Q-A Practice

YOGA FOR HIPS, LEGS AND FEET

Could you advise me on Yoga classes for my son and I. I have a hip and back problem that has greatly benefited from practising Yoga. I have  been following the 10 week course outlined in Mira Mehta’s book Yoga: The Iyengar Way for the past 6 months. Although I have practised some Yoga sporadically for many years, I now feel I need to broaden my practice with a teacher. My son who is 15 years old has never done yoga. He has a congenital leg and foot complaint that results in flat feet and drawn in knees, which results in an aching back and legs. This is similar to myself. I would appreciate your advice for both of us. JB

Answer

An ancient authority on Aayurveda, the Indian system of medicine, extols the virtue of exercise as follows:

“Lightness [of the body], ability to do [hard] work, keen digestion, depletion of [excess] fat, stable and distinct physique accrue from (physical exercises).” (Vaagbhata in Ashtanga Hridayam I.2.10)

This view is reiterated in the mediaeval manual on Yoga, the Hatha Yoga Pradiipikaa. Instead of unspecified exercises, Yogic postures are given the accolade:

“Aasanas make one firm, free from maladies and light of limb.” (HYP I.17)

Of the 84 aasanas it claims were propounded by the God Shiva, it chooses only a small selection for description. The commentator adds that according to another authority on Hatha Yoga (Goraksha) there are as many aasanas as there are varieties of beings, and that Shiva enumerated 84 lakhs (84 hundred thousand).

In the Hatha Yoga Pradiipikaa it happens that no standing poses are described. These are, however, most important for problems concerning the hips, legs and feet as they aid structural alignment. We have to turn to modern textbooks for information about them.

The most comprehensive and detailed of these is BKS Iyengar’s Light on Yoga. In the section on the effects of the various standing poses mention is made again and again of their therapeutic benefit for the legs, back and hips. To quote some examples:

Trikonaasaana “tones up the leg muscles, removes stiffness in the legs and hips, corrects any minor deformity in the legs and allows them to develop evenly. It relieves backaches… strengthens the ankles…”

Parivritta Trikonaasana “tones the thigh, calf and hamstring muscles. The spine and muscles of the back are also made to function properly, as the pose increases the blood supply round the lower part of the spinal region. [It] relieves pains in the back…and strengthens the hip muscles.”

Paarshvakonaasana “tones up the ankles, knees and thighs. It corrects defects in the calves and thighs…and relieves sciatic and arthritic pains…”

Ardha Chandraasana “is beneficial for those whose legs are damaged or infected. It tones the lower regions of the spine and the nerves connected with the leg muscles and it strengthens the knees…”

Paarshvottaanaasana “relieves stiffness in the legs and hip muscles and makes the hip joints and spine elastic…” (LOY pp. 63-71)

Standing poses are not the only aasanas which are beneficial. Dropped arches and other structural defects can be corrected or greatly improved through some seated postures which involve placing the legs and feet in different positions, increasing mobility and encouraging realignment. Pre-eminent is Viiraasana, the “Hero’s Pose”, but there are others.

The fatigue experienced as a result of weak and aching back and legs disappears with inverted poses and therefore these are also an important aspect of the Yoga programme to be followed. You can begin with the following aasanas; as you become practised and confident you can add more standing poses, more sitting poses, more twists, in fact, more of everything!

Viiraasana (sitting on a support)
Bharadvajaasana (on a chair)
Supta Paadangushthaasana (using a belt)
Trikonaasana (against a wall)
Paarshvakonaasana (against a wall)
Viirabhadraasana II (against a wall)
Viirabhadraasana I (back foot against wall)
Paarshvottaanaasana (hands on floor or blocks/supports)
Viiraasana Forward Bend
Sarvaangaasana (independently or on a chair)
Ardha Halaasana
Shavaasana

REFERENCES

Ashtanga Hridayam of Vaagbhata

Hatha Yoga Pradiipikaa of Svaatmaraama

BKS Iyengar, Light on Yoga

Silva, Mira & Shyam Mehta, Yoga: The Iyengar Way
 

CAN YOGA CONTROL APPETITE?

Answer

Yes – Yoga can help to control appetite.

