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Articles on this Page
- 06/06/14--12:13: _The Gluteus Medius ...
- 12/19/14--08:31: _Connect Your Feet t...
- 03/26/15--09:24: _ Stretching, Age an...
- 05/26/15--15:43: _The Pelvic Floor
- 06/11/15--08:32: _The Sacroiliac Joint
- 08/11/15--14:18: _Diaphragmatic (Bell...
- 11/06/15--16:08: _Stabilizing Your Sh...
- 03/06/16--12:26: _Shoulder Biomechani...
- 03/13/16--13:08: _Shoulder Biomechani...
- 03/19/16--18:11: _The Supraspinatus M...
- 03/23/16--18:29: _Quiz #1 - Your Rota...
- 03/28/16--15:49: _Bandha Yoga QuickQu...
- 04/05/16--15:35: _Connect Your Cuff t...
- 04/07/16--11:31: _Your Gluts and Lats...
- 04/14/16--09:28: _Bandha Yoga QuickQu...
- 04/14/16--17:56: _BandhaYoga QuickQui...
- 04/21/16--12:40: _QuickQuiz #4: How S...
- 04/30/16--10:31: _How well do you kno...
- 05/20/16--06:38: _QuickQuiz #6 - The ...
- 07/18/16--18:19: _Bandha Yoga QuickQu...
- 05/20/17--07:12: _Your Glutes in Back...
- 06/04/17--06:23: _Around Your Core in...
- 01/22/18--10:25: _Shoulder Biomechani...
- 10/19/18--07:29: _Hurricane Michael: ...
- 10/20/18--09:48: _Co-activate Your Ps...
- 06/06/14--12:13: The Gluteus Medius Muscle in Yoga
- 12/19/14--08:31: Connect Your Feet to Your Shoulders in Side Forearm Plank Pose
- 03/26/15--09:24: Stretching, Age and Your Down Dog
- Lavoie BA, Devanne H, Capaday C. “Differential control of reciprocal inhibition during walking versus postural and voluntary motor tasks in humans.” J Neurophysiol. 1997 Jul;78(1):429-38.
- Hortobágyi T, del Olmo MF, Rothwell JC. “Age reduces cortical reciprocal inhibition in humans.” Exp Brain Res. 2006 May;171(3):322-9.
- S. Meunier , S. Pol , J. L. Houeto , M. Vidailhet “Abnormal reciprocal inhibition between antagonist muscles in Parkinson's disease” Brain. 2000 May;123 ( Pt 5):1017-26.
- A. J. Blazevich , A. D. Kay , C. Waugh , F. Fath , S. Miller , D. Cannavan “Plantarflexor stretch training increases reciprocal inhibition measured during voluntary dorsiflexion” Journal of Neurophysiology Published 1 January 2012 Vol. 107 no. 1, 250-256.
- Meroni R, Cerri CG, Lanzarini C, Barindelli G, Morte GD, Gessaga V, Cesana GC, De Vito G. “Comparison of active stretching technique and static stretching technique on hamstring flexibility.” Clin J Sport Med. 2010 Jan;20(1):8-14.
- 05/26/15--15:43: The Pelvic Floor
- 06/11/15--08:32: The Sacroiliac Joint
- The anterior (front) and posterior (back) sacroiliac ligaments running from the sacrum to the ilium;
- The sacrotuberous ligaments running from the sacrum to the ischial tuberosity;
- The sacrospinous ligaments running from the sacrum to the posterior iliac spine;
- 08/11/15--14:18: Diaphragmatic (Belly) Breathing
- 11/06/15--16:08: Stabilizing Your Shoulders In Downward Dog
- Contract the triceps to straighten your elbows. Then, press the mound at the base of your index fingers into your mat to engage the forearm pronator muscles.
- Next, fix your palms into the mat and try to drag the hands towards each other. This engages the adductor muscles of the shoulders as well as the biceps.
- Finally, gently roll the shoulders outward. This externally rotates the humerus bone and helps to bring the greater tuberosity away from the undersurface of the acromion.
- Graichen H1, Bonel H, Stammberger T, Englmeier KH, Reiser M, Eckstein F. Subacromial space width changes during abduction and rotation--a 3-D MR imaging study. Surg Radiol Anat. 1999;21(1):59-64.
- Hinterwimmer S1, Von Eisenhart-Rothe R, Siebert M, Putz R, Eckstein F, Vogl T, Graichen H. Influence of adducting and abducting muscle forces on the subacromial space width. Med Sci Sports Exerc. 2003 Dec;35(12):2055-9.
- 03/06/16--12:26: Shoulder Biomechanics, Part I: The Subscapularis Muscle
- 03/13/16--13:08: Shoulder Biomechanics, Part II: The Infraspinatus & Teres Minor
- 03/19/16--18:11: The Supraspinatus Muscle
- 03/23/16--18:29: Quiz #1 - Your Rotator Cuff
- 03/28/16--15:49: Bandha Yoga QuickQuiz #2 - Your Piriformis Muscle
- 04/05/16--15:35: Connect Your Cuff to Your Core in Forearm Plank
- 04/07/16--11:31: Your Gluts and Lats in Bird Dog Pose
- 04/14/16--09:28: Bandha Yoga QuickQuiz #3 - Downward Facing Dog Pose
- 04/14/16--17:56: BandhaYoga QuickQuizzes
- 04/21/16--12:40: QuickQuiz #4: How Strong is Your Warrior?
- 04/30/16--10:31: How well do you know your hamstrings? BandhaYoga QuickQuiz #5
- 05/20/16--06:38: QuickQuiz #6 - The Anatomy and Biomechanics of Your Psoas.
