Hacking the Nervous System - Learning to Control One Nerve

Shaping your health by learning to control the one nerve that connects your vital organs

When Maria Vrind, a former gymnast from Volendam in the Netherlands, found that the only way she could put her socks on in the morning was to lie on her back with her feet in the air, she had to accept that things had reached a crisis point. “I had become so stiff I couldn’t stand up,” she says. “It was a great shock because I’m such an active person.”

It was 1993. Vrind was in her late 40s and working two jobs, athletics coach and a carer for disabled people, but her condition now began taking over her life. “I had to stop my jobs and look for another one as I became increasingly disabled myself.” By the time she was diagnosed, seven years later, she was in severe pain and couldn’t walk any more. Her knees, ankles, wrists, elbows and shoulder joints were hot and inflamed. It was rheumatoid arthritis, a common but incurable autoimmune disorder in which the body attacks its own cells, in this case the lining of the joints, producing chronic inflammation and bone deformity.

Inflamed joints

Waiting rooms outside rheumatoid arthritis clinics used to be full of people in wheelchairs. That doesn’t happen as much now because of a new wave of drugs called biopharmaceuticals – such as highly targeted, genetically engineered proteins – which can really help. Not everyone feels better, however: even in countries with the best healthcare, at least 50 per cent of patients continue to suffer symptoms.

Like many patients, Vrind was given several different medications, including painkillers, a cancer drug called methotrexate to dampen her entire immune system, and biopharmaceuticals to block the production of specific inflammatory proteins. The drugs did their job well enough – at least, they did until one day in 2011, when they stopped working.

I was on holiday with my family and my arthritis suddenly became terrible and I couldn’t walk – my daughter-in-law had to wash me.

Vrind was rushed to hospital, where she was hooked up to an intravenous drip and given another cancer drug, one that targeted her white blood cells. “It helped,” she admits, but she was nervous about relying on such a drug long-term.

Luckily, she would not have to. As she was resigning herself to a life of disability and monthly chemotherapy, a new treatment was being developed that would profoundly challenge our understanding of how the brain and body interact to control the immune system. It would open up a whole new approach to treating rheumatoid arthritis and other autoimmune diseases, using the nervous system to modify inflammation. It would even lead to research into how we might use our minds to stave off disease.

And, like many good ideas, it came from an unexpected source.

The nerve hunter

Kevin Tracey, a neurosurgeon based in New York, is a man haunted by personal events – a man with a mission. “My mother died from a brain tumour when I was five years old. It was very sudden and unexpected,” he says. “And I learned from that experience that the brain – nerves – are responsible for health.” This drove his decision to become a brain surgeon. Then, during his hospital training, he was looking after a patient with serious burns who suddenly suffered severe inflammation. “She was an 11-month-old baby girl called Janice who died in my arms.”

Dr Kevin Tracey

These traumatic moments made him a neurosurgeon who thinks a lot about inflammation. He believes it was this perspective that enabled him to interpret the results of an accidental experiment in a new way.

In the late 1990s, Tracey was experimenting with a rat’s brain. “We’d injected an anti-inflammatory drug into the brain because we were studying the beneficial effect of blocking inflammation during a stroke,” he recalls. “We were surprised to find that when the drug was present in the brain, it also blocked inflammation in the spleen and in other organs in the rest of the body. Yet the amount of drug we’d injected was far too small to have got into the bloodstream and travelled to the rest of the body.”

After months puzzling over this, he finally hit upon the idea that the brain might be using the nervous system – specifically the vagus nerve – to tell the spleen to switch off inflammation everywhere.

It was an extraordinary idea – if Tracey was right, inflammation in body tissues was being directly regulated by the brain. Communication between the immune system’s specialist cells in our organs and bloodstream and the electrical connections of the nervous system had been considered impossible. Now Tracey was apparently discovering that the two systems were intricately linked.

The first critical test of this exciting hypothesis was to cut the vagus nerve. When Tracey and his team did, injecting the anti-inflammatory drug into the brain no longer had an effect on the rest of the body. The second test was to stimulate the nerve without any drug in the system. “Because the vagus nerve, like all nerves, communicates information through electrical signals, it meant that we should be able to replicate the experiment by putting a nerve stimulator on the vagus nerve in the brainstem to block inflammation in the spleen,” he explains. “That’s what we did and that was the breakthrough experiment.”

