Lung Health, Disease, and Iyengar Yoga Kelly Sobanski and Tony Hirsch

Another oft-mentioned problem for many who want to hike or do yoga is pain in the knees. Many people complain that their knees hurt when hiking, and there can be many reasons for this. The way in which we are moving can dramatically affect how our joints experience our weight. Environmental variables exacerbate these tendencies. The slope or grade that one faces when going up or down hill can be hard on the knees, especially if our legs are not strong enough or if the knee is traveling too far forward over our toes in its bent or flexed position. This way of moving is not inherently bad, but it might increase the load experienced by our knee joints. This can also occur when climbing up or down stairs. The load is not our weight, per se, but how our various tissues experience our weight. If we can learn to keep our shin bones a bit more perpendicular as we are going uphill, for example, we can better utilize the muscles of our buttocks and hamstrings. This, along with the action of our back leg and foot, can help save our knees from unnecessary wear and tear. This is not unlike the way we move from Virabhadrsana I to Virabhadrasana III or from Trikonasana to Ardha Chandrasana.

If we are in the habit of tucking our pelvis under excessively, we might experience pain in our knees when we are going downhill. When we move this way, our quadriceps tend to fatigue more quickly because they need to work hard to help decelerate the mass of our body as we go downhill. Many IYENGAR YOGA

solved through Iyengar Yoga. her classes.

lung impairments that result from diseases of the lung caused by factors such as smoking, air pollution, exposure to toxic particles, fumes and gases, genetic disorders, heart disease, and obesity. Many people have difficulty breathing these days because lung disease ailments and processes produce people are not sufficiently conditioned to handle the loads created by this activity. Our ability to utilize the support of the muscles in our pelvic region can help our body move much more efficiently. Here, as in yoga, we are learning to distribute the work in such a way that we do not unnecessarily tax one particular region while neglecting another. We become more efficient because we are inviting the entire orchestra to participate in the symphony.

Now back to the hike in Squaw Valley … As my friend and I began our descent after finally making it to the elusive lake, we came across an older (much older) couple. They did not look as if they could have made it up those rocks, yet here they were remarking to each other about the genus of a particular mountain flower that one of them had stumbled upon. We said hello and sheepishly asked how they had managed that rock face and the climb up from the valley. The woman, looking up from the flower said laughingly, “We move in botanical time.” They move in botanical time! Another wonderful way to get off of the beaten path.

Carrie Owerko is certified at the Senior Intermediate 2 Level, is a Laban Movement Analyst, and lives in New York City when

LUNG HEALTH, DISEASE, AND

Tony Hirsch has been a registered respiratory therapist for 34 years. He has worked with all age groups in the

areas of intensive care, emergency medicine, and home care. His own health history has involved two sternotomies over the past two decades with subsequent open-heart surgeries to replace defective aortic valves. He also has neuropathy in his right arm from spondylosis in his cervical spine, which he has essentially

His yoga teacher, Kelly Sobanski, says having Tony in class has taught her a lot about lung anatomy and disease, and how Iyengar Yoga can be used to improve lung health for everyone. She is now more motivated to focus on the lungs in

Here’s a conversation between Kelly and Tony about all things lung.

Kelly Sobanski: Please explain how the lungs are affected by respiratory ailments.

Tony Hirsch: The quality of our breathing is affected through

not traveling the world to share her love of Iyengar Yoga.

changes in the muscles and physiologic structures of the lungs, both of which are important for gas exchange. This directly affects our ability to regulate the vacuum of inspiration and the relaxation of expired breath. When we push air completely out, we exhale down to a residual volume of air. All of us exhale down to a certain pressure called our functional residual capacity. It takes a certain amount of remaining residual volume of air in the lungs to create the vacuum that pulls outside air into the lungs.

Notice, for example, how it is easier to blow a balloon up to size if you begin with a little bit of air inside the balloon than it is if you begin with the balloon completely empty. Similarly, our balloon-like lungs need a certain volume of air always remaining for the next breath. This vacuum during inspiration allows an exchange from a high-pressure area (our atmosphere) to a lower pressure area (our chest cavity) in which we take in oxygen and exhale our metabolic waste product of carbon dioxide. Breathing, or ventilation, is all about using muscular movement to create this vacuum. This vacuum is part of the physiologic and anatomic process that creates efficient gas exchange. Yoga helps tone the muscles of breathing for efficient ventilation.

Given some of the factors that cause an imbalance in breathing, I believe yoga teaches us to renew energy and helps us build strength in our breathing. Through yoga practice, the vacuum of inspiration and the relaxation of muscles during expiration are both renewed and empowered to fuel us as life gives us breath.

KS: How does gas exchange between the lungs and the atmosphere work?

TH: Planet Earth supports us because she is a wonderfully pressurized “bubble” of gases. For humans and other life forms, oxygen is the most important of these atmospheric gases. Oxygen exists at Earth’s atmospheric pressure, which is higher than the pressure in our lungs. When we inhale, we bring oxygen into our lungs using muscles of the lungs—mainly the diaphragm and chest-lifting muscles that enlarge our thorax or rib cage—and this causes our lungs to expand. Expansion of our lungs is what creates a pressure differential between the lower pressure of our lungs and the higher pressure of the atmosphere.

