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The DailyBandha. A twice weekly blog on combining modern western science and the ancient art of hatha yoga.

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    In our last post we focused on the benefits of engaging the quadriceps in forward bends. These include reciprocal inhibition of the hamstrings and the contribution of one head of the quadriceps, the rectus femoris, to flexing the hip joint and tilting the pelvis forward. Tilting the pelvis forward helps to prevent hyper flexing of the lumbar spine through lumbar-pelvic rhythm. 

    This post emphasizes the role of hip adductors and abductors in flexing the hips with a cue for co-activating these muscles. Balanced engagement of these muscles produces a stabilizing bandha about the hip joint and pelvis, while at the same time synergizing hip flexion. This contributes to femoral-pelvic rhythm, which in turn aids to prevent hyper flexing the lumbar in forward bends.

    First, let’s look at the anatomy. The more anterior adductor muscles (the adductors longus and brevis) draw the femurs toward the midline, adducting them. The pectineus contributes to this action. The tensor fascia lata (TFL), on the other hand, draws the femurs away from the midline, abducting them. Thus, the TFL and adductors (and pectineus) are antagonists for these actions. These same muscles all flex the hip joint and are synergists of this action. Accordingly, co-activating this antagonist/synergist pair can be used to stabilize the hip (through opposing actions) and synergize hip flexion. 

    The adductors longus and brevis and pectineus in Dandasana.

    Dandasana (staff pose) is a good pose for learning this how to work with these muscles together. I begin by drawing the upper inner thighs towards one another. This activates the more anterior adductor muscles — the longus, brevis and pectineus Then, I press the calves into the mat, fixing them there, I attempt to drag the legs apart. The legs are fixed on the mat and so will not actually abduct, but this cue engages the TFL (which you can feel contract on the sides of the pelvis). Adding slight internal rotation of the thighs refines this action. The adductors and the TFL work together to synergize hip flexion, which then acts to lift the lumbar region (through lumbar-pelvic rhythm). Try each of these cues independently. Then combine both actions by gently squeezing the upper inner thighs together while attempting to draw the lower legs and heels apart. Note how the opposing actions of these muscles create a stabilizing bandha across the hip joint, while their common actions synergize hip flexion and pelvic tilt.

    The tensor fascia lata in Dandasana.

    This cue is portable to other poses like Paschimottanasana (and Uttanasana link to accessing nutation) as shown. If you can reach your feet in Paschimottanasana, then the cue for engaging the TFL becomes pressing the outer sides of the feet into the hands. If you are working in a modified version of this forward bend (as with a belt around the feet) then the cue is the same as in Dandasana. In Uttanasana, fix the feet onto the mat and attempt to drag them apart (to engage the TFL) while drawing the upper inner thighs together (to engage the adductors longus and brevis and pectineus).

    Co-activating the adductors, pectineus and tensor fascia lata in Paschimottanasana.

    Combining contrasting elements produces balance and stability. Combining synergistic elements produces movement. Movement creates rhythm. Lumbar-pelvic rhythm helps to prevent hyperflexing the lumbar spine—which can aid to prevent lower back strains in yoga.

    If you suffer from back pain, be sure to consult your physician to determine the cause; work under the guidance of a physician to manage your pain (see our full disclaimer here).

    Thanks for stopping by! Check in next week for Part Three of this series on preventative strategies for lower back strains in yoga. Also, be sure to visit us on Facebook for your free Chakra poster and e-book.

    Namaste’

    Ray and Chris





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    In our last post we focused on the hip abductors and adductors and how they can be used to stabilize the pelvis and synergize flexing the hips in forward bends. In this post we zoom out and look at a technique that can be learned with Chaturanga Dandasana and then transported to other poses to improve benefits and safety. I call this technique “ease in, ease out” and it relates to how one approaches the end point of a pose.

    For this cue, I take a yoga block and place it at the level of my sternum, then lower down to lightly touch it from plank position. I then straighten my arms to return to plank. The image that body weight practitioners use for this is “kissing the baby” because one touches the block as gently as kissing a baby on the forehead. Working in this manner teaches muscle control and sensitivity. 

    Figure 1

    Those who avoid full Chaturanga due to weakness of the muscles involved can develop the strength for the full pose by starting at a wall as shown in figure 2. Here instead of the chest touching the block, bend the arms to lower towards the wall and gently touch the forehead, hold for a moment and then straighten the arms. Work in this manner until you can comfortably do ten repetitions. As strength builds, transition to a plank with the knees on the mat, lowering down to touch the block as in the final version. (Figure 3)

    Figure 2 Figure 3

    Visualizing the muscles involved is a powerful adjunct to this technique. Use a mental image of the triceps, pectoralis major and serratus anterior muscles engaging to stabilize the arms, shoulders and chest as shown in figure 4. The triceps straightens the elbows and is a secondary stabilizer of the shoulder joint. The pectoralis major draws the upper arm towards the midline (adduction) and helps to expand the chest (when the shoulders are held in place). The serratus anterior extends from the upper nine ribs to inner (anterior) medial surface of the scapula. It acts in concert with the rhomboids to stabilize the shoulder blades and thus preventing “winging” of the scapula in this pose. (Figure 4)

    Figure 4

    Take a moment to review our post on “co-activating the gluts and abs in Chaturanga” and integrate these muscles into this technique. Also, feel free to browse through the Yoga Mat Companion series. The illustrations in these books are designed to aid in visualizing the muscles in action in a variety of poses.

    Slowing the movement as one approaches the endpoint of the pose also sets up a cadence or rhythm, especially when working with a Vinyasa Flow based practice. It can be applied to any pose and also to inhalation and exhalation, thus smoothing the breath. It also aids to protect the joints, which have smooth curved surfaces that adapt best to gradual transitions during movement.

    Thanks for stopping by! Check in next week for Part Three of this series on preventative strategies for lower back strains in yoga. Also, be sure to visit us on Facebook for your free Chakra poster and e-book.

    Namaste’

    Ray and Chris

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  • 05/17/12--15:50: Hanumanasana—Front Splits
  • To paraphrase the poet William Blake, you can see the world in a grain of sand. Similarly, you can learn a great deal about all asanas by carefully studying one. For this blog post, I focus on Hanumasana, or front splits. I use this pose in workshops to illustrate such factors as pose analysis, agonist/antagonist muscle pairs (and their synergists), physiological reflex arcs, and stretching biomechanics.


    First, let’s look at the muscle-tendon unit—the muscle and its tendon—to see what lengthens in the pose. The muscle-tendon (MTU) unit is composed of several elements. These include the contractile structures (sarcomeres) and the fascial elements that surround the muscle fibers and tendons. Although these elements are often presented separately in articles on the science of stretching, in reality they are inextricably linked to one another. All of these elements contribute to muscle contraction and stretching. In addition, many factors contribute to the way a muscle lengthens, including the viscoelastic properties, creep (a type of deformation that has been postulated for fascial elements), psychological factors (such as muscle memory and tolerance), and extramuscular links to synergists. Individual muscle architecture or shape also plays a role. Below, I include several references from the scientific literature that discuss these factors in greater detail.


    Cross-section of muscle illustrating the contractile sarcomeres with fascial elements such as the perimysium

    Next, there is the timing of the stretch or how long to hold it. I derive my personal approach to timing the stretch in Hanumanasana from published biomechanical studies on stretching. These studies indicate that the majority of lengthening or release of the MTU takes place in the first twenty seconds of the stretch. Similarly, when repeating a stretch, the lengthening of the muscle-tendon unit appears to diminish with each successive stretch, reaching its maximum at the fourth stretch, after which little additional length is gained by further stretching. We provide an illustrative curve for this process below. You can see the experimental curves in the referenced articles 1,2. Note that each successive lengthening of the muscle is followed by a brief recovery period in which it is released from the stretch. This is important because one two-minute stretch is not equivalent to four thirty-second stretches. Accordingly, I divide my approach to Hanumanasana into four consecutive stretches—each focusing on a different muscle group. Obviously, this is only one of the many ways to approach stretching. It is, however, a method I have found beneficial for working on specific poses such as front splits.


    Illustrative curves for changes in muscle length vs time in a stretch

    To begin, I analyze the positions of the major joints in Hanumanasana. For example, the back hip is extending. This means that the agonist muscles for this part of the pose are the gluteus maximus (the prime mover of hip extension) and the synergists of this action—the posterior portion of the gluteus medius and minimus, the hamstrings and the adductor magnus. Next, I use this analysis to determine which muscles are stretching. Extending the hip lengthens the hip flexors, including the psoas and its synergists. Then I apply physiological reflex arcs, including proprioceptive neuromuscular facilitation (PNF)3,4,5 to gain length in the muscles during successive thirty-second stretches. This is the first part of the Bandha Yoga Codex, a systematic approach that can be applied to any asana. Feel free to browse through the Yoga Mat Companion Series to see this concept in action.



    Hanumanasana (front splits) illustrating the positions of the major joints


    For step one, I focus the stretch on the prime mover of hip flexion—the psoas—for the extended back hip. This stretch also works the rectus femoris. I use two sturdy chairs for support and begin by taking the muscle out to length by engaging the back leg gluteus maximus, producing reciprocal inhibition of the psoas and aiding it to relax into the stretch. Then I attempt to draw the back knee towards the front foot in a flexing type action, using just enough force to gently engage the psoas. I hold this for several breaths and then ease deeper into the stretch by again engaging the gluteus maximus, and limit the stretch to thirty seconds. Then I come out of the pose and stand in Tadasana to provide a brief recovery.



    Cue for engaging the back leg psoas and rectus femoris to use PNF for muscle lengthening

    For step two, I focus the stretch on the prime movers of hip extension for the flexed front hip. I begin by engaging the flexors of the front hip, including the psoas. I also engage the quadriceps. These muscles provide reciprocal inhibition of the gluteus maximus and hamstrings. One head of the quadriceps, the rectus femoris, also synergizes hip flexion. Then I slightly bend the knee and gently press the heel into a towel or blanket to engage the hamstrings and gluteus maximus of the front hip. I hold this action for a few breaths and then take the hamstrings and gluteus maximus out to length by engaging the hip flexors and knee extensors, again holding the total time in the stretch for a maximum of thirty seconds. Once again, I stand in Tadasana for a brief recovery (usually for about twenty seconds).

    Cue for engaging the front leg gluteus maximus and hamstrings to use PNF for muscle lengthening

    For step three, I stretch the synergists of hip flexion and extension that are located more medially. For the front hip, my focus is the adductor magnus (a synergist of hip extension that is stretching). For the back hip, I focus on the adductors longus and brevis, and the pectineus (synergists of hip flexion that are stretching). I slowly build engagement of these muscles respectively by attempting to draw the front heel and back knee towards the midline (adduction), again holding for a few breaths, then deepening the pose by relaxing more fully and engaging the back leg buttocks and front leg psoas and quads. I again use Tadasana for a brief recovery.


    Cue for engaging the adductor magnus (front leg) and adductors longus and brevis and pectineus for PNF

    Finally, I focus on stretching the synergists of hip flexion and extension that are located laterally or on the outside of the hips (for the back and front leg respectively). For the front hip, the synergist of extension includes the posterior part of the gluteus medius and gluteus minimus. Since both of these muscles are prime movers of hip abduction, I use this for my cue to engage them by attempting to drag the front heel away from the midline. At the same time, I engage the back hip tensor fascia lata by gently attempting to drag the knee away from the midline in the stretch. I hold this action for a few breaths and then ease deeper into the pose once again by engaging the back leg gluteus maximus and front leg psoas (and quads)—all for thirty seconds followed by a relaxed Tadasana. This is the fourth and final stretch of the series.

    Cue for engaging the abductor muscles of the front and back legs for PNF

    For a balanced stretch, I repeat the series on the other side. I allow a 48-hour recovery period after applying PNF stretches. I never force myself into the pose, but rather use physiological reflex arcs to gently lengthen the muscles. I also use visualization and sensation of the muscles I’m stretching to focus my drishti for a safer and more effective practice. I slow my movements as I near the endpoint of the stretch and come out of the pose carefully. This aids to prevent injury. 



    Agonist (blue) and antagonist (red) muscles of the hips in Hanumanasana

    We hope you enjoy this blog post and invite you to join us in paradise at Blue Spirit in Costa Rica this winter for our workshop on combining Western science and Hatha yoga. We will be going over essential principles of injury prevention for each of the major joints and many other subjects in this intense, yet fun workshop.

    Remember that not all poses are suitable for all practitioners. Always practice under the direct guidance of a qualified instructor; use their assistance to determine modifications or suitability of a given pose for your individual practice. Always consult your healthcare provider and obtain medical clearance before practicing yoga or any other exercise program (read our disclaimer here).

    Great to see you again. Check back for our next blog post when we will discuss another protective strategy to aid in preventing lower back strains in yoga and be sure to "like" us on Facebook and download your copy of our free E-book.

    Namaste'

    Ray and Chris






    5)  Mahieu NN, Cools A, De Wilde B, Boon M, Witvrouw E. “Effect of proprioceptive neuromuscular facilitation stretching on the plantar flexor muscle-tendon tissue properties.Scandanavian Journal of Medicine and Science in Sports. Aug2009; 19(4):553-60. Epub 2008 Jun 17.


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    In “Preventative Strategies for Lower Back Strains Part I,” we discussed femoral-pelvic and lumbar-pelvic rhythm, muscles that influence these rhythms, and the effects of these muscles on the lumbar spine. Here, our discussion progresses as we cover the trunk, the thoraco-lumbar fascia (TLF), Uddiyana Bandha and how accurate knowledge of this can be used to enhance the benefits of yoga and decrease the risk of lower back strains.


    The thoraco-lumbar complex (TLC) is a multilayered structure comprised of the thoracolumbar fascia and the muscles that connect to it. This composition of passive fascial tissues and active muscular structures acts as a corset-like structure that encircles the torso. It plays a key role in maintaining the integrity and stability of the lumbar spine and the sacroiliac joint and is also important for load transfer from the upper limbs to the lower limbs. Engaging the muscles that connect to the thoracolumbar fascia acts to stabilize the spine and trunk. We give an example of this in a previous blog post on using the latissimus dorsi to lift the lumbar and expand the thorax. Figure 1 illustrates the thoraco-lumbar composite in cross section at the mid-lumbar. 

    Cross section of the thoracolumbar fascia with its connections to the abdominal core and erector spinae (at L3).

    To further illustrate, consider a cylindrical container of a fixed volume. Decreasing the circumference of the cylinder results in an increase of  its' length (to maintain the total volume). The torso, with the abdominal cavity, can be viewed in the same manner: tensioning the abdominals acts in combination with the TLF to lengthen the torso and lift and stabilize the lumbar. Think of this concept in conjunction with the Sanskrit term “Uddiyana,” which means lifting or flying up. Figure 2 illustrates this.

    The mechanism for lengthening the trunk with the thoracolumbar complex. The pelvic diaphragm is below and the thoracic diaphragm above.