Appetite, of course, has a physical basis, but is also linked to emotions. A healthy appetite should not be suppressed, but the desire to eat because of stress can be subdued by practising postures which calm and strengthen the nerves. Pre-eminent amongst these is the Shoulder-Balance (Sarvangasana), especially when it is done supported with the help of a chair.* In this pose the chest is lifted and broadened, giving a sense of freedom and emotional space. Cravings disappear, and with regular practice of the pose, within a balanced sequence of poses, they do not re-appear.

Yoga poses can also stimulate the appetite – but that is another story.

* For the method see my books Yoga: TheIyengar Way and Health through Yoga
 

YOGA AND ALZHEIMER’S DISEASE

I would be exceedingly grateful if you could point me in the direction of any articles or books on teaching yoga to those with Alzheimer’s or dementia related illnesses.  My parents are both in the more advanced stages of the disease but I have been asked to teach yoga to others in the earlier stages.  I am very intuitive in dealing with sufferers – I “speak their language”  … but really would appreciate any other’s experiences in this direction. JP

Answer

In the Yoga Suutras of Patanjali disease (vyaadhi), is cited as one of the nine distractions of the mind which become obstacles to Yoga (YS  I.30). It is defined as a disorder or imbalance of the humours, of the fluids or of the organs of the body. The other obstacles are lethargy, doubt, negligence, laziness, attachment to pleasures, wrong view of life, failure to achieve a meditative state and instability in this state. Consequent to these mental conditions and weaknesses are distress, depression due to the obstruction of desires, tremors, and irregular breathing (YS  I.31).

The remedy advocated by Patanjali first of all is focusing the mind on a single object (YS  I.32). Other practices for making the mind tranquil and stable are also suggested (YS  I.33-39).

While this discussion about disease and other impediments relates to meditation, it clearly has useful implications and pointers with respect to the less advanced stages of Yoga practice. The basic message is a positive one, that whatever difficulties beset the individual, persistence in practice and a dispassionate outlook are powerful counter measures which help to bring the mind under control.

Similarly an encouraging verse in the centuries-old Ha˜ha Yoga Pradiipikaa runs:

“Any person who is not lethargic in the pursuit of different forms of Yoga attains success through practice, be he young, old or even very old, sickly or weak.” (HYP I.64)

The modern authority BKS Iyengar explains the importance of Yoga practice in old age thus:

“At a certain age the body does decay, and if you do not do anything, you are not even supplying blood to those areas where it was being supplied before. By performing aasanas we allow the blood to nourish the extremities and the depths of the body, so that the cells remain healthy. But if you say, ‘No, I am old,’ naturally the blood circulation recedes. If the rains don’t come, there is drought and famine, and if you don’t do yoga – if you don’t irrigate the body – then when you get drought or famine in the body as incurable diseases, you just accept them and prepare to die.

“Why should you allow the drought to come when you can irrigate the body? If you could not irrigate it at all, it would be a different matter. But when it is possible to irrigate, you should surely do so. Not to do so allows the offensive forces to increase and the defensive forces to decrease. Disease is an offensive force; inner energy is a defensive force. As we grow, the defensive strength gets less and the offensive strength increases. That is how diseases enter into our system. A body which carries out yogic practice is like a fort which keeps up its defensive strength…” (TOY,  pp.30-31)

The question then is not whether to practise Yoga in old age but what to practise. This depends on the general physical condition of the students. In the case of people suffering from Alzheimer’s disease or other conditions in which memory and intellectual activities are impaired it is important to promote a good blood supply to the head. In general all postures in which the head is inverted or lowered are helpful as they facilitate the flow of blood to the brain. Supported supine poses, which give freedom to the chest region and facilitate breathing, thus improving oxygenation, are also beneficial. However, if there are other health problems these will also have to be taken into account and may necessitate modification of the aasana programme.

As these people are elderly you have to teach and observe them carefully and help them with the appropriate props. Some of the poses may not be immediately achievable.