Two good examples that relate the importance of air pressure to our breathing are mountain climbing and traveling in an airplane at high altitudes. As we approach altitudes of 2,000, 4,000, and 10,000 feet above sea level, atmospheric pressure decreases and begins to equal the pressure inside our lungs (or alveolar pressure). Because we no longer have an effective pressure difference between the atmosphere and our lungs, the ability of oxygen to load or absorb into our pulmonary circulation lessens. We feel these effects in our breathing as shortness of breath. Airplane cabins are pressurized at high altitudes so this phenomenon does not occur, and we can breathe easily.

KB: How do you approach working with people who have trouble inhaling or exhaling?

TH: As a respiratory therapist, I first listen to my patients’ stories and experiences of their difficulty with breathing. Once I understand their story, I can then work to determine whether the breathing difficulty (and possibly the root cause of the disorder)

Yoga helps tone the muscles of breathing for efficient ventilation.

is an inability to inhale a successful breath, to exhale a successful breath, or a combination of both.

Even if we do not have a lung disease process, our lungs still wear out over our lifetime. Humans have a lifetime high of between 400 million and 600 million grape-like clusters in our lungs, known as “alveoli.” The alveoli exchange oxygen and give off carbon dioxide in pulmonary circulation. These alveoli begin to atrophy around age 44 in all humans. Yoga practice gives us an opportunity to strengthen our lungs using postures and movements that benefit the muscles and structures that support breathing.

My yoga practice gives me compassion, observation, and personal experience to educate people and demonstrate the many benefits of renewing their lung health and lung strength.

KS: In Light on Pranayama, B.K.S. Iyengar states that pranayama “neutralizes lactic acid, which causes fatigue, so that recovery is quick” (p. 49). Can you elaborate?

TH: We benefit from pranayama because the relaxing and calming of muscle tissue triggers a healing response in our bodies. Soreness and inflammation can be reduced with repeated practice. So when B.K.S. Iyengar says that pranayama “neutralizes lactic acid,” I believe he is emphasizing the benefits of breathing techniques that restore normal oxygen to the damaged tissues and metabolize toxic lactic acid.

KS: Are there exercises you do as a respiratory therapist that are similar to Iyengar Yoga practices?

TH: Chest percussion, vibration, and postural drainage are similar practices. This therapy entails placing the patient in a forward tilted posture where the head is below the lungs and the lower trunk of the body. With the patient lying on the stomach, the practitioner cups his or her hands and uses a percussive, rhythmic tempo while beating on the ribs to cleanse the lungs below.

When treating disease processes such as bronchitis, cystic fibrosis, and pneumonia, the vibration and percussive rhythmic movement of cupped hands helps to mobilize secretions of mucous from the smallest airways into larger airways that spread out like branches of a tree. Mucous travels up through the bronchial tree into the trachea, our breathing pipe. Then we can cough to rid ourselves of mucous. When mucous moves from smaller to larger airways, the pathways in our lungs open up, and this process revitalizes muscular and physiologic gas exchange.

Tony Hirsch performs postural drainage on Kelly Sobanski.

Practicing Halasana to Paschimottanasana, as shown in Geeta Iyengar’s Intermediate Course, is helpful in utilizing gravity and muscular movement to help secretions move from the lowest zone of the lungs up through the bronchial tree, thereby helping get rid of pooled secretions. It is beneficial to do Tadasana or Dandasana after practicing the Halasana to Paschimottanasana movement because the transition from horizontal to vertical orientation produces a good cough that will effectively rid secretions and restore the flow of air in our bronchial tree.

KS: How is the spine connected to respiration and ventilation?

TH: Each thoracic vertebra has articulating points of connection to the spine. Our ribs move in a motion that resembles that of a handle on a bucket. The rib cage wraps around from the chest area of our bodies to the spine. When we inhale and exhale, our ribs either rise or fall, and spinal movements affect the orientation of the ribs. The spine stabilizes the rib cage so it can move in a full range of motion. This is another great example of the symbiotic relationship of our rib cage and spine working together.

KB: How do twists help the lungs?

TH: A twisting asana gives us an opportunity to open segments of lung tissue. If you close off one area, the lungs compensate. Blood tries to find where it can go to exchange the oxygen it is receiving and the carbon dioxide it wants to give off. When squeezing one area of the lung, another area of the lung that is Yoga practice gives us an opportunity to strengthen our lungs using postures and movements that benefit the muscles and structures that support breathing.

not being compressed can open up for maximal blood flow in pulmonary circulation.

KS: How do forward bends help the lungs?

TH: The benefit comes from focusing on pulling the abdomen inward. This allows the diaphragm to maintain its piston-like movement. Forward bends renew our relationship with our posterior and side lungs because those areas open up more in the forward bending asanas.

KS: How do backbends help the lungs?

