Yoga in Physical Therapy- a unique perspective
A lot is being said about fascia and its role in movement. I could fill up pages on the research done. While a fluid, free-flowing fascia is essential to permit smooth motion between various tissues and the different layers of a single tissue, its role is exaggerated in many instances. That is true for any isolated tissue –be it muscle, ligaments, bones. Isolation only facilitates understanding, hence reveals the nature or characteristic of any structure. You must see yourself as whole. Consider the fascia as the river seen in nature in the macrocosm. One that flows and nurtures. Since the tissues overlap each other, when injured, an injury to one impacts other tissues directly (due to proximity) or remotely (impacted function). One tissue cannot be at fault, while others are standing by. Identifying this pattern is what a physical therapist does. Some tissues play a protective role and you may see that as a “compensatory pattern.” Nothing wrong in that. It allows the injured tissue the healing time. However, once this resolves, do you bounce back to natural pattern?
You see a physical therapist when you are injured or at dis-ease with yourself. The only truth is you are unique as an individual. What is perceived by you, none other can perceive. In yoga (literally meaning “union”), that is all that matters. Union with what you ask? Your ideal, of course, which is nothing but your perceived higher self, a.k.a. your blissful self. Every one of us is moving in one and one direction only, our higher self. Then why all this discord? What lacks is consciousness of this truth in every moment of life. That is why all the various treatment options like allopathy, physical therapy, naturopathy, etc. do not work. So use this vital time with your physical therapist or any healthcare professional of your choice to know yourself. What you are and what you do when at dis-ease. Do you perceive your ideal at all times? Observe your patterns- those are indeed your manifested movement patterns.
It is said that man is a gregarious being and cannot live in isolation. Even twins living in a mother’s womb together for the gestational period, on being born, go their own paths. True, however to get to that conclusion, each of us must necessarily go within ourselves, to meditate in “isolation” because none other may get us there. Our individual intellect is instrumental here. This isolation period of meditation is your stability. How stable are you in your concentration (dharana), meditation (dhyana), or are you already one with yourself (Samadhi)?
The “enlightened beings” that come in our path are but our aspiration and inspiration, nothing more, nothing less. They “walk” with one for a distance making one “their mirror” that reflects what one may become. In yoga, that is why a “guru” is essential. It is difficult to accept the “formless reality” which is omnipresent, omniscient, and omnipotent. Hence to learn from ourselves we bring these beings into our lives. This may be anyone you want to learn from in life, in form of friends and colleagues, professors, and family. When that realization happens, do not waste a moment. “Time is precious, utilize it wisely.” You will know, for each one of us has that intuitive mind. Dive in and learn from them, leave no leaf, no stone unturned, I say. The deeper you go, the more tranquil the waters are.
So far everything we read about and hear in healthcare field, talks about prevention of disease, taking ill health and sickness to be basis of everything. That is to say, you start from illness and move towards well-being. Let’s shift the paradigm. Why not consider good health as a way of being, as our basis? It is a given, given the human birth. (Slide 1)
Here is an invitation, (age being no bar), to increase the awareness of instability and faulty movement patterns even before onset of injury and taking charge of your life towards health and wellness and improved productivity. (Slide 2).
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You know how when you begin an asana, you see it being done by your teacher and it is just perfectly done in alignment and stability. Now you would like to get there, perform it with the same grace and smooth flowing movements, but today you just cannot. Mental note you make to yourself; “I must do all I can to perform this asana exactly like my teacher.”
What if I said there is a magic pill for that. The magic pill is …….exercise or in yogic terms practice or “Sadhana”.
When we are grounded in material world it takes form of exercise, for those in the realm of thought, it takes the form of meditation….and when one transcends….there is only bliss of oneness (Samadhi).
Albert Einstein said, “if you cannot explain (something you know) simply, you don’t understand it well enough”. Profound! And a big responsibility to carry. So let’s see.
Let us consider ligaments and tendons and their role in changing movement patterns. Very relevant, is it not, when we want the range of motion, movement control, cadence, and rhythm we know we do not possess, yet are yearning for? How are ligaments and tendons related to this, you ask? Putting it into perspective, here is how….
In the last 2 posts we looked at the “hardware” which are the bones forming joints and the various soft tissue and their role in action or movement. Joints have a large degree of mobility available and this is amplified by the fact that in a human body, movement is limited by a soft-tissue end-feel (rubbery or springy). Rarely do we feel movement being limited by a bony clunk which represents bone coming in contact with bone at the end of range of motion. So there is always potential range available when it comes to movement of bones at joints.
Muscles are inherently the most flexible and stretchable structures in the body. They are also elastic in nature, which means when stretched, they lengthen. However, they retain memory of the original form and recoil back to that length when stretch forces are removed. Muscle function is much affected by the surrounding fascia which is a fluid soft tissue and when used regularly, it acts as a lubricant between structures during movement. Fascia when unused for a period tends to deposit collagenous fibers which are inflexible (they adhere to one another) and cause movement restriction in muscles. The body has the perfect mechanism to overcome this movement restriction, if pursued slowly and steadily.
Given good fascia function, the potential of joint mobility and muscle flexibility is significantly enhanced by ligaments and tendons when you are pushing yourself to the limit. In other words, tendons and ligaments operate with self-regulatory mechanisms. And to bring about either increase in range of motion, motor control, or static and dynamic stability in body alignment, these structures are instrumental.
