These are my modest and provisional notes on the subject of hypermobility, the issues of flexibility in yoga, being able to sustain a yoga practice and specifically practicing Yin yoga.
When I first taught yoga in 2001, I did not know what hypermobility or being too flexible meant. I remember Richard Freeman saying in June 2005, “the curse of flexibility and the blessing of stiffness”. I didn’t get it at the time. About six months later, as I observed practitioners and what happened in practicing, the penny dropped: yes, that makes sense.
TO BE CLEAR...
To be clear: I am not an anatomy expert (though I have a skeleton at home and another one that I always wear under my clothes when I go out). Nor am I highly skilled in dealing with hypermobility. If you are particularly interested in anatomy, these are three good books: Jo Avison's Yoga Fascia Anatomy and Movement; Leslie Kaminoff's Yoga Anatomy; and David Keil's Functional Anatomy of Yoga.
There is an excellent website Love Yoga Anatomy run by Stu Girling. There are interesting posts at Jules Mitchell Yoga. If podcasts are your way of accessing information, there is Liberated Body. And clearly many more...
For those specifically interested in hypermobility, Jess Glenny has written articles and runs workshops on this subject.
This piece is simply my reflections and my observations through practising and teaching. It is certainly not a definitive answer and I know that further research is always needed. Hopefully, we become less literal with our anatomical models, understanding that the skeleton is a caricature of a person, a plastic model that really bears little reflection to how a human being adapts and amends to their reality.
The way that I practice and teach Yin yoga has changed considerably – from my first Yin yoga experience in November 2001 to when I began teaching Yin yoga in February 2003 and to now. When I began teaching a weekly Yin yoga class at the North London Buddhist Centre in September 2003, it was the first weekly class of this style in London. Now there are more than fifty Yin yoga classes every week on London timetables. In my Ashtanga practice, I used to drop back into urdhva dhanurasana and (sometimes) come back up to standing. Now I don’t. Change happens.
Until recently (summer 2015), a standard line of mine was “Yin yoga is appropriate for everyone as long as it is practiced with care and sensitivity”. Now I am not so sure – maybe this is a dogma that has arisen in reaction to comments from other people. Perhaps I could do with being less dogmatic and more open to other options.
Paul Grilley (author of the first book on Yin yoga) sometimes says, “never is never right and always is always wrong.” Because we are such varied creatures, there will be some individuals who are not helped by a Yin yoga practice – as much as there are individuals who do not benefit from an Ashtanga or Bikram or vinyasa flow practice.
There are studies that show that a few people are not helped by meditation. According to the International Journal of Psychotherapy (March 2000), “during and after meditation 7.4% experienced profoundly adverse effects”.
Optimistically, I hope to lessen ‘shoulds’ and rigid views and to look beyond boxes so there is a genuine attempt to enquire into the pluses and the problems of Yin yoga. I am consciously trying to be less defensive and less reactive, more open to evidence and ideas that challenge my own opinions. Yet to balance this questioning, there is a requirement for faith: a trust and a belief in other people’s experience and in my own experience.
I know someone who has been diagnosed with Ehlers-Danlos Syndrome (EDS); this is a group of inherited disorders that affects connective tissue and can cause overly flexible joints. This – and also conditions such as Hypermobility Syndrome and Marfans Syndrome – relate to a genetic difference in the coding of fascia which make it looser than the ‘average’.
She said to me, “it’s like my body is melting”. She has done a lot of yoga and she has found that Yin yoga is not helpful for her body. “I wake up uber-flexi in the morning and spend the entire day pulling myself back together... holding poses for a long time just stretches the fascia even further and with already loose ligaments, it just pulls things out of place”.
There are differing statistics – for EDS, maybe 1 in 2,500 people are affected. A published number for joint Hypermobility Syndrome is up to 15% of the population (“Some estimates suggest that around one in every five people in the UK may have hypermobile joints” – see link). And of course there is a spectrum of hypermobility. Then there are people who are very flexible in their bodies and who are not necessarily defined as 'hypermobile'.
