​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!

This is a unique post perhaps in physical therapy- not because the subject has never been broached, albeit the new perspective or viewing lens provides an ever refreshing outlook. Why do problems recur and why is the human spirit kindled by the challenge to seek a solution? 
The big question is why do pain or injury recur? And why does one seek well-being or in other words want to be pain free and fit or healthy beyond that, in these situations? Our body is an amazing “instrument” to realizing this. 
Pain is both objective and subjective. It is a well-known fact among the medical community that the physical changes seen on various investigative procedures like x-rays, MRI’s, and body scans do not correspond with the subjective feeling the individual is undergoing. Hence history taking is an important art in understanding the depth of perception of the individual. However, it is also true that nerve endings in partially damaged tissues result in pain directly proportional to extent of damage. The individual mind interprets and perceives it differently, hence the subjectivity of pain. Another well-known fact in medical community is that when tissue damage is complete and the nociceptive nerve endings are destroyed, there is no pain or sensation associated with such an injury. This transcendence (“existence or experience beyond the normal or physical level.” ) or complete severance of association with pain is what yogis do best. And it takes tremendous practice to attain to this stage, though each one of us has access to this.
To quote from last weeks post:
“Yoga makes it possible to transcend the senses, mind, identity (or ego), and intellect. With anything in life, this should be the goal, not just a change in physical field. Truly, when approached from this perspective, movement patterns may be transcended, so that they are automatic at an intuitive or pure conscious level. Where one need not think and the movement/ action that takes place is nothing but the best and yet at a moments’ notice, the process of transcendence must be clearly available.” 
Here I would like to point out the difference between sub consciousness and pure consciousness. When a thought is subconscious, it refers to mastery gained through evolution- that is a “process of formation” for survival purpose only. In other words, learning for which the knowledge of process is lost. This is devoid of true spirit or let’s just say has the spirit concealed, resulting in an inability to respond as needed. When learning is mingled with involution which is a sort of self-knowledge of reality of its being, it is pure consciousness. In other words the knowledge that a movement pattern good or bad will not last forever, so what is the fear for? This realization is freedom in utmost pinnacle or liberty to sense, perceive, and live per choice. This liberty to act comes with great responsibility and using the intellect wisely, knowing time is precious. This knowledge is retained intuitively and leads to transformation so that new movement pattern is not forgotten by the body itself through ideal alignment, biomechanics, and kinetics. Thus, the senses, mind, and body are aligned with the spirit.
Changing a movement pattern from subconscious and replacing with a new pattern in subconscious is a kind of “compensation”. One dysfunctional pattern for another. One is an iron chain, the other gold…. And to a yogi, there is no difference between the two, a chain is a chain!
Movement patterns which are dysfunctional become automatic and ingrained in the sub-conscious mind. These are habitual, hence necessity of “breaking a habit.” The role of physical therapy is to bring this into awareness so that it may be “un-learned” and to demonstrate the ideal movement pattern which one must re-learn consciously (pure conscious), and repeat till this in turn becomes automatic i.e. it can be brought into mind at will and the steps of transformation are known (sound familiar to postural muscles?). This is the process
(P.S: The image is modified on Paint 3D from
http://www.swamij.com/yoga-meditation-what-levels.htm)

