The cellular component of bone consists of fibroblasts  & fibrocytes which produce type I collagene & other ECM components.The osteoblasts are the primary bone forming cells,which are responsible for its synthesis,deposition & mineralization.When osteoblasts cease to function they are called osteocytes.Osteoclasts are monocytes derived large multinucleated cells responsible for bone resorption.Homeostasis between bone synthesis & deposition is fine tuned by Nutrition,Hormonal status & Mechanical loading.Bone remodeling is a lifelong process of bone formation & its resorption.The condition called Osteoporosis results when an imbalance occurs between bone synthesis & its resorption.This leads to decrease in bone mass or it’s density. 

This happens due to faster rate of bone absorption by osteoclasts than its rebuilding by osteoblasts.Because of decreased mineral density or mass,they are weaker & hence more susceptible to fracture than bones with  normal density.

Menopause is a stage in woman’s life when ovaries stop producing Esterogen due to depletion of follicles.Since esterogen hormone has a stimulatory effect on osteoblatic activity,its abscence seriously affects the bone synthesis.Since the osteoclastic activity continues,every post menopausal year will decrease the bone mass. Trivial fall of injury may lead to fracture affecting her quality of life.HOWEVER THIS CAN BE PREVENTED BY REGULAR PRACTICE OF SELECTIVE YOGIC POSTURES & ACTIVE LIFE.

How?

Bone responds to external forces or loads such as pull of tendons & the weight of the body during functional activities. This change in form to match the function is Wolff’s law. Numerous studies have shown that bone deposition is increased with weight bearing exercises & in the areas of  increased muscle force . Application of external forces or loads repetitively or over time causes osteoblast activity to increase & as a result bone mass increases.

In addition, to increase in Bone mass,the regular practice of selective Yogic postures, increase muscle mass( hence strength) which helps the woman to delay Osteoarthritis of knee joint & prevent Cervical & Lumbar Spondylosis. This practice helps her for proper erect posture which maintains her dignity in spite of her increasing age.

Following are the selective Yogic Postures to be practiced by a woman since Peri menopausal phase of her life & to be continued till the last day of her life.

Set 1 ( Prone)

Sarpasan 1,2,3

Shalabhasan

Naukasan

Dhanurasan

Set 2 ( Supine)

Padangushthasan ( Single leg up & down & both – 30 degrees)

Lift torso with head & both hands in line with shoulder joints

Setubandha

Naukasan

Set 3

Konasan 1

Konasan 2

Urdhwamukh

shwanasan

Set 4

Anantasan ( Side lying leg raising)

These Yogic postures are weight bearing postures ( self weight) hence of immense value to maintain bone mass and muscle mass. 

We have to pay attention to Nutrition which should be rich in proteins, calcium & Vitamin D.

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Zero Point

Now to reach Lachung – 8738 ft. the next day. This is once again a stopover to reach Yumthang valley at 12,000 ft. But excitation is further….that is to travel further to reach Zero point- 15,300 ft.  the last civilian reach. Here you view a large panorama of Himalayan Mountains with soft snow everywhere to cater hundreds of tourists!!

Then of course back to Lachung to different destinations in Sikkim or back to Gangtok.

What I experienced is the 5 to 6 hours of daily car travel (all mountain travel……round & round), at times even 10 hours requires lots of patience. But expert, polite drivers, Xylo cars, perfect stops for waterfalls & healthy food ( momos, noodles, rice……piping hot!) make you forget everything.

The walking, climbing is not much! But sufficient strength in your muscles habit of stretching selective muscles, deep breathing techniques taught in Yogic practices surely multiply the pleasure.

Kala Pathar      

Above all the Art Of relaxation, enjoyment but being careful is well taught by Yoga.

GAURI…..Thanks once again!!

Dr Vineeta Ketkar

Visit website- www.gnosismedicalyoga.com

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2) Ganglia & Branches of Vagus

3)  Supply of Vagus

NUCLEI

Are present in Medulla Oblongata (lower most part of Brain Stem)

They are in the vicinity of Dorsal Respiratory nucleus.