The fact that there is a spectrum is important. Some people with EDS are housebound wheelchair users and some are professional dancers and circus performers. There can be lots of different genetic variations in the connective tissue. What is a ‘normal’ range of movement? In many ways, this is an inappropriate question because there is such a vast range of individuality. And within this mix of individuality, there are further, more subtle questions: as well as skeletal structures, there is activity of childhood/teenage years, and obviously how long a person has been practicing and with what level of consistency.
A small number of people can sit in padmasana straightaway. Some people can do hours of yoga every week for many decades and still be unable to bring heels into hips for that prize of padmasana. It is essential that we understand that these postures are much more about mind and heart than some physical movements. If we don’t, then this is a recipe for dissatisfaction, unfulfilled feelings and injuries.
CEMENT AND CHISELS
In my early years of practising yoga, it felt as though there was cement in my hips – stuck and solid. I had an image of chisel chipping away at that cement. It took me a while (several years) to realise that having a chisel chipping in my hips was not the most positive and affirming of images. Then I came across a story from Tibetan Buddhism about how a feather transforms a mountain into a valley. That then became my visualisation and it is a beautiful image for all of us practicing: this feather, that mountain, the valley.
I remember David Swenson (a highly influential Ashtanga teacher) saying that if you constantly bend the back in one place, then it is like bending a plastic bankcard: it strains and it can snap. A teacher I know likened Yin yoga to stretching and stretching and stretching knicker elastic so that it eventually it becomes baggy and saggy.
Such points are informative. However, human bodies are neither plastic bankcards nor knicker elastic. We are alive and we are many aspects: fields of electricity, complex biological organisms, systems of data processing, sensitive receiving apparatuses, living breathing feeling beings.
In the words of meditation teacher Gregory Kramer: “we are all creatures, born into a fleshy body with a tender underbelly and overactive mind”. The Harvard Professor of Medicine, Atul Gawande, said in his 2014 Reith Lecture: “We are these hidden beings inside this fleshy sack of skin and we have spent thousands of years trying to understand what is going on inside... The body is scarily intricate, unfathomable, hard to read.” This body (however we might be describing its construct and our experience of being body) does respond positively to and needs a certain amount of stress (you could call that ‘stretch’) – just not too much in one particular place (like that plastic bankcard).
A developing theme of mine (and also an element of my practice for more than 15 years) is doing different forms of yoga in different ways. I believe that doing a few forms of yoga with their different directionalities and their different emphasisings is much better for body (especially as we get older) than doing one form of yoga over and over and over and over again.
Robert Sapolsky comments in his book Why Zebras Don’t Get Ulcers: “at some point, too much exercise begins to damage various physiological systems...just because more of something is better, a lot more of something isn’t necessarily a lot better. Too much can be as bad as too little.”
If someone comes up me and says, “all I do is Yin yoga”, I tell them to do some weights or gym aerobic activity or dynamic yoga. It is about being as best as we can in balance. Though it has to be said that in my experience, nearly all of us are doing too much of the striving and the pushing and the yang activities. What we often most need is a softening and some stillness and the staying.
COMPARTMENTS AND CONNECTIONS
There can be a difficulty in compartmentalising the body as ‘muscle’ or ‘ligaments’. There are different forms of tissue within the body yet there is vast interconnectedness between them; for example, about a third of muscle is actually fascia. The technical description that is sometimes used ‘myofascia’. This fascia becomes denser and becomes tendon and becomes bone. Jo Avison suggests that bone is “a calcified form of fascia at its thickest, hardest and most compressed”.
According to Tom Myers (author of Anatomy Trains): “The word ‘myofascia’ connotes the bundled together, inseparable nature of muscle tissue (myo-) and its accompanying web of connective tissue (fascia)”. It needs to be noted that there are different opinions among fascia specialists about exactly which tissues constitute fascia – as an example, not all of them would consider bone to be fascia, though some certainly do.