Yoga is “[the process of starting with the gross and outer, and going ever subtler and inner.]” 
(http://www.swamij.com/yoga-sutras-31737.htm#3.26)
Since we are considering the body as an instrument in the path of yoga, the last post was dedicated to the unsung heroes of our body the involuntary muscles that keep life going. The postural or support muscles are skeletal muscles with the ability to work automatically or involuntarily, and yet strengthen voluntarily. Their function is to work beyond our conscious mind (i.e. within the active unconscious mind) with us being unaware of these without focused attention. These are kind of like the sun and moon which are always present in the sky. Though the sun is very stable, it is the movement of the earth that gives the appearance of sunrise- sunset. The heart and lung muscles and other smooth muscles are like the sun and the supporting postural muscles like the moon, which reflects light from the sun and illumines the night sky. In other words, in the scheme of things, they are in micro-cosm, much as in the macro-cosm. This phenomenon is going on around us in many different levels, like the multiple planets all revolving around the sun in their respective orbits. 
Here let us keep our attention to our bodies and its being an instrument. Though physical therapy mainly is concerned by effecting change through the body, it is not body in physical sense alone. It includes the whole being, including mind and intellect for this purpose. Once these dysfunctional patterns are identified, brought into awareness and practices incorporated to change these to functional patterns consciously, these patterns may be “transcended” so to speak. Transcendence is defined as “existence or experience beyond the normal or physical level.” 
The individual mind is influenced by the sense (sensory) perceptions (visual, proprioception through joint, muscle and skin receptors, and positional receptors in the inner ear or vestibular canals in medical terminology). However the thought patterns which manifest as movement patterns of the body may be regulated or controlled through higher intelligence (cerebral cortex), thus adding a voluntary component to movement. Once a movement pattern is mastered, with practice, it must be transcended or “witnessed” as in observing the process take place within yourself. Once completely absorbed in this movement pattern, one comes to a realization “I never thought this was possible” or into the realm of impossible or “not the doer.” So to attain this state of mastery over a movement pattern, requires tremendous concentration, (since dysfunctional patterns are habitual and occur without conscious knowledge), to bring it to conscious awareness and then controlling the latent tendency to go into the dysfunctional pattern, making a conscious effort into functional pattern. When this is repeatedly practiced, it breaks the old pattern with functional pattern employed more frequently, till even this is mastered and the functional pattern displays regularly or consistently. Once you do this with one pattern, now it is easier to apply the process to another pattern. And not only that, now automatically, your observation and discrimination, has become so keen that you notice functional and dysfunctional patterns with ease and may employ the process intuitively, as needed. This results in inherent stability within movement patterns. 
Yoga makes it possible to transcend the senses, mind, identity (or ego), and intellect. This should be the goal, not just a change in physical field. Truly, when approached from this perspective, movement patterns may be transcended, so that they are automatic at an intuitive or pure conscious level. Where one need not think and the movement/ action that takes place is nothing but the best and yet at a moments’ notice, the process of transcendence must be clearly available.

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!

Wish you all Happy Holidays 🎊🎄☕🍲🚶‍♀️🎂🎉
-StableMovement Physical Therapy.