    This lengthening of the torso takes place through several mechanisms that work in concert to variable degrees depending on the position of the trunk. The first action relates to intra-abdominal pressure (IAP). Engaging the abdominals increases IAP, which numerous scientific studies have indicated stabilizes the lumbar spine. The second mechanism relates to tensioning the TLF. Activating the transversus abdominis muscle tensions the TLF, thereby providing resistance to flexion at the lumbar spine. Furthermore, the transversus abdominis muscle has attachments to the thorax; engaging it transfers stresses from the lumbar region to the thorax and shoulders. Tensioning the TLF also improves the efficiency of the back muscles (surrounded by this fascia) through a mechanism known as the hydraulic amplifier.  Because the erector spinae are surrounded by the TLF, its various layers resist muscle expansion during contraction. This tends to straighten the spine (think of how a bicycle tire straightens when you fill it with air). Finally, the erector spinae muscles have fibers that insert onto the interior surface of the TLF so that as they lengthen into a stretch, they can exert a passive pull on the fascia. These various mechanisms contribute to lengthening the torso and stabilizing the lumbar spine. I provide a number of scientific references on this subject below.

    Clinical studies have demonstrated an association between low back pain and inefficient engagement of the abdominals. All of this has implications for the use of Uddiyana Bandha, both for protecting against low back strains and for potentially improving the treatment of low back pain through yoga. Below, we illustrate the sequence I use to access this mechanism.


    Ease in to awareness of the thoracolumbar composite by using a progression of poses. This leads to understanding of the action of Uddiyana Bandha in lifting and lengthening the trunk and stabilizing the spine. Begin with a pose like simple crossed legs (Sukhasana) or Dandasana. The cue for co-activating the abdominal core and erector spinae is to draw the navel towards the lumbar and lift the lower back. Visualizing the trunk as an hourglass and the anatomy of the thoracolumbar composite as a corset helps to access this lifting and lengthening action. Fixing the hands on the mat and attempting to drag them backwards accentuates this lift by including the latissimus dorsi. Incorporating the accessory muscles of breathing, including the pectoralis minor and serratus anterior, in this pose lifts the lumbar from the thorax. You can experience this lengthening effect by initiating these cues even as you sit reading this post.


    Co-activating the erector spinae and abdominal core to lift the lumbar.

    After warming up, incorporate these same principles into Downward Facing Dog Pose. Engage the thoracolumbar composite by co-activating Uddiyana Bandha and the erector spinae (and quadratus lumborum) to lengthen the trunk and to lift the tailbone, respectively. (Figure 4)


    Lifting the coccyx and lengthening the lumbar in Downward Dog Pose.

    These same protective mechanisms can be accessed in forward bends such as Paschimottanasana by using the abdominals to lengthen the trunk, as with the hour-glass visualization described above. Additionally, engaging the abdominal core aids in accessing the function of these poses, which is reflected by their form. Part of this function is to lengthen the muscles of the back. Engaging the abdominal core helps to relax the erector spinae through reciprocal inhibition. Peripheral fibers of the erector spinae attach to the TLF; as these muscles lengthen, their fibers exert a pull on the TLF, thus distributing the forces through the length of the spine. Accordingly, although I may use brief periods of contraction to release the muscle (through PNF), I do not recommend maintaining eccentric contraction of the erector spinae throughout the pose (I will explain why in the next blog post).

    I combine the actions of the thoracolumbar complex with lumbar-pelvic rhythm by engaging the muscles that contribute to tilting the pelvis forward. Figure 5 illustrates the connection between the tensor fascia lata, the pelvis, and the thoracolumbar composite. See “Preventative Strategies for Lower Back Strains, Part II” for the cues on engaging the synergists of hip flexion and forward pelvic tilt. Also see our post on co-activating the gluts and abs in Chaturanga Dandasana.

    Engaging the TLC with the abdominal core and connecting this to lumbar pelvic rhythm with the tensor fascia lata.

    The anatomy and protective mechanisms of the human body have evolved for eons. These same mechanisms have been researched and documented in the scientific literature. Anatomic and biomechanical principles that govern our bodies when we perform simple actions, such as walking, also apply when we are on the mat. Keeping this in mind, we must dispose of some incorrect concepts permeating the yoga world concerning anatomy and how the body works. The first of these implies that engaging the abdominals and Uddiyana Bandha harms the intervertebral discs. This misinformation, often circulated with graphic descriptions of lumbar disc herniations, discourages engaging the protective and stabilizing mechanisms of the thoraco-lumbar complex in yoga poses under the misguided premise that avoiding these essential mechanisms somehow protects an individual. Other disinformation discourages engaging the abdominal core in forward bends under the odd premise that contracting these muscles causes “congestion”. Finally, there is the breathtaking statement that the spine does not depend on muscles for stability. This widely circulated misconception is contradicted by basic anatomy and yoga itself. In this regard, I quote Jiddu Krishnamurti: "Until the false is seen as the false, truth is not."

    Good to see you again. Practice under the guidance of a qualified instructor; use their assistance to determine modifications or suitability of a given pose for your individual practice. Always consult your healthcare provider and obtain medical clearance before practicing yoga or any other exercise program.


    Check back again for our next blog post where we will go into greater detail on the stabilizing mechanisms of the spine with another protective strategy to aid in preventing lower back strains in yoga. Also, be sure to "like" us on Facebook and download your copy of our free E-book.



    References:



    2) Crow J, Pizzari T, Buttifant D. “Muscle onset can be improved by therapeutic exercise: a systematic review.”Physical Therapy in Sport. Nov 2011; 12(4):199-209. Epub 2011 Feb 26.



    4) Watanabe S, Kobara K, Ishida H, Eguchi A. “Influence of trunk muscle co-contraction on spinal curvature during sitting cross-legged.”Electromyography and Clinical Neurophysiology. Apr-Jun 2010; 50(3-4):187-92.



    6) Cholewicki J, Panjabi MM, Khachatryan "A Stabilizing function of trunk flexor-extensor muscles around a neutral spine posture." Spine. Oct 1997; 22(19):2207-12.


    7) Unsgaard-Tøndel M, Lund Nilsen TI, Magnussen J, Vasseljen O. Is activation of transversus abdominis and obliquus internus abdominis associated with long-term changes in chronic low back pain?" A prospective study with one-year follow-up. British Journal of Sports Medicine. Jul 2011; 26. [Epub ahead of print]


    8) Hodges PW, Richardson CA. Delayed postural contraction of transversus abdominis in low back pain associated with movement of the lower limb.”Journal of Spinal Disorders and Techniques. Feb 1998; 11(1):46-56.


    9) Bjerkefors A, Ekblom MM, Josefsson K, Thorstensson A. Deep and superficial abdominal muscle activation during trunk stabilization exercises with and without instruction to hollow.”Manual Therapy. Oct 2010; 15(5):502-7. Epub 2010 Jun 8.


    10) Hodges PW, Cresswell AG, Daggfeldt K, Thorstensson A. In vivo measurement of the effect of intra-abdominal pressure on the human spine.”Journal of Biomechanics. Mar 2001;34(3):347-53.

    11) Hodges PW, Eriksson AE, Shirley D, Gandevia SC. Intra-abdominal pressure increases stiffness of the lumbar spine.”Journal of Biomechanics. Sep 2005; 38(9):1873-80.

    12) Barker PJ, Guggenheimer KT, Grkovic I, Briggs CA, Jones DC, Thomas CD, Hodges PW. Effects of tensioning the lumbar fasciae on segmental stiffness during flexion and extension: Young Investigator Award winner.”Spine. Feb 2006; 31(4):397-405.

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    “A sword by itself rules nothing. It only comes alive in skilled hands.”

    Sir Te to Governor Yu in the martial arts classic, Crouching Tiger, Hidden Dragon.


    Many myths, legends, and historians hold that human beings in the ancient past were much more connected to their higher selves and power. These sources maintain that, at some point in our distant past, we suffered a primal trauma—an injury that affected us to our core, both biologically and psychically. Some theorize this event affected us on the very level of our DNA. The theory is that this trauma disconnected us from our higher powers and we have been suffering, causing suffering, and trying to heal ever since. Some postulate that yoga—specifically, hatha yoga—evolved in response to this trauma to re-establish this connection, hence, the name “yoga,” which means “to unite” (or re-unite).



    First, let’s look at the channel that connects the energy centers, according to yoga physiology. The Sushumna Nadi is said to run through the center of the spinal cord, connecting the seven chakras or subtle energy centers of the body. To understand exactly what this means, turn from yoga physiology and consider the spinal column itself. It is made up of vertebral bodies, the discs between them, and the ligaments that link the vertebral bodies to one another. The spinal cord runs in the spinal canal, entering the skull through an aperture called the foramen magnum.




    With this in mind, let’s look at a condition that affects the spinal column and, thus, has the potential to affect the Sushumna Nadi. Degenerative disc disease (DDD) is a condition, or medical malady.  It has been shown to affect as much as 90% of the population. This condition was previously believed to have arisen primarily from “wear and tear” on the intervertebral discs. Recent groundbreaking research, however, has shown that DDD is primarily hereditary, or genetic, in origin. The authors of "The Twin Spine Study: Contributions to a changing view of disc degeneration," state:


    “The once commonly held view that disc degeneration is primarily a result of aging and 'wear and tear' from mechanical insults and injuries was not supported by this series of studies. Instead, disc degeneration appears to be determined in great part by genetic influences.”1


    Ok. So we have, within our DNA, something that determines a degenerative process affecting us at our core--the intervertebral discs. Further, it appears that most of us have this affliction to some degree or another. Interesting.1,2,3,4,5,6,7,8 


    Furthermore, yoga does not cause degenerative disc disease; it may have been developed to circumvent it.


    Now, we know that DDD is associated with clinically relevant low back pain, but it can also be present asymptomatically, with no pain at all. With this in mind, it becomes interesting to consider how this genetically determined condition affects us beneath our conscious awareness.  Does this genetically encoded defect also affect us on the energetic level? For example, does it create blockages to the flow of energy within the Sushumna Nadi? If so, the next question becomes, “does practicing Hatha yoga have the capacity to over-ride this defect?”


    It is said that Hatha yoga re-connects us to the Sushumna Nadi, thus developing higher potentials in the mind and the body. Just as myths and legends say that we lost our connection to our higher selves at some point in time, so many esoteric practices have also become “lost" arts. The re-emergence of Hatha yoga is a relatively recent phenomenon, and it remains in the developmental stage. Because Hatha yoga uses the physical body to reinvigorate our connection to the subtle body, combining accurate Western scientific knowledge of the body has the capacity to truly refine the practice. Considering that the practice of Hatha yoga has now reached a critical mass in the population, what could a true “re-connection” to our higher powers mean? 


    Unsurprisingly, there is an element that has attached itself to yoga that is working diligently to derail this awakening process. They are attempting to do this by employing a manipulative methodology known as “Problem, Reaction, Solution." This process involves manufacturing a perceived problem that is designed to evoke a reaction (always anxiety or fear) and then offering a solution to the “problem” created. Since the problem was based on deception, so is the solution, which always involves disempowment. This scenario is typically presented under the guise of "protecting" you. Examples of how this is being used to manipulate fears in yoga are included below. 

    Enter the Couch Potato…


    As background for the first example, let’s look at herniated discs (a separate, though related pathology to DDD). Did you know that 40-75% of the population has some type of asymptomatic (painless) herniated disc? Put another way, the majority of people have some type of asymptomatic disc herniation before ever walking into a yoga class. Scientific references regarding this are included below. Like DDD, practiced properly, yoga doesn’t cause the disc herniation; it works with and around it.

    Keeping this in mind, let’s look at some widely circulated information on forward bends that seems to imply that forward bends in yoga cause disc herniations. It begins with a graphic description of lumbar disc herniations; however, absent from this description is any mention of the fact that most of us have asymptomatic disc herniations anyway. Also absent is any real evidence that yoga forward bends cause disc herniations. (My preliminary analysis of the data on ER visits for injuries from yoga did not reveal one herniation caused by yoga). Nevertheless, those circulating this information know that they can cause anxiety by implying that forward bends harm the discs. So far so good: a problem is presented, and a reaction (anxiety) is caused. All that’s left is the solution. The solution that has been circulated is to perform forward bends while sitting on a stack of blankets with the knees bent over a bolster, using the weight of the body to slump into the pose. While this is excellent preparation for sitting in a chair (or on a couch), it is almost unrecognizable from a yoga forward bend. Furthermore, the “slumped” posture has been shown to increase the pressures in the lumbar intervertebral discs, potentially harming them. 15,16,17

    Practising (and teaching) in this manner also establishes a “fear-avoidance” behavioral pattern, whereby the practitioner becomes habituated to doing the pose this way.18 The “solution” to the fear based “problem” thus creates a vicious cycle that disempowers the practitioner on both psychological and physical levels. This pattern of graphic descriptions of herniated discs and forward bends has been circulated several times in the media, (including with instructions to avoid using the protective and empowering mechanisms described in our previous post on the thoracolumbar complex).


    So, to recap, we have all of the elements of “Problem, Reaction, Solution,” but all of them are based on a false premise: the implication that yoga causes a core problem (herniated discs). This is a well-known disinformation technique: imply that the problem was caused by the potential solution.


    Deceptions of this nature are multilayered in that they also disempower yoga teachers, who naturally do not want to cause herniated discs in their students and, thus, find themselves in a “fear-avoidance” pattern of behavior in their teaching. Further compounding this disservice to teachers is that these types of articles open the door for a student to claim that the teacher caused a herniated disc that was already present prior to the student attending class.


    A passive aggressive variation of this theme is the manufacturing of a “dilemma” around a valuable and beneficial pose, implying the risk of injury. This technique also manipulates a fear of injury, so that the solution to the dilemma is for a practitioner to avoid the pose.


    Part of this process involves the “invoking of authority.” This can take the form of falsely attributing conclusions to a medical journal, as with the statement people with strong quads and misaligned kneecaps experience rapid progression of arthritis. A variation of this disinformation technique is to characterize something as a “fact supported by substantial evidence” without providing any such evidence (usually because none exists).  Another way to “invoke authority" is via “experts” who insert their opinions; however, upon careful examination, these individuals often are not actual experts. A variation of this concept is executed when a deception is being exposed; the calling of a “summit” or “panel” of “experts.” These events, often peopled by “stuffed shirts” and controlled by the few are designed to reach a disempowering “consensus opinion” that has been scripted beforehand. We’ve seen this happening many times in government and in the media. 

    Fear and anxiety are two of our most powerful emotional responses; they form in infancy and are very easy to manipulate. The same pattern of manipulation can be found in the situations we are discussing; create a problem to evoke anxiety, couple it with yoga, disempower the practice. Should persons engaging in this be creating “standards” for the practice?

    Friends we are living in an exciting time. Scientific discoveries like the genetic basis of degenerative disc disease may uncover many new understandings about our past, present, and future. More to follow...