- 07/18/16--18:19: Bandha Yoga QuickQuiz # 7: Your Gluteus Medius Muscle
- 05/20/17--07:12: Your Glutes in Backbends: Part I
- 06/04/17--06:23: Around Your Core in 4 Minutes
- 01/22/18--10:25: Shoulder Biomechanics Part IV: The Deltoid--Rotator Cuff Connection
- 10/19/18--07:29: Hurricane Michael: View from the Eyewall
- 10/20/18--09:48: Co-activate Your Psoas and Quads in Trikonasana
|Figure 1: The gluteus medius muscle with its innervation from the superior gluteal nerve. The gluteus maximus, with the inferior gluteal nerve is shown as a see-through.|
Tree pose and other one-legged standing poses help to strengthen the gluteus medius, which is essential for stabilizing the pelvis of the standing leg (figure 2). Click here to read more about the function of the gluteus medius in one-legged asanas in our blog post, “Anatomic Sequencing in Yoga”. Click here to read about the connections of the gluteus medius during gait.
|Figure 2: The gluteus medius stabilizing the pelvis in Tree Pose.|
Figure 3 illustrates the gluteus medius contracting to help lift the leg in Ardha chandrasana (Half Moon Pose).
|Figure 3: The gluteus medius stabilizing the lifted leg in Half Moon Pose.|
Engaging the gluteus medius in Downward Dog pose can be used to synergize hip flexion. This muscle also helps to internally rotate the hips, thereby bringing the kneecaps to face forward. The cue for engaging the gluteus medius in Downward Dog Pose is to press the feet into the mat and then attempt to drag them apart. The feet remain constrained on the mat and do not move. However, the abductor muscles, including the gluteus medius, minimus and TFL, engage to refine flexion and rotation of the hips. Click here to read about this in our blog post, “How to Use Nutation to Refine Uttanasana.” Figure 4 illustrates how to work with the gluteus medius and minimus to refine Downward Dog Pose.
|Figure 4: Engaging the gluteus medius and minims in Downward Dog Pose.|
Figure 5 illustrates the gluteus medius synergizing hip extension in Purvottanasana.
|Figure 5: Engaging the gluteus medius to synergize hip extension in Purvottanasana.|
Finally, figure 6 illustrates stretching the gluteus medius in Garudasana.
|Figure 6: Stretching the gluteus medius in Garudasana.|
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.
Ray and Chris
Side forearm plank is another awesome pose to strengthen your core while protecting your wrists. You do this one by placing your forearm on the mat and attempting to drag it towards your feet, while engaging the core muscles on your sides to stabilize the lumbar pelvic complex. Keep your supporting arm (the humerus bone) straight up and down (at a right angle to the floor). This way the passive strength of the bone aids to support your body weight. Click here for more on this concept in Vasisthasana.
|Figure 1: Side Forearm Plank Preparatory Pose|
Begin by stabilizing the shoulders. Do this by attempting to externally rotate your forearm on the mat. At the same time, attempt to internally rotate your forearm on the mat as well. It’s a bit like a windshield wiper that’s fixed in place. This cue “co-activates” the infraspinatus and teres minor (external rotation) and the subscapularis (internal rotation) muscles of your rotator cuff. Feel how this stabilizes your shoulder. Folks that are new to this pose can use the preparatory version to work with this cue. Figure 1 shows the prep pose and Figure 2 illustrates the action of the forearms.
|Figure 2: This illustrates the cue for co-activating the external and internal shoulder rotators (the infraspinatus, teres minor and subscapularis of the rotator cuff).|
Next, press the edge of your lower side foot into the mat and gently draw it upwards toward the shin to “evert” your foot. These cues activate a series of muscles—including the “lateral subsystem”--to connect your shoulders and legs to your core. Figure 3 shows the cue for attempting to drag the forearm and the feet towards each other (while engaging the side abs).
Now let’s check out the myofascial connections in side forearm plank. When you press the side of your foot into the mat, you activate the peroneus muscles as well as the abductor muscles up at your hip (the TFL and gluteus medius). These muscles have a fascial connection to your abs, specifically the external oblique (which attaches to the rim of the pelvis). The external oblique connects to your shoulders via the serratus anterior muscle. The serratus anterior is a scapular stabilizer that works in concert with the rotator cuff. So the whole operation helps to integrate your feet, legs, pelvis and lumbar--all the way up to the shoulders.
|Figure 3: This illustrates the cue of everting the lower foot and dragging the elbow towards it. It also shows the deep longitudinal subsystem.|
So let’s talk about the deep longitudinal subsystem…
Your deep longitudinal subsystem is made up of the peroneus longus muscle (on the outside of your lower leg), the biceps femoris of your hamstrings and your sacrotuberous ligament (up in the pelvis), the thoracolumbar fascia and the erector spinae muscles (in your back). The biceps femoris creates a link between the lower extremities and the trunk via the sacrotuberous ligament. This ligament helps to transmit force across your sacrum, and, via the thoracolumbar fascia on up the trunk to your deep back muscles. Check Figure 3 for a color coded illustration of this connection. Click here to see this connection in the lower legs in Reverse Pigeon Pose.
This subsystem is part of the global movement system and is thought to be important in force transmission between your trunk and the ground—as in walking. We’ll have more posts on the other subsystems and how to work with them in yoga soon. Click here to see how the abductor muscles of the hip work in your poses. Click here to learn more about the thoracolumbar fascia and its importance in yoga.
Figure 4 shows the myofascial connection between the external oblique muscle (of the abs) and the serratus anterior of the shoulder girdle.
|Figure 4: This illustrates the myofascial connection between the external oblique muscle of the abdomen and the serratus anterior of the shoulder girdle.|
Thanks for checking in! Click here to browse through our books by clicking the links on the right. These books have lots of practical cues with key info on anatomic sequencing to integrate into your practice!
Ray and Chris
First, let’s take a look at reciprocal inhibition…
Reciprocal inhibition is a biomechanical and physiological process whereby when we contract a muscle on one side of a joint, the muscle on the other side is inhibited from contracting. This takes place to varying degrees throughout the range of motion of a joint and enables us to do things like walking. For example, when you contract your tibialis anterior to dorsiflex your foot while walking, you automatically inhibit the calf muscles. This helps to prevent catching your toes.
Reciprocal inhibition is controlled and regulated at the level of the spinal cord level and also the brain. Of course, as we reach the ends of range of motion of a joint, a process known as co-contraction kicks in to stabilize the articulation, thus modulating the inhibitory effect of the contracting muscle on its antagonist. In other words, we are not Gumby. (Most folks know this implicitly, but I point it out here to correct some confusing info from recent blogs on the subject of stretching and yoga). Figure 1 illustrates the agonist/antagonist pairs for the forward bend Paschimottanasana and the backbend Setu bandhasana.
|Figure 1: Agonist/Antagonist pairs in Paschimottanasana and active Setu bandhasana.|
What can happen as we age…
Scientific studies have demonstrated that reciprocal inhibition diminishes as we age (and also in certain disease processes). This is particularly important for activities such as walking. For example, if the tibialis anterior does not efficiently inhibit the gastroc/soleus muscles of the calf, the person tends to catch their toes, stumble and fall. If that weren't bad enough, our bones also weaken with age, so falls can lead to fractures--especially of the hip. This puts the person in a hospital under the care of an orthopedic surgeon as so on…(a story I know all too well). So, methods or techniques that improve reciprocal inhibition could potentially benefit us as we age.