Tendons connect the muscles to bones and efficiently transmit the forces produced by muscle contraction, thereby bringing about movement of the bones they connect with. Tendons are made of elastic connective tissue which stretch to some degree, when forces are applied, to bend around joints. This is because they are made of connective tissue which are helical or coiled like a spring. These unfold or stretch to permit the movements. Another role of tendons is to harbor the sensory feedback mechanism to provide the brain information on the force applied –the tension in a contracting muscle and to inhibit movement which is detrimental to integrity of the soft tissue. Kind of like an electric wire which efficiently conducts current and has a fuse in the circuit to prevent overload of current.
Ligaments are made of mostly collagenous connective tissue fibers with few elastin fibers and they connect bone to bone at joints. These fibers are also helical like tendons and so their inherent nature is elasticity, though by virtue of the alignment of fibers in multiple crisscross layers, they withstand tensile forces from several directions maintaining joint integrity and stability. Which is why when pushing our bodies beyond the existing range of motion in any direction, requires training- gradual and steady release or lengthening of the ligament fibers. Though ligaments do not stretch much (only 6% of their original length), they open up the “portal” for the proper biomechanical alignment and muscle flexibility to further open up the range of movement. The results can be amazing…we have all seen gymnasts and acrobats perform amazing feats. This does not mean we all have to aspire to be gymnasts! What is revealed to us, is what we must aspire for- nothing more, nothing less.
While tendons need some amount of flexibility upfront to perform their function of force transmittal (energy transference), ligaments are not outright flexible and stretchable, however with regular training, the ligaments do undergo lengthening, hence allowing increase in flexibility (Range of motion) at joint. That is to say, ligaments once trained into lengthened position, retain that length and do not recoil back immediately when forces are removed. This basic property of the respective structures enhances the function they undertake-i.e. muscle-tendon units in production and regulation of movement and ligaments in providing stability at joints and joint integrity.
Not ignoring other soft tissue in the body like blood vessels and nerves, which also have elastin fibers and accommodate to slow and gradual stretching by not only flexibility, albeit other mechanisms like sliding and gliding to permit movement while maintaining structural integrity.
So go on, move and move well. Your body is composed, aligned, and equipped to work with you.
P.S. Image credits
Figure 1 (Hip Joint) https://opentextbc.ca/…/11-6-appendicular-muscles-of-the-p…/
Figure 2 (knee joint)-
"Medical gallery of Blausen Medical 2014". WikiJournal of Medicine 1 (2). DOI:10.15347/wjm/2014.010. ISSN 2002-4436. - Own work
Warm up is very essential in yoga, since here the focus is on smooth movement through the range of motion and holds for stability and stretching to further free up movement. Once soft tissue is warmed up, it is easier to take it effortlessly through the available range of movement and actually even further to gently and surely gain improved range and general ease of movement. In an earlier post I have mentioned not only are yoga postures executed “with accuracy, but also the performance must exude tremendous grace throughout, including a smooth transition from one posture to next. Mindfulness to cadence can impart a rhythmic quality. The body stretches and as you progress into a few cycles, you will notice ability to bend further into the postures.”
In this context, it is important to consider the differences in soft tissue and their ability to stretch, lengthen, or adapt, to tension applied, by mechanisms like sliding to take shortest path and gliding. While stretching feels good, when overdone, it may lead to micro-tears in the soft tissue and be replaced by more fibrous connective tissue, actually decreasing the range of motion. So be aware of your ranges and if you notice decrease in range or more obvious sign like discomfort or pain, slow down and increase the stretch in small increments. Tendons are not as flexible as muscles and may tear at their insertion point at the bone they connect the muscle with. However, it is not that easy to tear a tendon, specially, after a warm-up routine. Moreover, we have protective mechanisms within the body that sense an over-stretch, and inhibit movement. So it is essential for safety and integrity of the body to listen to these signs since the motor drive from higher centers may override this protective mechanism. Injuries result from ignoring these signs hence it is necessary to tune into the body during yoga. That is why, the software, i.e. perception, processing, and action is so important to be in tune with yourself.
Like computers have hardware-tangible and visible parts, and software which is code to operate and perform functions, in the same way human body has hardware like bones and soft tissue which includes ligaments, muscles, fascia, blood vessels (circulatory system), and nervous system.
The bones being the base of the skeletal system, are responsible for support and making movement possible mechanically, and the soft tissue is responsible not only for movement initiation and control, albeit also for stabilizing and limiting movement to maintain the integrity of the body.
The bones move conveniently at the joints, which are essentially two approximating complimentary bone surfaces as in
i) the synovial joints- permitting mobility either in multiple directions (flexion, extension, abduction, adduction and rotational movement, as in case of ball- and- socket joints) as in shoulder and hip joints, or mobility in a single plane (flexion/extension movement) as in elbow and knee joints,
ii) the amphiarthroidal joints -permitting little movement with cartilage lining between approximating surfaces as between vertebrae in the spine, or
iii) the synarthroid joints – permitting no movement at all as in the joints of the skull .
The software is the messages sent and received by the brain, the processing done within the central nervous system, and transmitted via nerves (spinal cord and peripheral nerves) to the stabilizing structures (torso including spine, pelvis, shoulder girdle) and soft tissue moving the bones and body parts.
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.