What do you do when you’re dead beat, the legs feel like lead and you can barely take a step forward?
Slump into a chair or collapse in bed probably.
An easy method to kill fatigue and rejuvenate the body and mind is put your legs up on the wall.
Yep, it’s that simple. No massage, magical rubs or isotonic drinks necessary.
All you need is a solid wall to hold the weight of your legs.
In yoga, this pose is called viparita karani. In Sanskrit, viparita means “inverted” or “reversed”, and karani means “doing” or “making.”
But you don’t need to be a yoga practitioner or use fancy props to practise this.
A beginner can painlessly get into viparita karani as it is a passive pose that doesn’t require much flexibility or strength.
The touted benefits are plentiful: alleviates pain and tightness of the leg muscles, calms the nervous system, reduces anxiety and headaches, aids digestion, minimises varicose veins and restless leg syndrome, and enhances sleep (a good remedy for insomniacs).
Some yogic texts claim it has anti-ageing properties, eliminates wrinkles and reduces the effects of old age as well.
When you put your legs up against the wall with your pelvis elevated on a pillow or folded blanket, lymph and other fluids that can cause swollen ankles, water retention, tired knees and congested pelvic organs, flow into the lower belly.
This “refreshes” the legs and reproductive area.
We are all subject to many stressors in life and this pose is especially refreshing as it gives your blood circulation a boost.
If you are jet-lagged, it works wonders. I often put my legs up on the hotel bed’s headboard after a long flight and feel the relieving effects the next day.
I also introduce it to anyone who complains of tiredness from being upright or seated for long periods, or after a marathon or intense workout.
And so far, no one has reported any ill effects, except those who fell asleep in the pose and woke up to numb legs!
You’ll often find track and field athletes helping each other hold their legs up after a race.
Track and field athletes often help each other hold their legs up after a race, as seen in this filepic.
Getting into position
This is the most difficult part!
You can do it two ways.
The first way is to lie sideways in foetal position with the soles of the feet facing the wall, move onto your back and swing your legs up.
Then walk your feet up to inch your body closer to the wall.
The second way is to lie down, place your feet on the wall and shimmy your buttocks as close as possible to the wall.
If you have flexible hamstrings, try not to bring the body to a full 90° angle to the wall as this can impede circulation at the hips.
Instead, slide your hips a few inches away from the wall and/or elevate your hips by placing a cushion under your sacrum (also known as the tailbone).
Your hamstrings should feel comfortable and not overly stretched, while your groin should feel soft and hollow.
If you find it hard to balance your straight legs on the wall, then keep the knees a bit bent and place the entire foot on the wall with the soles of the feet touching the wall.
Adjust your position so that you’re completely relaxed. You should not feel any distress in any part of the body.
You can place your hands on the belly, have them (palms facing up) next to your body or bend the arms at the elbows and take them over the head, which helps stretch the shoulder muscles out.
There are no hard and fast rules of whether the feet should be flexed or the toes pointed, so just keep them relaxed.
Close your eyes and take slow, deep breaths. Surrender to relaxation.
Stay here for 15 to 20 minutes, not more.
When you’re done, bend your knees and bring them to your chest, roll sideways and slowly find your way up.
If your feet begins to tingle, bend your knees or come out of the pose.
If you’re elevating your legs in bed before retiring for the night, come out of the position and go right to sleep.
With a quietened mind and “lighter” legs, you’ll be dozing off within seconds.
An advanced option is to keep your legs in the “butterfly” position by turning the knees outward and bringing the soles of the feet together.
Variations of the pose
Once you’ve conquered the first position, you might want to try other variations.
One option is to spread the legs out in V-position so that the inner thighs get a deeper stretch.
Ensure that the knees are not rotated outwards as this places a strain on the inner side of the knee (medial collateral ligament). The kneecaps should be kept parallel to the floor.
If the knees start to hurt, bend them for a few minutes to allow the groin area to stretch more. Then attempt to straighten the knees again.
Dancers love this position as it helps improve flexibility to obtain a wider side split.
Another viparita karani variation is to keep your legs in the “butterfly” position.
Turn the knees outward and bring the soles of the feet together, with the legs pressed against the wall.
This is quite an intense stretch, allowing you to experience the deepest groin stretch from this pose.