Lying on cross-bolsters (raise the feet onto a support also)
Matsyaasana (simple cross legs only, trunk on a bolster)
Supta Baddhakonaasana (with bolster support)
Adhomukha Svaanaasana (head supported)
Uttaanaasana (head supported)
Prasaarita Paadottanaasana (head supported)
Janushir™aasana (head supported)
Triangamukhaipaada Pashcimottaanaasana (head supported)
Pashcimottaanaasana (head supported)
Sarvaangaasana on a chair
Ardha Halaasana
Setubandha Sarvaangasana (on bench)
Vipariita Karaši
Shavaasana (on bolster)

REFERENCES

Yoga Suutras of Patanjali

Ha˜ha Yoga Pradiipikaa of Svaatmatraama

B.K.S. Iyengar – The Tree of Yoga
 

YOGA AND DEPRESSION

My daughter suffers from bouts of deep depression and at times is suicidal. Can Yoga help? SA

Answer

The purpose of Yoga is to gain ascendancy over the mind. The definition given by the ancient authority Patanjali is that Yoga is the control of the states of the mind  (yogah chittavrttinirodhah, YS  I.2). The various practices it encompasses are directed towards giving the practitioner mental peace, strength and clarity as a preliminary to gaining spiritual knowledge.

In the Yoga Suutras of Patanjali (I.31) depression or despair (daurmanasya) is mentioned as a condition which disturbs equanimity and strength of mind. Vyaasa’s commentary on this sutra defines daurmanasya as “the mental condition consequent upon obstruction of desire”. The triad of dejection, pain and tremors of the body are said to accompany nine impediments which distract the mind and prevent progress. The impediments are “disease, laziness, doubt, failure to practice, indolence, addiction to sensual pleasures, delusion, failure to attain a plane of Yoga, and instability” (YS  I.30). Of these nine several can be recognised as symptoms of depression.

Thus depression is a condition which affects both the physical body and the mind. A depressed person often has a slumped posture with a caved-in chest. Positive thinking, self-esteem, laughter and optimism cannot find room in this posture. Modern medicine, too, recognises the psychosomatic nature of depression and the efficacy of exercise in combating it.

Even in cases where depression is deep-seated and medication is needed to maintain mental stability Yoga can be a powerful tool which goes to the root of the problem and helps to sort it out. I taught intermittently for several years a young girl who suffered from severe depression. She came to me first when she was fourteen and had already been under medication for some time. She would lie curled up on the floor, and, while she would answer when spoken to, she had the habit of going off into her own dream world. She was also physically weak and had scoliosis. With a regular, supervised regimen of exhilarating and calming aasanas her depressions lessened and she developed self-esteem and self-reliance. By her early twenties she was able to cope with going to college and to pass her driving test. Although she still has relapses she is not recognisable as the girl she grew out of. She has reduced her dependence on medication.

The Yoga programme to counteract depression consists of postures which invert the body, bringing a refreshing flow of blood to the head, and bend the spine backwards so that the chest is expanded, increasing oxygenation. Both these types of postures build up concentration, will power and strength of the nerves. They also alter mood, promoting a positive frame of mind. In cases of severe depression where lethargy and weakness of limbs are also present the postures need to be done with support, and under the guidance and encouragement of a teacher.

To quote the modern authority B.K.S. Iyengar on the key inverted poses Shirshaasana (head balance) and Sarvaangaasana (neck balance or shoulder stand):

“Regular practice of Shir™haasana makes healthy pure blood flow through the brain cells. This rejuvenates them so that the thinking power increases and thoughts become clearer…People suffering from loss of sleep, memory and vitality have recovered by the regular and correct practice of this aasana and have become fountains of energy…

The importance of Sarvaangaasana cannot be over-emphasised…Due to the soothing effect of the pose on the nerves, those suffering from hypertension, irritation, shortness of temper, nervous breakdown and insomnia are relieved…It also helps to relieve epilepsy, low vitality and anaemia…” (Light on Yoga, pp 127 & 137)

Suitable praanaayaama practice is inhalation in stages, Viloma I. This is non-strenuous, and increases the intake of air gently and effectively.

SUGGESTED PROGRAMME (see also Yoga: The Iyengar Way, p.185):

Adhomukha Vrikshaasana
Pinchha Mayuraasana
Adhomukha Shvaanaasana
Shirshaasana
Vipariita Dandaasana (on chair)
Ushtraasana
Uurdhvadhanuraasana
Viiraasana forward bend
Sarvaangaasana on chair
Setubandha Sarvaangaasana
 

YOGA FOR NECKS AND SHOULDERS

A few months ago I was in car accident and suffered whiplash. I get neck pain and stiffness, and also lower back pain. Please can you advise me.