    Check back again for our next blog post where we will go into greater detail on the stabilizing mechanisms of the spine with another strategy to aid in preventing lower back strains in yoga. Also, be sure to "like" us on Facebook and download your copy of our free E-book.

    References:

    1) Battie MC, Videman T, Kaprio J, Gibbons LE, Gill K, Manninen H, Saarela J, Peltonen L. "The Twin Spine Study: Contributions to a changing view of disc degeneration." The Spine Journal. Jan-Feb 2009; 9(1): 47-59.

    2) Livshits G, Popham M, Malkin I, Sambrook PN, Macgregor AJ, Spector T, Williams FM. "Lumbar disc degeneration and genetic factors are the main risk factors for low back pain in women: The UK Twin Spine Study." Annals of Rheumatic Diseases. Oct 2011; 70(10): 1740-5. Epub 2011 Jun.

    3) Hancock MJ, Battie MC, Videman T, Gibbons L. "The role of back injury or trauma in lumbar disc degeneration: an exposure-discordant twin study." Spine (1976). Oct 2010; 35(21): 1925-9.

    4) Videman T, Gibbons LE, Kaprio J, Battié MC. "Challenging the cumulative injury model: Positive effects of greater body mass on disc degeneration." The Spine Journal. Jan 2010; 10(1): 26-31. Epub 2009 Nov.

    5) Battié MC, Videman T, Parent E. "Lumbar disc degeneration: Epidemiology and genetic influences." Spine (1976). Dec 2004; 29(23): 2679-90.

    6) Battié MC, Videman T. "Lumbar disc degeneration: epidemiology and genetics." The Journal of Bone and Joint Surgery. Apr 2006; 88 Suppl 2: 3-9.

    7) Battié MC, Videman T, Levalahti E, Gill K, Kaprio J. "Heritability of low back pain and the role of disc degeneration." Pain. Oct 2007; 131(3): 272-80. Epub 2007 Mar.

    8) Paajanen H, Erkintalo M, Kuusela T, Dahlstrom S, Kormano M. "Magnetic resonance study of disc degeneration in young low-back pain patients." Spine (1976). Sep 1989; 14(9): 982-5.

    9) Boos N, Rieder R, Schade V, Spratt KF, Semmer N, Aebi M. "1995 Volvo Award in clinical sciences. The diagnostic accuracy of magnetic resonance imaging, work perception, and psychosocial factors in identifying symptomatic disc herniations." Spine (1976). Dec 1995; 20(24): 2613-25.

    10) Jensen MC, Brant Zawadzki MN, Obuchowski N, Modic MT, Malkasian D, Ross JS. "Magnetic resonance imaging of the lumbar spine in people without back pain." New England Journal of Medicine. Jul 1994; 331(2): 69-73.

    11) Boden SD, Davis DO, Dina TS, Patronas NJ, Wiesel SW. "Abnormal magnetic-resonance scans of the lumbar spine in asymptomatic subjects: A prospective investigation." The Journal of Bone and Joint Surgery. Mar 1990; 72(3): 403-8.

    12) Powell MC, Wilson M, Szypryt P, Symonds EM, Worthington BS. "Prevalence of lumbar disc degeneration observed by magnetic resonance in symptomless women." Lancet. Dec 1986; 2(8520): 1366-7.

    13) Masui T, Yukawa Y, Nakamura S, Kajino G, Matsubara Y, Kato F, Ishiguro N. "Natural history of patients with lumbar disc herniation observed by magnetic resonance imaging for minimum seven years." Journal of Spinal Disorders and Techniques. Apr 2005; 18(2):121-6.

    14) Jarvik JJ, Hollingworth W, Heagerty P, Haynor DR, Deyo RA. "The Longitudinal Assessment of Imaging and Disability of the Back (LAIDBack) Study: baseline data." Spine (1976). May 2001; 26(10): 1158-66.

    15) Watanabe S, Kobara K, Ishida H, Eguchi A. "Influence of trunk muscle co-contraction on spinal curvature during sitting cross-legged." Electromyography and Clinical Neurophysiology. Apr-Jun 2010; 50(3-4): 187-92.

    16) Watanabe S, Eguchi A, Kobara K, Ishida H. "Influence of trunk muscle co-contraction on spinal curvature during sitting for desk work." Electromyography and Clinical Neurophysiology. Sep 2007; 47(6): 273-8.

    17) Claus AP, Hides JA, Moseley GL, Hodges PW. "Different ways to balance the spine: Subtle changes in sagittal spinal curves affect regional muscle activity." Spine (1976). Mar 2009; 34(6): E208-14.

    18) Kell RT, Risi Ad, Barden Jm. "The response of persons with chronic nonspecific low back pain to three different volumes of periodized musculoskeletal rehabilitation." Journal of Strength and Conditioning Research. Apr 2011; 25(4):1052-64.

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    Greetings Friends, 

    Welcome back to The Daily Bandha. I’m just now returning to the blogosphere after completing an intensive year of study in Sports Medicine and will be sharing with you some of the knowledge I gained about the body and how to apply it to your yoga practice and teaching. Our first post in this series looks at a common disorder that can affect the foot.

    You can learn a great deal about the normal function of the musculoskeletal system by looking at what happens when things go wrong. This knowledge can be used to deepen your practice, prevent injuries and to understand the role of yoga as a therapeutic adjunct in the management of various disorders. With this in mind, let’s focus on the condition known as adult acquired flat foot deformity, it’s anatomical basis and how to work with yoga to maintain a healthy foot arch.

    As I discuss in "The Key Muscles of Yoga" and "The Key Poses of Yoga", mobility and stability about the joints is a function of three variables; the shape of the bones, the capsuloligamentous structures that connect the bones to each other at the joints, and the muscles that surround the joint. Adult acquired flat foot deformity is a disorder that relates to a muscular insufficiency of the tibialis posterior muscle, which in turn leads to weakening of the calcaneo-navicular ligament and then collapse of the bony arch.

    The underlying muscular imbalance in acquired flatfoot deformity is between the weakened tibialis posterior muscle on the inside of the foot and it’s stronger antagonist, the peroneus brevis muscle on the outside. This imbalance places undue stress the calcaneo-navicular ligament that can lead to pain and collapse of the medial foot arch.

    The exact underlying cause of adult-acquired flatfoot deformity is unknown, but is thought to be multifactorial; however, the muscular imbalance I describe is well established. In addition, it is associated with tightness of the Achilles tendon and it’s associated muscles, the gastrocnemius and soleus (so stretching these muscles can be an important factor in management and prevention). This problem affects women more frequently than men, typically at around the 6thdecade of life.

    Here’s the anatomy:


    (Note: if you’re new to anatomy, focus on studying the images.)

    The calcaneo-navicular ligament runs between the calcaneus, or heel bone and the navicular bone. The navicular is a boat shaped bone in the medial mid-foot (hence it’s name). This ligament is an important stabilizer of the medial longitudinal foot arch.

    The calcaneo-navicular ligament supports the medial arch of the foot

    The key muscle providing support for the calcaneo-navicular ligament is the tibialis posterior. This muscle originates from the interosseous membrane, the upper 2/3rds of the posterior fibula and the upper posterior tibia. After passing under the calcaneo-navicular ligagment it splits into two parts: one inserts onto the navicular bone and the other divides again to insert onto the plantar surfaces of second through fourth metatarsals and the second cuneiform bones (of the midfoot).

    The bones of the foot with muscle insertions

    The principle action of the tibialis posterior is to invert (supinate) the foot, with secondary actions of adduction of the foot and flexion of the ankle. It is an important stabilizer of the midfoot during the “heel off” phase of walking. The tibialis anterior muscle, which inserts onto the inside of the midfoot, works with the tibialis posterior to invert (supinate) the foot.

    Pressing down the outer edge of the foot engages the tibialis posterior and anterior

    The antagonist to the tibialis posterior is the peroneus brevis muscle, which originates from the lower 2/3rds of the lateral (outer) fibula bone and inserts onto the styloid process at the base of the fifth metatarsal. It acts to evert (pronate) the foot and plantar flex the ankle. The peroneus longus works with the peroneus brevis to evert (pronate) the foot. It also helps to stabilize the transverse arch.

    Pressing the ball of the foot engages the peroneus longus and brevis


    Here’s the yoga cue…


    In standing poses like Utthita Trikonasana, press the outer edge of the foot into the mat to engage the tibialis posterior. Holding this action, then press the ball of the foot into the mat to engage the peronei. Note how the medial (inside) foot arch lifts. This sequence of cues: 1) uses the tibialis posterior to support the medial arch and; 2) uses the peronei (on the outside of the lower leg) to provide resistance to strengthen it’s antagonist, the tibialis posterior. The biomechanical term for simultaneously engaging antagonist muscles is “co-contraction” or “co-activation”. We illustrate many examples of co-activation in the Yoga Mat Companion book series.
    Co-activating the muscles that invert and evert the foot

    Once you get a feel for this in the back foot, then try the same sequence in the front foot, and then in other poses such as tadasana. To see an example of this in downward facing Dog Pose click here. You can also combine it with engaging the thoracolumbar fascia to lengthen the trunk in Dog pose. Click here for more information on the thoracolumbar fascia.

    Working with these types of cues strengthens the arch of the foot. This gives a feeling of lightness in the step as we go through the day. Remember that the feet are important centers in energetic anatomy and physiology and are thought to be the location of minor chakras. Finally, look at the importance of the feet for the mind-body connection, as illustrated by their representation in the brain on the homunculus.

    If you would like to learn much more about combining Western science and yoga, please join us for a week in paradise at Blue Spirit Costa Rica for our second annual intensive on anatomy, biomechanics and therapeutics for Hatha yoga. I will be teaching state of the art techniques including much new material relating to therapeutic applications of yoga—all with great 3-D illustrations, great food, beautiful facilities and much practice of yoga.

    Thanks for stopping by. Stay tuned for our next post on the foot and yoga. Also, please be sure to share us on Facebook and Twitter.

    Namaste’,

    Ray and Chris


    References:

    1) Alvarez RG, Marini A, Schmitt C, Saltzman CL. “Stage I and II posterior tibial tendon dysfunction treated by a structured nonoperative management protocol: an orthosis and exercise program.” Foot Ankle Int. 2006 Jan (1): 2-8

    2) Imhauser CW, Abidi NA, Frankel DZ, Gavin K, Siegler S. “Biomechanical evaluation of the efficacy of external stabilizers in the conservative treatment of acquired flatfoot deformity.” Foot Ankle Int. 2002 Aug; 23 (8): 727-37.

    4) Lin JL, Balbas J, Richardson EG. “Results of non-surgical treatment of stage II posterior tibial tendon dysfunction: a 7- to 10-year followup.” Foot Ankle Int. 2008 Aug;29(8):781-6



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      The therapeutic benefits of Hatha yoga arise from whole body energetic balancing combined with distinct biomechanical adjustments. We gave an example of this in our last blog post, where we looked at the disorder known as adult acquired flatfoot deformity, its biomechanical basis and how to utilize yoga to maintain healthy foot arches. In this post we focus on the plantar fascia of the foot and examine the most common cause of heel pain—plantar fasciitis—to see what happens when things go wrong. Finally, we consider how yoga can be used to bring things back into balance and even to prevent this condition. First, let’s look at fascia in general.

      A fascia is a fibrous structure that is formed from sheets of connective tissue. The deep fascia covers and invests muscles, tendons, ligaments and blood vessels throughout the body. An important example of a deep fascia is the thoracolumbar fascia. All yoga practitioners should be familiar with this structure and its myofascial connections, as it forms a critical support system for the lumbar spine and sacroiliac joint. Other types of fascia include the superficial fascia of the subcutaneous tissue (under the skin), and the visceral and parietal fascia, which surround organs such as the heart and lungs. Figure 1 illustrates the deep fascial elements of skeletal muscles. Click here to see this in the context of stretching and Hanumanasana (front splits).


      Figure 1: The deep fascia covering and investing skeletal muscle.

      The plantar fascia or plantar aponeurosis (you can use either term) originates from the medial tubercle of the calcaneus (heel bone) and continues forward to attach to the proximal phalanx of each of the toes (via the plantar plates). Extending (dorsiflexing) the toes tightens the plantar fascia, thus elevating the foot arch. During this process, the metatarsal heads act as pulleys to form a “windlass” that tightens the plantar aponeurosis. The plantar fascia has elastic qualities in that its fibers are somewhat wavy in the relaxed position. These fibers straighten in response to forces applied (like the heel-off phase of gait). Thus, the plantar fascia can store energy like a spring. Figure 2 illustrates this concept.

      Figure 2: The windlass mechanism of the plantar aponeurosis (fascia).

      The plantar aponeurosis also forms a myofascial connection with the muscles of the calf (gastrocnemius and soleus) via the Achilles’ tendon and, by extension, the hamstrings (and potentially other muscles of the posterior kinetic chain). Forces that stretch the plantar fascia are distributed along these muscles. Conversely, tightness in these muscles can adversely affect the function of the plantar fascia and thus the arch of the foot. Figure 3 illustrates these myofascial connections in Downward Facing Dog pose.

      Figure 3: The myofascial connections to the plantar fascia in Downward Dog pose.

      Plantar fasciitis is an overuse injury related to repetitive overstretching of the plantar aponeurosis. In this condition the forces of gait are concentrated where the plantar fascia attaches to the calcaneus, instead of being distributed over the fascia and the muscles at the back of the legs. This results in microtrauma to the plantar aponeurosis near its origin, causing inflammation and heel pain. Risk factors for developing plantar fasciitis include tight calf muscles and hamstrings, endurance-type weight bearing activity (such as running) and a high body mass index. Figure 4 illustrates plantar fasciitis. Click here to see a reference MRI image of this condition. 

      Figure 4: Plantar fasciitis (note the inflammation at the origin of the plantar aponeurosis).

      Note that there are other conditions that can cause heel pain. An example of such a condition is a stress fracture of the calcaneus, which is also seen in runners. This problem is treated differently from plantar fasciitis. Accordingly, if you have heel pain be sure to consult a health care practitioner who is appropriately trained and qualified to diagnose and manage such conditions. Use your knowledge of pathological conditions to deepen your understanding of the body and to work with yoga as an adjunct in prevention and treatment. 

      Since one of the most important aspects of managing this condition is stretching of the plantar fascia, heel cords (gastrocnemius/soleus complex) and hamstrings, yoga offers an ancient preventative solution.  For example, Downward Dog pose stretches both the hamstrings and heel cords. Click here to see how to use reciprocal inhibition to release the gastrocnemius and soleus muscles and allow the heels to lower to the floor in Downward Dog. 


      Figure 5: Stretching the plantar aponeurosis (fascia) in Chaturanga dandasana.

      Chaturanga dandasana (figure 5) stretches the plantar fascia itself. Use this image to aid in visualization of this process while in the pose. One of our previous posts gives some tips on how to ease into Chaturanga and another describes a key muscular co-contraction in this pose.

