Reality in its grossest aspect is portrayed as life as we see it. We struggle when the gross and subtlest aspect of this reality in our perception do not match. Life presents itself in layers. That is nature. The basis to success is to realize the layers, know them, and practice from the inside-out. Reality is blissful when the inside pierces the layers as is and matches with the outside- that is actions sprouting from pure consciousness. Which brings us to the core. Is that not why the core is so emphasized in PT? The truth is presented to us in all walks of life. It must be perceived in simple sincerity and ultimate depth, to live a life truly liberating. By liberation, I mean the ability to choose at every step of the way- it is exhilarating. Initially it does seem like there is a box, and there is constant striving to “think out of the box.” Then suddenly there is grace, and “poof” the box vanishes! –The truth is it never existed- it is all in the perspective.
For any movement to have a stable basis, it is necessary to have stability. Static stability is the ability to hold a posture with the apical skeleton (i.e. extremities or arms and legs) in a steady or stationary position. However with daily activities, we seek dynamic stability, which is a whole new world in itself. Here constant adjustment in muscular contraction is demanded to maintain a stable form, specifically in the spine. There is a popular notion in physical therapy, fitness training, and athletics/ sport training about spinal/lumbar stabilization (stable lumbo-pelvic region) with a mobile hip. This hand-in-hand notion of mobility only in the hip and to keep the spine neutral at all times has made “the squat” very popular-. This is no doubt, the first step. Though this is imperative to learn and the first step, so that mobility between the two (lumbar spine and hip) maybe discriminated between and mastered, spinal mobility should not be taboo in my perspective. We would not have been given the mobility, if we were to keep the spine neutral at all times! In fact, it is not possible for us to not use or employ spinal mobility and yet be graceful in our movements! How soothing is the movement in ballet or gymnastics? It takes training the spinal mobility, does it not? To think that it must always result in injury is to fear movement. It takes an additional level of skill however to strengthen the trunk musculature sufficiently with spinal mobility. Yogis have done this for years and their spines were never at dis-ease or in pain and they flex forwards, backwards and sideways and twist and turn without any problem.
So once the first step is mastered (lumbar stability with hip mobility), and don’t mind me saying this again since it is to be emphasized, it is the layer deeper than spinal mobility, and until this is mastered and understood well, one must not attempt the next level (reminiscent of developmental patterns?). This is simply for the health of the spine. Thus such a progression is a skill.
So yoga is an integral part of PT. In fact it is an integral part of anything we do. Yoga not in the modern or popular sense but the traditional yoga I have alluded to in the previous post. “Yoga “is an inherent part and by giving it a separate name conjures picture of separate entity or process, which it is not!
From the PT perspective, let us consider an idea, say performance of a forearm plank position. For this to be executed in an ideal pattern, the idea of this is necessary- visually, mentally, intellectually. What is ideal pattern? The arms are shoulder width apart, with elbows directly under the shoulder joints, neck and entire spine in neutral, scapula slightly squeezed and firm on thoracic cage, hips, knees in neutral and aligned, ankle in neutral weight bearing on ball of feet and forearms only. In other words, the body viewed from the side or above appears straight like a “plank. “
I have mentioned earlier, that movement may be brought about through involuntary muscle action, with the example of cardiac muscle and smooth muscles in the visceral organs which work constantly without our volition, and if these stop functioning, life stops. So what is it within each one of us that functions for life to go on? Let us call this the cause.
Swami Chinmayananda brings it out beautifully through the 3 laws of causation:
1) Effect cannot be without cause
2) Effect is cause in different forms (effect is plural)
3) From the effect when the cause is removed, nothing remains.
This cause he says is the life spark within each of us, not only humans albeit all the living organisms including animals and plants.
With this pure consciousness, when the world is perceived, one can only act selflessly. Then the body, mind, and intellect, which are instruments of the perceiver, feeler, and thinker, are tuned/transcended. The field of object, emotion, and thoughts is limitless.
To realize the cause, we all have the same instruments (body, mind, and intellect). One way is to perceive, feel, and think till the truth is realized. This is done through expansion of the limited field of this self and make it limitless through inclusion of everything in our field (objects, emotions, and thoughts). Another way is to negate everything “neti- neti,” (not this-not this) till at last one reaches conclusion that there is only pure consciousness. Once this journey is undertaken, the unconscious within us slowly attenuates to nothingness and only pure consciousness remains. This is the state of nothingness and everythingness at once.
Bringing this down a notch into experiential realm of movement, one may go about executing the movement. Here the “root cause” is the idea of performing a plank position, and the “effect” will be its execution. Hence, without the idea of performance of the forearm plank, the movement has no existence or may not be executed. Now let’s say there is a group of people who are instructed on doing the plank. Here, the idea or cause of a plank position exists in many different minds. The effect or performance will vary based on the perception and interpretation of the individual. So though the forms that the “effect” or performance of the plank has taken is varied and in different forms, it is however one and the same “root cause” (idea of plank position).
Through yoga any movement we undertake, even the ones involving voluntary muscles may be performed effortlessly! Amongst our skeletal muscles, the support or postural muscles are the ones with endurance and the ones that may work with or without voluntary input (being a reflex loop at the spinal cord level with connection to the cerebrum for voluntary input). So these are the essential “link” muscles, so to speak. The key to execution of an ideal plank is stability in these postural muscles (the multifidi, transversus abdominus, obliques). The quadratus lumborum with the obliques balances the pelvis (maintains spinal symmetry) and prevents unilateral pelvic rotation (or dipping of the pelvis on one side). The toe extensors and foot dorsiflexors are engaged, as are the quadriceps and gluteus maximus. To maintain stability of legs in the transverse plane, voluntary co-contraction of the hip musculature (agonist-antagonist pairs) like gluteus medius and hip adductors, hip flexors-hip extensors, is essential. Plenty of muscles are activated in the trunk to maintain stability as the rectus abdominus co-activates with the gluteus maximus to prevent anterior pelvic rotation and hence hyperextension of lumbar spine. The rhomboids and middle trapezius keep the scapula or shoulder blades close to the midline/ spine and provide the ideal channel for weight transference. The serratus anterior fires making load transfer from stable shoulder blades to the arms. The rotator cuff (set of muscles- supraspinatus and infraspinatus, subscapularis and teres minor) stabilizes the shoulder girdle and keeps the head of the humerus (upper arm bone) snug in the glenoid socket of the scapula (shoulder joint). Triceps and biceps co-contract as do the forearm supinators-pronators. With practice, the reflex loop may be tweaked and altered through input from higher centers, till the muscle fibers are recruited and strengthened to perform consistently in an ideal pattern.
When mastered, the process becomes easier and easier and eventually effortless. That is the once voluntary activity has now become involuntary or automatic and an ideal reflex loop has been created. Once an activity (the performance of plank position) is seen as ideal in alignment and stability, involuntary, effortless, the effect is and cause is removed (the idea of plank). Now your PT says “do a plank” and you simply do it, executing the ideal plank, nothing remains. You do not think “first I have to bring my elbows under the shoulders, next I have to lift the pelvis and knees and bring the hips and knees in line, and then I have to squeeze the gluteii to maintain….etc.” You simply do it!
So with PT, this is the goal, to make the idea effortless. And even this is a mere pointer. That lack of idea or that “nothing remains” is in fact true fulfillment of life. It is this “nothingness” or the pure consciousness beyond our ego which uses the body, mind, and intellect as instruments to express and play in the world, which is at once nothing and everything within each one of us that we seek and the one that guides our movement. That is ideal movement!
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.