TH: Backbends stretch the muscles of respiration; they encourage a maximal expansion of the chest cavity. Backbends help the diaphragm move in a piston-like function and allow the muscles of the abdomen to work for better exhalation. Because the rib cage is essentially winged and open at its maximum capacity, the intercostal muscles can become long. To me, it’s the most beautiful exercise for the lungs and for the airways to open. When you are back bending and the head is hyperextended backward, the diameter of the trachea has the

We need to think about how the air we breathe feeds our brains. Without gas exchange, the organs cannot receive oxygen and the muscles cannot detoxify.

most opening, which brings fresh oxygen.

KB: Why is pranayama breathing important for pregnancy?

TH: A pregnant woman breathes to sustain not just her own life, but also the life of her growing baby. As the baby grows, it presses upward against the mother’s abdominal contents and then progressively further upward against the diaphragm. The diaphragm is our primary breathing muscle. It helps draw breath into the lungs. Just like a piston, the diaphragm does not change its radius as it descends. With a growing baby pressing up against the mother’s diaphragm, the diaphragm’s range of motion is decreased.

Because movement of the diaphragm is especially compromised as birth approaches, breathing becomes more rapid and shallow. That’s why some moms experience the challenge of shortness of breath. Breathing becomes difficult because the mother’s body needs more oxygen and also a balanced release of carbon dioxide.

Pranayama enables the mother to control her pattern of breathing (ventilation) to restore a balanced intake of oxygen and exhalation of carbon dioxide. In the words of B.K.S. Iyengar, “the cellular system is completely energized.”

KS: How can Iyengar Yoga teachers better integrate breath awareness into our classes to take a lung practice to the next level?

TH: It would be beneficial if yoga teachers could talk about pulmonary health, hygiene, inhaling, and exhaling as a way to bring calmness and a state of focus to the mind or body. We need to think about how the air we breathe feeds our brains. Without gas exchange, the organs cannot receive oxygen and the muscles cannot detoxify. It is essential to learn about what is going on in the thoracic cage because the benefit of asana for whatever region you are working on, whatever organ or pain you are working with, will not improve without the functionality of the lungs.

KS: Tell me about your home practice.

TH: It happened naturally. I discovered through studio practice in this sixth decade of my life that Iyengar Yoga began giving me something so very intrinsic. I can manage chronic pain without relying on daily medications. Without really fully understanding why, I just found myself practicing the asanas I had learned in class at home on the days I was unable to go to class.

There are so many wonderful tools I utilize including websites that feature current Certified Iyengar Yoga Teachers, books written by B.K.S. Iyengar, and shared experiences of my fellow practitioners. I cannot go wrong. Home practice has evolved so naturally.

It’s such a great fit where heart, mind, and soul is fed in yoga practice at home and in the studio. I truly am grateful.

Kelly Sobanski (Intermediate Junior I) teaches at Yoga Mala in Bloomington, IN, and assists in Lois Steinberg's therapy class in Champaign/Urbana, IL.

Tony Hirsch in Chatushpadasana

Standing on Her Feet:

HOW IYENGAR YOGA HELPED A VESTIBULAR PATIENT REGAIN BALANCE

BY MICHELLE D. WILLIAMS

Ruth Ann Bradley adjusts Sandra Roberts in Trikonasana. Using the trestle for support after she was diagnosed with a vestibular disorder was critical to helping Sandra regain her balance in standing poses.

n May 2013, Sandra Roberts underwent a brain surgery called “microvascular decompression.” Cranial nerves 7 and 8 on the right side of her brain were compressed, causing facial spasms. Cranial nerve 7 is responsible for facial expressions, and cranial nerve 8, also known as the vestibulocochlear nerve, controls the systems of hearing and balance.

During the surgery, Sandra’s cranial nerve 8 was compromised, and she lost hearing completely in her right ear. “When I came out of surgery, I was dizzy and I had no balance— it was an immediate result of the surgery.” She was diagnosed with vestibulopathy of the right side, which meant the entire right-side nerve in charge of balance was damaged. The vestibular system includes the parts of the inner ear and brain that process sensory information to control balance and eye movements. Disease, injury, genetics, and environmental conditions can all contribute to a vestibular disorder. According to a recent epidemiological study 1 , approximately 35 percent of adults 40 years and older have experienced some kind of vestibular dysfunction. Symptoms can include vertigo and dizziness, lack of balance, vision disturbance, hearing changes, cognitive changes, and headaches. In Sandra’s case, symptoms were severe— the entire world spun around her and she had no depth perception. “I would try to grab a door handle and just miss it. Or I’d be walking across a

room and would bump into a wall.” But our bodies are amazing. When one system goes down, the brain calls for reinforcements. When the brain stops getting information from its usual sources, it immediately starts to adapt.

Sandra’s doctors knew this and assumed that as she continued to heal from the surgery, she would get her hearing and balance back— but they had no idea how long that might take. Unfortunately, for Sandra, it took three years for her brain to compensate for the damage to her right vestibular system. She now has control over her balance issues, but her hearing has still not returned.