If you’re game to work some more muscles, take it up a notch by avoiding the wall and using no support.
This will force the abdominal muscles to engage and help with toning.
A word of caution
Viparita karani is suitable for most people in any age group, but is contraindicated for those with eye conditions such as glaucoma and detached retina.
Generally, any exercise that requires the body to be in an inverted position, i.e. placing the legs higher than the heart or having the heart higher than the head, should be avoided by people with cardiovascular problems.
This position is also a no-no for those with high blood pressure.
Beginners and those with back discomfort or spinal issues may use a bolster or a pillow to support the lower back.
Many yoga teachers advise women against practising this mild inversion during their menstruation to prevent “back flow” of blood.
My take: As long as the pelvis is not elevated with a bolster or other props, and is not higher than the heart (i.e. you’re lying flat on the floor), it is perfectly safe to do viparita karani.
In fact, many of my female students find the pose helps relieve cramps and stretches out sore back muscles.
Traditionally, yogis believe that inversions during menstruation lead to endometriosis, a painful condition that occurs when bits of the tissue that lines the uterus (endometrium) grow on other pelvic organs, such as the ovaries or fallopian tubes.
This is highly unlikely unless you’re staying in inversions for an extended duration during your period, or are experiencing a heavy flow, which then makes staying in the pose uncomfortable.
Putting your legs up on the wall is such a simple exercise with a range of benefits that it’s almost a crime not to do it daily. You don’t even need to warm up!
Some of my fidgety friends do a two-in-one by getting into the pose and fiddling with their electronic gadgets.
Please don’t do this. Be kind to yourself and switch off for 20 minutes. Your body will thank you and serve you well in the long run.
So, wait no more and toss ‘em legs up!
Revathi Murugappan is a certified fitness trainer who tries to battle gravity and continues to dance to express herself artistically and nourish her soul.
Physicians experience extremely high levels of burnout, and that’s contributing to medical errors.
That’s the conclusion of a new Mayo Clinic study (in August 2018) that found more than half of the physicians in the United States experience burnout, defined as either emotional exhaustion or a feeling of distance from a one’s job and colleagues, said Dr Christine Sinsky, the vice president of professional satisfaction at the American Medical Association and a researcher on the study.
Those findings resonate with Dr Albert Chan, chief of digital patient experience for Sutter Health, California, and a family medicine doctor.
“Our physician culture (is) very much a culture of: put the patients first, which we always do and still do,” he said. “But sometimes, it’s at the expense of ourselves. And increasingly we understand that that’s not a healthy thing.”
The study, published in Mayo Clinic Proceedings, compiled survey results from 6,695 physicians in the US responding to topics like fatigue, burnout, thoughts of suicide and workplace safety.
Thirty-two percent of respondents reported feeling excessive fatigue and more than 10% said they had committed what they considered to be a major medical error in the three months prior to taking the survey.
The physicians who reported major medical errors also acknowledged higher levels of burnout.
Of the 663 physicians who reported medical errors, nearly 40% said the mistakes were caused by errors in judgment and 20% attributed them to an incorrect diagnosis.
“The study found that there’s two times the rate of perceived error when physicians are burned out,” Dr Sinsky said.
The survey asked physicians to give their work areas a grade based on patient safety.
Burnout was found to be more likely in areas with low safety grades, but it also occurred in areas with high safety grades.
“High burnout, even in an excellent safety environment, is nearly as risky as no burnout in a unit that had a poor safety grade,” she said.
Medical errors are responsible for 100,000 to 200,000 patient deaths every year in the US, according to the study.
The study linked burnout rate to factors including a “chaotic work environment or lack of control over that work environment”, said Dr Sinsky.
Another factor is work that takes physicians away from direct patient care.
“(There is) a great increase in the amount of administrative and clerical work,” she said. “That disconnects physicians from the reason why they went into the profession in the first place and that’s a source of burnout.”
Physicians can be slow to seek out personal help, sometimes resorting to self care and end up committing suicide at a rate that exceeds national averages, the study reports.
Dr Peter Yellowlees, a professor of psychiatry and the vice-chair for faculty development in the University of California (UC), Davis, Department of Psychiatry, has researched the suicide issue.