The vagus nerve

The wandering nerve

The vagus nerve starts in the brainstem, just behind the ears. It travels down each side of the neck, across the chest and down through the abdomen. ‘Vagus’ is Latin for ‘wandering’ and indeed this bundle of nerve fibres roves through the body, networking the brain with the stomach and digestive tract, the lungs, heart, spleen, intestines, liver and kidneys, not to mention a range of other nerves that are involved in speech, eye contact, facial expressions and even your ability to tune in to other people’s voices. It is made of thousands and thousands of fibres and 80 per cent of them are sensory, meaning that the vagus nerve reports back to your brain what is going on in your organs.

Operating far below the level of our conscious minds, the vagus nerve is vital for keeping our bodies healthy. It is an essential part of the parasympathetic nervous system, which is responsible for calming organs after the stressed ‘fight-or-flight’ adrenaline response to danger. Not all vagus nerves are the same, however: some people have stronger vagus activity, which means their bodies can relax faster after a stress.

The strength of your vagus response is known as your vagal tone and it can be determined by using an electrocardiogram to measure heart rate. Every time you breathe in, your heart beats faster in order to speed the flow of oxygenated blood around your body. Breathe out and your heart rate slows. This variability is one of many things regulated by the vagus nerve, which is active when you breathe out but suppressed when you breathe in, so the bigger your difference in heart rate when breathing in and out, the higher your vagal tone.

Breathing and the vagus nerve

Research shows that a high vagal tone makes your body better at regulating blood glucose levels, reducing the likelihood of diabetes, stroke and cardiovascular disease. Low vagal tone, however, has been associated with chronic inflammation. As part of the immune system, inflammation has a useful role helping the body to heal after an injury, for example, but it can damage organs and blood vessels if it persists when it is not needed. One of the vagus nerve’s jobs is to reset the immune system and switch off production of proteins that fuel inflammation. Low vagal tone means this regulation is less effective and inflammation can become excessive, such as in Maria Vrind’s rheumatoid arthritis or in toxic shock syndrome, which Kevin Tracey believes killed little Janice.

Having found evidence of a role for the vagus in a range of chronic inflammatory diseases, including rheumatoid arthritis, Tracey and his colleagues wanted to see if it could become a possible route for treatment. The vagus nerve works as a two-way messenger, passing electrochemical signals between the organs and the brain. In chronic inflammatory disease, Tracey figured, messages from the brain telling the spleen to switch off production of a particular inflammatory protein, tumour necrosis factor (TNF), weren’t being sent. Perhaps the signals could be boosted?

He spent the next decade meticulously mapping all the neural pathways involved in regulating TNF, from the brainstem to the mitochondria inside all our cells. Eventually, with a robust understanding of how the vagus nerve controlled inflammation, Tracey was ready to test whether it was possible to intervene in human disease.

Pacemaker implant

Stimulating trial

In the summer of 2011, Maria Vrind saw a newspaper advertisement calling for people with severe rheumatoid arthritis to volunteer for a clinical trial. Taking part would involve being fitted with an electrical implant directly connected to the vagus nerve. “I called them immediately,” she says.

I didn’t want to be on anticancer drugs my whole life; it’s bad for your organs and not good long-term.

Tracey had designed the trial with his collaborator, Paul-Peter Tak, professor of rheumatology at the University of Amsterdam. Tak had long been searching for an alternative to strong drugs that suppress the immune system to treat rheumatoid arthritis. “The body’s immune response only becomes a problem when it attacks your own body rather than alien cells, or when it is chronic,” he reasoned. “So the question becomes: how can we enhance the body’s switch-off mechanism? How can we drive resolution?”

When Tracey called him to suggest stimulating the vagus nerve might be the answer by switching off production of TNF, Tak quickly saw the potential and was enthusiastic to see if it would work. Vagal nerve stimulation had already been approved in humans for epilepsy, so getting approval for an arthritis trial would be relatively straightforward. A more serious potential hurdle was whether people used to taking drugs for their condition would be willing to undergo an operation to implant a device inside their body:

There was a big question mark about whether patients would accept a neuroelectric device like a pacemaker,” Tak says.