How stretching can help…
Recent scientific evidence has shown that stretching can increase reciprocal inhibition between antagonist muscles. For this study, the authors investigated the effect of stretching on reciprocal inhibition between the tibialis anterior and the gastroc/soleus complex. They stated:
“In conclusion, we have found that 3 wk of twice-daily, static plantar flexor stretching resulted in a significant increase in RI, measured in soleus and gastrocnemius during voluntary, tonic dorsiflexion contractions.” (The full article is linked below in the references)
These are some of the same muscles we work with in Downward Dog. Thus, regular practice of this pose may help maintain reciprocal inhibition between the tibialis anterior and the calf muscles. For a tip on how to make this pose more efficient, take a read through “A Tip to Help You Lower Your Heels In Downward Dog." This blog uses active stretching to improve flexibility of the gastroc/soleus muscle complex. I received a lot of positive feedback on it, so give it a go.
|Figure 2: The tibialis anterior as agonist and gastroc soleus as antagonist in Down Dog pose.|
On Active Stretching…
In active stretching, one improves muscle flexibility by contracting the opposing muscle group while stretching the target muscle. In the case of the hamstrings, this means engaging the quadriceps during the stretch. Shirley Sahrmann, PhD (Professor of Physiotherapy at Washington University School of Medicine) and others have advocated active stretching as a means of increasing muscle flexibility. It improves flexibility of the muscles on one side of the joint while improving strength and function of the muscles on the other side.
A recent article from the medical literature compared active vs. passive stretching of the hamstring muscles. The authors stated:
“Such an active technique is based on reciprocal inhibition between agonistic and antagonistic muscles.”
“Active stretching produced the greater gain in the AKER test, and the gain was almost completely maintained 4 weeks after the end of the training, which was not seen with the passive stretching group. Active stretching was more time efficient compared with the static stretching and needed a lower compliance to produce effects on flexibility.” (AKER=active knee extension range of motion)
This makes sense to me from a yoga perspective as well--keeping in mind that there are many different ways to climb the mountain. Improving muscle flexibility is only one of the functions of asanas. Active stretching, among other benefits, improves your mind/body connection, alignment of your joints and your mental focus. Improved focus in turn helps to identify and correct imbalances. Click here to read more on the subject of muscle imbalances.
|Figure 3: An agonist/antagonist pair in Warrior I (gluteus maximus and illiopsoas).|
Figure 4 shows a couple of page spreads from our Yoga Mat Companion book series, illustrating a step-wise approach to working with muscle engagement in the poses.
|An excerpt from "Yoga Mat Companion 1 - Vinyasa Flow and Standing Poses".|
|An excerpt from "Yoga Mat Companion 2 - Hip Openers and Forward Bends".|
NB: Evidence based medicine ranks publications and studies according to “levels of evidence”. Level I studies are considered to be more reliable, and are based on randomized controlled trials. Level VII evidence, on the other hand, is essentially an opinion, with variable reliability depending on the source and their actual expertise. The study on active vs. passive stretching I referenced above was a randomized controlled trial (RCT), and is thus Level I(b) evidence.
Thanks for checking in! Click here for more information on combining modern Western science and your yoga. Hope to see you soon.
Ray and Chris
|Figure 1: The Pelvic Floor|
|Figure 2: The Pelvic Floor|
The SI joint depends primarily on the stout ligaments that cross it for stability. The bones also have shallow interdigitations that correspond on each side, thus conferring some bony stability. Finally, there are the muscles (dynamic stability) and fascia—especially the thoracolumbar fascia.
Figure 1 illustrates the bones that comprise the SI joint.
|Figure 1: The bones of the sacroiliac joint.|
Figure 2 illustrates the stout ligamentous stabilizers of the joint. These include:
|Figure 2: The ligaments of the sacroiliac joint.|
Movement is very limited for this joint, but includes nutation or anterior tilt (flexion) of the sacrum between the ilia, counter-nutation or posterior tilt (extension) and small movements of the ilia themselves. The stable SI joint thus functions for shock absorption and transfer of torque during ambulation.
Muscles and fascia also confer stability to the joint. Figure 3 illustrates the relationship between the erector spinae muscles of the back and the muscles of the pelvic floor. You can see that the erector spinae muscles draw the sacrum into flexion (nutation) and the muscles of the pelvic floor (especially the pubococcygeus) draw the bone into extension (counter-nutation). Simultaneously engaging these muscles creates opposing forces that stabilize the joint.
|Figure 3: The interaction between the erector spinae and pelvic floor muscles for stabilizing the SI joint.|
Figure 4 illustrates the relationship of the latissimus dorsi and gluteus maximus muscles on opposite sides of the body. In between is the thoracolumbar fascia. Note how the fibers of these structures run perpendicular to the joint. Thus, working with core exercises such as Bird Dog Pose can help to strengthen the dynamic stabilizers of the SI joint. These muscles, along with the fascia comprise the “posterior oblique subsystem”.
|Figure 4: The posterior oblique subsystem for stabilizing the SI joint.|
Hope you enjoy this overview of the foundational structures of the SI joint. I’d also like to say to our friends in Asia that I’ll be teaching at the Urban Ashram in Manila next weekend. This is a four-day workshop for which you can attend any days you wish or the entire session. We’ll be going over details and applications of anatomy, biomechanics, and physiology of yoga with all of the practical applications to take your practice and teaching to the next level. This intensive is the only course I'll be teaching in Asia this year--hope to see you there! Click here for more information…
All the Best,
Ray Long, MD
|Figure 1: The thoracic diaphragm (also showing psoas major muscle).|
In diaphragmatic breathing, you actively expand the abdomen during inhalation. The abdominal expansion occurs via the diaphragm contracting and pressing down on the abdominal contents. Chest expansion is kept at a minimum in this type of breathing. Exhalation is a relaxed process and occurs through the elastic recoil of the chest wall and lungs.
