Last post I wrote about balance. Our human body is a wonder of wonders. And at times I find myself at loss of words to describe the inherent beauty in the co-ordination of muscle work and the fine tuning for nuances in movement patterns. Suryanamaskar in yoga involves alternate spinal movements, synergistic bilateral, and reciprocal movement patterns in a rhythmic symphony, exercising most muscle groups and instilling a sense of overall balance in the body. There, I did it again! (Suryanamaskar enters my posts regularly and with much ease, and well deservingly so).
Being bi-pedal, trunk stability is key to execution of dynamic movement patterns with less muscular demands and subtle adjustments in small centralized or proximal body movements (for example breathing movements) and greater muscular demands with increasing adjustments needed for movements distally (for example extremity movement in upright postures). In other words, greater the shift of COG of the body during any movement, greater the muscular effort to maintain stability.
From the perspective of a physical therapist, the abdominals, the back extensors, and the surrounding hip muscles contribute much towards dynamic stability with movement. Hence lumbo- pelvic stability is important to begin any movement and pelvic-hip stability is imperative for weight transfer from the spine to the lower extremity- as in the vrikshasana or standing on one-leg. This ability is very crucial in activities involving single limb stance, such as gait, when weight is shifted from one leg to the other as we move forward.
When we move, certain muscles have a lower threshold for their activation due to frequent recruitment i.e. muscles that hold us upright in presence of gravity, while others have higher threshold due to infrequent use or activation on demand. Static strength (isometric strength) is to be measured by holding steady in given position and isotonic strength by the ability to lift and move a certain weight. The “seeming paradox” here is that when one holds steady, one moves better. When you look into it, you realize these are in fact complimentary and a steady trunk is a requirement for stable, smooth dynamic movement. Our body is equipped with tonic or postural muscles which support the framework and allow smooth movement through phasic or movement muscles. Postural muscles are closer to the midline or spine and more distally, in the limbs, the joint stabilizing muscles are closely surrounding the joints. These postural or stabilizing muscles are basis of movement and their being in optimal flexibility and tone, enhances the quality of movement. The phasic muscles may have a longer lever arm for efficiency with movement.
One fresh perspective is that the important muscles are the ones that work involuntarily/ subconsciously and through their health, allow the voluntary muscles to function ideally. Lifestyle, over decades, has been changing steadily and we have begun adopting more seated postures. This employs more of the postural muscles, which we have taken for granted. Those intermittent stretches and change of posture your physical therapist has suggested, are necessary for the health of the postural muscles. What’s more, walking and exercising are necessary also.
The abdominals are big contributors to spinal stability. Wait! Did I not mention earlier that our body is a wonder of wonders? Breathing is an ongoing and involuntary function with the control-center in the brainstem. The diaphragm involuntarily contracts and decreases the pressure in the lungs, thus pulling air in from the atmosphere (inhalation) and when it relaxes, it pushes the air out (exhalation). In upright postures, the lumbar multifidus (LM), being supportive, postural muscle, is active providing posterior inter-segmental vertebral stability. The transverse abdominus (Tr.A), the deepest of the four abdominals, has been scientifically found to be one of the first of the voluntary skeletal muscles to contract when movement is contemplated. And though true in relation to the skeletal, mobility muscles, its contraction intuitively (subconsciously / reflexively) co-ordinates with diaphragmatic and pelvic floor contraction thus forming not only a corset around the abdomen, but also bracing the abdominal organs to provide support. As we all have experienced, this is not something trainable or at voluntary conscious level. Though it may seem sequential, the involuntary-voluntary stabilizing muscle contractions occur with such harmonious synergies, within a few milliseconds that it is mind boggling. This is the wonder of the human body and there are a multitude of speculative articles explaining the sequence in which this occurs, I neither support nor refute any of them. In the true spirit of yoga, we must take charge of the known (voluntary) and leave the results or outcome to that intuitive ability within us. One thing most of the studies agree with is the contribution of the LM, Tr. A, and intra-abdominal pressure regulation through diaphragm in providing stability. Then, it is the support to the spine that must be coordinated with breathing through LM, and Tr. A re-education, by awareness of contraction strength (muscle fiber recruitment speed), isometric holds, positional changes, and functional movement pattern re-education rather than sequence or order of muscle recruitment.
Physical Therapy has not much explored the role of the involuntary muscles and the supportive postural muscles, other than scientifically study its role or actions. I wonder what makes the involuntary muscles work relentlessly to keep us alive ( think of the diaphragm or the cardiac muscle) and the supportive postural muscles work in moving well (LM and TR.A, Obliques). And it is not by chance that the muscles that provide stability are postural muscles that act beyond our conscious awareness! However, we can bring our awareness to these and exercise them at conscious level to make them stronger. What's more, they stay healthy when the voluntary muscles function well. Which is why movement study and re-education is effective in influencing them and making physical therapy interventions effective. Though this is an indirect approach, it does alleviate acute pain and discomfort. Direct approach may be beyond the scope of physical therapy as we currently know it. When one realizes yoga is the root of physical therapy and there is much to explore beyond, one may look into yoga for these answers. For the body is a mere instrument and to explore beyond that, yoga is necessary.