A historical view of human anatomy emphasises muscles and ligaments and describes the agonist-antagonist relationship of muscular tissue. This is when during movement, the muscle that contracts is the ‘agonist’ muscle and the opposing muscle is the antagonist, that returns the agonist muscle back to its relaxed state. But this is two dimensional, a substantial simplifying of body. Body is so much more than just this. We are round beings, there is a curving river of spine, the bones of this body are rounding – like the skull, the pelvis, the ribcage, the heels, the roof of mouth.
The body is made up of tissue webbings that connect and link and wrap – and also separate. Jo Avison wrote, “fascia could be described as the fabric of our form.” This word of fascia comes from Latin where it means bands. Instead of the specialisations and the fragments and all the separate compartments, instead of the emphasising of bits – I wish for there be a noticing of connections, of perceiving these bands and associations and webs that are being woven.
By breaking the body down into bits, we lessen our understanding of the subtle arisings that only make sense in terms of the whole matrix. This is the trap of breaking down and that simplifying into anatomical descriptions and classical bio-mechanics. One example is the nervous system. Robert Schleip (a fascia expert) stated: “rather than picturing the nervous system as a hard-wired electric cable system...picture it in your mind’s eye as a wet tropical jungle. This jungle is a self- regulatory field with an amazing amount of complexity, continual reorganisation and plasticity, even in adults.” (‘Fascial Plasticity: A New Neurobiological Explanation’, Journal of Bodywork and Movement Therapies (2003).
I suggest that we need practices that consciously relax and soften and practices that consciously strengthen and develop. It is finding this balance for the optimal health of body. For that person mainly doing a Yin-style practice, I encourage them to do dynamic activities that help to strengthen musculature. For a person doing strength-building exercises, they could become more restricted in their body – so they might need more of a stretching and lengthening and softening.
I know a restorative yoga teacher whose dynamic activity is walking her dogs every day. This is a vigorous and brisk way of walking because those dogs are pretty active. There are naturally options and paths. Again, what we are looking for is balance.
I am sure there are people coming to Yin yoga classes and overstretching, which then causes them damage. There are people doing the same in dynamic yoga and other activities. When playing park football, I saw a player badly break his leg. Things obviously happen and our challenge is to accept what has happened, deal with it appropriately – and lessen the chances of this happening again (that was the end of my park football career).
THE IDEOLOGY OF FLEXIBILITY
The ideology of flexibility is a great obstacle in the yoga world. This can mean that there is a revering of a person with joint hypermobility when they are on their mat. Yet potentially, that person is going to have more problems than the ‘average’ practitioner. Remember the “curse of flexibility”? It is true — as those who are more flexible are more liable to injury.
Yoga poses are so much more than stretches and we need to keep evaluating where do we stretch and what is being stretched. Part of this ideology of flexibility can be an addiction to strong sensations and the neglecting of subtlety, the rejection of props and the focusing on acquisition and achievement.
This ideology needs to be undermined: deeply and truly. This is not about how far forwards we might be able to fold or how long we can sustain the strong stretching. As practitioners, we can remind ourselves that the flexibilities that we assiduously cultivate are undeniably time limited. At some point along this lifeline, our possibilities of bending will become less. And later on, we will be so restricted that we are either in a wooden box or a crematorium. This is the inevitable trajectory of tissue: that it tightens over time (time does mean decades).
As teachers, we can do our utmost to undermine this ideology. We can mention that fact of tissue trajectory over time. We can emphasise qualities of attention over postural aesthetics. We can use humour. That if flexibility is venerated, then really the people to worship are eleven-year-old Chinese acrobats. We can emphasise that practice is about deepening awareness of body as is and encouraging a growing integrity of being body.
Back to being balanced. Jess Glenny writes about “fram[ing] physical practice as a movement towards balance and integrity...for some students this will mean working on strength and stamina; for others it will mean focusing on loosening restrictions in fascia and muscle.”
