pleased that I practice but can offer no specifics either. Maybe you can point me toward some useful information? — cfsic, Tampa

A. I’m not sure I can, cfsic. The mechanism of cerebellar ataxia is usually unknown, and unfortunately, there is scanty evidence that this part of the brain can learn. It is mainly a processing center. However, yoga will powerfully ward off secondary effects: the weakness, stiffness and imbalance that would disable you so much further without yoga.

RESOURCES AND TEACHERS

Q. I practiced yoga daily from age 15 to 52 when I suffered severe tearing of my gastrocnemius, soleus and achilles. I also injured my neck and head. I’ve had multiple-month bouts of vertigo, insomnia and total body pain since then. Now 56, no yoga for over 4 years. I learned of you when I read Mr. Broad’s book “The Science of Yoga.” I grew up in New York near William, and in recent years felt my own yoga practice becoming increasingly unsatisfying the more “popular,” trendy and commercialized yoga was evolving around me here in Oakland (East SF Bay Area) where I’ve lived most of my adult life. There’s a yoga place on every other block here but I want an M.D. like you and to consult with an equally knowledgeable, experienced yoga master/teacher (Iyengar, Hatha, Ashtanga)! I would be so grateful if you would recommend such persons in my area. Thank You. — Omzoc, California

A. To Omzoc in California: I believe Baxter Bell and Timothy McCall, both M.D.s, both yoga experts, are in your neck of the woods. If they’re not available, I recommend superb yoga teachers named Judith Lasater and Osha. You should be able to take up yoga again.

I think William J. Broad’s book “The Science of Yoga” has had at least two good and very important effects: Better reporting of yoga injuries, and greater care by yoga teachers to avoid them.

Q. I am disabled. I bought a sitting yoga CD from PBS. Will this CD help me? — Bobier, Las Vegas

A. It has got to be a good start, Bobier.

Q. I used to do yoga regularly and want to return to it. How do I find an appropriate yoga class for a 60-year-old in Pasadena, Calif.? I know I could google or Yelp this but I would love a recommendation. Thanks. — Elizabeth, California

A. I would try Eric Small in Beverly Hills. Failing that, try the Iyengar Association in Los Angeles.

Q. For fit people without specific health issues in middle age who already practice yoga, it would be nice to have knowledge about and access to a series of poses appropriate for this age group, which can be arranged into routines of various difficulties to form the core of a yoga class. Also targeting areas, like the lower back, with specific poses for this age group would be helpful. We can then take this knowledge to and practice it with our local yoga community. Thanks. — David, Maine

A. Suza Francina has a number of relevant books with excellent sequences.

Previous Ask an Expert columns can be found here.

Booming: Living Through the Middle Ages offers news and commentary about baby boomers, anchored by Michael Winerip. You can follow Booming via RSS here or visit nytimes.com/booming. You can reach us by e-mail at booming@nytimes.com.