      Uttanasana illustrates a stretch of the posterior kinetic chain, linking to the feet (figure 6). Click here for a tip on integrating the hip abductors to access sacral nutation to refine Uttanasana. Thus, we can see that the Sun Salutations (Surya Namaskar) offer an ancient self-contained method for working with the plantar fascia and its myofascial connections to maintain a healthy foot arch. For many more tips and cues like this, check out the Yoga Mat Companion book series and The Key Muscles and Key Poses of Yoga.

      Figure 6: The posterior kinetic chain and its connection to the feet in Uttanasana.

      We conclude with a step-wise technique on using biomechanics and physiology to lengthen the heel cords in Janu Sirsana (seated forward bend): 

      Step one: Bend the knee about 15 degrees to release the gastrocnemius muscle at its origin on the posterior femur.

      Step two: Use the hands to gently draw the ankle into dorsiflexion and stabilize it in this position by engaging the biceps to flex the elbows. The cue I use for this is to "draw the top of the foot towards the front of the shin (dorsiflexion)."

      Figure 7: Steps to release and then lengthen the calf muscles in Janu sirsasana.

      Step three: Hold the foot in place and gradually engage the quadriceps to straighten the knee. Ease into this position. Maintaining the ankle in some dorsiflexion with the arms and extending the knee distributes the stretch throughout the calf muscles (the gastrocnemius and soleus) as illustrated here. 

      Figure 8: The myofascial connection between the plantar fascia, heel cord and calf muscles.

      You can add a facilitated stretch to the calf by gently pressing the ball of the foot into the hands for 8-10 seconds and then taking up the slack by further dorsiflexing the ankle. This activates the Golgi tendon organ at the muscle tendon junction, resulting in relaxation of the contractile elements. We describe a similar technique to lengthen the hamstrings, as well as the physiological basis for facilitated stretching in our blog post on how to lengthen the hamstrings in Janu sirsasana.


      If you would like to learn more about combining modern Western science with the ancient art of yoga, please join us for a week in paradise at Blue Spirit Costa Rica for our second annual intensive on anatomy, biomechanics and therapeutics for Hatha yoga. I will be teaching state of the art techniques on these subjects, including much new material relating to therapeutic applications of yoga--all with great 3-D illustrations, excellent food, beautiful facilities and expertly taught daily Hatha yoga classes. We encourage you to register soon, as this workshop is nearly full.

      Thanks for stopping by the Daily Bandha. Stay tuned for our next post when I'll go over a common condition affecting the shoulder joint and its yoga solution.  Also, please be sure to share us on Facebook, Twitter and Google Plus.


      Namaste'


      Ray and Chris



      References:

      1) Neufeld SK, Cerrato R.“Plantar fasciitis: evaluation and treatment.” J Am Acad Orthop Surg. 2008 Jun;16(6):338-46.

      2) Digiovanni BF, Nawoczenski DA, Malay DP, Graci PA, Williams TT, Wilding GE, Baumhauer JF.  “Plantar fascia-specific stretching exercise improves outcomes in patients with chronic plantar fasciitis. A prospective clinical trial with two-year follow-up.”  J Bone Joint Surg Am. 2006 Aug;88(8):1775-81.

      3) Riddle DL, Pulisic M, Pidcoe P, Johnson RE“Risk factors for Plantar fasciitis: a matched case-control study.”  J Bone Joint Surg Am. 2003 May;85-A(5):872-7.

      4) Pohl MB, Hamill J, Davis IS. “Biomechanical and anatomic factors associated with a history of plantar fasciitis in female runners.”Clin J Sport Med. 2009 Sep;19(5):372-6.

      5) Harty J, Soffe K, O'Toole G, Stephens MM. “The role of hamstring tightness in plantar fasciitis.”  Foot Ankle Int. 2005 Dec;26(12):1089-92.

      6) Bolívar YA, Munuera PV, Padillo JP. “Relationship between tightness of the posterior muscles of the lower limb and plantar fasciitis.”  Foot Ankle Int. 2013 Jan;34(1):42-8.

      7) Labovitz JM, Yu J, Kim C. “The role of hamstring tightness in plantar fasciitis.”  Foot Ankle Spec. 2011 Jun;4(3):141-4








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      "God is in the Details"--Ludwig Mies van der Rohe

      Attention to detail integrates mindfulness meditation into your Hatha yoga practice, enhancing the benefits. This blog post  illustrates a detailed tip for engaging the TFL in the forward bend Upavista konasana, its biomechanical basis and the benefits of utilizing this important muscle in your forward bends.

      Here’s the anatomy…

      The tensor fascia lata originates from the front part of the iliac crest and outer surface of the anterior superior iliac spine (ASIS). It inserts onto the iliotibial tract (IT band), which continues on to the front outside of the tibia (lower leg bone). It is considered a polyarticular muscle because it crosses both the hip and knee joint. Thus, contracting the TFL can influence both the hips and the knees, as we illustrate below.

      Here’s the cue…

      I always begin by taking the general shape of the pose. In the case of Upavista konasana this means taking the legs apart (abduction) and extending the knees. Then I actively engage the quadriceps to straighten the knees. This initiates reciprocal inhibition of the hamstrings, preparing them for the stretch. Next, I bring in the tensor fascia lata (TFL). The cue for this is to press the heels into the mat and then attempt to drag them apart (abduction). This causes the TFL to contract, which you can feel by placing your hands on the sides of the hips as shown below. Pressing the sides of the feet with your hands augments this cue (see figures 1 and 2 below--click on image to enlarge).

      Figure 1 illustrates pressing the heels down and attempting to drag the feet apart. Figure 2 shows how you can feel the TFL contract. Figure 3 is an intermediate version of the pose.

      Attempting to drag the feet apart with the heels fixed in place on the mat uses the primary action of the TFL (hip abduction) as a cue to access its secondary actions—knee extension, and hip flexion and internal rotation. Knee extension synergizes the quadriceps and helps to align and protect the knees. Hip internal rotation counteracts the thighs rolling outward as a result of the pull from stretching the gluteus maximus. The TFL synergizes the psoas for hip flexion and contributes to femoral-pelvic and lumbar-pelvic rhythm. You can learn more about the concept of joint rhythm and its effect on the spine from our blog post “Preventative Strategies for Lower Back Strains in Yoga”. Figure 4 illustrates these actions in Uppavishta konasana.

      Figure 4 illustrates the action of the TFL on tilting the pelvis forward, internally rotating the thighs and synergizing the quadriceps to extend the knees.

      Once you get the hang of this cue in seated angle pose, try it in other forward bends like Janu sirsasana (figure 5). This illustrates the concept of “portability” for these cues. For many more similar tips, check out the Yoga Mat Companion book series. Learn about the individual muscles in the context of yoga from The Key Muscles and Key Poses of Yoga (you can use the "page through" feature to see the entire books).

      Figure 5 illustrates the action of the TFL on tilting the pelvis forward, internally rotating the thighs and synergizing the quadriceps to extend the knees in Janu sirsasana.


      If you would like to learn more about combining modern Western science with the ancient art of yoga, please join us for a week in paradise at Blue Spirit Costa Rica for our second annual intensive on anatomy, biomechanics and therapeutics for Hatha yoga. I will be teaching state of the art techniques on these subjects, including much new material relating to therapeutic applications of yoga--all with great 3-D illustrations, excellent food, beautiful facilities and expertly taught daily Hatha yoga classes. We encourage you to register soon, as this workshop is nearly full.

      Thanks for stopping by the Daily Bandha. Stay tuned for our next post when I'll go over a common condition affecting the shoulder joint and its yoga solution.  Also, we greatly appreciate when you share us on Facebook, Twitter and Google Plus.


      Namaste'

      Ray and Chris

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      Practicing yoga benefits our activities of daily living. We breathe easier, sit more comfortably and feel stable and strong when standing and walking. For this post, we’ll focus on the muscles that are active during the “mid-stance” phase of walking—which is essentially a one legged standing pose. Then we’ll develop some cues for engaging these muscles to improve stability in poses such as Tree pose and Hasta padangustasana. Improved stability in these asanas in turn enhances the beneficial effects of the practice.

      Figure 1: Illustrating the phases of gait with the mid-stance phase highlighted.

      The walk cycle is traditionally divided into several phases, as illustrated in figure 1. Researchers have used surface EMG’s to detect which muscles are most active during each of the various phases of walking. For example, during the mid-stance phase, the hip muscles that show a higher level of contraction include the gluteus minimus and tensor fascia lata (figure 2). The gluteus minimus helps stabilize the head of the femur (ball) in the acetabulum (socket). The tensor fascia lata acts to stabilize the pelvis and knee. These muscles engage automatically when we stand on one leg (unless there is an underlying pathological condition). We can improve their function in one legged standing poses by consciously engaging them in a variety of other asanas, including Downward dog, Uttanasana, and Upavista konasana.

      Figure 2: The gluteus minimus stabilizing the head of the femur in the acetabulum and the tensor fascia lata (and gluteus medius) stabilizing the pelvis. Note that the TFL also stabilizes the knee.

      Another muscle that is active during the mid-stance phase of gait is the rectus abdominis, which runs from the pubis to the front of the ribcage and xiphoid process of the sternum. This muscle aids to stabilize the lumbar spine and pelvis during this part of the walk cycle (figure 3). Consciously engaging the rectus abdominis during one legged standing poses thus helps to maintain balance. The transversus abdominis also contributes to stability through its myofascial connection to the thoraco-lumbar fascia.

      Figure 3: Illustrating activation of the rectus abdominis in Tree pose.

      Here’s the cue…

      Begin by working with a support, such as a chair or the wall so that you can focus on integrating the muscular engagement without having to also focus on balancing (figure 4). Take Tree pose (Vrksasana) and, on your exhalation, gradually tense the abdomen; a visual cue is to draw the navel inward. Activating the abdominal muscles increases intra-abdominal pressure and tightens the thoraco-lumbar fascia, thus lifting the torso and stabilizing the lumbar spine. Working with the abdominals also amplifies the mind body connection to this region, creating a "functional focal point". 

      Figure 4: Engaging the abdominals in supported Tree pose.

      Cues for stabilizing the core are best worked with over a period of several practice sessions (using a support for balance). The targeted muscular engagement becomes increasingly refined and efficient with each successive session and is easier to use with the final pose.

      Figure 5: Engaging the abdominals in Navasana.

      Other poses that improve core strength, especially that of the abdominal muscles, include Navasana (figure 5) and Chaturanga dandasana (figure 6). Click here for a tip on co-activating the gluts and abs in this pose. For many more techniques and practical cues on integrating Western science into your practice, check out the Mat Companion Series and The Key Muscles and Key Poses of Yoga (use the “look inside” feature to page through the entire books).

      Figure 6: Co-activating the gluts and rectus abdominis in Chaturanga dandasana.

      If you would like to learn more about combining modern Western science with the ancient art of yoga, please join us for a week in paradise at Blue Spirit Costa Rica for our second annual intensive on anatomy, biomechanics and therapeutics for Hatha yoga. I will be teaching state of the art techniques on these subjects, including much new material relating to therapeutic applications of yoga--all with great 3-D illustrations, excellent food, beautiful facilities and expertly taught daily Hatha yoga classes. We encourage you to register soon, as this workshop is nearly full. 

      Thanks for stopping by the Daily Bandha. Stay tuned for our next post when I'll present another subject on combining science and yoga.  Also, we greatly appreciate when you share us on Facebook, Twitter and Google Plus.

      Namaste'

      Ray and Chris


      References:

      1) Crommert ME, Ekblom MM, Thorstensson A. “Activation of transversus abdominis varies with postural demand in standing.” Gait Posture. 2011 Mar;33(3):473-7.

      2) Winter DA: The biomechanics and motor control of human gait: normal, elderly and pathological, ed 2, Waterloo, Canada, 1991, University of Waterloo Press.

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      If a picture's worth a thousand words, then what is an animated video worth? In this blog post we look beneath the skin to see what happens with the piriformis muscle in Reverse Pigeon Pose and provide an overview of the muscle, its attachments and action, and its role in stabilizing the sacroiliac joint. We also examine the use of joint rhythm to optimize the stretch. 

      The piriformis muscle originates on the anterior (front) surface of the sacrum and inserts onto the greater trochanter of the femur (thigh bone). Figures 1 (a) and 1 (b) are front and back views of the piriformis muscle. Figure 1 (c) illustrates the stout ligamentous stabilizers of the sacroiliac joint. 

      Figures 1 (a) is a front view of the piriformis, (b) is a back view and (c) illustrates the ligaments that stabilize the sacroiliac joint. (click on image to enlarge)

      Note that the piriformis is a muscular stabilizer of the sacroiliac joint. Imbalances between the piriformis muscles can contribute to subtle asymmetries within the pelvis, which can then be transmitted to the vertebral column. This underscores the importance of achieving a balanced stretch between the two sides when working with this muscle in yoga. Learn more about the stabilizers of the sacroiliac joint and lumbar spine in our post on the thoracolumbar fascia. We discuss the details of the static and dynamic stabilizers of the joints in The Key Muscles and Key Poses of Yoga.

      To understand why Reverse Pigeon Pose works to stretch the piriformis we need to know that the actions of this particular muscle vary according to the position of the hip joint. For example, when the hip is in a neutral position, the piriformis acts to externally rotate (turn outward), flex and abduct the hip joint. When the hip is flexed beyond about 60 degrees the piriformis becomes an internal rotator and extensor (and remains an abductor). Muscles stretch when we move a joint in the opposite direction of the action of the muscle. In Reverse Pigeon Pose, the hip is flexed and externally rotated, thus stretching the muscle (which extends and internally rotates the hip in this position). This video illustrates the stretch (click on image to open in a separate window).


      When viewing the video, note how flattening the back moves the origin of the piriformis on the sacrum further away from its insertion on the femur, thus accentuating and refining the stretch. This is an example of lumbar-pelvic and femoral-pelvic rhythm. The last section of the video, where we have digitally hidden one half of the pelvis to expose the movement of the sacrum, illustrates this concept. Learn more about joint rhythm in our post “Preventative Strategies for Lower Back Strains in Yoga.”

      Figure 2: variations for stretching the piriformis muscle.

      Figure 2 illustrates some variations for this stretch. Figure 2 (a) is the classic stretch that is typically utilized in yoga. Figure 2 (b) is a modification for persons that cannot practice the full stretch. This variation is also useful to experience the effect of flattening the lumbar in the pose. Figure 2 (c) stretches the piriformis of the lower side leg by adducting and internally rotating the femur. Figure 2 (d) adducts (draws toward the midline) the upper side leg, thus opposing the action of the piriformis for abducting the femur. Figure 2 (e) illustrates a variation commonly employed in physical therapy as part of the regimen for Piriformis Syndrome, a condition that can cause sciatica (we cover this condition in an upcoming post). In this variation, the upper leg crosses all the way over, thus adducting the femur and stretching the muscle. This is a good alternative for those who experience knee issues in the classic stretch. Our next post illustrates a technique for protecting the knee in Reverse Pigeon Pose (and similar asanas).