“It’s estimated there’s something like 400 physicians a year in American suicide – that’s the equivalent of two large medical school classes,” said Dr Yellowlees, who recently published a book titled Physician Suicide Cases and Commentary.
As a practising psychiatrist, he sees physicians as clients. These physicians come from a variety of health groups, including UC Davis, Sutter Health, Kaiser Permanente and Mercy General Hospital, as well as private practice.
Burnout is a minor psychiatric problem that can have more severe implications, he said.
“I think it’s pretty clear burnout can act as a trigger,” he said. “We know that there are lots of causes of depression. If you are then in a situation where you’re feeling very burnt out through your work, it can be a trigger.”
In addition to its effect on physicians, burnout also hurts physicians’ families and their patients in various ways.
“We know that patients are less adherent to our treatment recommendations when physicians are burned out, physicians show less empathy to their patients when burned out, and physicians are less satisfied with their care,” Dr Sinsky said.
“Physicians and other clinicians who are burned out are at higher risk of divorce, diseases such as coronary artery disease, drug and alcohol abuse.”
In the 16 years Dr Chan has been in practice, he said he’s never experienced burnout. But he’s seen the impact on his colleagues.
“At a minimum, we spend 11-plus years to get where we’re at and to reach the end of your training, which is really just the beginning of your career, and you wonder if you should continue to be a physician and you’re fatigued – that’s a concern,” he said.
Californian health providers like Sutter and Kaiser are aware of these issues and are actively working to reduce the number of stressors affecting physicians.
A feature story published by Kaiser in 2017 addressed the health group’s active and ongoing focus on improving the mental health and well-being of its medical students and staff.
Efforts by Kaiser include providing wellness services like nutrition counselling and teaching students “resilience and coping skills”.
In the summer of 2016, Sutter encouraged its providers to engage in acts of gratitude during a two-month campaign aimed at reducing burnout.
And the Sierra Sacramento Valley Medical Society hosts the annual Joy of Medicine summit, which looks to connect local physicians and help them bring joy back into their profession.
Some researchers looking into physician burnout have criticised similar efforts, saying they blame physicians instead of broader issues and employers for burnout.
“It’s more nuanced, I think,” Dr Yellowlees said. “It’s absolutely true that you can’t resilience yourself out of burnout. It’s undoubtedly the organisational issues that cause burnout and that need changing.
“That’s why most groups… are trying to change the organisational culture. And you’ve got to avoid blaming physicians.”
But because physicians tend not to seek out care, it can be important for health systems or organisations to encourage physicians to do so, he said.
Dr Sinsky said she thinks change on a systemic level will yield more long-term results.
“It’s my observation that 80% of burnout is driven by system factors and only 20% is driven by individual factors,” she said. “We really get more for our investments if we invest in system factors that reduce burnout.”
The American Medical Association and Sutter Health are looking into regulatory issues that can add to the administrative load on physicians.
Maintenance of electronic health records is one time-consuming area both groups mentioned.
Dr Chan mentioned research published by Health Affairs, which found physicians spend around 3.08 hours in face-to-face interactions with patients and 3.17 hours interacting with electronic health records and other virtual tasks every day.
Sutter is one of several healthcare systems that use a system developed by Augmedix Inc. that connects physicians with a remote, trained scribe.
Physicians wear Google Glass during appointments with patients and the technology allows the remote scribes, who take notes and provide medics with information, to sit in on the appointment.
Sutter patients are made aware of the remote digital assistant beforehand and there is a 98% patient acceptance rating for the service, used in doctors’ offices in areas including Sacramento and the Central Valley, said a Sutter spokesperson.
This service allows providers more time doing the face-to-face work they most enjoy.
Reducing burnout among physicians is important both to ensure quality of care and because burnout is one of the reasons behind the nationwide physician shortage, Dr Sinsky said.
The Association of American Medical Colleges projects a shortage of up to 100,000 doctors by the year 2030.
Dr Sinsky referenced data from surveys completed in 2007 and 2014 that predict 2% of physicians are highly likely to leave the medical profession. That can be reduced if the job is made more fulfilling.
“Anything that gets in the way of physicians being able to provide that high quality care is likely a contributor to burnout,” she said. “This is a solvable problem. I believe that we can work more productively together to begin to solve these problems.” – The Sacramento Bee/Tribune News Service