(To be continued….)
P.S. :- Video edited from following image/video:
What better way to start the New Year than a post about balance? Though StableMovement Physical Therapy is a physical therapy boutique, the approach to healing, health, fitness, and wellness is holistic. That is both at gross physical level and in the subtler realms impacting overall health and wellbeing.
As the New Year dawns and we enter into it, we sincerely hope to give our best and that demands a balanced life. What do I mean by balanced life? Well let’s just say it is equanimity in all things we undertake. Imagine a beam balance sitting on a fulcrum, and based on where you move on this beam, you could tip it over or be agile, skilled, and light to keep it balanced so it does not hit ground and stays balanced in the air. Now, each individual will have a unique skill set and comfort level as to how far out along one side of the beam one can go and yet not tip the balance beam over. Get the picture? I have worded this out since it is not only in the physical balance, albeit mental balance as well that is involved here. In other words, balance at gross and subtle levels. At a certain point gross gets subtle and subtle keeps getting subtler and rarer (like water particles turn to steam and when this is further heated the particles move further apart as density decreases). When that happens, movement suddenly becomes very effective and balance is the outcome of this. Do what you may, you will not tip the beam balance! The stability we all seek in movement which results in a balanced life.
Physical therapists employ a variety of exercises to promote physical balance, though that is not the sole purpose of such exercise. It is truly imbibed when we are in equilibrium (stable) moment after passing moment. Initially, it is not a state of passivity, it is the constant striving or fine tuning (dynamic adjustments made to maintain balance). With practice however, each level of challenge gets easier and we seek a new zenith to work towards (as it is said, sky is the limit- notice the analogy here---the higher up you go, the lower the density). As a physical therapist, I see success in both being close to the center and staying in static balance through fine tuning, as well as how much further out you can reach along the beam balance and still return to the center. It takes a very different skill set to accomplish these two, however they both demand presence and alertness.
Stability is the quality that closely resembles equanimity. In other words, stability is that dynamic state in which one has complete command over all the faculties to make the split second decision with only the goal in mind and not the result or outcome (i.e. looking forward to future) and where there is no space for brooding on the past. Our bodies/form is the best instrument to realize this truth. Balance poses in Yoga without use of props, let’s one go deeper inside and master nuances with utmost clarity and calmness, so that such equipoise may be reproduced with mindfulness. Need help? To clarify this concept, it is easier to make use of equipment like the rocker board, BOSU or balance disc, Airex cushion, etc. and explore the gross adjustments initially and experience the finer tuning through smaller weight shifts. As the mind calms, it gets easier to be present for subtler adjustments. By doing best in whatever you do, you subtly invigorate people around you to do the same. In his study about Vibrational Medicine, Dr. Richard Gerber mentions of cells within our body that are capable of receiving and emitting light energy(ultraviolet light).
Vrikshasana is one- leg stance pose that demands stability and is a wonderful asana to go within and explore the workings of the subtler realm of thoughts.
• When one balances on one leg, it shifts the center of gravity of the body, as the weight bearing line shifts to the stance leg. The non-stance leg is lifted higher and abducted at the hip which changes the dynamics and muscles recruited to maintain standing balance.
• Lumbar spine stability in sagittal and coronal planes, pelvic stability in the coronal plane and overall ankle stability (in all three planes- sagittal, coronal and transverse) is of paramount importance.
• The gastroc-soleus, tibialis anterior, peronei and toe flexors, provide ankle and foot stability.
• The gluteus medius/minimus, TFL, hip adductors keep the pelvis stabilized in the coronal plane, the psoas and gluteus maximus stabilize the pelvis in sagittal plane.
• The trunk stability is through transversus abdominus and the thoraco-lumbar fascia, rectus abdominus and erector spinae co-contraction.
• The scapulae are symmetrically stabilized through serratus anterior, trapezii, and rhomboids.
• Stability at the shoulder during overhead arm extension is through rotator cuff muscles and co-contraction of biceps and triceps.
• When ligaments are in optimal condition, the skeletal alignment ideal, and muscles supple yet strong, the harmonious working of these results in pain-free, stress –free, stable posture.
Wishing you all a Happy, Healthy, and Stable New Year. Make that Ecstatic, Lively, and Balanced New Year!
Ami Gandhi is a licensed physical therapist in the state of California. She is the owner of StableMovement Physical Therapy, a small boutique practice in San Jose that offers patient centered, one-on-one, hands-on physical therapy.