      I typically do several 20-30 second stretches on each side, easing into and out of the pose. We explain the rationale for this length of time in a pose in the blog post on Hanumanasana (front splits). If you experience pain in this (or any) stretch, carefully come out of the pose. Folks with sciatic type pain should consult a health care practitioner who is appropriately trained and qualified to diagnose and manage such conditions. Follow their guidance, working with yoga as an adjunct in prevention and treatment (where appropriate).

      If you would like to learn more about combining modern Western science with the ancient art of yoga, please join us for a week in paradise at Blue Spirit Costa Rica for our second annual intensive on anatomy, biomechanics and therapeutics for Hatha yoga. I will be teaching state of the art techniques on these subjects, including much new material relating to therapeutic applications of yoga--all with great 3-D illustrations, excellent food, beautiful facilities and expertly taught daily Hatha yoga classes. We encourage you to register soon, as this workshop is nearly full.

      Thanks for stopping by. Stay tuned for our next post on protecting the knee in poses like Reverse Pigeon. We also greatly appreciate when you share our posts on Facebook, Twitter and Google Plus.

      Namaste'

      Ray and Chris

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      Working with the muscular stabilizers surrounding the individual joints is a central tenet of both injury prevention and rehabilitation. In this blog post we illustrate how to work with myofascial connections to protect your knee in Pigeon and Reclining Pigeon pose

      Let’s begin with an experience I had at one of my recent workshops in helping a student recover from a yoga injury. One of the participants mentioned to me that he had sprained his knee a couple of weeks before while overdoing it in Pigeon pose. I examined him and concluded he had a mild sprain. First, I told him to lose the neoprene sleeve he was wearing (which was doing nothing). Then we began working with the muscular stabilizers of the knee, in particular using a progressive series of postures that culminated in Lotus pose—all while paying close attention to engaging the muscles that provide dynamic stability to the knee joint. By the end of the workshop, his knee was completely pain free and felt normal. At which point he made an insightful comment: “injured my knee doing yoga wrong, healed it doing yoga right.” Put another way, “poses don’t injure people; doing poses incorrectly injures people—and doing them correctly heals.” With this in mind, let’s look at how to engage the muscular stabilizers and myofascial connections on the outside of the leg in Pigeon pose.

      Here’s the cue…

      Maintain the ankle in a neutral or slightly dorsiflexed position, extend the toes and then press the ball of the foot forward (as shown). This engages the peroneus longus and brevis and tibialis anterior muscles of the lower leg, and activates a myofascial connection between these muscles and the TFL and biceps femoris muscles of the thigh. Slightly externally rotating the ankle activates the hamstrings on the lateral (outside) of the thigh. These actions create a type of dynamic “brace” on the outside of the leg, protecting the inside of the knee. Similarly, the outside of the knee is protected from overstretching. You can experience this opening on the inside of the knee even while you are reading this by crossing one leg over the other and activating these cues. 

      Protecting the knee in Reverse Pigeon: Figure 1 (left) illustrates everting the ankle to access the muscles on the outside of the leg. Figure 2 (right) illustrates the opening on the inside of the knee.

      Figures 1 and 2 illustrate this cue for Reverse Pigeon and figures 3 and 4 for Pigeon Pose. Click here for an animated video of the piriformis muscle in Reverse Pigeon pose and click here for an animated video that illustrates joint reaction forces and the beneficial effect of releasing the internal rotators for Lotus pose.

      Protecting the knee in Pigeon Pose: Figure 3 (left) illustrates engaging the muscles on the outside of the knee. Figure 4   (right) shows the piriformis muscle stretching in Pigeon Pose.

      Thanks for checking in. We greatly appreciate when you share us on Facebook, Twitter and Google Plus. For many more tips on combining Western science and yoga, check out The Key Muscles and Key Poses of Yoga and the Yoga Mat Companion series (you can page through each book on the right of this page). Be sure to tune in next week for a special edition of The Daily Bandha that you will not want to miss!

      Namaste'

      Ray and Chris



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      Techniques of visualizing are employed in many disciplines. Elite athletes, from NFL quarterbacks to champion racing car drivers often integrate visualization into their training regimens. A racer will use this technique by entering a meditative state and picturing the details of the track they are going to drive, seeing every curve and bump and visualizing themselves driving a safe and flawless race. Then they go out and drive a safe and flawless race.

      Visualization is also a powerful tool utilized by the medical field, particularly as an adjunct to cancer treatment. Patients relax and then picture detailed images of their immune system attacking and defeating the cancer. Indeed, visualization techniques were even utsed by my surgical training program; we were trained to conduct a mental “walk through” of the surgery we were preparing to perform, picturing each step going perfectly--with excellent results. And, as we demonstrated in our previous blog post on the piriformis muscle, an animation can be a powerful tool for integrating knowledge of the body into actual practice.

      In this blog post we use visualization, combined with knowledge of function, to access one of my favorite “hidden” muscles—the popliteus. We will see how picturing the function of this muscle leads to engaging it. This engagement in turn provides additional stability for the knee in poses like Lotus, Baddha konasana and Janu sirsasana. First, let's look at the muscle itself.

      Here’s the anatomy…

      The popliteus muscle originates from the lateral (outside) surface of the lateral condyle of the femur (with a small slip to the lateral meniscus and fibular head) and inserts onto the inside of the back of the tibia, as shown in Figure 1. It acts to flex and internally (medially) rotate the tibia when the leg is not weight bearing and is a synergist of the medial (inside) hamstrings—the semimembranosus and semitenonosus—for these actions. It is here we will focus our attention for this blog post. The popliteus also “unlocks” the knee joint as we begin to flex it from the extended position, so strengthening this muscle can be beneficial for avoiding hyper-extending the knees. Overall, the popliteus is an important rotational stabilizer of the knee joint; engaging it enhances joint congruency. That is why I teach this cue in my workshops on Lotus pose.

      Figure 1: The popliteus muscle viewed from behind the knee.

      Here’s the cue…

      The key to poses like Lotus, Baddhakonasana and Janu sirsasana is to obtain range of motion of the hip joint, while maintaining congruency of the knee (click here for an explanation of joint congruency). So before I practice these poses, I typically warm up with some asanas that release the muscles about the hip joint. Click here for Reverse Pigeon Pose, and here for a tip on protecting the knee in this pose.  Click here for a technique on releasing the internal rotators of the hip and here for a technique to release the hip adductors.

      As a general consideration, when working on isolating smaller difficult to access muscles like the popliteus, begin with a couple of short duration visualizations. Don’t try too hard, but simply imagine the action of the popliteus in Baddha konasana as shown in Figure 2 and gently contract the muscle.  Then release and take the counter pose, Dandasana.  Repeat the process, picturing the popliteus muscle near the knee joint engaging to synergize flexing the knee and internally rotating the tibia.  Several short duration repetitions allows the brain to create circuitry to more efficiently access this important knee stabilizer. Do this process over several days, after which you will be able to engage the muscle at will and with increasing refinement.  Use gentle muscular engagement and “ease into and out of” your poses, paying attention to detail. If you experience pain in your stretch, then carefully release and come out of the pose.

      Figure 2: Visualizing the popliteus muscle flexing and and internally rotating the tibia in Baddha konasana.

      Muscles have evolved so that when they engage they not only move the joint but also stabilize it, maximizing joint congruency. Our books are designed to enhance the visual experience of this process for the reader. We use carefully designed vivid images that stimulate the visual cortex of the brain, in essence “lighting up” the muscles that are engaging in each part of the body during each pose.  In fact, many practitioners say that they can actually “feel” the muscles when looking through the Key Muscles and Key Poses of Yoga. The Yoga Mat Companion series deepens this visual experience by illustrating each pose in a step-wise fashion. This visual experience then translates to improvement in your asanas. Click here to page through all of our books.

      Thanks for stopping by. Be sure to tune in this week for our next post. Also, many thanks for your support by sharing us on Facebook, Twitter and Google Plus.

      Namaste’

      Ray and Chris


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      The Sanskrit word “Sankalpa” has been interpreted to mean a “resolution” or “intention”, usually in association with the practice of Yoga Nidra.  According to Swami Saraswati, “sankalpa has the potential to release tremendous power by clearly defining and focusing on a chosen goal.” The focus of this blog post is to illustrate the subtle, yet powerful myofascial connections between the diaphragm and iliopsoas muscle all the way down to the feet in Triangle pose. Understanding and visualizing these connections in Trikonasana will enable you to do the same in other poses.

      Figure 1: Myofascial connections between the diaphragm, psoas and lower extremity.

      The diaphragm, as we all know, is the central muscle of breathing. It operates mostly unconsciously, though we can consciously influence its rate and depth of contraction.  As the central muscle of breathing the diaphragm is inextricably linked to our life force and thus, our emotions and energetic body. Practicing yoga asanas influences the diaphragm in subtle ways, particularly through its connection to the psoas muscle. In fact, every pose has a slightly different effect on the diaphragm, and thus on its energetic connections. 

      Figure 2: Myofascial connections between the diaphragm, psoas and lower extremity in Trikonasana.

      Visualization is a powerful tool you can use to access these connections. So, before we go on to the details of anatomy and biomechanics, spend a few relaxed moments looking at figures 1 and 2, which illustrate these myofascial connections. Look at the images and then picture the connections within your body (click on the image for a larger view). Repeat this exercise two or three times, devoting five or ten seconds to each visualization. Note how you can feel the connections within yourself. Please complete this process before proceeding with the details of anatomy and biomechanics. 

      And, here’s the anatomy…

      The thoracic diaphragm is a dome shaped muscle that separates the chest and abdominal cavities. The contractile part of this muscle is located peripherally, inserting onto a central tendon (that is not connected to a bone). The origins of the muscle are divided into costal and lumbar portions. The “costal” portion originates from the inner surface of ribs seven through twelve. The “lumbar” portion has both medial (closer to the midline) and lateral (further from the midline) aspects. The medial aspects of the diaphragm arise from front of the first three lumbar vertebrae (L1-L3). The lateral aspects arise from three tendinous arches. The first tendinous arch is associated with the abdominal aorta, and the second and third with the psoas major and quadratus lumborum muscles respectively. Figure 3 illustrates these structures.

      Figure 3: The diaphragm-psoas connection.
      1) diaphragm 2) diaphragm tendon 3) aortic aperture 4) psoas arcade 5) vena caval aperture 6) esophageal aperture

      Engaging the diaphragm with the glottis open expands the ribcage and produces a pressure gradient by lowering intrathoracic pressure. The negative inspiratory pressure causes air to be drawn into the lungs, thus equalizing the gradient. These fluctuating pressure gradients also facilitate blood flow, particularly venous return to the heart.

      Conversely, contracting the diaphragm after exhalation with the glottis closed (as in Nauli) also produces a pressure gradient. In this case the negative inspiratory pressure draws the abdominal contents upwards (and the abdomen in). Engaging the diaphragm on exhalation with the glottis closed is a form of eccentric contraction, whereby a muscle is engaged in its lengthened state. 

      Engaging the abdominals during exhalation passively stretches the diaphragm by raising the intra-abdominal pressure and lifting the abdominal organs upward against the muscle. Note that engaging the abdominals on exhalation also tensions the thoraco-lumbar fascia, which serves to stabilize the lumbar spine and sacroiliac joint. Click here for more information on this particular connection.

      The psoas major muscle originates from the vertebral bodies of T12 and L1 through L4 (lateral surfaces and discs), with a deep layer originating from L1-L5 (costal processes). It combines with the iliacus muscle, which originates from the inside of the ilium (the iliac fossa) to form the iliopsoas muscle. The iliopsoas then runs over the brim of the pelvis to insert onto the lesser trochanter, a knob-like structure on the upper, inside of the femur (thigh bone). The iliopsoas crosses multiple joints and is thus considered a polyarticular muscle. When contracting on one side it can act to flex and externally rotate the femur and/or laterally flex the trunk (as in Trikonasana) or tilt one side of the pelvis forward. When the iliopsoas contracts on both sides it can flex both femurs and the trunk. Bilaterally contracting this muscle lifts the trunk from supine position (lying on the back). Figure 4 illustrates the iliopsoas muscle. Click here for a technique on isolating and awakening this important muscle to use it consciously in yoga poses.

      Figure 4: The psoas.
      1) psoas major 2) psoas minor 3) iliac us 4) iliopsoas (at tendon attachment to the lesser trochanter)

      Now, return to the images illustrating myofascial connection between the diaphragm, the psoas and the lower extremities (figures 1 and 2). Spend a few moments in relaxed visualization of these key structures. Note how your body awareness has deepened in the brief period between now and when you first looked at them. Integrate this process into your daily practice. 

      Sankalpa and creative visualization are two of the eight components of Yoga Nidra, as described by Swami Satyananda. Though typically performed during the deep relaxation phase of an asana practice, visualization and intent can be worked with during the asanas themselves. Swami Saraswati beautifully describes the process of Sankalpa as a series of stepping-stones that are used to cross a wide river. 

      Our books are designed to facilitate this experience. They are based on many years of formal study of anatomy and biomechanics and use carefully designed vivid images that stimulate the visual cortex of the brain, in essence “lighting up” the muscles that are engaging in each part of the body during each pose.  In fact, many practitioners say that they can actually “feel” the muscles when looking through the Key Muscles and Key Poses of Yoga. The Yoga Mat Companion series deepens this visual experience by illustrating each pose in a step-wise fashion. This visual experience then translates to improvement in your asanas. Click here to page through all of our books.

      If you would like to learn more about combining modern Western science with the ancient art of yoga, please join us for a week in paradise at Blue Spirit Costa Rica for our second annual intensive on anatomy, biomechanics and therapeutics for Hatha yoga. I will be teaching state of the art techniques on these subjects, including much new material relating to therapeutic applications of yoga--all with great 3-D illustrations, excellent food, beautiful facilities and expertly taught daily Hatha yoga classes. Although our allotment of rooms is complete, my assistant Carol will work with Blue Spirit to obtain one of the remaining rooms at the Retreat, but please contact her soon on this. 

      Namaste’

      Ray and Chris

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      I’m thinking the ancients were onto something. Meaning this (possibly) 5,000 year old art that so many of us enjoy practicing and teaching. I’m talking about the tradition of Hatha yoga. The one that includes putting our bodies into poses like Uttanasana, Dandasana, Padmasana (Full Lotus), Sirsasana (Headstand) etc. Now, part of that practice involves poses that take some of our joints to the extremes of their range of motion (from a western medical perspective). Indeed, many of the benefits of Hatha yoga derive from moving our joints (carefully) within their range of motion.

      Obviously, we want to avoid injuries when practicing yoga. One way to do that is to eliminate a bunch of the asanas on the grounds that they’re “too dangerous”. That approach also eliminates the benefits of those poses. Or, we can practice mindfully, using modifications where appropriate and working in a progressive manner towards the classical asanas that are appropriate for each of us individually. Knowledge of the body combined with awareness of mechanisms of injury aids in this process.

