June Yoga Journal "Ask the Expert" features Leslie Kaminoff

The current (June) issue of Yoga Journal’s “Ask the Expert” column focuses on some breathing-related questions. I was asked to write the responses by YJ’s former executive editor, Mary Bolster. This was one of the last pieces Mary worked on before relocating to New York to become the new Editor-in-Chief at Natural Health Magazine. It was a pleasure working with Mary, and I look forward to doing so again in the future.

Q: Will it help or hurt a person with high blood pressure to practice Kapalabhati breathing followed by breath retentions?

A: I view Yoga exercises as being instructive rather than prescriptive; I don’t prescribe them like pills to cure specific things. Quite often, it’s not so much what exercise you do that determines its effect, but how you do it.

A hypertensive student practicing Kapalabhati (short, quick exhales followed by passive inhales) is a great example of this. The truth is that you’re likely to put far more strain on your cardiopulmonary system lifting a heavy package or having a difficult bowel movement than by doing Kapalabhati. Nevertheless, it’s entirely possible that a hypertensive student might increase their blood pressure as a result of intense breathing practice. So, Kapalabhati could potentially be harmful, if it’s practiced the way it’s commonly taught in group classes.

But with Kapalabhati, the key is doing it in such a way that is beneficial rather than harmful, which means that the diaphragm must be completely relaxed so that its movement will be caused by the contraction and release of the lower abdominal muscles. This is essentially an active exhalation followed by a passive inhalation— literally non-diaphragmatic breathing. Therefore, if Kapalabhati is done with a relaxed, slow rhythm, it can help free up tension in the abdomen that is associated with the inability to shut off the “fight-or-flight” response, which is almost invariably a major component of hypertension. In this context, Kapalabhati could be quite helpful for a student with high blood pressure.

Now let’s talk about breath retention, which can refer either to suspending breath movement after inhalation (internal, or anta kumbhaka), or after exhalation (external, or bhaya kumbaka). Most Yoga systems teach internal retention after Kapalabhati, but for a student with high blood pressure, I’d try to achieve a more calming effect after a round of gentle Kapalabhati by pausing briefly after the final exhalation, then relaxing the throat muscles so that a passive inhale can occur followed by a period of easy breathing.

These modifications are examples of T. Krishnamacharya’s dictum that Yoga must be adapted to the individual. This is especially significant when breathing techniques are involved because our unique constitution, history, and habits are literally written in our breathing patterns. This is why the effect of a particular breathing technique will vary quite widely from person to person.

In short, just about any practice you do gently and with self-awareness will benefit you— even if you have high blood pressure—because it has the potential to reveal and dismantle your unconscious breathing habits.

2) What asanas and breathing techniques are good for improving the
immune system?

I assume that “improving the immune system” refers to stimulating a compromised immune system, but it’s important to remember that the vast majority of immune disorders are autoimmune, in which a misdirected immune system produces antibodies to substances occurring naturally in your body. In this case, you’d want to reduce the immune system’s activity.

Regardless of whether your immune responses require stimulation or reduction, conscious breathing combined with guided imagery or visualization has been proven to be a highly effective and powerful tool for healing. Try the following: Find a quiet place, sit in a comfortable position, and bring a relaxed awareness to the breath. Think about your desired internal changes and then consciously link your breath to these goals: If you want to bring something positive in such as health and vitality, focus on the inhalation. If you want to release something undesirable like pain or discomfort, focus on the exhalation. Concentrate on what imagery you associate with these feelings, such as a certain color, a sensory feeling like warmth or tingling, or a calming scene in nature. Use whatever imagery helps you; the possibilities are endless. The key is to allow yourself the freedom to discover what is specifically nourishing to you – what works for other people is irrelevant.

In addition to breathwork, I’d recommend practicing a well-balanced asana sequence that leaves plenty of time for relaxed breathing and restorative poses. Ending your sequence in Savasana (Corpse Pose), puts the body in a state of maximum repose where it is freed from the need to contend with gravity. Here, you can bring your focus more fully to the inflow and outflow of the breath and whatever imagery you’ve chosen to help heal your immune system.

3) Can you recommend any specific breathing techniques for
asthmatic kids?

When it comes to dealing with asthma attacks, how you prepare for an attack will determine how you react when you actually have one. When the airways are constricted, relaxed shallow breathing is what’s needed. This goes against what seems like common sense, as everyone’s instinct is to tell an asthmatic during an attack to “breathe deeply.” This is the worst advice, because it just makes them more tense; after all, if they could breathe deeply, they wouldn’t be having an attack in the first place! Without training it’s very difficult to relax when having an attack because relaxed, shallow breathing is so counterintuitive when you feel like every cell in your body is starving for oxygen.

What does this training consist of? Slowly and systematically lengthening the exhalation and the periods of external retention. As my teacher T.K.V. Desikachar is fond of saying: “If you take care of the exhale, the inhale takes care of itself.” Non-forcefully holding an external retention puts your body in a similar situation to when you are actually having an attack, because in both cases your body is deprived of oxygen. Remaining clam in this state is the key to being able to relax during an acute asthma attack.

Gentle, non-forced external retention has shown to improve asthmatic symptoms so dramatically that an entire asthma treatment system called the Buteyko Method is based on it.