Regular practice of diaphragmatic breathing draws the mental focus into what is known as the “belly brain”. It has a calming effect on the mind while, at the same time, potentially strengthens the diaphragm. I recommend practicing diaphragmatic breathing for 5-10 minutes per day. We have included a video link below to guide your practice and aid you in visualization of the movement of the diaphragm and abdomen.
Diaphragmatic Breathing Video:
How much does your diaphragm actually move?
The answer to this question depends on how deep of a breath you take and what part of the diaphragm you are asking about. The diaphragm is a sheet like dome-shaped muscle (when it is relaxed). Upon contraction, it flattens out and presses down on the abdomen. The net result is a negative inspiratory pressure, which draws air into the lungs.
Tidal, or resting breathing results in smaller movements of the diaphragm, while vital capacity breathing (as in a deep diaphragmatic breath) results in much larger movement. This is where you take a complete full inhalation.
The posterior, or back part of the diaphragm exhibits the greatest excursion; the amount of diaphragmatic motion decreases progressively as we come forward. Figure 2 illustrates this. MRI studies have accurately quantified diaphragmatic motion during deep breathing, with the posterior region moving an average of 10 cm (about 4 inches) between inhalation and exhalation. This decreases progressively moving forward, with the most anterior portion moving about half that of the posterior. Diaphragmatic motion decreases by about one-third in the sitting position compared to lying on your back.
|Figure 2: Thoracic diaphragm (side view): P= posterior; D= dome; A= anterior. Note that the excursion of the posterior diaphragm is greatest.|
Does the heart move with your diaphragm when you breathe?
Yes, but not the full excursion of the posterior diaphragm. The pericardium, which is a sac surrounding the heart, has fascial connections to the diaphragm. Accordingly, the heart does move during breathing. Your heart is located more anterior on the left dome of the muscle, and so it moves less than the full excursion of the posterior portions of the diaphragm, but it moves significantly nonetheless. The video below illustrates diaphragmatic and cardiac movement during breathing (I recommend you start viewing at about the 40 second point, and later at about 4:00 for deeper breathing). This cineradiography video strikingly illustrates this process. (you may also want to mute the sound :)
Thanks for stopping by. Be sure to have a look at the videos on Youtube. Check back in the next week or so as I have some new info on stretching to share as well.
All the Best,
Ray Long, MD
and Chris (illustrator/animator)
In our last post, we discussed joint rhythm for the shoulders. In this blog post I want to share some of my recent investigations on the biomechanics of the shoulder joint, with some specific tips for Down Dog. Shoulder pain is one of the problems that comes up in yoga, especially with folks who are doing Vinyasa based practice. The underlying cause of the pain can be multifactorial, but it is frequently related to impingement of the rotator cuff and subsequent inflammation of the cuff tendon (specifically the supraspinatus muscle). Inflammation of the tendon, in turn, affects function of the shoulder. Weakness or instability in the shoulder can then lead to abnormal pressures at the wrist, causing pain there as well. Thus, stabilizing the shoulders has beneficial effects beyond the shoulders. is a complex process involving strengthening the core and then linking the strong core to the shoulders.
With this in mind, let’s look at one of the key factors in shoulder impingement, namely, the acromio-humeral interval. This refers to the distance between the undersurface of the acromion and the humeral head, as measured using radiology intruments (x-ray, ultrasound, mri). The acromion is a shelf of bone on the scapula, above the spine (seen in Figure 1). It serves as the attachment for the deltoid muscle. The humeral head articulates with the shoulder joint and serves as the attachment for the muscles of the rotator cuff (on the greater and lesser tuberosities). Factors that decrease the space between the acromion and humeral head can lead to inflammation of the cuff tendon due to compression between the two bones.
|Figure 1: The acromio-humeral interval.|
Research has shown that contracting the main adductor muscles of the shoulder serves to increase the acromio-humeral distance. These include the pectoralis major and latissimus dorsi. Co-contracting the biceps and triceps muscles when the arms are overhead can also draw the humerus away from the glenoid, as shown in Figure 2. Finally, externally rotating the shoulder humerus moves the vulnerable area of the supraspinatus tendon away from the area where it would impinge on the acromion (click here to learn more).
|Figure 2: The long head of the triceps and short head of the biceps in relation to the gleno-humeral joint with the arms overhead.|
Here’s the cue…
Warm up first a bit. Then, take Downward Dog pose. I use three steps for the shoulders. Go slowly and use gentle engagements.
Figure 3 illustrates the various muscles involved in these cues.
|Figure 3: Attempt to drag the hands towards one another. This engages the shoulder adductors. Then externally rotate the shoulders.|
As a final adjustment, I like to link the action of the shoulders to the lower extremities. The cue for this is to engage your lower gluteus max and adductor magnus muscles by drawing in with the upper inner thighs and then attempt to drag your feet away from the hands. Feel how this stabilizes your pose. See Figure 4 for the graphics.
|Figure 4: Engage the lower parts of the gluteus maximus and adductor magnus as you attempt to drag the feet away from the hands to stabilize the pose.|
Bear in mind that shoulder stability is a complex process. The shoulders are linked to the core; so building a strong core leads to stable shoulders. Stable shoulders help to protect the wrists, and so on. Click here to read more on your core. If you would like to learn more anatomic sequencing to improve your poses, click here to take a tour of The Yoga Mat Companion Series.
Thanks for stopping by—see you in a couple of weeks for another post on combining anatomy, biomechanics and yoga.
All the Best,
Ray Long, MD
|Figure 1: The subscapularis muscle, illustrating the origin on the inside of the scapula and the insertion on the lesser tuberosity of the humerus.|
|Figure 2: This illustrates the effect on the subscapularis muscle of the upper arm in Gomukhasana. External rotation of the humerus stretches the muscle.|
|Figure 3: This image illustrates contraction of the subscapularis muscle to internally rotate the humerus.|
|Figure 4: Co-contracting the subscapularis and the infraspinatus stabilizes the humeral head in the socket while the deltoid muscle abducts the humerus.|
All the Best!