Yoga is the root of physical therapy. This has been a recurring theme in my posts and it comes up naturally as I write, again and again (the post on 6th October, 2017, 15th September, 2017). I look at it from various angles and through different microscope lenses. For physical therapy to succeed and set you on a wellness path, yoga principles (character building for a still mind) are a must. The name is not important here. You may call it yoga or not, the principles are key.
Yoga is widespread in the world today, not only here in the western world, now it has caught on at a feverish pace in Asia, Europe, Australia and Africa. In fact the United Nations on 11th December, 2014 proclaimed June 21st to be “International Yoga Day.”
Due to the popularization of yoga, the pure form of yoga has been sacrificed and it is being interpreted in different ways. Among the many variants of yoga popularized (may I say by name-sake only) are hatha yoga, raja or ashtanga yoga and vinyasa yoga. The most prevalent misconception being that it is a way to perfect only asanas which is at the gross level of the body. However, true yoga as M.S. Viswanath (Pattabhi Jois’ student and a yoga master himself) suggests, is only one. There may be different ways or paths to practice this. The main aim and goal of yoga he mentions is Samadhi or “evenness of mind.”
When Patanjali originally composed the yoga sutras in 400 CE, he was by no means the first one to practice yoga. It was in fact visualized and practiced many generations before, and Patanjali was the observer, knower, and compiler of these sutras. We still do so in this day and age, however, we need to be mindful about it and gather our scattered efforts for an effective practice. Traditionally in India, we also are aware of Bhakti Yoga, Gnana yoga, and Karma yoga. Though the end goal of each of these paths is ultimately the same- that is stillness of mind (or equal-mindedness) in the divine play of life, which is the realization of our true nature. 
The most important challenge in the kind of lifestyle we live today is the ability to be in charge of the mind-body so that we may dwell in spirit. Hence the popularity of yoga involving the bodily asanas. With all the amenities and comforts of modern world, the connection with our divine aspect is hanging on loose threads. It is up to each one of us to establish this connection and strengthen it into a firm and strong thread/string. And if your chosen path is through contemporary yogasana, welcome to StableMovement Physical Therapy.
Often one goes to a physical therapist when in pain or injured. In this case, the first step would be rehabilitation of the acutely involved structures (inflamed soft tissue, through manual techniques). Once that is healed, or an individual comes in for health and wellness without an existing injury, a functional movement assessment would reveal the root of problem. This may vary from one of the following- joint stiffness, ligament tautness or instability, muscle weakness, faulty biomechanical alignment, a combination of multiple factors, or all of the above. A skilled PT is able to distinguish and address this accordingly.
How does the yoga tie in with physical therapy you wonder?
Well physical therapy is nothing but yoga modified and “broken down” so to say to bring the focus on a particular part. A good analogy would be the use of a microscope to reveal finer and subtler tissues, cells, and sub-cellular structures which are not visible to the naked eye. The important thing here is to look at the finer aspects yet at the same time keeping the whole picture in mind. That is precisely where yoga comes in. Not only in the sense of a particular yogasana, though that is definitely a tool to recovery, albeit the process undertaken through the rehab and wellness journey. See the similarity between the modern PT stretches and yogasanas in the pictures?
How do we go about establishing our connection?
Though yoga is distinguished into various types, it is in the intermingling and practicing of all of these with perhaps predominance of one which would make one a follower of that particular path. When I say ‘predominance of one,’ I mean it is the one you have faith in and fall back on when all else fails (for in yoga, you never, never give up). Once the goal is achieved though, the demarcation boundaries of the various paths merge or vanish altogether.
Hatha means nothing but a strong will or firm determination. That is when one chooses to practice any form of yoga (or physical therapy for that matter) taught by a qualified master (skilled PT), and stay on this journey through sheer will and determination to see the end.
Ashtanga yoga also means the eight-limb yoga. These are 

1. Yama- ahimsa, satya, asteya, brahmacharya, aparigraha (non-violence, truthfulness, non-covetousness, self-restraint/moderation, non-possessiveness)
2. Niyama- saucha, santosh, tapas, svadhyay, ishvara pranidhana (cleanliness, satisfaction, austerity, self-inquiry and study, surrender to higher Self)
3. Asana- sukham sthiram asanam
4. Pranayama- breath regulation
5. Pratyahara- sense withdrawal
6. Dharana- concentration
7. Dhyana- meditation
8. Samadhi- stillness of mind or “I-sense dissolved in object of meditation”

Vinyasa yoga (Vinyasa flow) though practiced as a variant of yoga, it only refers to a series of asanas or postures undertaken before and after performance of a particular set of asanas to help the body limber up and increase flexibility and range for optimal performance as well as decrease fatigue and allow for nourishment of active muscles and tissue, prior to the next asana in the set.
Pursue anything or any action with these golden principles for with this attitude, you will not fail.