Answer

When there is neck pain there is usually some compression in the neck area – the vertebrae or surrounding tissues, together with weakness and stiffness. Alleviation comes from two sources: support and the creation of space by stretching. The following programme is suitable for chronic or recurrent mild to medium conditions. If the pain is severe or trauma to the neck is recent, it is advisable to seek the guidance of a teacher.

Parvataasana in Sukhaasana or standing
Gomukhaasana (arms only)
Namaste behind back
Bharadvaajaasana (on chair, first without turning head) 2-3x then turn neck with dorsal spine concave
Marichyaasana standing 2-3x
Ardha Chandraasana (against wall, hand on support, looking down)
Parivritta Ardha Chandraasana (against wall, back foot supported, looking down)
Uttaanaasana (clasping hands behind)
Bharadvaajaasana I (against wall)
Maricyaasana III (against wall
Supine poses on bolster
Shavaasana (with head supported and an additional thinly rolled blanket under neck)
 

HELP WITH PRANAYAMA

In your book Yoga: The Iyengar Way in the section about praanaayaama you comment that mistakes made in praanaayaama may affect the nervous system and brain. Have you heard of people being affected in this way?  What happens? How can it be rectified?

About 18 months ago I was doing a beginners’ yoga class, really enjoying it and feeling great. The inhalation we were taught was from the diaphragm, chest and top chest and the exhalation was the same, from the diaphragm, chest and top chest.  However, when I had done yoga previously, we always were told to breathe out from top chest, chest and diaphragm. When walking in the mornings I would try to inhale and exhale from my diaphragm up to the chest.

Since that time my right leg and three right fingers have felt numb intermittently. For periods my lower legs and arms feel heavy as if I have weights on them, and there is the sensation of tingling. Sometimes I have pins and needles in the throat and around the lips. I have been to doctors for tests and scans of the brain but everything is always 100%.  I feel my body is out of kilter. I walk and swim for exercise but have not done yoga for 18 months.

Could you please explain which way is the correct breathing? If you can help me, I would be very grateful. LM

Answer

Problems can occur through incorrect practice. In Patanjali’s Yoga Suutras, which is regarded as the authoritative source text on Yoga, it is stated that praanaayaama requires the mastery of aasana (PYS II. 49). The mastery of aasana implies total equanimity in which the practitioner is not disturbed by conditions and emotions, viewed as paired counterparts such as heat and cold or pleasure and pain.

The Hatha Yoga Pradiipikaa, an important mediaeval manual of Yoga practice, gives a strong warning:

“As the lion, elephant or tiger is tamed gradually, even so should praana be brought under control, else it will kill the practitioner. Through the proper practice of praanaayaama there is freedom from all diseases. By a mistaken course of Yoga [the practitioner] brings upon himself all diseases. By a wrong course of praanaayaama are produced hiccup, asthma, bronchial diseases, pains in the head, ears and eyes and various other diseases.” (HYP II.15-17)

It further instructs:

“The Yogin, having perfected himself in aasana, should practise praanaayaama according to the instructions of his Guru, with his senses under control, conforming to a beneficial and moderate diet.” (HYP II.1)

In practical terms this means that praanaayaama is not for beginners in Yoga; a tranquil and steady mind has first to be achieved. In order to gain this a solid basis of regular practice of aasanas is advisable. B.K.S. Iyengar explains:

“There is a popular misconception that both aasanas and praanaayaama should be practised together from the time Yoga-saadhana is begun…If a novice attends to the perfection of the postures, he cannot concentrate on breathing. He loses balance and the depth of the aasanas. Attain steadiness and stillness in aasanas before introducing rhythmic breathing techniques. The range of bodily movements varies from posture to posture. The less the range of movement, the smaller will be the space in the lungs and the breathing pattern will be shorter. The greater the range of bodily movement in aasanas, the greater will be the lung capacity, and the deeper the breathing pattern. When praanaayaama and aasanas are done together, see that the perfect posture is not disturbed. Until the postures are perfected, do not attempt praanaayaama…When aasanas are well performed, praanaayaamic breathing automatically sets in.” (LOP, p.10)

Therefore, rather than doing praanaaayaama or breathing exercises you need to do a programme of restorative aasanas which calm the nervous system. You need not be afraid of doing them. If there is no teacher near you you will have to learn from books. You should include the following, if possible:

Supta Baddhakonaasana supported
Supta Viiraasana supported
Matsyaasana supported (do simple cross-legs if you can’t manage full lotus)
Lying on cross-bolsters
Adho Mukha Svaanaasana, head supported
Uttaanaasana, head supported
Shirshaasana (if you can do it)
Sarvaangaasana on a chair
Ardha Halaasana, thighs supported
Setu Bandha Sarvaangaasana supported
Vipariita Karani

You should feel comfortable in all these poses, otherwise there is something wrong (probably with the arrangement of props). If you do not have time to do all of them every day, you should make a selection. You must not do inverted poses during menstruation.