1. Nucleus Ambiguus
2. Dorsal nucleus of Vagus
3. . Tractus Solitarius
4.  Upper part of Spinal nucleus of Trigeminal

1. Nucleus Ambiguus- gives rise to Special Visceral Efferent ( SVE) fibres which supply to muscles of pharynx, larynx & soft palate.
2.  Dorsal nucleus- gives rise to General Visceral Efferent (GVE) fibres which supply Para sympathetic innervation to heart, bronchi & gastrointestinal tract. These fibres are preganglionic ending in postganglions situated near viscera or in the walls of viscera. They innervate smooth muscles & glands of viscera.
3.  Nucleus Solitarius – Receives Special Visceral Afferent  (SVA) fibres For Taste from posterior most part of tongue & epiglottis.It also receives General Visceral Afferent (GVA) fibres from pharynx ,larynx, trachea ,thoracic wall, oesophagus & thorasic & abdominal viscera
4. Upper part of Spinal nucleus of Trigeminal – Receives General Somatic Afferent ( GSA) fibres From skin of auricle.

GANGLIA & BRANCHES

1. Superior
2. Inferior

1. Superior ganglion – gives
2. Meningeal branch supplying dura matter in the region,
3. Auricular branch supplying posterior wall & floor  of external acoustic meatus 

• .Inferior ganglion – gives    
• Pharyngeal branch dividing into numerous branches to form a plexus. These supply to muscles of pharynx & soft palate.( The pharyngeal plexus is joined by branches of Glassopharyngeal nerve & branches from Sympathetic trunk)
• Carotid body branches ( responsible for Baroreceptor buffer reflex of arterial pressure)
•  Superior Laryngeal nerve ends by dividing into internal & external laryngeal nerve. Internal laryngeal nerve is sensory, carries the sensory signals from posteriormost part of tongue, pharynx, epiglottis & mucus membrane of upper part of larynx.( upto vocal folds)External laryngeal nerve is motor supplies crick thyroid muscle.
• Recurrent laryngeal nerve course is different on right & left side. It has sensory & motor fibres. Sensory fibres supply to lower half of larynx, trachea, oesophagus. It gives branches to cardiac plexus. Motor fibres supply to all intrinsic muscles of larynx ( except cricothyroid)

Cardiac branches– Each Vagus nerve gives one or more Superior  Cervical Cardiac branch( in upper neck),Inferior Cervical Cardiac branch ( in lower neck),additional branches from its mediastinal part & from Recurrent laryngeal…..all together end in superficial & deep Cardiac plexus.

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Vagus means *wandering*. The name suggests that it has a long wandering journey for its supply, reaching abdominal cavity.

Vagus nerve carries 75 % of Parasympathetic fibers. Parasympathetic system is the branch of Autonomic nervous system. As the name shows, this systemic is not under our will or wish. It works when we rest & are peaceful. Its function is vital for repair, regeneration & energy conservation.

Science of Yoga has deep understanding of this nerve. It gives us many techniques to reach this nerve. Vagus nerve stimulation will benefit us for healing & health. Today’s era, where sympathetic system is overworking due to persistent stressful situation, it is vitally important to learn these techniques to balance both systems.

(Sympathetic system works for * flight, fight, fright* response)

Let us study this nerve under three headings….

1) Anatomy

2) Physiology

3) Medico Yogic Correlation

Dr Ketkar

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 But still it needs attention, as when it comes to health, someone may get confused as to which path to walk.

Gym workout involves a meticulous study of skeletal muscles & various gadgets to increase the strength & endurance of them .It also pays attention to cardiac fitness by slowly increasing the heart rate in a span of 6 to 8 weeks so that the left ventricular muscles increase in number to increase the stroke volume. This later on reduces the increase in heart rate, which is called cardiac fitness. Gym workout is called Training as it leads to slow & sustained changes in Physiology. This involves multiple endocrine glands to maintain the Homeostasis .For example…release of endorphins, growth hormone, antidiuretic hormone, aldosterone, prolactin etc. Thus initially the body looks at exercise as a stress leading to stress response which slowly gets converted to training effect.