A detailed view of back bend or hasta uttanasana
Modern day yogasana (karma) can be approached through “feel” (bhava) of movement or “technique” (Shastra -gnana) that is based on anatomy and biomechanical principles. No method is right or wrong and one may lie anywhere along the spectrum from totally feel based to totally technical and the myriad of ways in between. It is important to find your own niche for the best learning to happen. Go slow and figure out your own way…. and master it. This is no easy task, though it may sound like it….and when you are willing to “climb the ladder”, StableMovement PT is at hand.
Yogasanas involve large movements to the end of range of motion and skillful movement beyond, promoting flexibility. Yet at the same time, for a safe and effective execution of the movement, necessitate biomechanical and muscular stability. These two acts are not mutually exclusive and actually happen synchronously for stable, smooth, and graceful execution.
Back bend is one such posture that requires spinal, hip, and shoulder extension to end range, yet gently balancing the posterior weight shift (COG) on stable feet with effective dorsiflexor contraction throughout. Moving upwards from the ground (feet), the quadriceps need to be engaged distally by upward pull on the knee cap or patella.
In order to deepen the pose, it is essential to relax the anterior chain of muscles including the hip flexors, abdominals, and pectorals. This relaxation is intermingled with synergistic lengthening (eccentric elongation) which must be slow and gradual to gain optimal extension. Breathing, slow and deep (diaphragmatic), is very effective during deliberate relaxation and eccentric elongation phases. The rectus femoris (two-joint quadriceps muscle) which is also a hip flexor must relax and lengthen proximally at the hip joint along with the iliopsoas and pectineus. The TFL and gluteus medius are engaged in mild contraction to maintain the in hip neutral (rotation) position. This allows the pelvis to rotate back on the femur and the extension of lumbar spine. The thoracic spine extension and rib cage lifting and opening is facilitated by relaxation and elongation of the obliques and rectus abdominus. The emphasis is on slow movement, thereby moving one vertebrae at a time during lumbar and thoracic extension, ensuring a uniform spinal curve instead of a hyper-mobile and hypo-mobile segment with a rib-thrust.
The agonist muscles in a backbend are the hamstrings, gluteus maximus, spinal extensors, and the intercostals. Multiple muscles co-contract for scapular stability and to allow smooth glenohumeral (shoulder joint) mobility. Namely the serratus anterior, the trapezii, rhomboids, levator scapulae, and the rotator cuff muscles.
The body is stable both dynamically, while moving for optimal range or flexibility, and at the end of movement, when static stability is imperative to maintain acquired position. This end range hold calls for gentle muscle contraction of the anterior chain muscles so that they co-contract with the agonist extensors for joint stability at the given alignment.
This co-contraction and static stability produces a blissful experience of the end range (it is natural when observant) and thereby prevents stress on the joint surfaces and unnecessary strain of the ligaments.

In earlier posts we have looked at Suryanamaskar in Vinyasa Flow A with 12 postures. Let us look at the Suryanamaskar in Vinyasa flow B with 21 postures.
Enumerating the postures we have:
1 Pranamasana or salutation pose 
2 Hasta Uttanasana or backward bend
3 Hasta Padasana A or initial forward bend 
4 Hasta Padasana B or deep forward bend
5 Kumbhakasana (Phalakasana) or high plank pose
6 Chaturanga Dandasana or plank pose
7 Bhujangasana or Urdhva- Mukh Swanasana
8 Adho- Mukh Swanasana or Parvatasana
9 Virabhadrasana 1 or warrior pose 1 (with right leg forward)
10 Chaturanga Dandasana or plank pose
11 Bhujangasana or Urdhva- Mukh Swanasana
12 Adho- Mukh Swanasana or Parvatasana
13 Virabhadrasana 1 or warrior pose 1 (with left leg forward)
14 Kumbhakasana or high plank pose
15 Chaturanga Dandasana or plank pose
16 Bhujangasana or Urdhva- Mukh Swanasana
17 Adho- Mukh Swanasana or Parvatasana 
18 Hasta Padasana A or initial forward bend
19 Hasta Padasana B or deep forward bend
20 Hasta Uttanasana or backward bend
21 Pranamasana or salutation pose