The tingling in the lips should stop with the practice of these recuperative postures. To bring back sensation in the fingers and legs you need to stretch them. Do

Parvataasana
Gomukhaasana (arms only)
Supta Paadaangushthaasana (using a belt)

Once the problems you have been experiencing are eliminated you should build up a regular, varied practice of aasanas. You should, however, continue with plenty of the above poses so that you do not lose what you have gained in calmness, steadiness, emotional strength and lung capacity. When your confidence is restored you can begin with simple praanaayaama techniques, preferably under the guidance of a teacher.

Regarding the question of the method of inhalation and exhalation: the intake and expulsion of breath in the lungs happens like the pouring of water into and out of a jar. When you pour water in, it fills from the bottom; when you pour water out, it empties from the top. Similarly, inhaled air reaches the bottom of the lungs first, and exhaled air leaves the top of the lungs first. This is the natural process. Any deliberate deviation from this norm should only be done by an experienced practitioner under the guidance of an experienced teacher.

REFERENCES

Yoga Suutras of Patanjali

Hatha Yoga Pradiipikaa of Svaatmaaraama

BKS Iyengar – Light on Praanaayaama

Silva, Mira and Shyam Mehta – Yoga: The Iyengar Way
 

INFORMATION, PLEASE!

Is it correct to try and keep the abdomen in while practising the asanas? AF

Answer

The abdomen is a breeding ground for stress, housing as it does the major portion of the digestive tract, which is supplied with an abundance of nerve endings. Think of “butterflies in the stomach”, “stomach-churning” anxiety, and those stress-related conditions like ulcers and irritable bowel syndrome. It also contains the female reproductive organs that regularly undergo physiological change and are liable to tensions such as menstrual cramps and dysmenorrhoea. – discomforts that have given menstruation its nickname, “the curse”.

As it is such a sensitive area, care should be taken not to induce or exacerbate tension in it.

This is not to say, however, that abdominal toning is not required. It is, and there is a natural process of tension free toning which occurs as a result of practising different kinds of postures.

In certain poses, such as Dog Pose with Head Down (Adhomukha Shvanasana) and Head Balance (Shirshasana), the abdomen naturally pulls back towards the spine. This occurs without tension: as the abdominal organs are inverted they are relieved of the weight of the upper body and become decompressed. Instead of hanging forward they are supported against the spine; this produces a soothing sensation.

Other postures such as seated twists involve contracting and turning the abdomen deliberately on an exhalation. In this way the intestines are exercised and massaged, increasing blood flow to them and reducing stress. (However, for obvious reasons, twists are not advised for ladies during menstruation or pregnancy, or for people who have recently undergone abdominal surgery.)

It is important to lengthen and relax the abdomen in order to reduce compression in the organs and give space for the physiological actions that occur in them. In the activities of normal life – standing, sitting, walking – the upper body always presses down on the lower body. Yoga poses help to counteract this. Standing poses make the abdomen stretch both upwards against gravity and laterally. Forward bends and inverted poses relax it.

Through all these diverse actions the abdomen – both its musculature and its organs – becomes toned. Once it is toned it can be strengthened further by postures requiring abdominal control, such as Boat Pose (Navasana) and Stomach-Churning Pose (Jathara-Parivartanasana) and Staff Pose (Chaturanga-Dandasana). Later still powerful abdominal muscles can be developed by advanced postures such as Peacock Pose (Mayurasana), Crane Pose (Bakasana) and so on.

In this way muscle strength in the abdomen is built progressively by stretching, relaxing, improving blood circulation and developing the grip of the abdominal muscles – not by holding it tensely in.
 

ABOUT FORWARD BENDS

At what point in forward bending is it acceptable to stop spinal extension and let the back “round”? AF

Answer

It is not a question in forward bending of being “acceptable” to stop spinal extension and let the back “round”. Both actions are part of the pose.