He needn’t have worried. More than a thousand people expressed interest in the procedure, far more than were needed for the trial. In November 2011, Vrind was the first of 20 Dutch patients to be operated on.

They put the pacemaker on the left-hand side of my chest, with wires that go up and attach to the vagus nerve in my throat,” she says. “I waited two weeks while the area healed, and then the doctors switched it on and adjusted the settings for me.”

Pacemaker x-ray

She was given a magnet to swipe across her throat six times a day, activating the implant and stimulating her vagus nerve for 30 seconds at a time. The hope was that this would reduce the inflammatory response in her spleen. As Vrind and the other trial participants were sent home, it became a waiting game for Tracey, Tak and the team to see if the theory, lab studies and animal trials would bear fruit in real patients. “We hoped that for some, there would be an easing of their symptoms – perhaps their joints would become a little less painful,” Tak says.

At first, Vrind was a bit too eager for a miracle cure. She immediately stopped taking her pills, but her symptoms came back so badly that she was bedridden and in terrible pain. She went back on the drugs and they were gradually reduced over a week instead.

And then the extraordinary happened: Vrind experienced a recovery more remarkable than she or the scientists had dared hope for.

“Within a few weeks, I was in a great condition,” she says. “I could walk again and cycle, I started ice-skating again and got back to my gymnastics. I feel so much better.” She is still taking methotrexate, which she will need at a low dose for the rest of her life, but at 68, semi-retired Vrind now plays and teaches seniors’ volleyball a couple of hours a week, cycles for at least an hour every day, does gymnastics, and plays with her eight grandchildren.

Other patients on the trial had similar transformative experiences. The results are still being prepared for publication but Tak says more than half of the patients showed significant improvement and around one-third are in remission – in effect cured of their rheumatoid arthritis. Sixteen of the 20 patients on the trial not only felt better, but measures of inflammation in their blood also went down. Some are now entirely drug-free. Even those who have not experienced clinically significant improvements with the implant insist it helps them; nobody wants it removed.

We have shown very clear trends with stimulation of three minutes a day,” Tak says. “When we discontinued stimulation, you could see disease came back again and levels of TNF in the blood went up. We restarted stimulation, and it normalised again.”

Nerve stimulation

Tak suspects that patients will continue to need vagal nerve stimulation for life. But unlike the drugs, which work by preventing production of immune cells and proteins such as TNF, vagal nerve stimulation seems to restore the body’s natural balance. It reduces the over-production of TNF that causes chronic inflammation but does not affect healthy immune function, so the body can respond normally to infection.

I’m really glad I got into the trial,” says Vrind. “It’s been more than three years now since the implant and my symptoms haven’t returned. At first I felt a pain in my head and throat when I used it, but within a couple of days, it stopped. Now I don’t feel anything except a tightness in my throat and my voice trembles while it’s working.

“I have occasional stiffness or a little pain in my knee sometimes but it’s gone in a couple of hours. I don’t have any side-effects from the implant, like I had with the drugs, and the effect is not wearing off, like it did with the drugs.”

Raising the tone

Having an electrical device surgically implanted into your neck for the rest of your life is a serious procedure. But the technique has proved so successful – and so appealing to patients – that other researchers are now looking into using vagal nerve stimulation for a range of other chronic debilitating conditions, including inflammatory bowel disease, asthma, diabetes, chronic fatigue syndrome and obesity.

But what about people who just have low vagal tone, whose physical and mental health could benefit from giving it a boost? Low vagal tone is associated with a range of health risks, whereas people with high vagal tone are not just healthier, they’re also socially and psychologically stronger – better able to concentrate and remember things, happier and less likely to be depressed, more empathetic and more likely to have close friendships.

Twin studies show that to a certain extent, vagal tone is genetically predetermined – some people are born luckier than others. But low vagal tone is more prevalent in those with certain lifestyles – people who do little exercise, for example. This led psychologists at the University of North Carolina at Chapel Hill to wonder if the relationship between vagal tone and wellbeing could be harnessed without the need for implants.

In 2010, Barbara Fredrickson and Bethany Kok recruited around 70 university staff members for an experiment. Each volunteer was asked to record the strength of emotions they felt every day. Vagal tone was measured at the beginning of the experiment and at the end, nine weeks later. As part of the experiment, half of the participants were taught a meditation technique to promote feelings of goodwill towards themselves and others.