Life unfolds in cycles. Yoga embraces this fact. See how things repeat in cycles in nature? For example seasons, revolution and rotation of the earth, and keeping current, our body’s very own circadian rhythm. One who has mastered these cycles and lives amicably with them and yet may take charge of the cycles when needed is a true yogi. Evolution is a necessary part of the cycle. It allows the circle to be complete, to return to the point one starts from and yet be immensely wiser, energetic, and stable. That is the journey. Any journey we undertake, no matter how small or insignificant, points to our nature in undertaking this final journey to fulfillment, i.e. our larger journey to learn in life, master learned concepts through repetition and then apply this mastered art. In a similar way, PT is about learning new motor patterns through manual therapy (reset), mastering them through repetition (reload), and applying them in daily movement(perform). StableMovement Physical Therapy is nothing but a part of this evolution that enables the completion of the circle. 
When I say, Stable Movement PT makes this journey with you, it is a journey full of insights leading to the ultimate truth of your being and bringing about healing and recovery from injury along the way. Yoga is the basis of anything and everything and when approached sincerely and diligently reveals our being and purpose in life. About yogasana, Patanjali says “Sthiram Sukham Asanam.” Simply put, the posture in which you are stable or steady and yet at ease and comfort is the posture to be assumed. Notice how yogasanas demand stability for accomplishment and a good movement pattern is essential to experience ease and comfort in its performance? The whole practice revolves around this!
Injured? Worry you not! See this as an opportunity to learn about yourself and the way your body moves. Is it stable and balanced (Static Postures/Alignment)? Are the whole body movements smooth and graceful in execution and transitions (Dynamic Postures/ Vinyasa flow)? Help is along the way with the PT being your guide, cheerleader, and best friend. With a skillful eye, the PT identifies the nuances of movement patterns that need to be modified, the muscles that need to be stretched or motor components that need to be activated and the body parts that need to provide stability in order to achieve the goal. Prescribing appropriate exercises is the next step. The final responsibility lies with you, the execution of this newly acquired skill.
So what are you waiting for? Make that call. Visit us. You have nothing to lose.
www.stablemovement.com

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

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.