Gym workout thus has a definite role in body build up & fitness. Yoga on other hand is an ancient science which has its roots from Pre Vedic period, Vedic period, Upanishadas & Bhagvatgeeta. It is compounded by Mahamuni Patanjali as Patanjal Sutras (196) about 500 years BC. He has called the Yogic Technique as Ashtang Yoga. This pathway of eight limbs namely Yama, Niyam, Asan, Pranayam, Pratyahar, Dharana, Dhyana & Samadhi teaches us to practice the discipline. This discipline is aimed at self-control of body, sense organs, mind & thought process. It proves an invaluable companion to face the changes & challenges of life.

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 But natural we are attracted to Practical as it can be immediately learnt & practiced. Though it is an express highway to reach the destination faster, we should be well aware of myths of Yoga.

 Firstly it is a Science & not a matter of miracle. We have to follow a code of conduct for our behavior & observe for the effects.

 Secondly it does not work like a quick fix but needs time as it reaches root cause of the situation.

 Thirdly it is not a way for only elderly people, But from for everyone from age 10 years to 100 years.

 Fourthly Yoga is not only Asan, Pranayam & Dhyan (Meditation) but there are other limbs which should be studied & followed.

Fifthly it does not promote any religion or god since it is a science.

Sixthly it not only helps for flexibility of joints, but helps to increase the resilience of our mind.

Seventhly it not only makes us humble but capable, strong & humble.

Eighthly it is not a science developed for Therapy but for Evolution of our personality.

Ninethly it is not for a short term duration course, but a life time commitment.

Tenthly it is not only in the benefit of an individual but the whole world around is benefitted!!!

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Their causes may vary as per the age.

1) Adolescent age group (12 years to 18 years – which is called Peri menarchal)

For late cycles, we have to check Hemoglobin & Thyroid status. If needed, medicines should be started. For early cycles, her nutritional status & Hemoglobin should be checked.

 We can advise easy & effective Yogic Postures to this group to correct the irregular periods.

For Late cycles – Surya namaskar, all prone & supine Postures done in sequence is found to be effective. In addition, twisting Postures help a lot. These girls should be motivated for day to day activities too. All Postures are to be done with five or ten counts for repetitions & holding. Slowly these counts should be increased.

For Early cycles – These girls need to practice all forward bending Postures with a resting attitude. For example, Shashankasan, Paschimottanasan, Janushirshasan, Uttanasan can be practiced with head resting on support. They are immensely helped by relaxation techniques like Shavasan, Conscious Deep Breathing, and Bhramari Pranayam.

2) Reproductive age (20 to 35years)

3) Peri & Postmenopausal age – Irregular periods need medical assessment in expert’s hands.

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 If I have decided to study the concepts of this wisdom, am I supposed to prepare myself in a particular pattern….? The answer is ….Yes! The biological clock of our body needs to be tuned to biological clock of day & night. The nature in body is to be linked with outside nature. The Yogic study understands the circadian rhythm in our body. It helps the process of Homeostasis by its wonderful techniques.

So one has to be careful about sleep & wakefulness pattern. Yogic Science is best understood as Neuroscience, hence role of sleep in neuronal functions can be explained. Wakefulness has to have limitation of time.

I need observe my eating habits as well. Nutritious, moderate quantity food at fixed time is helpful. Complete digestion & assimilation of food is a key to Success.

 My socialization should be selective to conserve my energy.

 My activities should be within limit of my capacity.  I should commit myself to this precious Science by my relentless efforts.

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It becomes challenging to decide which training will fulfill your requirements.

For this to explore, one should know the purpose of this training.

 The purpose can be

1. To be healthy
2.  To be peaceful
3.  To be successful 
4.  To develop emotional quotient
5.  To enhance individual capacity
6.  To develop managerial skills
7.  For effective stress management
8.  To be a professional
9.  To help the society
10.  Personal spiritual quest

Except the last one which is decided by the full time activity of Yogic practices, all can be imbibed by methodical Training.

