This week we will consider unilateral stretch for the dorsal-lumbar fascia.
As we already know, the dorsal-lumbar fascia is a diamond-shaped visco-elastic, soft, connective tissue that is vital to static and dynamic stability of the spine and pelvis as well as thoracic-scapular region, permitting the body various degrees of freedom in movement of the trunk and extremities.
The DLF is a multi-layered, wide expanse of fascial connective tissue. Various movements bring about a stretch in a segment or particularly oriented fibers of the fascia. It is stretched unilaterally by side-bending and turning activities. Let’s look at some of these. As always, we will look at right sided stretch. The pattern may be reversed for left sided stretch.
This is done while lying supine on the mat. The physical therapist flexes the hips and knees, and turns them as far as possible to the left, ensuring the pelvis and hips move as a unit while both the shoulders are on the ground/mat. This brings about rotation in mid to lower thoracic spine and lumbar spine. The stretch is held as long as possible between 5 seconds to 30 seconds. Then the legs are brought back to neutral in supine.
Active Static stretch:
i) Supine trunk rotation or jathar parivritasana: Begin in the supine position. Bend the hips and knees so that heels are closest to, or touching, the buttocks. The inner thighs, knees, and ankles touch each other throughout the stretch. Bring the arms to the sides by abducting the shoulders (shoulders should stay on the ground) and pronating forearms, so that the palms are facing the floor. Lift the feet slightly off the ground, ensuring the tailbone is still resting on the ground. Rotate the trunk by moving the legs to the left while the head turns to the right. Hold the end position for as long as possible between 5 seconds to 30 seconds. Bring the legs back to center and rest them on the ground.
ii) Ardh Matsyendrasana: This asana is done on the floor or on a mat in seated position. Begin in cross-legged seated position. Bring the right foot next to the left thigh, just above the left knee, so that thigh and leg is upright and the right knee is pointing toward ceiling. Reach overhead with the left hand and elongate the spine while bringing torso close to the right thigh. With the left arm reach across the right knee, gently pushing the right thigh across midline, into hip adduction and if possible, bring a left flat palm onto the floor by hooking it under the left knee. The left arm is externally rotated and supinated to achieve this position. Next, turn the trunk and neck to the right bringing the right hand to the floor behind the torso for spinal rotation to right. Ensure the pelvis is facing forward, while the left shoulder moves away. This stretches the diagonal fascial fibers /aponeurosis of right gluteus maximus and left latissimus dorsi. Hold the position for few seconds. Release asana by bringing spine to neutral rotation, unhooking the left hand and bringing right leg back to cross-legged sitting position.
Active Dynamic Stretch:
i) Side bending or Ardh kati chakrasana: Stand with feet about hip width apart, spine upright and elongated. Raise both arms up overhead elongating spine, and join palms in namaste as you inhale. Slowly exhale as you bend to the left and hold in fully exhaled, side-bend position (that is pure lateral flexion) for as long as possible. It is important to keep hip and trunk neutral in the sagittal plane without bending forward or backward (no hip or spine forward flexion or extension). This stretches the DLF on the right side. Slowly return to neutral trunk position as you inhale.
ii) Kati Chakrasana: Begin in the standing posture with feet slightly more than shoulder width apart. As you inhale, raise both arms to shoulder level with palms facing the floor and middle fingers meeting in the midline, in front of the heart. Exhale as you rotate trunk over the right shoulder and extend right elbow looking behind. The pelvis should face forward without rotation in transverse plane, so that rotation takes place only in the spine (no hip rotation). This stretches the diagonal fascial fibers /aponeurosis of right gluteus maximus and left latissimus dorsi. Hold at end range for as long as possible. Inhale as you rotate trunk to neutral and face forward.
Stretching with tools and equipment:
This was described in detail in the last post, dated May 19th.
Proceeding cranially, after considering major lower extremity muscles and stretching techniques, we come to the trunk.
Ever notice, when you get up in the morning and you stretch with arms overhead and leaning backwards, opening the front chest and abdomen, bending to the sides with arms stretched overhead or even rounding the mid/upper back and shoulders? Aah! That feels so good. All these are stretching muscles in the trunk. Let’s see them one group at a time.