Forearm stretch
This week we will see the two forearm stretches: 
i) volar or anterior forearm stretch for the flexor muscles, and 
ii) dorsal or posterior forearm stretch for the extensor muscles. 
The biceps and brachialis muscles insert on the anterior aspect of forearm, distal to the elbow joint. Another set of muscles which originates from the medial epicondyle of the humerus, traverses the front of the forearm and inserts at various points near the wrist and hand. These are the common flexors of the wrist/ hand/ fingers and the pronator teres. 
The triceps inserts on the olecranon process of the ulna (which is a forearm bone), just distal to the elbow joint. A set of muscles which originates from the lateral epicondyle of the humerus and inserts at various points near wrist and hand. These are the common extensors of the wrist/hand/fingers and the supinator. 
Any repetitive motion of the hand, wrist or turning of the forearm may lead to pain near the elbow usually due to inflammation of the common flexor tendons (golfers elbow) or the common extensor tendons (tennis elbow).
Passive stretching and soft tissue mobilization
One may very easily do self-mobilization for these muscle groups and follow up with gentle active stretches to release the muscles and perform eccentric muscle contractions to strengthen the muscles through the full released range of motion.
* Sit upright in a chair with back rest and neutral spine with both feet supported on the floor. 
* Place a pillow on your lap and rest the right forearm on the pillow with palm facing upwards. This makes the volar or anterior forearm available for mobilization. 
* Bring the left thumb pad slightly distal to the inner/medial side of the right elbow, below the elbow crease. Begin by gently pressing the thumb into the soft tissue and move in small circles. Slide the thumb towards the wrist in small increments repeating the circles. You will distinctly detect tender points and can emphasize specific release by working locally over that area. Also you may slide the thumb side to side over the muscle bulk (proximal half of forearm) and hold mild pressure over detected tender points for 5-20 seconds(this should be to tolerance and not be painful). 
* * Now place the right forearm on the pillow across your lap with palm facing down. This makes the dorsal or posterior forearm available for mobilization. 
* * Bring the left thumb pad slightly distal to the outer /lateral side of the right elbow, below the elbow crease. Begin by gently pressing the thumb into the soft tissue and move in small circles. Slide the thumb towards the wrist in small increments repeating the circles. You will distinctly detect tender points and can emphasize specific release by working locally over that area. Similar to volar mobilization, the thumb may slide along the dorsal muscle bulk from side to side. Hold mild pressure for 5-20 seconds, to tolerance over detected tender points. 
Follow up the release obtained through soft tissue mobilizations with gentle stretches.
i) Anterior forearm stretch: 
1) In standing position, with elbow straight (extended), hold the right hand (distally around fingers) in your left hand. Passively extend the right wrist and fingers with the left hand to stretch the anterior forearm and hold position for 5-30 seconds and release. Repeat 2-3 times with 15-30 second rest break in between stretches.
2) Sit on the mat in vajrasana. Lean forward to bring both palms on the floor in front of the respective knees with fingers pointing forwards. Rotate the arms out by turning the hands on the mat till the wrist faces forward and the fingers back. In this position, the elbow crease is facing forward. Hold here for 5-30 seconds for anterior forearm stretch. When the tendon is not stretched in this position, deepen the stretch by gradually sliding the palms forwards , away from the knees while maintaining the heels of palm in contact with the floor as well as the kneel sitting with buttocks on the heels of feet.
3) Begin in vajrasana and progress to veerasana. Veerasana is a position in which you sit on the floor/mat with sit bones resting on the floor between the feet. This needs good mobility at the hip and knee joints as well as rotary movement of the leg (tibia and fibula) and should not be done in case of knee discomfort without guidance. Bring both hands in front and interlace the fingers. Slowly rotate forearm so the palms face forward, with fingers interlocked. Extend the elbows slowly, moving the palms away from body, and raise arms up overhead while stretching the entire arm upwards. At the end position, palms face upwards. Hold position for 5-30 seconds and slowly bring arms down, turning palms inwards and release the fingers.
ii) Posterior forearm stretch:
1) In standing position, raise the arm up by flexing at the shoulder, palm facing the floor. With the left hand bend wrist downwards to stretch the posterior forearm and hold position for 5-30 seconds and release. Repeat 2-3 times with 15-30 second rest break in between stretches.
Forearm stretch
This week we will see the two forearm stretches: 
i) volar or anterior forearm stretch for the flexor muscles, and 
ii) dorsal or posterior forearm stretch for the extensor muscles. 
The biceps and brachialis muscles insert on the anterior aspect of forearm, distal to the elbow joint. Another set of muscles which originates from the medial epicondyle of the humerus, traverses the front of the forearm and inserts at various points near the wrist and hand. These are the common flexors of the wrist/ hand/ fingers and the pronator teres. 
The triceps inserts on the olecranon process of the ulna (which is a forearm bone), just distal to the elbow joint. A set of muscles which originates from the lateral epicondyle of the humerus and inserts at various points near wrist and hand. These are the common extensors of the wrist/hand/fingers and the supinator. 
Any repetitive motion of the hand, wrist or turning of the forearm may lead to pain near the elbow usually due to inflammation of the common flexor tendons (golfers elbow) or the common extensor tendons (tennis elbow).
One may very easily do self-mobilization for these muscle groups and follow up with gentle active stretches to release the muscles and perform eccentric muscle contractions to strengthen the muscles through the full released range of motion.
Sit upright in a chair with back rest and neutral spine with both feet supported on the floor. 
Place a pillow on your lap and rest the right forearm on the pillow with palm facing upwards. This makes the volar or anterior forearm available for mobilization. Bring the left thumb pad slightly distal to the inner/medial side of the right elbow, below the elbow crease. Begin by gently pressing the thumb into the soft tissue and move in small circles. Slide the thumb towards the wrist in small increments repeating the circles. You will distinctly detect tender points and can emphasize specific release by working locally over that area. Also you may slide the thumb side to side over the muscle bulk (proximal half of forearm) and hold mild pressure over detected tender points for 5-20 seconds(this should be to tolerance and not be painful). 
Now place the right forearm on the pillow across your lap with palm facing down. This makes the dorsal or posterior forearm available for mobilization. Bring the left thumb pad slightly distal to the outer /lateral side of the right elbow, below the elbow crease. Begin by gently pressing the thumb into the soft tissue and move in small circles. Slide the thumb towards the wrist in small increments repeating the circles. You will distinctly detect tender points and can emphasize specific release by working locally over that area. Similar to volar mobilization, the thumb may slide along the dorsal muscle bulk from side to side. Hold mild pressure for 5-20 seconds, to tolerance over detected tender points. 
Follow up the release obtained through soft tissue mobilizations with gentle stretches.
i) Anterior forearm stretch: 
1) In standing position, with elbow straight (extended), hold the right hand (distally around fingers) in your left hand. Passively extend the right wrist and fingers with the left hand to stretch the anterior forearm and hold position for 5-30 seconds and release. Repeat 2-3 times with 15-30 second rest break in between stretches.
2) Sit on the mat in vajrasana. Lean forward to bring both palms on the floor in front of the respective knees with fingers pointing forwards. Rotate the arms out by turning the hands on the mat till the wrist faces forward and the fingers back. In this position, the elbow crease is facing forward. Hold here for 5-30 seconds for anterior forearm stretch. When the tendon is not stretched in this position, deepen the stretch by gradually sliding the palms forwards , away from the knees while maintaining the heels of palm in contact with the floor as well as the kneel sitting with buttocks on the heels of feet.
3) Begin in vajrasana and progress to veerasana. Veerasana is a position in which you sit on the floor/mat with sit bones resting on the floor between the feet. This needs good mobility at the hip and knee joints as well as rotary movement of the leg (tibia and fibula) and should not be done in case of knee discomfort without guidance. Bring both hands in front and interlace the fingers. Slowly rotate forearm so the palms face forward, with fingers interlocked. Extend the elbows slowly, moving the palms away from body, and raise arms up overhead while stretching the entire arm upwards. At the end position, palms face upwards. Hold position for 5-30 seconds and slowly bring arms down, turning palms inwards and release the fingers.
ii) Posterior forearm stretch:
1) In standing position, raise the arm up by flexing at the shoulder, palm facing the floor. With the left hand bend wrist downwards to stretch the posterior forearm and hold position for 5-30 seconds and release. Repeat 2-3 times with 15-30 second rest break in between stretches.
(P.S: Anatomy pictures from Wikimedia Commons
Version 8.25 from the Textbook
OpenStax Anatomy and Physiology
Published May 18, 2016)