Ray Long, MD
|Figure 1: The infraspinatus and teres minor muscles of the rotator cuff (the supraspinatus is the faded muscle on top).|
The Force Couple
|Figure 2: The force couple between the infraspinatus and subscapularis muscles. This view is looking down on the shoulder with the front of the joint towards the bottom of the page.|
Poses with the arms in reverse Namaste' stretch the infraspinatus and teres minor, as does Gomukhasana. Those of you who are more flexible may gently press the knife edge of the hand into the back to "load" the external rotators. Folks who are tighter may simply grasp the elbows or hands behind the back. Click here for more details and an animation of Gomukhasana stretching these muscles as well as a not so obvious cue for loading and using PNF for this stretch.
|Figure 3: Stretching the infraspinatus and teres minor by internally rotating the shoulders in Parsvottanasana.|
Externally rotating the shoulders in poses like Trikonasana (Triangle) can be used to activate the infraspinatus and teres minor. Figure 4 illustrates this, as well as the myofascial connection between these muscles and the muscles that retract the scapula, namely the trapezius and rhomboids.
|Figure 1: The supraspinatus muscle of the rotator cuff (with the infraspinatus and teres minor faded).|
|Figure 2: The supraspinatus contracting to synergize the deltoid in abducting the shoulders in Warrior II.|
The supraspinatus is the rotator cuff muscle that is most frequently torn. Tears start to become common beyond the age of forty, with an increased incidence in each decade of life. Figure 3 illustrates a supraspinatus rotator cuff tear.
|Figure 3: Full thickness tear of the supraspinatus muscle (with the long head of the biceps shown in front of the supraspinatus).|
|Figure 4: The supraspinatus muscle stretching in Garudasana. The muscles in red are stretching and those in blue are contracting.|
Scientific studies have demonstrated that having a strong core can improve the efficiency of your rotator cuff. A strong and efficient rotator cuff leads to improved stability of your shoulder girdle. This decreases load transfer to your wrists in poses where you bear weight on the hands (like arm balances, Dog Pose and Chaturanga).
Conversely, if your core is weak, or you don’t properly engage it in these types of poses, your cuff is less efficient and your wrists have to bear more of the load. Practicing with imbalances of this nature can lead to a cycle that reinforces the imbalance and, ultimately, injury to the wrist (and shoulders).
The Sanskrit term “Ahimsa” means nonviolence or reducing harm (translation from Nicolai Bachman’s book “The Language of Yoga”). While this term is often used in relation to social ethics, it also applies to how we work with the body.
Reducing the risk of harm to your wrists (and other joints) can include decreasing the frequency and duration of poses that load the wrists and correcting imbalances in the postures. If you have developed wrist pain, you should consult a trained medical professional and work under their guidance. Managing wrist pain almost always includes a period of time off and resting from weight bearing poses, usually combined with some light wrist mobility exercises.
In the interim, I’ve found that Hard Style Plank Pose is a great pose to work on. That’s because it’s awesome for strengthening the core and addressing the underlying imbalance and it doesn’t involve weight bearing on the wrist. Figure 1 illustrates this pose.
|Figure 1: Forearm Plank Pose with the posterior oblique myofascial subsystem.|
In Hard Style Plank, your weight is on your forearms, with the upper arm bones (the humerus) perpendicular to the floor (in Chaturanga, they are parallel to the floor). Clench your fists to strengthen the muscles that cross the wrists. Then press your forearms into the mat and gently attempt to internally rotate the shoulders. Your forearms are fixed on the mat and don’t actually move. Next, co-contract the external rotators of your shoulders by attempting to externally rotate them. The cue for this is to pretend that your forearms are like windshield wipers that are fixed in place. This co-contracts the subscapularis, infraspinatus and teres minor muscles of the cuff and connects them to your core. Finally, engage the lats and attempt to drag the forearms towards the feet while, at the same time, contracting your abs and gluts. Hold for five to ten seconds and repeat two times. Remember to breathe!
Figure 1 above illustrates the muscles involved here, with color-coding according to the strength of your engagement. Check out the posterior oblique subsystem of the lats, thoraco-lumbar fascia and gluts. Engaging this connection helps stabilize the SI joint. Click here for info and illustrations of side forearm plank and the another myofascial subsystem. Click here and here for more on the gluts and abs connection and the lumbar spine in Chaturanga.
As an aside, soaking your wrists in ice water between sessions of injuring them is a lousy solution; it doesn’t address the underlying imbalances and can lead to more injury. You have to dedicate time off from weight bearing to let your wrists heal, not to the “practice” of injuring them.
Once you learn the individual muscles, then it’s time to look at how they function together during movement and in your asanas. Use your knowledge to develop cues to refine and deepen your poses. Groups of muscles, ligaments and fascia that function together are known as “subsystems”. In this post we examine the posterior oblique subsystem in Bird Dog pose.
The posterior oblique subsystem is comprised of the gluteus maximus on one side of the body and the latissimus dorsi on the other side, with the thoracolumbar fascia between (as shown in the inset illustration). These structures operate synergistically with other groups of muscles, ligaments and fascia, particularly during rotational movements such as a golf swing.
Figure 1 illustrates how the fibers of the gluteus maximus and opposite side latissimus dorsi run perpendicular to the sacroiliac joint. Co-contracting these two muscles can be used to tension the thoracolumbar fascia, thus stabilizing the sacroiliac joint. Click here to learn more about the thoracolumbar fascia and its important role in core stability.
Bird Dog is an excellent pose for strengthening the core and engaging the posterior oblique subsystem. A good cue for activating the latissimus dorsi muscle in this pose is to straighten the arm forward and then imagine pushing down with the hand against an immoveable object (as shown with the dotted arrow). Alternatively, imagine pulling down on a rope with the forward hand. Combine this isometric contraction of the lats with engaging the gluts on the side of the lifted leg to augment the stabilizing effect on the SI joint.
|Figure 1: The posterior oblique subsystem and sacroiliac joint in Bird Dog Pose.|
Click here to check our our previous post, "Connect Your Cuff to Your Core in Forearm Plank" and see how this subsystem works in plank pose. With this in mind, what other poses can be used to activate the posterior oblique myofascial subsystem? Place your answer in the comment section below…
In this post we take a look at the glute max in backbends and how to avoid splaying out your knees in poses like Urdhva danurasana (Wheel). I give you some cues for sequencing muscle engagement and also address a misconception about contracting your adductor muscles.
For decades now we’ve heard the instruction in yoga, “soften your glutes in backbends” with no valid explanation why. Your hips are extending in backbends, and your gluteus maximus is the prime mover for that action. Why wouldn’t you want to contract the very muscle that creates that movement?