Meditating to promote feelings of goodwill

Those who meditated showed a significant rise in vagal tone, which was associated with reported increases in positive emotions. “That was the first experimental evidence that if you increased positive emotions and that led to increased social closeness, then vagal tone changed,” Kok says.

Now at the Max Planck Institute in Germany, Kok is conducting a much larger trial to see if the results they found can be replicated. If so, vagal tone could one day be used as a diagnostic tool. In a way, it already is. “Hospitals already track heart-rate variability – vagal tone – in patients that have had a heart attack,” she says, “because it is known that having low variability is a risk factor.”

The implications of being able to simply and cheaply improve vagal tone, and so relieve major public health burdens such as cardiovascular conditions and diabetes, are enormous. It has the potential to completely change how we view disease. If visiting your GP involved a check on your vagal tone as easily as we test blood pressure, for example, you could be prescribed therapies to improve it. But this is still a long way off: “We don’t even know yet what a healthy vagal tone looks like,” cautions Kok. “We’re just looking at ranges, we don’t have precise measurements like we do for blood pressure.”

Meditation for health

What seems more likely in the shorter term is that devices will be implanted for many diseases that today are treated by drugs:

As the technology improves and these devices get smaller and more precise,” says Kevin Tracey, “I envisage a time where devices to control neural circuits for bioelectronic medicine will be injected – they will be placed either under local anaesthesia or under mild sedation.”

However the technology develops, our understanding of how the body manages disease has changed for ever. “It’s become increasingly clear that we can’t see organ systems in isolation, like we did in the past,” says Paul-Peter Tak. “We just looked at the immune system and therefore we have medicines that target the immune system.

“But it’s very clear that the human is one entity: mind and body are one. It sounds logical but it’s not how we looked at it before. We didn’t have the science to agree with what may seem intuitive. Now we have new data and new insights.”

And Maria Vrind, who despite severe rheumatoid arthritis can now cycle pain-free around Volendam, has a new lease of life: “It’s not a miracle – they told me how it works through electrical impulses – but it feels magical. I don’t want them to remove it ever. I have my life back!”

4 Strategies for Staying Calm in Stressful Moments

“Between stimulus and response, there is a space. In that space is our power to choose our response. In our response, lies our growth and our freedom.” –Dr. Viktor Frankl

In the famous quote above, Frankl, a physician and holocaust survivor, presents a radical idea about personal growth and fulfillment. He seems to say that, if we could simply pause for long enough to access our uniquely human ability to evaluate the wisest response, we can break free from suffering and tap our higher potential.

Frankl not only survived time in three different Nazi death camps, he also helped his fellow prisoners. As he describes in the international bestseller, Man’s Search for Meaning, Frankl also noticed that, among his fellow prisoners, those with a sense of greater meaning or purpose (such as the desire to live to share their story and prevent another genocide) were most likely to survive. After his release, Frankl took the lessons from his experience and created an entirely new school of psychology based on finding meaning in life, which is still in use today.

The Chinese character for crisis contains the sub-characters danger and opportunity. Within every crisis, there is the possibility of falling into the danger, or the potential to find or create an opportunity. Frankl exemplified this possibility: He transformed his greatest crisis—something far more trying than what most of us can imagine—into an opportunity to serve and his life’s legacy.

What if we could all learn to pause for long enough to get into the gap between stimulus and response and choose a response that makes the highest possible use of a situation?

Getting in the gap may sound like a fantastic idea, but it can seem exceedingly difficult to do in trying times. In moments of stress the region of our brain that triggers the fight or flight response, the amygdala, shuts down the pre-frontal cortex, the brain region responsible for clear thinking and rational decision-making. When we’re hot headed or afraid, we literally can’t think straight.

Have you ever said something you regretted when upset? Or acted in a hot flash of rage? Or, maybe you’ve gotten up to give a public speech, and suddenly your mind goes blank? That’s the fight or flight response in action. What if, like Frankl, we learned to slow down time for at least long enough to gain access to this gap between stimulus and response?