​The biceps muscle is located in the front of the upper arm. It is the muscle that pops up when you flex your arm at the elbow- yeah, that one, that is used to display strength. Since the muscle fibers in this muscle are long and parallel, contracting them causes the biceps “bulge.” This muscle can be trained and hypertrophies significantly since the myofibrils which make up muscle cells enlarge due to increase in size and amount of the composing contractile proteins.
The biceps consists of the long head and the short head. The long head is intra-articular, that is it originates inside the capsule of the shoulder joint from the supra-glenoid tubercle of the scapula. The short head originates from the coracoid process of the scapula and is extra-articular (outside the shoulder joint). Both the heads meet to form a common tendon which inserts to the proximal radius. This muscle flexes the elbow and supinates the forearm and since it passes the shoulder joint, it contributes to flexion and abduction (when humerus is externally rotated) and horizontal adduction (when humerus is medially rotated) of shoulder joint. It is the main muscle enabling carrying of load in hands with the palm facing upwards (supinated forearm).
Here are the various ways to stretch the biceps brachii. For ease of understanding, and consistency, description is for right sided stretch.
Passive Stretch
This is done by various manual techniques based on the examination of the shoulder joint and shoulder girdle. The trigger points maybe located in the muscle belly (front middle of upper arm), the upper back, the lateral shoulder joint, or down the front of upper arm towards the elbow joint. Myofascial release and transverse friction by a trained therapist to release proximal tendon of long head of biceps in the bicipital groove, improves the ROM.
Beginning from a good upright seated posture with neutral spine and feet supported on the floor, the therapist may also passively stretch the biceps by externally rotating the shoulder so that the elbow crease is facing forward and extending the shoulder behind the back. Wrist extension further stretches the biceps via the distal insertion of this muscle.
Active Stretch
i) The easiest stretch in acute phase is done in supine with the arms resting by the side on the mat, palms facing up. Place a towel roll under the right upper arm and slowly extend the arm at the elbow joint so that the right wrist is extended and off the edge of the mat with gravity assisting elbow extension. Hold the position for 5-30 seconds as stretch is experienced in the front of upper arm. Repeat 2-3 times with rest breaks in between.
ii) The stretch may be done standing with feet shoulder width apart and facing forward. The hands are clasped behind the back by interlocking fingers and turning the arm so that palms face down. Engage the transverse abdominals and hold spine neutral while slowly elevating the arms away from the back. Ensure the chest is open and shoulders pulled back with trunk upright. Hold when stretch is felt in the front of shoulder, upper arm for 5-30 seconds. Release and rest for the same time as the stretch is held. Repeat stretch 2-3 times.
iii) Long sitting position is assumed with the hands palm down and resting on the mat behind the back, and arms externally rotated so that fingers are pointing away from the body. Shoulders should be neutral or slightly depressed (gently press the wrists into the floor/mat). Now start sliding the wrists back and away from the trunk. Hold when stretch is felt in the upper arm or front of shoulder along the biceps muscle/tendon. Mild downward pressure should be maintained at the wrist throughout. To release, slide hands towards the trunk. Repeat stretch 2-3 times with rest breaks in between.
iv) Parsva Anjali Mudra or in other words Namaste or hands joined as in prayer behind the back is a great way to stretch the biceps. This is done with the Parsvottanasana, which is a forward bending posture, however may be done stand-alone in an upright seated posture for upper body benefits. The key here is to keep shoulders rolled back and to open the chest while bringing the hands behind the back in prayer position. It requires maximal shoulder internal rotation with extension and is not recommended in existing rotator cuff injuries without rehabilitation and guidance.
Stretch with tools and equipment
i) The biceps maybe released by using a tennis ball along the front of upper arm along the length of the biceps at the wall. Since these are parallel muscle fibers, they are best stretched by lengthwise movements along the muscle fibers. When a tight trigger point is detected, small, circling, motion of the ball over the specific area may help release the local tightness.