So if someone comes to a Yin yoga class and they are very flexible and/or experience hypermobility, then I would strongly – no pun intended – advise care and caution. Instead of muscular relaxing (a common instruction in Yin yoga), they could be helped by an approach of engaging muscles. Rather than stretching outwards, it might be better for them to draw inwards – so the limbs draw in and there is use of bandhas and spiraling (such as gluteal creases, front thighs, inner thighs). It is more drawing towards centre than an extending into extremities. This is more about stabilising, aligning and strengthening than just a simple stretching.
Certain bodies and particular postures require more assistance and support than others. One example is the Yin yoga version of low lunge: dragon. I recommend that participants avoid ‘hanging out’ in the hips. This is especially true for those who are hypermobile. The advice is to draw in rather than stretch outward.
Jess Glenny suggests that hypermobile practitioners may benefit from staying for shorter periods in the postures (like two minutes rather than the regularly recommended five-minute holds). This time for holding a pose is not fixed in stone. When a practitioner feels that their edge has become too edgy, then they are ready to move away from that place. That place can be made more appropriate by using props such as blocks and bolsters, so that the body is supported rather than locking limbs.
Yet at the same time we need to keep acknowledging individuality. That long-term practitioner with EDS said: “too many props can make me lose the integrity I need to stay in a safe range of motion...perhaps it’s why I have always been a floor sitter and turn down the cushions that are offered to me.”
We can propose to practitioners that they gently approach what they perceive as edge. Once they have arrived at that stretch, rather than continuing to lean into it, they ease away from the edge. And then in that easing away, they stay and focus on these feelings and study the sensations – and then maybe again lean towards the edge. This requires skill and sensitivity, which obviously are great virtues for practicing all forms of yoga.
COMMENTS AND CRITICISMS
In these discussions, we need to be careful to avoid throwing baby out with the bathwater. All of us need to stretch in our own way. When we are not stretching tissue then the trajectory is accelerated and there is an increasing degeneration of tissues.
By stretching, we lessen contraction and restrictions; we can alleviate that trajectory. Note that I avoid using the term ‘stiff’; restriction is a more accurate way of describing this situation. We actually want to be ‘stiff’ as this means that we are strong and resilient. This is a different way from the standard yoga perception of ‘stiffness’. According to Jules Mitchell: “our connective tissues – tendons, ligaments and fascia – they all have stiffness. It’s an unavoidable property that we should not try to do away with by stretching.”
Yin yoga of course has its critics. Like all forms of yoga, some teachers of this form are not as knowledgeable or skillful as they possibly could be. Like myself back in 2001 at the start of my yoga teaching and my lack of comprehension about hyper mobility.
One critic is a UK anatomist: “my personal thoughts with Yin is that it destabilises the structure – going too deep, too quick”. Julie Martin, a vinyasa teacher of many years experience, reported: “I have found when I have attended a Yin class... After the third hip opener I end up with debilitating pain in my Sacroiliac joint... Initially I thought ‘this is just me and Yin doesn’t suit me’... But I shared my story and the response I get is overwhelming in that it mirrors the same as my own experience. This is from mostly teachers, all with at least five or more years of continued yoga practice in either Ashtanga or vinyasa flow and all woman.”
That is a valid experience and this is evidence. As a contrast, my experience and my evidence are different. I have consistently practiced this form since 2001, I have taught many others and I know a lot of people who have been practicing Yin yoga for more than ten years. My perspective is that the rate of injuries/physical issues appears to be less than in dynamic practices like Ashtanga and vinyasa flow.
Bernie Clark (author The Complete Guide to Yin Yoga) wrote: “If Yin yoga was being touted as beneficial only because it helped Paul Grilley and Sarah Powers, then we would be on very shaky ground. While Paul and Sarah were flexible yang yogis before starting Yin yoga, I started doing Ashtanga in my mid-forties, and even after five years of a daily Mysore style practice, I could not get my head to the floor in prasarita padottasana A. After I added Yin yoga to my practice, within three months, my head was on the floor. Yin yoga added mobility in areas that yang yoga had not. To my own story, I could add dozens of other stories from students and teachers I have worked with over ten years of teaching Yin yoga....