Let's look closer. When you deliberately soften your glutes, then the hip extension comes from the hamstrings, because your hamstrings work as synergists to the gluteus maximus for this action. So, why not just use your hamstrings to extend the hips and avoid getting scolded for using the prime movers (glutes)? Well, if you do that enough, you potentially set up a muscle imbalance that can lead to “synergistic dominance” whereby the hamstrings become the prime mover of this action. In the hip joint, this can result in abnormal kinematics and, ultimately, pain. I’ll go over some other problems with doing backbends without the glutes in Part II of this series.
One side effect of using your gluteus maximus is that it is also a powerful external rotator of the hip. Thus, when you engage your glute max in a backbend, your hips will rotate outward and your knees tend to splay apart.
Do we care if the knees splay out? Well, it depends on your objective in the pose. Recent literature shows that if the femurs are parallel, you fire your entire gluteus maximus, whereas when they are splayed apart, you fire mainly the upper portion (Selkowitz, 2016).
The “solution” that is usually proposed for this is to have folks try to squeeze a block between their knees to get them to “fire those adductors!” In India, this instruction was often accompanied by much shouting at the frustrated person attempting it. There is a reason, however, why this cue works so poorly, despite the yelling. That is because when your hips are extended (in a backbend), the orientation of the adductor muscle fibers makes them become external rotators of the hip and synergize the gluteus maximus in splaying your knees apart. So it’s a bit like hitting the brakes and gas at the same time. Frustrating. Figure 1 illustrates this.
|Figure 1: Note the orientation of the fibers of the adductor group and how contracting these muscles leads to splaying out of the knees in backbends.|
This cue works well, but it must be implemented in a sequence to function optimally. You have to engage the hip internal rotators before going up into the backbend. It's difficult to engage them once you are up in the pose because when the hips are extending, the TFL and front part of the gluteus medius are at a biomechanical disadvantage for initiating contraction. Thus, you want to first train the cue to engage these muscles with the hips flexed, where it is easy to contract them. Then bring in the glute max to do the backbend. I’ve taught this sequence all over the world and had great feedback. Done properly, the muscles form a “sheath” that lifts the pelvis in a balanced and stable fashion. (Figure 2)
|Figure 2: Note how the muscles at the front of the hips internally rotate the thighs to balance external rotation from the gluteus maximus.|
Here’s the sequence.
Lie on your back and bend your knees so that your feet are flat on the ground as shown. Place your hands on the front part of the pelvis to feel your internal rotators contract. Now, on exhalation, press the feet down and attempt to scrub them apart while allowing you knees to roll inward. Don’t actually move your feet. You should be able to feel your TFL contract. Release on the inhalation and repeat for about 10 times to train the action. Press your feet down and then attempt to scrub them away from the midline. The feet should remain fixed on your mat, as your knees roll inward and you should feel your muscles contract if you've got it.
|Figure 3: Press your feet down and attempt to drag them apart as you allow your knees to roll inward. Place your hands on the front of your hips to feel the TFL and front of the gluteus medius contract with this action.|
Follow the instruction from step 1, maintain the cue of pushing away from the midline with your feet and then dial in contraction of the gluteus maximus to lift the pelvis. You will be pushing down and away from the midline to engage your internal rotators and then engaging your glute max to extend the hips. Go up on the exhalation and down on inhalation. Try this about 10 times (2-3 sets). I recommend working with this set of cues for a few days before integrating them into a full back bend. Once you get it, then try the block thing (if you want). You’ll find it works better this way.
(NB: if you experience knee pain in this pose, try pressing down with the heels more--this often helps.)
|Figure 4: This illustrates the sheath of muscle surrounding the pelvis and lifting it into the bridge.|
I hope you enjoy this post. Use muscle engagement as a barometer to help identify imbalances between the two sides of the body. Then carefully work to balance things. This is one of the benefits of practicing Hatha Yoga using knowledge of anatomy and biomechanics.
Good to see you all again. Check back for Part II in the sequence when I will go over the role of the deep external rotators and discuss synergistic dominance of the hamstrings in more detail.
All the Best,
Ray Long, MD
|Figure 2: Forearm plank. Attempt to drag your forearms towards your feet.|
2) Now go to plank pose on your right side. Press the edge of your right foot into the mat and lift your pelvis. Attempt to drag your forearm towards your foot. Co-activate the rotator cuff by attempting to “windshield wiper” your forearm in internal rotation while resisting with external rotation (Figure 3). Hold for 10-30 seconds the come down and rest for 10 seconds. Click here to learn the key cues to activate your pose as well as the muscle subsystems it amplifies…
|Figure 3: Side plank. Attempt to drag your forearm toward your foot and your foot toward your forearm.|
|Figure 4: Bridge pose. Engage your glutes.|
Added Bonus: engage the muscles on the sides of your lower legs to lift your feet arches. Click here to learn more about this important cue.
|Figure 5: Engage the muscles on the sides of the lower leg to lift your arch.|
Keep your breathing smooth throughout this sequence. Be sure to check out the details in the links above. Start with 10-30 seconds in each pose and build to 1-2 minutes. The adjustments in the links are the keys to integrating the extremities and core. For more cues to help you get the most from your practice, page through the Yoga Mat Companion Series and the Key Muscles and Poses of Yoga.
The shoulder joint proper is a ball and socket joint comprised of the humeral head which articulates with the shallow glenoid fossa (socket) of the scapula. The bone shapes of the shoulder joint allow for a high degree of motion. Contrast this with the hip joint, where the socket is much deeper and constraining on motion. In addition to the bony stabilizers, there are also soft tissue stabilizers such as ligaments and the labrum and muscular dynamic stabilizers. Figure 1 illustrates the bones of the shoulder. Click here for more on this in relation to your Down Dog.
|Figure 1 - (1) humerus. (2) scapula. (3) clavicle.|
In the force couple between the deltoid muscle and the rotator cuff, the rotator cuff stabilizes the humeral head against the glenoid fossa. The deltoid muscle then levers the humeral head off the glenoid fossa to raise the arm. At the same time, the scapula and clavicle rotate to aid in producing movement, a process known as scapulohumeral rhythm (click here for more on this subject).