Today we will see the DLF or the dorsal-lumbar fascia, so known because of the span of fascial connective tissue extending in the dorsal(thoracic) and lumbar regions of the spine/trunk. The fascia is a visco-elastic tissue that contracts (resulting in stability through contractions of the various muscles which insert via aponeurosis into this fascial sheath) and expands (allowing mobility during forward and lateral flexion movements of the spine).
This fascial sheath encases various muscles and accepts muscle insertion forming aponeurosis. The posterior layer (deep lamina) with the middle layer encases the iliocostalis, longissimus, multifidus, and erector spinae muscles. Laterally, this sheath forms the aponeurosis with transversus abdominus. The posterior layer (superficial lamina) also receives insertion of latissimus dorsi forming aponeurosis with latissimus dorsi. The quadratus lumborum (QL)muscle lies between the middle and anterior layers. The psoas muscle lies anterior-most, being separated from the QL by the anterior layer. The fascia itself originates from the spinous processes of the dorsal and lumbar vertebrae, supraspinous and interspinous ligaments, the iliac crest, SI joint and sacrotuberous ligament. Thus, it covers a large, diamond-shaped area, in the back.
Together with the abdominal muscles (transversus abdominus and obliques) and back extensors (Longissimus, iliocostalis and multifidus), it forms a corset-like structure in the trunk, providing static postural and dynamic stability during the various movements. The latissimus dorsi and contralateral gluteal muscles and the internal oblique with the contralateral hip adductors exert forces through the DLF, contributing to trunk stability. Hence, even though, the DLF is not a muscle, it has a major contribution to healthy functioning of the trunk, both during static postural maintenance and dynamic movement in various planes.
Now, let us consider the technique for stretching the Dorsal-Lumbar Fascia or DLF, bilaterally and symmetrically.
In the supine position, the therapist brings the hips and knees into maximal flexion with knee to chest position, thus flexing the lumbar spine with posterior pelvic tilt, lifting the buttocks off the mat. The head and neck are flexed bringing the chin to knees, thus rounding the back completely.
It is important to note, that mechanism of stretch through tension in passive stretch (stretching fascial tissue throughout its course by posterior pelvic tilt and spinal flexion) is different from an active stretch in which case, the contraction of muscles and resulting tension in the fascia contribute to provide stability to the spine and pelvis during functional movements.
Active Static Stretch:
In this post, we are basically looking at symmetrical, bilateral stretch. Hence any forward bending activity is effective.
i) Paschimottasana: Begin on the floor mat in long sitting position or dandasana. Allow the low back musculature to contribute to sitting upright. Hands are placed besides the hips on either side with fingers pointing forwards. Elevate the arms overhead, elongating the spine
(transversus abdominus and latissimus dorsi engaged). Slowly rock back and forwards by tilting pelvis and bring hands to knees, shins and big toes of feet in succession. Deepen the pose during exhalation. Gently bring the elbows to floor by side of knees and lower the forehead to the knees. Hold for 5 to 30 seconds. To release, slightly bend the knees, lift head and arms overhead and come into dandasana.
Active dynamic stretch:
i) Balasana: Also known as child’s pose or prayer pose. Begin in kneel sitting pose or vajrasana with an upright, elongated, spine that is engaging of transversus abdominus, erector spinae, and multifidus. The feet should rest on dorsum with toes pointing behind or slightly inwards. Sit completely with buttocks/back of thighs resting on the heels. Bring the knees apart. Begin bending forward at the hips and lower the torso to the ground, bringing the forehead to the floor. The arms are outstretched overhead to stretch the DLF through the latissimus dorsi. Hold for 5 to 30 seconds, then release by bending the elbows and pulling hands towards torso, lift the forehead off the ground, sit up by extending at hip and tilting pelvis anteriorly towards neutral.
ii) Pavanmuktasana: This active stretch is much the same as a passive stretch in supine position. Bend the hips and knees from neutral supine position, so that the heels are as close to buttocks as possible. Lift the feet off the floor bringing the knees to chest and lifting tailbone up, tightly circle arms around the shin and pull up while raising the head from the floor to bring the forehead/ chin to knees. Deepen pose on exhale and hold for 5 to 30 seconds, then release by lowering head to floor first, next the pelvis/tailbone and finally and expands he feet. Straighten the legs to come back to supine position.