“When a student tells me that after six months of coming to my Yin yoga classes that her back pain, which she has been suffering for years, has gone – that is evidence. Evidence of what? It is impossible to say that what stopped her pain was the stress on her back’s ligaments, the stress in her fascia, the effect of her paying attention mindfully to the sensations, the relaxing deeply for 75 minutes at a time each class, or just the effort to get out of her house and come to the class. I cannot pinpoint the exact cause of her relief, but I also cannot deny her relief. It is real. Data is real. Theories must accommodate data, not the other way around.”
MORE THE AWARENESS
It is not what we are doing – it is how we are doing the practice. It is not the asana, it is the awareness. Perhaps sometimes practitioners come into a Yin yoga practice with the vigorous energy of ‘yang’ approach: that determination to ‘achieve’, the drive of pushing strongly into postures.
We can be too reductionist with our approach to yoga, reducing this practice down to the mere matters of physical movement. What happens within this moving? The parasympathetic nervous system, the mind, the heart ... and undeniably there can be the simplicity of the placebo effect. This placebo effect is when a person’s condition improves simply because there is an expectation that the treatment will be helpful.
How able are we to apply intelligence with awareness to the physical practices that we are doing? Personally I have found that Yin yoga has given me more space to evolve a growing sensitivity and understanding of body and being. A great power of Yin yoga is this slowing down and softening and staying.
A fact of life is that most people spend much of their time sitting down. This is one of the reasons that Yin yoga postures are predominantly concentrated on the hip/middle/lower back. This is where a lot of our stuff is stuck – physically, emotionally and mentally.
People get more physically restricted because of lifestyles and the inevitably of ageing and this is a crucial reason for the importance of movement. Moving the body is essential for health; especially when the movement is self-motivated like a yoga practice. Then the question arises, “what kind of movement?”. Obviously, we have to make allowances for the vastness of individuality. What can work well for one person can be damaging for another.
In my experience and that of other people, Yin yoga is a bridge towards levels of stillness and quieting of thoughts and emotions that are so needed in this world of noise and rushing. Experiencing stillness is a radical action in our whirling helter-skelter world. Many people do find in these long, slow holds a greater level of awareness than they might do in a more active practice. There can be a real quieting of the inner body when we are doing this practice. This can be a path towards meditation and a form of meditation in itself. In the society of stimulated distractions, a practice of stilling can have immense consequences.
Holding postures for prolonged periods of time can be deeply profound. Clearly we have to be conscious of how we are holding and what we are stretching. One of my current themes in teaching is to ask people who are already open in their bodies – “do you want to be ever more open and flexible in hips and hamstrings...and hopefully your answer is, ‘no’”. Of course we do want to be more open in our hearts and our minds.
Over the years I have increasingly used props as part of this practice. Jules Mitchell writes: “if we plan to be in passive stretches for three to five minutes, we can reduce the potential of too much elongation by providing proper support... (In forward bend) I have placed a bolster under my head to minimise the creep under the constant load (gravity). The back side of my body is now getting a continuous stretch (tensile load) but is not under continuous elongation.”
Of course, statements like “destabilises the structure” from that experienced anatomist carry considerable weight. But what might his answer have been if the question he was asked about Yin yoga was phrased in another way. If he had been asked: “many people have experienced Yin yoga and found that it reduces pain in their body and joints, or increases their ability to move functionally in their daily life, or improves their range of motion and allows them to achieve more challenging yoga postures. How do you think Yin yoga could have done that?”
Another piece in this puzzle is provided by Stuart McGill (author of Low Back Disorders). Bernie Clark asked McGill, “Are there any studies showing benefits/dangers of long held, static, passive stresses to connective tissues?” His reply was “I know of no studies.”
HOW ARE WE DOING?
Yes, we have to question what we are doing and ho