Here are three very simple techniques we can apply to put on the brakes and increase the space between stimulus and response:

1. STOP is an acronym designed to help us get in the gap.  It stands for:

• Literally pause before saying or doing anything.
• Take one to three deep breaths, and really feel the sensations of each breath. (Deep breathing, especially with a slow exhale, helps send signals of relaxation to your brain).
• Observe the entire situation, both internal and external. Take stock of the sensations in your body, your emotional state, the circumstances/dynamic of this situation/interaction.
• Proceed in a way that supports you and your highest intentions for this situation. If you’re unclear about the best next step, it can help to return to your intention for your relationship with this person, or simply who you want to be. Then, from this place of highest intentions, choose your next move.

Making the simple choice to STOP can create a literal gap between stimulus and response and enable us to calm down enough to make choices that align with our highest intentions.

2. RAIN is another acronym that can help us deal with difficult emotions.

• Recognize the emotion you’re feeling
• Accept the emotion or emotions, without judgment. Often we make things worse by beating ourselves up when we feel angry, sad, or jealous. This only creates additional suffering. In Buddhism, this is often referred to as the second arrow—we’ve already been shot with a difficult emotion; why make the situation worse?
• While we can’t necessarily change the emotion we’re feeling in this moment, we can prevent unnecessary pain by not berating ourselves for how we feel. We can avoid launching the second, third, or thousandth arrow. Accepting our emotions as they are is the first step in this process.
• Emotions can feel extremely solid. However, in reality, they’re quite dynamic, frequently shifting in intensity, location in our body, etc. As you move to the “I” in RAIN, please take a moment to investigate how the emotion feels in your body. What physical sensations do you notice? What’s the story you’re telling yourself? Is the emotion static and heavy, or is it fiery and dynamic. Is it monolithic—do you feel only anger—or are there shades of disappointment, embarrassment, or resentment? According to the work of Daniel Siegel, M.D., clinical professor of psychiatry at the UCLA School of Medicine and the founder and co-director of the Mindful Awareness Research Institute, just naming an emotion can help to tame it by engaging the brain’s logical, linear left hemisphere.
• Non-identification. One of the best things we can do is to recognize we are not our emotions. The fact I feel anger in this moment does not make me an angry or bad person. Non-identification can be helped by changing our language. In English, we talk about emotions using phrase “I am …” such as, “I am angry,” or “I am scared.” However, in many romance languages, people say “tengo miedo” or “I have fear” rather than “I am scared.” This helps the person speaking separate his identity from the emotion he is feeling. Although we may not speak French or Spanish, we can change the terms we use, shifting from “I am angry” to “I feel anger arising.” This simple shift can help us get unhooked/disentangled from gnarly emotions.

3. Hold your difficult emotions like a crying baby. Zen master Thich Nhat Hanh often encourages his students to hold anger and other difficult emotions like they would a crying baby. When a baby cries, we don’t generally get angry with it or make it wrong for feeling upset. Rather, we hold the infant tenderly in our arms, do our best to soothe its distress, and ask, “What do you need?” Unfortunately, when we’re upset, we often make ourselves wrong for feeling a certain way. Instead, Thay (as he’s known by his students) encourages us to hold our emotions with tenderness and care and ask the simple question:  What do you need? As we soothe this fiery emotion and care for its underlying need, we often find ourselves freed from the emotion’s grasp.

4. Get in touch with your sole(s). This final strategy is the simplest: Any time you feel overwhelmed by a “negative” emotion, merely take a few moments to feel the sensations of the soles of your feet as they press into the floor below you. This can help ground you in the present moment (by definition, physical generally happen in the present moment.) A research study looking at kids with autism and emotional difficulties found that this simple technique helped them regular emotions.

The Muscle You've Never Heard of But Need to Know

When it comes to a tight core, most people picture six-pack abs. But a truly toned core is much more than what you see on the surface. Deep within your loins, the psoas (pronounced SO-az) muscle group partners with other muscles to stabilize and girdle the lower spine, promoting proper body alignment.

"It's our most important skeletal muscle," says Jo Ann Staugaard-Jones, an advanced Pilates and Hatha yoga instructor and author of The Vital Psoas Muscle: Connecting Physical, Emotional, and Spiritual Well-Being. "The psoas is the only muscle connecting the spine to the legs, so it serves as the sole link between the upper and lower extremities." Even though you've never seen it, it creates movement and flow throughout the body, constantly contracting and releasing.