Kids can learn how to do this, but of course training is more easily accepted if it’s fun and engaging. I recommend singing, rhyming, and chanting, because the breathing pattern is similar to what you are trying to learn: Long, slow supported exhalations followed by relaxed, efficient inhalations. Practicing silence in between verses produces the necessary pause after the exhalations. Make up games and create songs that incorporate increasingly longer phrases. Asthmatic kids, and kids in general will benefit enormously from this, because they are learning the skill of relaxing in the face of discomfort – something most of us only learned in our first Yoga classes as adults.

Leslie Kaminoff is a New York City breathing specialist and Yoga Therapist inspired by the teachings of T.K.V. Desikachar. His 27 years of teaching experience are culminating in his book “Yoga Anatomy,” to be published this year by Human Kinetics. He is the founder of the non-profit educational corporation “The Breathing Project” (breathingproject.org). His personal website is yogaanatomy.org.

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3 comments on “June Yoga Journal "Ask the Expert" features Leslie Kaminoff

  1. Hi Leslie–

    Just a few comments with regard to what you’ve said.

    First, in discussing Kapalabhati and high blood pressure, you described Kapalabhati as “essentially an active exhalation followed by a passive inhalation–literally non-diaphragmatic breathing.” I hope you really didn’t mean the last part of this sentence, since clearly the diaphragm is very much involved. I think perhaps your statement shows the degree to which so many of us still sometimes unconsciously revert to the old paradigm that says that diaphragmatic breathing requires some kind of effort of inhalation, which, of course (and I’m sure you would agree), is just plain wrong. When diaphragmatic breathing is efficient, the in-breath comes as an effortless reflex, sometimes referred to as “the inhalation reflex.”

    By the way, the key to how Khapalabhati will influence someone with high blood pressure also has to do with how much carbon dioxide per minute the person breathes out. Breathing out too much carbon dioxide per minute can cause the arteries and veins to constrict which can raise blood pressure.

    With regard to question # 3 regarding asthma, you say “non-forcefully holding an external retention puts your body in a similar situation to when you are having an asthma attack, because in both cases your body is deprived of oxygen.”

    Leslie, this really isn’t true. The fact is that when you hold the pause longer after the exhalation, you are allowing a build up of carbon dioxide which will help free oxygen in your blood and allow it to reach the cells of your brain and body. It will also help open the airways. A person having an asthma attack is also often hyperventilating which actually dispels more carbon dioxide and closes the airways and thus ensures the experience of breathlessness. I think it is clear that these two experiences are absolutely not similar.

    With warm regards,

    Dennis Lewis
    Author “The Tao of Natural Breathing” and “”Free Your Breath, Free Your Life”.

  2. Hi Dennis.

    Thanks for your thoughtful comments. My original response to Yoga Journal was longer, with a bit more explanatory detail, some of which was edited out.

    My article said:
    “…Kapalabhati…is essentially an active exhalation followed by a passive inhalation— literally non-diaphragmatic breathing.”

    and you commented:

    I hope you really didn’t mean the last part of this sentence, since clearly the diaphragm is very much involved.

    My response:

    My intent was to point out that the diaphragm is not ACTIVELY involved. It is, of course moving, but not under it’s own power. It is being moved by the abdominals.

    There are other contexts in which the thoracic cavity changes volume without the active contraction of the diaphragm; the chest compressions of CPR, and the action of a ventilator are two that come to mind. Kapalabhati is the only one I can think of that doesn’t involve life threatening situations, though.

    You commented:

    With regard to question # 3 regarding asthma, you say “non-forcefully holding an external retention puts your body in a similar situation to when you are having an asthma attack, because in both cases your body is deprived of oxygen.”

    Leslie, this really isn’t true. The fact is that when you hold the pause longer after the exhalation, you are allowing a build up of carbon dioxide which will help free oxygen in your blood and allow it to reach the cells of your brain and body. It will also help open the airways.

    My response:

    You’re absolutely right. My wording here is very imprecise, and I should be ashamed of myself, considering how I’ve been known to take others to task for similar imprecision. I should have said “your intake of oxygen is suspended.”

    I originally had written more info on the CO2 issues, but space didn’t permit it to be included. YJ said 800 words, and they meant it.

    I cover this very issue much more fully in an upcoming article I’ve written for the International Journal of Yoga Therapy called “What Yoga Therapists Should Know About Breath Anatomy.”

    Thanks again for your comments. I feel as if this is evolving into a peer-reviewed blog.

  3. Hey L.K.-
    regarding astmatic kids and adults-
    personal experience taught me that if I got the chance of teaching/working with them prior to the attack, and if they were already in some control of the mechanics of Ujaii Pranyama- (including the concious use of the epiglottis)- then there is less fear from the situation and more willingness to try and apply that knowledge when the attak comes. They then have a memory of breathing against constriction, and can many times apply that knowledge: calm down a bit AND try and relax the constricting muscles, startung an uphill process of getiing rid of the inhaler addiction, as the training goes on.
    BUT- this is not a proper research or study yet.

    well, will this become the revival of good old E-sutra?
    peace,please.
    gilli Harouvi
    Yoga Shala, Tel-aviv.–>

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