Stretch with equipment/tools:
Foam roller stretch: Place the foam roller on the mat. Sit on the mat with the foam roller placed perpendicular to the trunk/spine. Lie down with upper thoracic spine on the foam roller, keeping the hip and knee flexed with feet on the floor. Cross arms and place them over stomach/abdomen. Roll upwards/cranially on roller slowly and hold in places which are tender (trigger points), to allow them to release. Progress in small increments rolling back and forth along the back of trunk till you reach the sacrum. You can also place the foam roller lengthwise along spine and roll it outwards to release the diagonally or laterally arranged connective tissue.
Last week was a deviation from the stretch posts and diving into yoga in healthy living.
Getting back to the lower extremity stretches, gluteal stretch is the last in the series.
There are three gluteal muscles, the deepest being the gluteus minimus, next the gluteus medius and gluteal maximus being the most superficial muscle.
• The gluteus maximus originates from the posterior gluteal line (on ilium), the iliac crest, the sacrum, coccyx, the sacrotuberous ligament, and lumbodorsal fascia. It inserts in two parts:
• i) majority of fibers insert into the iliotibial band after passing over the greater trochanter (here it is protected by a bursa between the tendon and bone), ii) the rest of the fibers insert into the gluteal tuberosity on the femur.
• The gluteus medius originates between the anterior and posterior gluteal lines on the ilium and completely covers the deeper gluteus minimus. It inserts into the greater trochanter of femur.
• The gluteus minimus originates between the anterior and inferior gluteal lines on the ilium and inserts with the gluteus medius on the greater trochanter of femur.
The gluteus maximus and hamstrings are the major hip extensors. The gluteus maximus being a one-joint muscle, functions only as extensor at the hip joint. The gluteus medius is an important hip abductor, especially during walking, as it prevents the pelvis from dipping when the contralateral leg is in swing phase.
Since the gluteal muscles are fan-shaped covering a wide area, stretching them is not done in one fixed position, albeit it varies from person to person, and also the same individual may experience stretch at more than one angle. It is good to explore the span of the muscle and stretch as tightness is encountered.
Here are ways to stretch the gluteal muscles. These are similar to piriformis stretches. As always we will consider right sided stretch for ease of understanding. However it is good to stretch muscles bilaterally (both sides).
Passive Stretch: This is done on the mat in supine position, with the left leg in neutral. The therapist flexes the right hip and knee to end range of motion. Hip flexion is limited by approximation/contact of soft tissue and has a soft- tissue like springy end-feel. The span of muscle is stretched by rotating the right knee from pointing to left shoulder and gradually aligning with hip joint to pointing outwards in an arc. When a stretch is experienced, the position is held between 5-30 seconds for as long as possible.
Active Static Stretch: This can be done in supine with the individual flexing the right hip and knee to end range of motion. Circle the thigh/leg with both arms and pulling the leg towards the chest/abdomen. Move the right knee in an arc from pointing at left shoulder, to pointing caudally (towards head), and finally, outwards. Hold the position between 5-30 seconds, for as long as possible.
Active Dynamic Stretch:
i) The pigeon pose or kapotasana: You begin from the plank pose and bring the right foot onto the floor in front of the left hip joint. Bring your foot and toes up while sticking out the ball of right foot and push the outside of foot onto the mat. Bring the right knee to the floor. The hip may be abducted so that the knee is slightly lateral to the hip and slowly scoot the left leg back and rest the top of foot onto the mat, ensuring the left hip is in line with the left foot at all times and the body weight is centered. The forearms here will rest on the mat as you continue slowly scooting the left foot back and elongating the body. When you feel a stretch in the right buttock area, stay there for a while. Deepen the stretch when possible by lowering the trunk to the floor and outstretching the arms in front during exhalation.
ii) Ardh Matsyendrasana: This asana is done on the floor or on a mat in seated position. Begin in cross-legged seated position. Bring the right foot next to the left thigh, just above the left knee, so that thigh and leg is upright and the right knee is pointing toward ceiling. Reach overhead with the left hand and elongate the spine while bringing torso close to the right thigh. With the left arm reach across the right knee, pushing the right thigh across midline, into hip adduction and if possible, bring a left flat palm onto the floor by hooking it under the left knee. The left arm is externally rotated and supinated to achieve this position. Next, turn the trunk to the right bringing the right hand to the floor behind the torso for spinal rotation to right. Hold the position for few seconds. Release asana by bringing spine to neutral rotation, unhooking the left hand and bringing right leg back to cross-legged sitting position.