      In medicine, we look for ways to eliminate the risks of a given activity, not the activity itself. To illustrate my point, check out this quote from one of the scientific articles that studied the effect of extreme hip motion in professional ballerinas:

      These results do not mean that the dancers should stop executing these movements, but rather they should limit them in frequency during dancing class.”2

      Wow. Think I’m down with that.

      You mean we don’t have to toss out Developpe Devant, Developpe a la Seconde, Grand Ecart Facial and Grand Ecart Latéral and create a new "gentler ballet"? Of course not. Because it would be kind of boring to watch a ballet that consisted of folks sitting on a stage, waving their arms around (to say nothing of the dangers to the rotator cuff). Similarly, Hatha yoga wouldn’t have its beneficial effects without, you know, the poses of Hatha yoga.

      So, with this in mind, let’s review the structure of the hip, paying particular attention to the labrum.

      As a general consideration, mobility and stability of the joints are determined by three factors. First, there is the shape of the bone at the joint; for example a ball and socket vs a hinge. Next there are the soft tissue stabilizers such as the ligaments, capsule, labrum or meniscus. Finally, there are the muscular stabilizers that surround a given articulation. A related subject is the concept of joint congruency. This refers the fit of opposing joint surfaces. High joint congruence means there is more surface area in contact; low joint congruence decreases the contact area.

      A central tenet of rehabilitation and injury prevention relates to strengthening the muscular stabilizers of the joints. This aids to enhance congruency of the articular surfaces while at the same time providing dynamic support for the soft tissue stabilizers such as the ligaments, labrum and menisci. For example, in sports that put the soft tissue and bones at risk, we integrate training that improves proprioception and strengthens the muscles surrounding the joints.

      Hip joint cross-section showing articular surface and acetabular labrum.

      Let’s begin by looking at the acetabular labrum. This is a fibrocartilaginous ring-like structure that encircles the outer edge of the socket of the hip joint. Like the meniscus of the knee and the labrum of the shoulder, the hip labrum deepens the joint and contributes to its stability, while aiding in pressure distribution along the articular cartilage. It also acts as a type of seal that helps to retain the synovial fluid within the joint itself, thus allowing for some of the load on the joint to be borne by fluid pressurization, while at the same time helping with joint lubrication.

      1-hip joint and labrum, 2-acetabular cartilage, labrum and ligamentum teres, 3-capsule lining showing synovium.

      The labrum is relatively avascular, with blood vessels entering near the peripheral edge where it attaches to the bone and cartilage, and penetrating about one third of the way into the structure. This limits its ability to heal. Tears of the labrum are associated with hip osteoarthritis. Figures 1 and 2 illustrate the hip labrum from the outside of the joint and the acetabulum with the femur removed.

      The hip is a synovial joint. These types of joints are surrounded by a capsule, which is lined by a synovial membrane (synovium) which faces the joint cavity. The synovium contains two primary cell types. The first are called fibroblasts and they secrete synovial fluid. This fluid lubricates the joint surfaces, reduces friction during movement and acts as a shock absorber through fluid pressurization. It also carries oxygen and nutrients to the articular cartilage and removes carbon dioxide. The other cell type lining the synovium is a macrophage cell; this cell removes debris or other unwanted material from the joint space. Activities that maintain joint range of motion aid in circulating the synovial fluid and bringing unwanted material into contact with the macrophages. Figure 3 (above) illustrates the joint capsule with the synovium for the hip.

      1-iliofemoral ligament, 2-hip capsule, 3-pubofemoral ligament, 4-ischiofemoral ligament, 5-iliofemoral ligament.

      On the outside surface of the hip capsule are the ligaments. The iliofemoral ligament runs from the anterior inferior iliac spine (AIIS) to the front and lateral part of the top of the greater trochanter of the femur. The iliofemoral ligament is the strongest ligament in the body. It functions to resist extension and external rotation of the hip and helps to prevent the pelvis from tilting backwards during standing. It also stabilizes the pelvis during the stance phase of walking, thus assisting the hip abductors. The pubofemoral ligament runs from the pubis to the neck of the femur; it prevents hyperextension and hyperabduction of the hip. The ischiofemoral ligament runs from the ischium in a spiral manner to the femoral neck. This ligament tightens in hip extension and becomes loose during flexion. The image above illustrates the hip ligaments.

      Finally, there are the muscular stabilizers of the hip. I’m not going to discuss the specific actions of the individual muscles in this post. What I want to illustrate is the positions of the muscles around the joint. For example, look at the psoas and the rectus femoris muscles and how they provide an anterior support to the hip. The images below illustrate the muscular stabilizers of the hip joint.

      1-iliopsoas, 2-pectineus, 3-rectus femoris, 4-sartorius, 5-gluteus medius,
      6-tensor fascia lata, 7-piriformis, 8-external rotators, 9-quadratus femoris.

      1-gluteus maximus, 2-tensor fascia lata, 3-adductor brevis, 4-adductor longus, 5-adductor magnus, 6-semimembranosus, 7-semitendinosus, 8-biceps femoris.

      Take your time going over this material, and use the great images Chris produced to help you understand the hip joint. Stay tuned for Part II of the series, where we’ll go over some of the latest scientific research being conducted on the hip joint (research for which all of us in yoga should be extremely grateful, btw).

      As always, if you have pain in your hips (from any activity), be sure to consult a health care professional who is trained and qualified to diagnose and treat such conditions.

      Namaste'

      Ray and Chris

      References:

      1. Reid DC.Prevention of hip and knee injuries in ballet dancers.” Sports Med. 1988 Nov;6(5):295-307

      2. Charbonnier C, Kolo FC, Duthon VB, Magnenat-Thalmann N, Becker CD, Hoffmeyer P, Menetrey J. “Assessment of congruence and impingement of the hip joint in professional ballet dancers: a motion capture study.Am J Sports Med. 2011 Mar;39(3):557-66.

      3. Gilles B, Christophe FK, Magnenat-Thalmann N, Becker CD, Duc SR, Menetrey J, Hoffmeyer P. “MRI-based assessment of hip joint translations.J Biomech. 2009 Jun 19;42(9):1201-5.

      4. Mandelbaum BR, Silvers HJ, Watanabe DS, Knarr JF, Thomas SD, Griffin LY, Kirkendall DT, Garrett W Jr. Effectiveness of aneuromuscular and proprioceptive training program in preventing anterior cruciate ligament injuries in female athletes: 2-yearfollow-up.Am J Sports Med. 2005 Jul;33(7):1003-10.

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      In this post we discuss labral tears and the condition of joint hypermobility. I also present the case of a specific injury from yoga practice, its biomechanical basis and the steps that can be taken to aid in its  prevention.

      First, however, let’s look at the concept of association vs causality. Simply put, because some activity is associated with a problem does not mean it caused it. In medicine, we when we recognize that an injury is associated with a specific activity we then investigate whether there are factors associated with that activity that could cause the injury. An example would be anterior cruciate ligament (ACL) tears.

      A while back, we recognized that ACL tears were approximately five times more common in female athletes compared to males. Thus, investigators sought to identify circumstances that could account for this increased incidence. The risk factor thought to contribute most significantly to the higher rate of ACL ruptures in female athletes related to insufficient neuromuscular control of the knee joint in certain athletes. Accordingly, neuromuscular training regimens were devised that have reduced the incidence of ACL ruptures in this group. This approach to ACL injuries is an example of working with science to decrease the risk of an activity, not the activity itself. With this in mind, let’s look at the potential association of joint hypermobility with yoga injuries.

      Joint hypermobility, also known as generalized ligamentous laxity, is a spectrum ranging from mild “loose joints” to systemic pathological conditions such as Ehlers Danlos syndrome (a rare inherited condition that affects the connective tissue throughout the body). “Benign” joint hypermobility, or “double jointedness”, affects between 5% and 15% of the population, with most studies showing this condition to be significantly more common in women vs men. We evaluate the degree of hypermobility using the Beighton criteria, which examines factors such as knee, elbow and thumb hyperextension. Based on these factors, a score is created to quantify whether a person has hypermobility syndrome.

      Joint hypermobility affects the capsular and ligamentous stabilizers of the articulations, which are lax. It is associated with an increased incidence of musculoskeletal injuries, including to the labrum of the shoulder and hip joints due to increased translations across the structure. The mainstay of management for ligamentous laxity (hypermobile joints) is physical therapy that is focused on strengthening the muscular stabilizers surrounding a given joint and improving proprioception. Now, let’s look at joint hypermobility in relation to injuries that may be associated with yoga.

      Injuries that can be unequivocally directly attributed to practicing yoga, like the one described below, are infrequent (in my clinical experience) simply because yoga practitioners are active people who engage in other pursuits that may also cause injuries (sports, dance etc). Put another way, folks that actually practice yoga are generally not couch potatoes. Further complicating the issue are age related disease processes that can affect the joints whether or not one practices yoga. Nevertheless, we need to watch for associations of injuries with yoga and, where possible, determine their underlying cause, identify subgroups that may be at particular risk, and take steps to minimize those risks. With this in mind, let’s look at a specific injury that was caused during yoga practice, its biomechanical basis and steps that can be taken to aid in prevention.

      During the past year I saw one yoga injury that was specifically caused by practicing a pose. This involved an experienced teacher who was demonstrating the “wrong way” to perform Vasisthasana (side plank pose) by having the hand of the supporting arm forward of the shoulder joint instead of directly below the shoulder and at a right angle to the floor. In the process, she experienced a “clunk” in her shoulder, followed by pain. On exam in the clinic, she was found to have joint hypermobility, as quantified by the Beighton criteria. Her MRI demonstrated a tear of the posterior part of the shoulder labrum. Conservative treatment with physical therapy, etc. was not successful in relieving her pain and she required arthroscopic repair of the labrum with tightening of the capsule.

      It is worth noting that this teacher had practiced Vasisthasana many times with the hand placed below the shoulder without difficulty. Additionally, on questioning it was clear that she was not actively engaging the muscular stabilizers of the shoulder joint during the demonstration.

      Now, let’s look at the mechanism of injury. First, as part of their joint hypermobility, this person had a condition known as “multidirectional shoulder instability”. In patients with this condition, the shoulder capsule and ligaments are lax and thus, do not contribute sufficiently to stability of the joint. As a result, the head of the shoulder can “slide” around on the glenoid (socket) more than usual. This causes increased translational forces across the glenoid labrum. In this particular case, while attempting side plank, she subluxed the head of the humerus over the labrum, tearing it.


      Shoulder bony structures, ligaments and muscular stabilizers.
      1-supraspinatus, 2-subscapularis, 3-infraspinatus, 4-triceps, 5-biceps(short head),
      6-biceps(long head), 7-deltoid, 8- pectoralis major, 9-pectoralis minor

      The three factors that contribute to mobility and stability of the joint are the bone shape, the capsulo-ligamentous structures and the muscles surrounding the articulation. Figure 1 illustrates the structure of the shoulder joint. Composed of a shallow socket and relatively thin capsular and ligamentous supports, this is the most mobile articulation in the body. The muscular stabilizers, including the rotator cuff play an important role in maintaining the congruency of the shoulder joint. When the capsule and ligaments are loose, then the muscles must compensate. This is why we focus on strengthening the muscles in multidirectional shoulder instability. Figures 1, 2 and 3 illustrate the bone structure, capsulo-ligamentous stabilizers and muscular stabilizers respectively.
      Figure 4: Vasisthasana illustrating the direction of gravity in variations of hand position.

      Looking at the factors that caused this teacher to experience a subluxation with the hand forward of the shoulder we can see that, in this position, the body weight is directed at an angle to the alignment of the arm bones. When the hand is placed below the shoulder, the supporting arm is aligned in a position such that the bones are perpendicular to the direction of gravity. Practicing the pose in this way requires less muscular effort because it uses the inherent passive strength of the bones to aid in supporting the body weight. When the hand is placed forward of the shoulder, greater muscular effort is required to maintain the pose (figure 4). People with joint hypermobility depend to a greater degree on the muscular stabilizers of the joint. Placing the hand so that the arm is angled against gravity means that these muscles must also take up the weight that would be borne, in part, by the bones. You can experience this concept yourself by standing near a wall and leaning against it (figure 5). Then, move the feet a bit further from the wall. Which one requires less muscular effort?

      Figure 5: Illustrating using bone alignment vs muscular force.

      Figures 6 illustrates Vasisthasana with the supporting muscular stabilizers. I go over a step-wise approach to engaging these muscles and the other core stabilizers of the trunk and legs in Yoga Mat Companion Four (arm balances and inversions).

      Figure 6: Muscular stabilizers of the shoulder in Vasisthasana.

      Labral Tears in the Hip:

      In our most recent blog post we discussed the normal structure and function of the hip labrum. Now let’s discuss labral tears. A number of activities have been associated with this injury including soccer, hockey, golf, ballet, gymnastics, and running. Additionally, a number of specific movements have been associated with labral tears. Pregnancy and childbirth have also been associated with acute tears of the labrum. Even shopping has been associated with injuries to this structure ("supermarket hip"). Other causes of labral tears include ligamentous laxity and abnormalities of the bone. Nevertheless, up to 75% of the time, symptomatic labral tears of the hip are not associated with an identifiable event or cause.

      Adding to the complexity is the consideration that labral pathology may be related to the aging process, with up to 96% of cadaver specimens having tears. Furthermore, labral tears do not always cause pain; indeed, a prospective blinded study published in the American Journal of Sports Medicine identified labral tears in 69% of volunteers with no history of injury, pain or other symptoms. Even accounting for false positive mri’s, that is a significant number. Indeed, hip injuries are one of the most intensively investigated areas of medicine today, with new studies being published each month. In this regard, please review the linked references below.

      Figure 7: Hip Labral Tear.

      One of the known causes of tears of the hip labrum is joint hypermobility. This is also a factor during pregnancy, when hormonal influences cause ligamentous laxity in persons who are not normally hypermobile. Tears of the hip labrum occur in this setting as result of increased translational forces across the labrum from the femoral head. As with hypermobile joints elsewhere in the body, hypermobility in the hips is managed (at least initially) by strengthening the muscular stabilizers that surround the joint. This aids to prevent injuries.

      I think this is relevant in light of recent media attention on hip injuries and yoga, particularly since many of those practicing poses that take the hip joints into extreme positions also have hypermobile joints. In my experience, such individuals—who can easily perform extreme movements—often do so without maintaining muscular engagement during extremes of motion. Of particular note is a recent NY Times article that discusses flexibility as a liability for women in yoga. While spending considerable time discussing bone abnormalities (which are more prevalent in men, and were not thought to be a factor in studies on dancers), the NY Times article does not discuss joint hypermobility or the use of muscular stabilization to prevent injury during practice. Instead, the author appears to discourage (or may be unaware of) working with muscular engagement in yoga--something that is a cornerstone of injury prevention, especially in persons with high levels of joint mobility. Perhaps a more relevant view of the matter was presented in the Canadian media. Yoga Dork and Baxter Bell, MD also had insightful commentaries on the NY Times article.