Just like other muscles, the psoas can grow stronger or weaker, depending on your lifestyle. Sitting all day is a killer, as one might expect. In today's sedentary society, Staugaard-Jones says the average person spends five to 11 hours a day sitting, hastening muscle atrophy. Between computer use, driving, flying, reading, watching TV, and sitting at a table to eat or write, we are constantly placing our bodies in a relaxed hip flexion position, with the full weight of the torso hovering on top and the lower extremities inactive. Such a position can inhibit circulation, muscle conditioning, and nerve response, leading to lower back pain, sciatica, and poor posture.

Related: An Expert Guide to Learning Crow Pose

"If you sit for a good portion of the day," Staugaard-Jones warns, "chances are your psoas is tight." Pain isn't always a symptom, but it can be. "If a patient complains of chronic, dull, bilateral pain in their lower back and groin, that's a big clue that their psoas needs relaxing and stretching." They may also feel discomfort in their hip sockets, glutes, or sacroiliac joints in the back of the pelvis.

Another, more surprising, cause of psoas pain may be emotional trauma. The psoas is known as "the fight or flight muscle" because when the body or mind become stressed, the psoas tightens and contracts in a primal response designed to protect us from harm. Thousands of years ago, an approaching brontosaurus would cause our psoas to instinctively shrink and contract, reducing us to as small a target as possible. Today, the trigger could be a divorce, job loss, losing a friend or family member, or just the general stress of life.

Related: 4 Strategies for Staying Calm in Stressful Moments

In some situations, strengthening moves like lunges, windmills, and Boat Pose can help, but often a painful psoas first needs stretching and rest, not exercise. The following three moves will help relax and stabilize the psoas, promote proper posture, ease pain and help break the fight or flight cycle.

Constructive rest position, or CRP, is an incredibly effective, and relatively easy, way of releasing a tight psoas; you essentially lie down and let gravity do the work. (If you like Corpse Pose, you'll love CRP.) Mental imagery intensifies the process. Begin by lying face-up on a yoga mat on the floor or another firm, flat surface. Knees should be bent and resting against each other; feet are flat on the floor, hip-width apart (or slightly wider if that's more comfortable). Arms can be relaxed alongside you in classic Savasana pose. Then, have someone read the following prompts to you (or visit Staugaard-Jones' website, where she narrates the CRP):

Close your eyes and imagine a current of energy traveling down your spine, looping up between your legs, traveling up the front of the body and back down the spine again. Inhale as the energy flows downward; exhale as it moves up. Feel your head melting into the ground. Imagine your knees are draped over a hanger suspended from above, thighs hanging on one side, lower legs on the other. Next, picture a small waterfall trickling down your thigh, first from the knees into the hip sockets, and then down the skins to the ankles. Feel as if your eye, hips, and feet are relaxing in calm pools of water.

Slowly repeat this imagery for 10 minutes. By the end, your femurs will relax in their corresponding hip sockets, free from the hip flexors' grip, and your spine will follow its natural curves. Both improvements are excellent for releasing the psoas. Roll to one side and bring yourself to a sitting position (rather than sitting straight up, which will compromise your new alignment.)

Half Bridge Pose stretches out the hips and low back. Begin in the same position as with CRP, feet hip-width apart. Position both arms along the sides of your body, palms down, fingers reaching toward heels. Press your arms and feet into the floor, exhale and lift your pelvis, pushing it towards the ceiling. Keep your thighs parallel to one another and your pelvis in line with your knees. (If this position hurts your neck or upper back, place a folded towel underneath.) If your hips are high enough, you may be able to clasp your hands underneath and bring the shoulder blades closer together. Hold for 30 seconds to one minute, then slowly release as you exhale.

Hint: If this pose feels too challenging, place a yoga block beneath the base of your spine for added support and stress relief.

Related: A Bridge Sequence for Opening the Shoulders

Warrior I and II poses strengthen, stretch, and stabilize the psoas; like all standing poses, they teach correct alignment and improve circulation and joint mobility. Watch this video tutorial to learn the foundations of Warrior postures. To practice, begin standing up, facing forward. Take a large step back (three to four feet) with your right leg, keeping hips facing forward. Your right foot will be turned out slightly. Pressing the outer edge of your right foot into the ground, bend the front (left) knee directly over the left ankle. Your weight should be evenly distributed between both legs. Hands can rest on your hips, or you can raise your arms overhead. (Individuals with untreated high blood pressure should not raise their arms in this pose.). Breathe in and out for 30 seconds to a minute. Return to standing and repeat on the other side.