In forward bends, whether seated (Head-to-Knee Pose (Janushirshasana), etc) or standing, it is necessary to extend the trunk and spine before going down. Apart from stretching and therefore toning muscles and soft tissue, this prevents compression of the abdominal and thoracic organs. However, the seated forward bends are deeply relaxing because the head is lowered and the abdomen softens. For this reason if one stays in the preliminary stage of stretching the trunk and trying to make the back concave, a key benefit of these poses is lost. It does not make sense to say that people who are stiff should not bend forward at all – this would deny them the experience of relaxation enjoyed by more supple people.

There are various ways of approaching any type of pose, and different methods are appropriate at different times. Postures, like Rome, cannot be built in a day. So, sometimes one can bend forward, perhaps resting the head on a chair or other support to increase the relaxing effect. At other times one can concentrate on stretching the trunk in order to strengthen the spine and make it more flexible. Neither action should be neglected. (220)
 

ABOUT TWISTS

From what point should we begin twisting in the seated twists? AF

Answer

All rotation of the trunk, whether in seated poses or in standing poses, should begin from the base.

Imagine a skeleton sitting down and twisting its trunk. You can see clearly that the lower spinal vertebrae are embedded in the pelvis, while the upper ones are attached to the rib cage. Only the lumbar vertebrae – at the waist – are free.

Now imagine that the skeleton turns from the waist area and the lower back stays put. What will happen? If enough torsion is applied, the lumbar vertebrae may snap.

However, if the skeleton turns with the aid of the pelvic bones, the spine turns in its entirety and no part is placed under strain.

The living body can be viewed as the skeleton fleshed out with soft tissue, and so the principle of turning remains the same. Any spinal rotation should start from the base and be supported by the turn of the hips. As more torque is possible in the upper body the effect is like that of a spiral, with a small amount of turn at the bottom allowing a much greater arc of turn at the top.
 

UNEVEN HIPS

My hips work differently because I have arthritis and a bone spur in one hip. Should I work both legs evenly or each one at its own capacity? CW

Answer

One of the beauties of asana practice is that it brings both sides of the body into balance.

Although, broadly speaking, our bodies are symmetrical in design, in fact this symmetry hides smaller or larger asymmetries. These may be innate ~ such as right- or left-handedness ~ or acquired through birth defects, accidents or habitual patterns of movement. In either case we rely on one side of the body more than the other in our daily exertions.

When there is restricted movement in one hip, the ‘good’ leg compensates by taking on more than its proper burden of movement. This occurs during the pursuit of everyday activities as well as during asana practice.

Therefore it is important in asana practice to try and nullify the overactivity of the ‘good’ hip and leg and increase the effectiveness of the ‘bad’ hip and leg. This is achieved by intensifying the attention paid to the ‘bad’ side (without, however, using force). Here it is helpful to use props. For example, in Cobbler’s Pose (Baddhakonasana), do not sit with one knee up and the other down, as would be natural, but sit on a height so that both legs open outwards equally. If you also support the legs this removes strain, with the result that the stiff hip and tight groin can relax and open more.

In forward bends (Janushirshasana, etc.) sit on sufficient height so that the ‘bad’ hip gets freedom of movement. Here it will not matter that the supple side moves more easily because balance has been maintained at the level of the hips.

In lying down leg stretches (Supta-Padangusthasana) use the wall for support. For the variation where one leg is vertical, keep this against the wall. When taking the leg down sideways, support the foot of the arthritic side. Both these methods will encourage strain-free movement in the hip and groin.

In standing poses, turn the front foot turned out more than 90°; this will increase movement in the stiff hip. Another method is to do the poses on the diagonal. Start off with the feet aligned as usual along a line; after taking the feet apart move the front foot forward of the line and the back foot behind the line. Then proceed with the pose. A third method to activate the stiff hip is to place the front foot up on the wall, i.e. with the heel on the floor and the ball of the foot on the wall. Here the shin lifts rather than drops and in turn lifts the knee and thigh. The thigh bone is therefore helped to go deeper into the socket, thus aiding its proper movement.

The principle of support should be applied in all poses where unevenness of movement is a problem. In this way balance is restored to the mechanical function of the limbs and joints.