      Finally, here are a couple of suggestions that I have found to be helpful in my own practice and teaching:

      1. Ease into the end points of poses. Joints adapt to gradual changes much better than abrupt or rapid ones. For example, I deliberately slow down my movement as I near the end point of forward flexion in Uttanasana. This helps to protect the joints and also creates mindfulness in the practice.
      2. Use gentle muscular engagement to stabilize the joints. This is a cornerstone of rehabilitation and injury prevention. Knowledge of the musculoskeletal system and visualization helps in this process.

      Note: if you have pain in your hips (from any activity), be sure to consult a health care professional who is appropriately trained and qualified to diagnose and manage such conditions. Follow their guidelines for your condition.

      To learn more about anatomy, biomechanics and yoga, feel free to page through The Key Muscles and Key Poses of Yoga and the Yoga Mat Companion Series. If you would like to learn more about combining modern Western science with the ancient art of yoga, please join us for a week in paradise at our workshop in Bali for a five day intensive on anatomy, biomechanics and therapeutics for Hatha yoga.

      Thanks for stopping by. Be sure to tune in this week for our next post. Also, many thanks for your support by sharing us on Facebook, Twitter and Google Plus.

      Namaste',

      Ray and Chris

      References:
      1. Mandelbaum BR, Silvers HJ, Watanabe DS, Knarr JF, Thomas SD, Griffin LY, Kirkendall DT, Garrett W Jr. “Effectiveness of a neuromuscular and proprioceptive training program in preventing anterior cruciate ligament injuries in female athletes: 2-year follow-up.” Am J Sports Med. 2005 Jul;33(7):1003-10.
      2. Wolf JM, Cameron KL, Owens BD. “Impact of joint laxity and hypermobility on the musculoskeletal system.” J Am Acad Orthop Surg. 2011 Aug;19(8):463-71.
      3. Pacey V, Nicholson LL, Adams RD, Munn J, Munns CF. “Generalized joint hypermobility and risk of lower limb joint injury during sport: a systematic review with meta-analysis.Am J Sports Med. 2010 Jul;38(7):1487-97.
      4. Konopinski MD, Jones GJ, Johnson MI. “The effect of hypermobility on the incidence of injuries in elite-level professional soccer players: a cohort study.Am J Sports Med. 2012 Apr;40(4):763-9.
      5. McCormack M, Briggs J, Hakim A, Grahame RJoint laxity and the benign joint hypermobility syndrome in student and professional ballet dancers.J Rheumatol. 2004 Jan;31(1):173-8.
      6. Boykin RE, Anz AW, Bushnell BD, Kocher MS, Stubbs AJ, Philippon MJ. “Hip instability. J Am Acad Orthop Surg. 2011 Jun;19(6):340-9.
      7. Lewis CL, Sahrmann SA. “Acetabular labral tears. Phys Ther. 2006 Jan;86(1):110-21.
      8. Groh MM, Herrera J. “A comprehensive review of hip labral tears. Curr Rev Musculoskelet Med. 2009 Jun;2(2):105-17.
      9. Baker JF, McGuire CM, Mulhall KJ.Acetabular labral tears following pregnancy. Acta Orthop Belg. 2010 Jun;76(3):325-8.
      10. Yamamoto Y, Villar RN, Papavasileiou A. “Supermarket hip: an unusual cause of injury to the hip joint.Arthroscopy. 2008 Apr;24(4):490-3
      11. Register B, Pennock AT, Ho CP, Strickland CD, Lawand A, Philippon MJ. “Prevalence of abnormal hip findings in asymptomatic participants: a prospective, blinded study.Am J Sports Med. 2012 Dec;40(12):2720-4.
      12. Agricola R, Heijboer MP, Roze RH, Reijman M, Bierma-Zeinstra SM, Verhaar JA, Weinans H, Waarsing JH.Pincer deformity does not lead to osteoarthritis of the hip whereas acetabular dysplasia does: acetabular coverage and development of osteoarthritis in a nationwide prospective cohort study (CHECK).Osteoarthritis Cartilage. 2013 Oct;21(10):1514-21.
      13. Leunig M, Jüni P, Werlen S, Limacher A, Nüesch E, Pfirrmann CW, Trelle S, Odermatt A, Hofstetter W, Ganz R, Reichenbach S. “Prevalence of cam and pincer-type deformities on hip MRI in an asymptomatic young Swiss female population: a cross-sectional study.Osteoarthritis Cartilage. 2013 Apr;21(4):544-50.
      14. Agricola R, Heijboer MP, Bierma-Zeinstra SM, Verhaar JA, Weinans H, Waarsing JH. “Cam impingement causes osteoarthritis of the hip: a nationwide prospective cohort study (CHECK).Ann Rheum Dis. 2013 Jun;72(6):918-23.
      15. Charbonnier CKolo FCDuthon VBMagnenat-Thalmann NBecker CDHoffmeyer PMenetrey J. Assessment of congruence and impingement of the hip joint in professional ballet dancers: a motion capture study. Am J Sports Med. 2011 Mar;39(3):557-66.




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      A central concept in all healing arts is that of correcting imbalances within the body. The principle of re-establishing balance can be found across all cultures from Navajo sand paintings, Ayurveda, Traditional Chinese Medicine to modern allopathy.  And anything with true healing power also has the capacity to cause injury when practiced without balance. For example, joint mobility is beneficial for a number of reasons--provided it is balanced with joint stability. In this blog post I discuss the concept of joint proprioception and its relationship to joint stability and yoga, concluding with a tip for “re-setting” muscular proprioception following hip openers. 

      Proprioception refers to the sense of the relative position of neighboring body parts, such as the femoral head within the hip socket (acetabulum) as well as the muscular force utilized in movement of those parts. This is in contradistinction to exteroception, which is the perception of the outside world (like the feeling of the feet on the ground) and interoception, which is the perception of the inside of the body (pain, hunger etc). I look at proprioception as a type of “GPS” for the joints.

      Joint position is detected by specialized nerve endings known as “proprioceptors” that are located within the muscles, ligaments and joint capsule and the periosteum (on the surface of the bones). These receptors communicate information about the joints to the brain via the sensory columns of the spinal cord.  Conscious sense of joint position is transmitted to the cerebrum of the brain; unconscious proprioception is communicated to the cerebellum. Figure 1 illustrates this pathway in a cross section of the spinal cord. 





      Scientific studies have demonstrated that joint position sense is decreased in persons with osteoarthritis, with the consideration that reduced proprioception may play a role in the development of the disease. Indeed, exercises that improve proprioception have been demonstrated to be effective in the conservative management of osteoarthritis.  

      Proprioception is also reduced in persons with joint hypermobility; exercises that improve joint position sense are also effective in reducing symptoms in this population. I suspect that proprioception may be also be a factor in those having joint pain associated with subtle instability (who do not have an identifiable cause for their pain such as arthritis, hypermobility or a structural lesion). Similarly, the diminished performance seen in certain athletes following stretching routines may be related to reduced joint position sense.

      I bring this up in relation to yoga because certain individuals experience soreness in their hips following hip opening poses.  Understanding that this pain may be related to decreased proprioception, I have been using a simple technique to re-establish joint position sense following these poses. For example, I worked with several practitioners during the Blue Spirit Intensive who had this type of hip soreness. Following a sequence that led to Full Lotus, we applied the technique, which “resets” the joint position sense in the hips. After the “reset”, these folks noticed that the hip pain they typically felt was gone, with this benefit remaining throughout the day.

      This leads me to believe that some of the hip pain experienced by practitioners may be related to a reduction in muscular proprioception after stretching, which persists as a subtle form of instability during other activities following practice. Furthermore, the soreness appears to be relieved by a technique to increase proprioception that involves co-activating the muscles surrounding the hip joint at a midpoint of the joint's range of motion.

      Here’s the technique…

      Following a hip opening sequence, and before Savasana, I utilize an intermediate version of Warrior II, where the forward knee and hip are not flexing deeply (figure 2). Then I “co-activate” the hip muscles in the forward leg (co-activation involves simultaneously contracting muscles that have opposite actions). The cue for this is to imagine pressing the inside of knee into an immoveable object while at the same time pressing the outside of the knee into a similar object (the knee remains centered and does not move). This engages both the hip abductors and adductors, as well as the internal and external rotators in a position where the joint is in the mid-range of motion. Done properly, this cue should give a feeling of stability in the hip joint.

      Since it is a neurological process, this technique does not require strong muscular contraction; I only utilize just enough strength to feel the muscles engage and the hip stabilize. Furthermore, the cue only requires a short duration. I have been using 20 seconds, repeated twice on each side. The effect is a bit like “resetting” a GPS that has gone out of its normal range. Figures 3-5 illustrate the muscle groups involved with the arrows demonstrating the direction of force. Visualization of the muscles helps in this process.

      Figure 2: Warrior II intermediate version. I use this for training proprioception.

      Figure 3: Co-activating the hip adductors, abductors and rotators in Warrior  II.

      Figure 4: Co-activating the hip adductors, abductors and rotators in Warrior  II.

      Figure 5: Activating the deep external rotators of the hip in Warrior II.


      Thanks for stopping by. We hope that you enjoy this tip on training proprioception of the hip joint. Note that if you have persistent hip pain or other symptoms, be sure to consult a health care provider who is appropriately trained and qualified to manage such conditions. 

      If you would like to learn more about anatomy, biomechanics and yoga, feel free to browse through The Key Muscles and Key Poses of Yoga. Also, check out the Yoga Mat Companion series, which contains many examples of co-activation (including the one in this post). Many thanks for your support by sharing us on Facebook, Twitter and Google Plus as well.

      Namaste'

      Ray and Chris



      References:
      1. Wolf JM, Cameron KL, Owens BD. “Impact of joint laxity and hypermobility on the musculoskeletal system.” J Am Acad Orthop Surg. 2011 Aug;19(8):463-71.
      2. Smith TO, Jerman E, Easton V, Bacon H, Armon K, Poland F, Macgregor AJ. “Do people with benign joint hypermobility syndrome (BJHS) have reduced joint proprioception? A systematic review and meta-analysis.” Rheumatol Int. 2013 Nov;33(11):2709-16.
      3. Smith TO, King JJ, Hing CB. “The effectiveness of proprioceptive-based exercise for osteoarthritis of the knee: a systematic review and meta-analysis.” Rheumatol Int. 2012 Nov;32(11):3339-51.
      4. Sahin N, Baskent A, Cakmak A, Salli A, Ugurlu H, Berker E. “Evaluation of knee proprioception and effects of proprioception exercise in patients with benign joint hypermobility syndrome.” Rheumatol Int. 2008 Aug;28(10):995-1000.
      5. Lund H, Juul-Kristensen B, Hansen K, Christensen R, Christensen H, Danneskiold-Samsoe B, Bliddal H. “Movement detection impaired in patients with knee osteoarthritis compared to healthy controls: a cross-sectional case-control study.” J Musculoskelet Neuronal Interact. 2008 Oct-Dec;8(4):391-400.
      6. Sharma L. “Proprioceptive impairment in knee osteoarthritis.” Rheum Dis Clin North Am. 1999 May;25(2):299-314, vi.
      7. Liikavainio T, Lyytinen T, Tyrväinen E, Sipilä S, Arokoski JP. “Physical function and properties of quadriceps femoris muscle in men with knee osteoarthritis.” Arch Phys Med Rehabil. 2008 Nov;89(11):2185-94.
      8. Lauersen JB, Bertelsen DM, Andersen LB. “The effectiveness of exercise interventions to prevent sports injuries: a systematic review and meta-analysis of randomised controlled trials.” Br J Sports Med. 2013 Oct 7.
      9. Caplan N, Rogers R, Parr MK, Hayes PR. “The effect of proprioceptive neuromuscular facilitation and static stretch training on running mechanics.” J Strength Cond Res. 2009 Jul;23(4):1175-80.
      10. Higgs F, Winter SL. “The effect of a four-week proprioceptive neuromuscular facilitation stretching program on isokinetic torque production.” J Strength Cond Res. 2009 Aug;23(5):1442-7.
      11. Handrakis JP, Southard VN, Abreu JM, Aloisa M, Doyen MR, Echevarria LM, Hwang H, Samuels C, Venegas SA, Douris PC. “Static stretching does not impair performance in active middle-aged adults.” J Strength Cond Res. 2010 Mar;24(3):825-30.
      12. Wu Q, Henry JL. “Functional changes in muscle afferent neurones in an osteoarthritis model: implications for impaired proprioceptive performance.” PLoS One. 2012;7(5): Epub 2012 May 14.
      13. Shu B, Safran MR. “Hip instability: anatomic and clinical considerations of traumatic and atraumatic instability.” Clin Sports Med. 2011 Apr;30(2):349-67.
      14. Smith MV, Sekiya JK. “Hip instability.” Sports Med Arthrosc. 2010 Jun;18(2):108-12.
      15. Holla JF, van der Leeden M, Peter WF, Roorda LD, van der Esch M, Lems WF, Gerritsen M, Voorneman RE, Steultjens MP, Dekker J. “Proprioception, laxity, muscle strength and activity limitations in early symptomatic knee osteoarthritis: results from the CHECK cohort.” J Rehabil Med. 2012 Oct;44(10):862-8.

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      Years ago I developed sciatica as a consequence of a martial arts injury. I had seen a number of doctors who finally diagnosed it as an entrapment syndrome involving the piriformis muscle and the sciatic nerve. I tried, unsuccessfully, all of the conservative methods to treat it, including physical therapy, massage, manipulation—you name it. Finally, it looked like I would either have to live with the pain or have surgery—for which there was no guarantee of success. As it happened, one day I wandered into a yoga class at the Ann Arbor YMCA.

      I remember being impressed by how different (and difficult) a yoga class was, even though I was used to hard physical training from playing sports; we were working with the body in ways I had never experienced and using precise movements and muscular engagements I hadn’t seen in other exercise methods. Not only did I feel great after my first class but also, to my surprise, the next day I noticed that my sciatic pain was greatly improved. Putting two and two together, I started going regularly to classes at YMCA (and later, the basement of a church). As long as I went to class, my sciatica no longer bothered me. With this in mind, let’s take a look at piriformis syndrome.

      Piriformis Syndrome:

      Piriformis syndrome is characterized by buttock and/or hip pain that may radiate into the leg as a form of sciatica. This syndrome is thought to result from spasm of the piriformis which causes irritation of the sciatic nerve as it passes across (or through) the muscle. Spasm in the piriformis can be precipitated by an athletic injury or other trauma. The mainstay of treatment involves stretching the piriformis and its neighboring external hip rotators, with surgery to release the muscle reserved for recalcitrant cases.

      Tightness or asymmetries in the piriformis muscle can create rotational pelvic imbalances. This, in turn, can lead to imbalances further up the spinal column, through the process of "joint rhythm". Click here to learn more about lumbar pelvic rhythm in our previous blog post on Preventative Strategies for Lower Back Strains. Below in the links is a reference to an article from the Osteopathic literature addressing this subject in relation to the piriformis muscle.