Figure 2 illustrates the subscapularis and infraspinatus muscles acting together to stabilize the humeral head in the glenoid fossa. Click here for more information on the these muscles of the rotator cuff.
|Figure 2 - The Subscapularis / Infraspinatus force couple.|
Figure 3 illustrates the force couple between the rotator cuff and the deltoid muscle. Click here to learn about the supraspinatus muscle of the rotator cuff. As the deltoid contracts to raise the arm, the rotator cuff contracts to stabilize the humeral head in the socket. All of this happens automatically--the brain is hard wired for this force couple.
|Figure 3 - The Deltoid / Supraspinatus force couple.|
Injury to the rotator cuff, such as a tear or inflammation can lead to less efficient stabilization of the humeral head in the socket. As a consequence, when the deltoid contracts, instead of levering the humeral head off the glenoid, the force of the deltoid contraction causes the head of the humerus to shift upwards into the subacromial space. This can lead to impingement of the rotator cuff on the undersurface of the acromion, thus exacerbating the condition. To compensate, the body uses abnormal movement of the scapula in an attempt to stablize the humeral head in the socket. This abnormal movement of the scapula on the chest wall is known as “scapulothoracic dyskinesia”. I examine for this by comparing the movement of the normal and injured side from the back while having the patient raise the arms overhead.
|Figure 4 - Raising the arms over the head in Warrior I and Tadasana.|
I hope this post helps you build your fund of knowledge regarding shoulder biomechanics. Stay tuned for my next post where I discuss some of the yoga poses that can be used to stretch and strengthen the rotator cuff. Learn more about anatomy, biomechanics and physiology for your yoga in “The Key Muscles of Yoga”, “The Key Poses of Yoga” and the Yoga Mat Companion Series. Click on any of these books to page through.
Thanks for stopping by--look forward to seeing you for my next post!
Ray Long, MD
I’m writing from Panama City, FL. Last week, we got hit by Hurricane Michael. Please share this everywhere.
Most of you know me from writing about anatomy and yoga. My day (and night) job is an orthopedic trauma surgeon. I was on duty in Panama City for Hurricane Michael and wanted to share with you the experience and some things you probably won’t read in the news.
Here’s the timeline:
Tuesday October 9, 2018:
What had started as a tropical depression a few days earlier was now looking like a hurricane headed for the Panhandle of Florida. Folks were beginning to evacuate if they could. I had a busy morning clinic and it was clear that the patients and staff were worried. I had one surgical case I put on for after the clinic, a badly fractured femur in a really sweet lady. I needed to get her surgery done before the storm hit.
I operated on her in the afternoon, bridging the fracture with a retrograde nail. During the case, my phone went off with the caller ID “Mom”. I told my Mom through the speaker not to worry, I’d be in a safe place for the storm and finished up the case. There were a couple more consults to see and patients to round on, so I got home later in the evening and finished my notes from there.
I spent the night at my place on Panama City Beach. Checking the progress of the storm, I saw reports that it was heading for Panama City and coming in as a CAT 3 hurricane, with estimated landfall in the early afternoon EST. I looked at the weather map and, sure enough, it was going to hit my city. Before bed, I packed some extra scrubs in a sports bag and put some bottles of kombucha along with a couple of paleo MRE’s in a cooler in the fridge.
Wednesday October 10, 2018:
I was up at 5:00 AM when my phone beeped with a text from Rob, the senior partner in our trauma group up in Georgia. It was a checklist of things to do and have ready for what might well be a mass casualty situation. For years Rob had been one of Delta Force’s surgeons, deployed to numerous hotspots around the world. He was well versed on these real life scenarios. I went out on the balcony to go over his text.
The sky was grey. There was hardly any wind--just the occasional wispy gust. An light rain was falling. I looked down at the ocean to a mesmerizing sight. Rolling in from the horizon were sets of massive 25 foot waves (the news would later report that they were actually measured at 30 feet--before the measuring device broke).
In the distance, across the expanse of the Gulf, I could see what looked like a massive storm heading in. The ominous view across the ocean, along with Rob’s text, gave me a sinking feeling in my stomach that Hurricane Michael would be bad.
I grabbed my bags and headed out. The condo complex was silent because everyone had evacuated. The only sign of life was a crew of storm chasers, kitted out with weather gear and supplies on their 4-wheel drive, and bivouacked on the ground floor. We exchanged a few words, told each other to stay safe and then I wheeled out onto Thomas Drive. I think this is some of their footage from outside my complex.
The beach town was deserted--not a car or person in sight. I gunned the Hellcat through all of the red lights and got to the Hathaway Bridge. The wind was just starting to pick up. The bridge was empty except another storm chaser who was parked and measuring wind speed. As I turned off the bridge, Florida Governor Rick Scott sent out a text on the emergency broadcasting system reading: “the time to evacuate has come and gone. Seek shelter now!”
Panama City Florida is a working class town. We have a lot of Mom and Pop businesses. There are a lot of folks here for the military bases. Many of the people who live here are employed by the two major hospitals, Gulf Coast (my hospital) and Bay Medical. As a testament to the strong family values here, they passed an ordinance banning alcohol on the beach during Spring Break, due to the bad stuff that was happening. That probably cost some tourism dollars but they passed the ordinance anyway. We don’t have a Starbucks, or an Apple Store, or a Whole Foods.
I can say that the folks from Panama City are great to have as patients. They nearly always thank me, no matter how dire their circumstances. A day doesn’t go by that I’m not made to feel like a hero. The nurses and other staff are great too, as you will see below.
When I arrived at the hospital a few minutes later, Hurricane Michael had gathered force and was now coming in as a Category 4, with sustained winds in excess of 155 mph. It looked like it would hit us around 1:00 pm EST. I rounded on my patients, including my lady with the femur fracture. She had been too sedated right after surgery the day before, so I explained what I had done for her injury. She patted me on the arm and thanked me. Three new patients had come in overnight, two with hip fractures and another with an elbow fracture (distal humerus). I got them tucked in, planning to do surgery after the storm.
I gave my Mom a call to tell her I was safe and not to worry. The cell phone went dead and, at around that point, the building began to shake. I was heading down to the emergency department when wind and water started pouring through the ceiling of my office.
As I made my way through the short corridor to the main hospital, I caught a glimpse of the hurricane outside. It looked like a fast moving train, with large trees bent over horizontal at their trunks--or flying through the air--and it was going non-stop.
The first floor of the hospital was a bustle of activity. A line of people were moving the chairs from the waiting area into the corridor. I joined the line and helped drag some of the chairs and got word that we were evacuating the third floor patients to the first floor, and those that could sit would be in the chairs.
The hurricane had apparently breached the third floor. The nurses had barricaded the doors to the rooms it breached to prevent it from entering the hallway (where the patients had been moved to). The nurses did great work during this crisis situation. Things had to move fast and they got this initial evacuation done, while keeping the patients calm and safe.