Transition to Warrior II: While in Warrior I (bent left leg in front and right leg in back), keep your gaze forward while your body turns to the right. Your right arm will reach straight behind you, parallel to the floor, palm down; left arm extends straight ahead. Your back toes may naturally move out a bit to help open the hips. Breathe in and out for 30 seconds to a minute. Return to standing and repeat on the other side.

Hint: Concentrate on breathing; holding your breath will create tension and limit the stretch.

Learn more about the body's complex anatomy, and tools that can be used to realign imbalances on Sonima.com.

This article originally appeared on Huffington Post & was written by Leslie Goldman.

What To Do For Muscle and Joint Stiffness

Q: I went to see a chiropractor today to get orthopaedic lifts for my shoes, and he gave me a bit of an examination at the same time.

He told me that I was very stiff and I was likely feeling a lot of back pain. Actually I have no back pain but I am very stiff. I have always struggled with flexibility.

These days my upper shoulders and back of my neck are often sore and tight. I have been slowly working on some of the stretches on your website, but this guy wanted me to go see him and he would help me with adjustments, etc., etc.

I'm wondering if I can just rely on stretching (seriously 30 minutes a day) to regain flexibility and deal with these problems instead of actually seeing this guy.

A: Generally, my feeling is that it's best to see what you can accomplish with a regular stretching routine.

In the absence of chronic inflammation or pain from an acute injury, stiffness in the back, shoulder, and neck regions is typically caused by one or both of the following:

• Stiffness within the joints in the area

• Tight muscles

Joint stiffness can cause surrounding muscles to become tight from lack of use, and tight muscles can cause underlying joints to become stiff, also from lack of use. So for practical purposes, in addressing stiffness, it doesn't really matter which one is causing the other; the vast majority of stretches promote joint flexibility and healthy muscle length.

Chiropractic adjustments aim to prevent joint stiffness, typically by delivering a "short amplitude, high velocity" thrust through one of the planes through which the involved joints are designed to move.

Though chiropractic adjustments can be immensely helpful in promoting optimal joint motion, my experience has been that without regular stretching and awareness of daily activities and postures that are at the root of chronic stiffness, adjustments can become a short term fix.

In my opinion, it's better to adopt a lifelong program of stretching to establish and maintain healthy length and blood flow in all major muscle groups, which should help your joints and surrounding ligaments to stay healthy as well.

I would add foam rolling to your stretching routine, as I find it to be an invaluable tool for keeping muscles, ligaments, and the joints they service healthy.

Also keep in mind that beyond stretching and foam rolling, you can likely benefit from some resistance training that promotes a strong core and good body balance. For example, instead of doing conventional push-ups, by doing push-ups with one hand on the ground and one on a medicine ball, you force muscles, ligaments, and proprioceptors (joint receptors that register joint position sense) throughout your body to develop a high level of functional strength. By functional strength, I mean strength that your body can consciously and subconsciously use to stay balanced and be less prone to injury as you go about your daily activities.

Another example of an exercise that promotes good body balance is one-leg squats, where you keep your core strong, balance your weight on one leg, and do slow, controlled squats - even just a few degrees will yield big dividends to your functional core strength and balance.

But not to move too far away from your question, a regular program of stretching and foam rolling is where I would begin - this really needs to be the foundation of your self care program. If you try to do too much with strength and balance-related exercises without ensuring that your muscles are healthy and your joints are moving properly, you might just reinforce faulty patterns of being and moving.

Archive of Stretching and Foam Rolling Posts

After spending a few months taking care of your body, if you feel that you haven't experienced significant improvement and can use some help, that's when I might visit a chiropractor, physiotherapist, kinesiologist, or any other practitioner that specializes in functional movement work. If your stiffness is severe enough that you can't stretch and exercise effectively, then it makes sense to seek treatment from day one.

Find more info at: http://drbenkim.com/what-do-muscle-stiffness