      Figure 1 is an illustration of the relationship of the sciatic nerve to the piriformis muscle. Approximately 80% of the time the nerve passes anterior to the muscle, exiting below the piriformis. The sciatic nerve can also divide above the muscle, with one branch passing through the piriformis and another branch passing anterior. This variation occurs about 14% of the time. Other variations include the undivided nerve passing through the muscle and the divisions passing both anterior and posterior to the piriformis (without penetrating the muscle). Note that the sciatic nerve can penetrate the muscle without ever causing pain or other symptoms (as is usually the case). Persons with this variation may, however, be predisposed to developing piriformis syndrome from an injury.

      Various relationships of the sciatic nerve to the piriformis muscle.

      Diagnosis of piriformis syndrome is accomplished through a careful history and physical examination as well as radiological studies. The physical exam includes the FAIR test (flexion, adduction, internal rotation of the hip). Click here for an example of this test.

      Note that other causes of sciatica must be excluded before making the final diagnosis of piriformis syndrome. These include a herniated disc causing nerve root compression. Similarly, pathology affecting the hip joint must also be excluded. Accordingly, if you have sciatic type pain, be sure to consult a health care practitioner who is appropriately trained and qualified to diagnose and manage such conditions.

      To review, when the hip is in a neutral position, the piriformis acts to externally rotate (turn outward), flex and abduct the hip joint. When the hip is flexed beyond about 60 degrees the piriformis becomes an internal rotator and extensor (and remains an abductor). Muscles stretch when we move a joint in the opposite direction of the action of the muscle. Click here for a review of the piriformis muscle, its attachments and action, and the mechanism of Reverse Pigeon Pose (video below).

      Figures 2-5 illustrate several yoga poses that stretch the piriformis. Parvritta trikonasana and the rotating version of Supta padangustasana lengthen the muscle by adducting and flexing the hip. Similarly, Parsva bakasana and Marichyasana III adduct and flex the hip joint, thus stretching the muscle (which an extensor and abductor when the hip is flexing).

      Figure 2. Piriformis stretching in supta padangusthasana.

      Figure 3. Piriformis stretching in Parvritta trikonasana.

      Figure 4. Piriformis stretching in Marichyasana III.

      Figure 5. Piriformis stretching in Parsva bakasana.

      Figure 6. Supported setu bandha - a recovery pose which maintains the piriformis in a relaxed position.

      Video 1 demonstrates stretching of the piriformis in Reverse Pigeon Pose. This asana stretches the muscle by externally rotating and flexing the hip.



      Video 2 illustrates the technique for using mysofascial connections to protect the knee joint in this pose. Click here for the details of this technique.



      Thanks for stopping by. If you would like to learn more about combining modern Western science and yoga, feel free to browse through The Key Muscles and Key Poses of Yoga, as well as the Yoga Mat Companion series by clicking here. For a fun, yet intensive experience in anatomy, biomechanics and therapeutics of yoga, join us for our five-day intensive in Bali. Click here for more info and to register. Happy Holidays and many thanks for your support in sharing us on Facebook, Twitter and Google Plus!


      Namaste'


      Ray and Chris (illustrations)


      References:
      1. Pokorný D, Jahoda D, Veigl D, Pinskerová V, Sosna A. “Topographic variations of the relationship of the sciatic nerve and the piriformis muscle and its relevance to palsy after total hip arthroplasty.” Surg Radiol Anat. 2006 Mar;28(1):88-91.

      2. Boyajian-O'Neill LA, McClain RL, Coleman MK, Thomas PP “Diagnosis and management of piriformis syndrome: an osteopathic approach.” J Am Osteopath Assoc. 2008 Nov;108(11):657-64.

      3. Filler AG, Haynes J, Jordan SE, Prager J, Villablanca JP, Farahani K, McBride DQ, Tsuruda JS, Morisoli B, Batzdorf U, Johnson JP. “Sciatica of nondisc origin and piriformis syndrome: diagnosis by magnetic resonance neurography and interventional magnetic resonance imaging with outcome study of resulting treatment.” J Neurosurg Spine. 2005 Feb;2(2):99-115.
      4. Rodrigue T, Hardy RW. “Diagnosis and treatment of piriformis syndrome.” Neurosurg Clin N Am. 2001 Apr;12(2):311-9.

      5. Papadopoulos EC, Khan SN. “Piriformis syndrome and low back pain: a new classification and review of the literature.” Orthop Clin North Am. 2004 Jan;35(1):65-71.

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      Yoga often happens in millimeters. This means that relatively small adjustments can produce some of the most important openings and energetic shifts. In this blog post, I describe a cue to refine the pelvis in the asana, Warrior I (Virabhadrasana I), concluding with a brief discussion of the biomechanics of this adjustment.

      Here’s the cue...

      In Warrior I, press the back foot into the mat and attempt to drag it toward the midline (adduction). You will feel the pelvis turn forward to “square” with the front leg. Figures 1 and 2 illustrate this action, with its effect on the pelvis.


      Figure 1: Press the foot into the mat and then attempt to drag it toward the midline. This engages the adductor magnus.

      Here are the biomechanics of this cue...

      In Warrior I, the back leg is in extension. The prime mover muscle for this action is the gluteus maximus. One of the synergists for extending the hip is the adductor magnus muscle. Attempting to drag the foot towards the midline engages this muscle in the pose. The foot remains constrained on the mat and does not actually move, however, the force of contracting the adductor magnus decreases the angle between the femur and the pelvis, as shown. The result is that the pelvis turns (instead of the foot moving). In addition, the hip extends more effectively. All of this produces a unique opening in the front of the pelvis that stretches the hip flexors, including the psoas muscle (figure 3).


      Figure 2: This illustrates engaging the adductor magnus by attempting to drag the foot towards the midline. The mat constrains the foot, and the force of contraction turns the pelvis.


      Figure 3: This illustrates the flexor muscles of the back hip stretching.

      Use this adjustment after “setting” the feet. The technique for this is described in my previous blog post on connecting to your feet in yoga. Click here to read more. These cues can be combined with co-activation of the hip stabilizers for the front leg, as described previously for Warrior II (click here to read more). Finally, “ease into” your movements when working with cues such as this. Build muscular engagement gradually to turn the pelvis; then gradually release it as you come out of the pose.

      For many more helpful cues on biomechanics and yoga, feel free to browse through "The Key Muscles and Key Poses of Yoga". Also, see the "Yoga Mat Companion" series, which gives you step-by-step guidelines for applying these cues to all categories of poses. Click here to learn more.


      Namaste’

      Ray and Chris (illustrator)



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      This blog post continues the theme of balancing the pelvis in yoga asanas. Our last post focused on using the adductor magnus to turn the pelvis in Warrior I; this post zooms in on the hip abductors for Revolved Half Moon Pose. 

      As I discussed in “Connecting to Your Feet in Yoga”, you can learn a great deal about biomechanics by examining how the body responds to pathological conditions. In that post, I looked at a variation of flat foot deformity, the ligaments and muscles involved and how to work with yoga to strengthen the arches of the feet. Here, I examine what happens with the pelvis when the hip abductors are not functioning properly. Then I illustrate how to use this knowledge to refine asanas like Revolved Triangle and Revolved Half Moon. 

      Balancing the pelvis is a key factor in normal gait as well as yoga poses. Conversely, persons with weakness in the hip abductors develop what is known as a “Trendelenberg” gait, where the pelvis tilts up and shifts toward the affected side during the stance phase of walking. A variety of conditions can affect the hip abductors, including hip pain (from arthritis) and injury to the nerves supplying the gluteus medius. 

      In medicine, we test the function of the hip abductors by having the patient stand on one leg in the “Trendelberg Test”. When the muscles are competent, they automatically engage to draw the pelvis level; when the muscles are weakened, the pelvis on the standing leg side lifts (while the lifted leg side sags downward). At the same time, the spine curves toward the affected hip, with the shoulder girdle tilting towards that side.  Figure 1 illustrates the Trendelenberg Test. Note how the pelvis tilts and the spine laterally flexes when the gluteus medius does not engage properly.


      Figure 1: The Trendeleberg Test; Image on the left illustrates the gluteus medius engaging to stabilize the pelvis.  Image on the right illustrates pelvic tilt and lateral spine flexion with the dysfunctional gluteus medius.


      The spine compensating for the tilt of the pelvis is an example of lumbar-pelvic rhythm. Click here to read more on this important subject in our blog post, “Preventative Strategies for Lower Back Strains in Yoga”. Click here to learn more about the muscles involved in one-legged standing in our blog post, “Improving Stability in One Legged Standing Poses.”

      Now, let’s look at how we can apply this knowledge to help lift the back leg in Revolved Half Moon Pose…

      I begin by training awareness of the abductor muscles (especially the gluteus medius) in Revolved Triangle Pose. The cue for this is to fix the forward foot on the mat and attempt to drag it to the outside, while resisting with the hand. You will note that this helps to bring the pelvis in line with the rest of the body. Figure 2 illustrates the preparatory poses for this asana and Figure 3 illustrates the cue.


      Figure 2: Preparatory poses for Revolved Triangle Pose.

      Figure 3: Engaging the hip abductors in Revolved Triangle Pose.


      Next, I use sequential muscular engagement to lift the back leg in Revolved Half Moon Pose, beginning with the hip abductors of the standing leg. Engaging these muscles acts to lift, rotate and stabilize the pelvis on the side of the lifted leg (in a fashion similar to what we learned with the Trendelenberg Test). Then I engage the muscles that lift the leg itself, including the gluteus maximus and its synergists of hip extension (the hamstrings and adductor magnus). The gluteus maximus contracts eccentrically.

      Finally, I use the quadriceps to straighten the knee. Figure 4 illustrates the preparatory poses for Revolved Half Moon Pose. Figures 5 and 6 illustrate engaging the hip abductors in the standing leg to lift the side of the pelvis for the raised leg. Figure 7 illustrates the final step--engaging the hip extensors and the quadriceps of the raised leg. Work with a chair or block to gain stability if you are new to the pose.



      Figure 4: The preparatory poses for Revolved Half Moon Pose.

      Figure 5: Engaging the hip abductors to lift the pelvis on the side of the raised leg.

      Figure 6: Engaging the hip abductors to lift the pelvis on the side of the raised leg.

      Figure 7: Engaging the hip extensors of the raised leg (gluteus maximus, hamstrings, adductor magnus) and knee extensor (quadriceps).

      Note that the deep external rotators of the standing leg also facilitate stabilizing the pelvis in Revolved Half Moon Pose. Figure 8 illustrates these muscles.


      Figure 8: The deep external rotators stabilizing the pelvis in Revolved Half Moon Pose.

      These steps are an example of anatomic sequencing for yoga. Each muscle group is engaged in a specific order to achieve optimal form and stability. The Yoga Mat Companion Series gives you step-by-step anatomic sequencing for all of the major asanas, with a variety preparatory poses as well. Use these books to design your classes and optimize your practice. We’re pleased to announce that all of our books are now available in digital format for Kindle and other devices. Click here to learn more… Feel free to browse through all of our books by clicking here.

      Thanks for stopping by The Daily Bandha. Stay tuned for our next post when I'll present another subject on combining science and yoga.  Also, we greatly appreciate when you share us on Facebook, Twitter and Google Plus.

      Namaste'

      Ray and Chris

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      Big Thanks to everyone for your comments on Facebook for our “Muscle of the Week: The Soleus.” In this blog post we take a look at this muscle, its connection to the gastrocnemius and its relationship to practicing yoga.

      Here's the anatomy…

      The gastrocnemius and soleus muscles form the triceps surae or gastrocnemius/soleus complex. The soleus muscle originates from the head and neck of the fibula bone and, via a tendinous arch, the soleal line at the back of the tibia bone. The gastrocnemius has two heads; one originates from the medial epicondyle of the femur and the other from the lateral epicondyle. The soleus and gastrocnemius attach to the calcaneus (heel bone) via the Achilles tendon (figure 1).

      Figure 1: The gastrocnemius and soleus muscles.

      Both muscles act to flex the ankle and invert the subtalar joint. The gastrocnemius, because it crosses the knee, also acts as a knee flexor. Since the two muscles act to plantarflex the ankle, dorsiflexing the ankle joint acts to stretch them. Figure 2 illustrates the relationship between these muscles in cross section.

      Figure 2: The gastrocnemius and soleus muscles in cross-section.

      As B. W-B. pointed out in her Facebook comment on the soleus, “these muscles help to propel blood and fluids back up out of the legs for proper circulation of your legs.” This is because muscle contraction augments the flow of blood and lymphatic fluid towards the heart via a system of one-way valves within the vessels (figure 3). I discuss this concept in greater detail in a previous blog post (click here to learn more).

      Figure 3: One way valves in veins.

      In her Facebook comment, A. K. A. recommends placing a slight bend in the knee during dog pose to release the gastrocnemius and focus the stretch more deeply on the soleus muscle. I found this to be helpful as well.

      You can also release the gastrocnemius with a series of stretches in Downward Dog pose.  Our blog post on Hanumanasana illustrates the effect of several short duration (<30 seconds) stretches on muscle length, with some links to the biomechanical literature. Finally, engaging antagonist muscles aids to lengthen muscles in a stretch through reciprocal inhibition. Figure 4 illustrates sequentially releasing the gastroc by bending the knee, using the hands to dorsiflex the ankle and then engaging the quads to straighten the knee. A similar sequence can be applied to Downward Dog. Click here for a tip on using reciprocal inhibition to aid in lowering the heels in Down Dog.

      Figure 4: 1) bend the knee to release the gastroc; 2) dorsiflex the ankle to stretch the soleus; 3) contract the quadriceps to extend the knee and stretch the gastroc.

      The Silfverskiöld test also illustrates the rationale for increased ankle dorsiflexion with the knee bent. We use this test in orthopedics to differentiate a tight gastrocnemius from an Achilles tendon contracture by dorsiflexing the ankle with the knee straight and then with the knee flexed.  Increased ankle dorsiflexion with the knee bent indicates that the limitation of motion at the ankle is coming from the gastrocnemius.

      Finally, figure 5 illustrates the connection between the gastrocnemius/soleus complex and the plantar fascia. Click here to learn more in our blog post, “Plantar Fasciitis, Myofascial Connections and Yoga.”

      Figure 5: The plantar fascia and gastroc/soleus complex.

      Feel free to browse through our books, The Key Muscles of Yoga and Key Poses of Yoga by clicking here.The Yoga Mat Companion Series gives you step-by-step anatomic sequencing for all of the major asanas, with a variety preparatory poses as well. Use these books to design your classes and optimize your practice. We’re also pleased to announce that all of our books are now available in digital format for Kindle and other devices. Click here to learn more… Feel free to browse through all of our books by clicking here.

      Thanks for stopping by The Daily Bandha. Stay tuned for our next post when I'll present another subject on combining science and yoga. Also, we greatly appreciate when you share us on Facebook, Twitter and Google Plus.

      Namaste'

      Ray and Chris

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