By then the outside power was down and we were on generator. Water was also down, due to the uprooted trees. Word came in that Michael had shattered the windows at one of the nearby hotels, causing lacerations to around twenty people. I went to the emergency room to prepare. We put together the things we needed, including suture kits, lap pads, tubs of four by fours for compression. I had the tourniquets ready from the operating room, should I need them. Next, word came through that the roof of a nursing home had collapsed, with patients inside.
The problem was that the storm was still raging unabated like a freight train and the streets were impassable for EMS (or anyone else) due to power lines and trees being down across the roads. There was no possibility of transporting the patients to us--or us to them. All we could do was wait it out.
Finally, the storm passed. I went over to my office, which had about four inches of water on the floor and the ceiling sagging down. The sky showed through a hole in the roof. Then I walked outside to an apocalyptic scene. Trees were down everywhere, entangled power lines covered the streets. Cars were lifted up onto the curbs, trucks on their sides, windows smashed in. My car had sustained a severe bonk from a tree or something on the passenger side and had a jagged crease from a bash across the hood. Normally, that would have pissed me off. After this storm, I didn’t give it a second thought.
Patients started to come in. A woman had been crouched, seeking shelter in her house when the roof blew off. Water poured in and when she tried to get up, she slipped and fell, severely fracturing her wrist. Later, she had wandered out into the darkness to seek help. A police officer patrolling found her, put her in his car and navigated the power line strewn streets to bring her to the hospital. Amazing.
We did our best to comfort her and, under conscious sedation, I reduced the fracture and splinted her wrist. She told me what happened, how she had no means or place to evacuate to and how her roof had been blown off. I mentioned in passing that the roof of my office had been damaged too. She immediately said she would pray for me and thanked me for helping her. This woman had lost everything and was injured and yet was concerned for me. As I said, there are some amazing people in this town.
The Coast Guard brought in a patient that had been extricated from a house by a PJ who had been lowered down with a basket from a helicopter. As soon as the patient was transferred, the Coast Guard team was out the door on another run without batting an eye. We had someone struck by a tree with severe head and other injuries, another person crushed between vehicles, other patients with fractures. I found out that nobody was injured at the nursing home. A few of the laceration patients made it in and were sewn up by the ER docs.
Throughout the build up to and during the storm, the nurses and other hospital staff were staying in the hospital and sleeping in shifts on air mattresses and cots. The cafeteria staff were great. We formed up a chow line and made our way through. The staff made us great meals and always served us with smiles. To put this in perspective, most of the nurses and other hospital staff are local residents, many with young kids. They were working and focused on helping others, at the same time not knowing what was happening to their own homes and families during this raging storm.
Thursday October 11, 2018:
One of the nurses gave me a pillow and, around 3 am, I crashed out on the gurney in the pediatric trauma room. I got up at 6 AM to the news that we would be evacuating all of the patients to Tallahassee and Fort Walton Beach. The nurses lined up, one to a patient, getting ready to take them out to the helicopters that were landing. The head nurse, who must surely be former military, was giving orders to the team leaders, who then organized the teams, twelve patients at a time, each with their nurse. They carried off the evacuation without a hitch.
A few days later I saw an article on the net entitled “Doctors Evacuate Patients from Panama City Hospitals”. I had to laugh. The nurses did it all. It should have read “Doctors stay out of way as patients are evacuated…”
That night I made my way back to my place on the beach. It was a surreal scene snaking down 23rd Street, with high tension lines, trees and telephone poles reducing the road to one lane in some places. When I got home, I saw that there was no power or water, and the darkened buildings were empty. I walked up the eleven flights to my place. It was intact except a little water leakage. The night was like a scene out of “Blade Runner”, a huge building standing silent against a clear starry sky. Looking back at the darkened city, the only lights were the blue flashing lights of police cars and ambulances.
Rescue personnel are still trying to get through the many nearly impassable streets, and the death toll rises daily. The power is still out in much of the area, including much of Panama City, though it is back now on the beach. People are now coming in with the injuries we expect in the aftermath of a hurricane--fractures from falls from roofs, rattlesnake bites, chainsaw injuries, dehydration. The serious have to be transferred to hospitals outside the area.
Here's some video footage that I took during the storm and of the aftermath.
And here's another video right after the storm passed.
The media cycle is moving on but it’s going to be a long road back for this area of the world. Many of the folks who live here, good people who live from paycheck to paycheck, are truly left with nothing. I’m particularly concerned for the incredibly dedicated hospital staff who may have lost much or all in this storm. I just wanted to give you a view of what happened. I have started a GoFundMe campaign in support of the hospital staff affected by the hurricane. All funds collected will go to the HCA Hope Fund, which helps families of staff who are displaced. Click here to help.
Please help out in any way you can and please spread the word around the world.
Ray Long, MD
Sometimes doing just one pose can set you up for the whole day. In this post, let’s look at Trikonasana or Triangle Pose and a powerful cue for stabilizing your pelvis and lumbar.Understanding tips like this one also sharpens your knowledge of anatomical and biomechanical principles.
The principle at work here is that of muscle co-contraction. This cue co-contracts or activates two separate muscles, namely, the psoas and quadriceps of the forward leg. As a consequence, you will feel a deep stability in your hip joint and a connection from your leg to your lumbar spine.
Here's the cue:
Extend your forward leg knee by contracting the quadriceps. At the same time, press down with your torso through the arm into the hand, and onto your shin. This activates your psoas (and iliacus), tilting the pelvis over the forward leg and, by lumbopelvic rhythm, drawing the lumbar out of hyperflexion. Feel how this connection stabilizes your pelvis and lumbar and awakens the forward leg in the pose.
|Figure 1:Co-activating the psoas and quads in Trikonasana|
In the beginning, it may be difficult to get the hang of activating your psoas. Get a feel for this by bending the knee and pressing down on the thigh through your elbow as shown here. Click here for an entire series of poses you can use to awaken your psoas.
|Figure 2: Activating your psoas (and iliacus).|
I hope you enjoy this cue. Think about what's happening biomechanically while you work with this. Thanks as well to everyone for your support of the folks in Panama City who were affected by Hurricane Michael. Check back next week to see how to integrate the back leg into this cue for Trikonasana.
All the Best,
Ray Long, MD