Stretching with tools equipment:
i) Foam roller stretch: This is similar to piriformis stretch, except that the gluteus fibers are oriented more vertically than the piriformis, which are diagonal in direction. For effective stretch, it helps to orient the foam roller perpendicular to the direction of muscle fibers. Place the foam roller on the mat and sit on it. Bend both the knees with feet flat in front on the mat. Bring both palms on mat, behind the roller and shift your weight onto the arms. Lift the right foot off the mat and bring it onto the left thigh, right ankle resting just below the left knee. Make a quarter turn to half a turn to the right side and gently roll the foam roller under the right buttock. You can release different segments of the muscle by rolling further onto right side in small increments. Base the body weight you put onto foam roller by the intensity of release experienced.
This week has flown past preparing for a health fair at the Bay Area Vaishnav Parivar (BayVp).
The topic was dear to me so, I just dove in: “Yoga for (in) Healthy Living.”
Decided to consider asana and pranayama, which are two of the most popular limbs from ashtanga yoga being adapted widely in the USA, and are intimately related to physical therapy. The eight limbs being yama, niyama, asana, pranayama, pratyahara, dharana, dhyana and samadhi.
I have covered Suryanamaskar in some detail in earlier posts, so it is only apt to consider pranayama in this post.
Pranamaya kosha is one of the five sheaths by Patanjali (who is considered to be the father of yoga). Pranamaya kosha is constituted of “energy” rejuvenated through breath, communicating with subtle layers-vital, mental, psychic, and spiritual.
Simultaneous processes are going on at various levels –for example biomechanically at the gross or physical level, physiologically at subtle or cellular level, sensory stimulation and processing at manomayakosha (mind) and a true understanding of this at the vijnanmayakosha (wisdom/discriminatory intellect), and just pure bliss from nourishment of being (anandamayakosha) .
Essentially, the body functions through the energy it gets from food we consume and the air that we breathe is used to “burn” (jatharagni) the food to release energy, which we then use to accomplish various life processes and works. This is the process of respiration which occurs at the cellular level.
The energy from the sun is stored in form of foods in the plants, vegetables, fruits, etc.; we consume. The air we breathe provides the fuel (oxygen) to burn the food.
The air we breathe goes into the lungs, which expand as the air fills the air sacs.
From the air sacs, the oxygen dissolves into the blood and is carried away by the blood to the cells for respiration (or burning the food consumed to produce energy).
At the same time the diaphragm contracts, the pelvic floor muscles relax and allow the abdominal organs to be accommodated and the abdominal wall moves out. This is inhalation.
The abdominal muscles- the transversus abdominis and internal obliques contract as the diaphragm relaxes and the abdominal contents push up narrowing the chest cavity. This is exhalation.
The transversus abdominis is in a mild contraction all the time, since it is a postural muscle. This stabilizes the spine. The fascial sheath wraps all around the low back like a corset.
• Simply put, when one breathes in, the stomach/abdominal wall moves out and the chest cavity expands.
• When one breathes out, the abdominal wall recoils inwards as the diaphragm relaxes and abdominal contents push into the chest cavity which also deflates (much like a balloon filling with and loosing air).
Practicing Sahaja Pranayama
• Sit cross-legged in sukhasana, padmasana, ardh padmasana, or on a chair (comfortable position).
• Maintain good upright posture in the spine.
• Look down by lowering the head. Breathe in through the nose. The stomach/abdominal wall moves out slightly and the chest cavity expands all around.
• Look straight forward by raising the head. Breathe out through the mouth. The stomach/abdominal wall recoils inwards as the diaphragm relaxes and abdominal contents push into the chest cavity which also deflates much like a balloon loosing air.
(P.S. The pictures for this post are from Clinical Anatomy by Richard Snell and from reuseable online sources.)
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.