 The Yoga Teacher Training should involve the structural & functional aspects of human body (Anatomy & Physiology)It should explain the aim of various systems to keep body functioning efficiently under variable conditions. The study should elaborate the deviations of health for common ailments.

With this background, Ashtang Yoga should be introduced with chanting of minimum 50 Patanjal Sutras everyday with their meaning & following them in day to day life. Co-relationship of Ashtang Yoga with Modern Medicine makes it very interesting to develop the power of awareness. The practice of awareness helps to evolve our personality to fulfill all of above aims. We at Gnosis Medical Yoga Foundation are dedicated to conduct Yoga Teacher Training with this theme.

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The Stress Response built in our body is a must for our survival. But in present life style, instead of appearing as and when need arises & vanishing soon, it is persistant. It’s persistant presence, instead of helping our body is posing multiple disturbances in our body functions. This if not attended in time leads to various diseases & disorders.

So the need is felt intently to

1. Minimize the duration of stress response.
2. To learn its counter response called  Relaxation  response (Our body has the infrastructure for counter response, but we are not programmed to use it.)
3. To minimize the duration of Stress Response the technique of Pratyahar from Ashtang Yoga is very useful. This technique teaches us the pathway of sensory inputs   generating   emotions, thoughts which govern our actions. The ongoing  practice of Pratyahar identifies the triggers in the form of sensory inputs, which leads to stress response. We need to identify them, so that they can be avoided or managed before their flare up.

This will help to reduce the persistant stress response leading to its short burst but vanishing soon.

The practice of  Dharana &Dhyana will help us in this journey by ability of not getting involved in each and every event occurring around us & not being judgmental about it. This practice teaches us to observe without attachment.

Repeated attempts & practices develop         new neuronal connections, strengthen existing connections to be more effective.

• To learn the counter response called Relaxation response- We know the acute stress response is mediated by Sympathetic branch of Autonomic nervous system. Its’ associate branch which works when we rest has the ability to minimize the physiological effects of Sympathetic branch. We need to learn & practice the voluntary efforts to stimulate it.This is learning the generation of Relaxation response.

Science of Yoga offers various techniques to reach Parasympathetic nervous system. They are-

1. Conscious muscular relaxation- in the form of PMR –Progressive muscular relaxation. It is to be learnt as a process of Shavasan. We need to lie down or sit comfortably, close our eyes & pay attention to our muscles part by part to  relax them consciously. Though appears simple requires long term practice.
2. Conscious Deep Breathing- Our breathing is an involuntary function controlled by a center in Medulla Oblongata. It is gifted with automatically & rhythmicity. It sends signals to muscles of breathing leading to inhalation for 2 seconds & exhalation for 3 seconds.

Nature has given us a  limited capacity to work on duration of breathing.

This is the principal of Pranayam, as defined by MahamuniPatanjali, to change the area, duration, frequency, subtleness & holding it.

Our rib cage can be expanded to increase its’ transverse, vertical & anteroposterior dimensions. Lungs expand with its expansion. Vagus-the 10^thcarnial nerve carries  afferent impulse from stretch receptors of lung, bronchial airway & larynx. Working on rib cage expansion by conscious deep breathing (Bucket handle & Pump handle thoracic breathing & Abdominal breathing) helps in stimulating the para-sympathetic system

Conscious deep breathing leads to decrease in rate of breathing which increases the Para sympathetic tone.

Contracting laryngeal muscles in Ujjayi Pranayam leads to generation of afferent impulses in Vagus nerve,which helps in stimulation of Para sympathetic nervous system.

Relaxation response can be generated at body level by working on body as mentioned above.

It can be generated at  mind level by other techniques such as music, sports, being with nature, exercise, hobby, loving relationships.One has to choose it according to one’s preferences.

Lastly the relaxation response may be generated at spiritual level by finding the meaning & purpose to one’s life.

So choices are plenty, we have to choose any one or multiple to generate relaxation response,  to minimize the harmful effects of persistant stress response.

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