The next muscle we will consider is the triceps. This muscle forms the bulk of the posterior upper arm and is an extensor muscle for the elbow joint and one of the shoulder joint extensors.
As the name suggests, this muscle originates with 3 heads- the long head (which starts from the infra- glenoid tubercle of the scapula) and the medial and lateral heads which originates from the posterior surface of the humerus. The three heads form a muscle belly and insert via a common tendon into the olecranon process of the ulna and the elbow joint capsule. The triceps muscle is an elbow joint extensor. The long head of triceps contributes to shoulder extension and adduction.
The triceps is one muscle of the arm which is strengthened and hypertrophies when workouts target triceps such as push-ups, press downs, bench presses, bench dips, overhead extensions. However, it is important to maintain healthy length and flexibility of the muscle, and stretches for triceps should be incorporated in the exercise program.
Passive stretch
This may be done via manual techniques and release of trigger points along the triceps by a physical therapist. Passive manual stretching may be done in supine position by flexing the elbow joint completely with palm facing up. Once the forearm muscle bulk approximates the upper arm muscle bulk, stabilize the scapula downward and into the rib cage with one hand, while the other flexes the upper arm at shoulder with the elbow in flexed position as far as possible and hold for 5-30 seconds. It is important to keep the spine neutral and not extend the thoracic spine. Release by lowering upper arm and extending elbow to neutral. Repeat stretch 2-3 times.
Active Static Stretch
i) Initially this stretch is best done in supine as it eliminates need to stabilize the trunk and scapula as it is well supported on the mat. Similar to above passive technique, first begin by actively flexing the elbow with palm facing up. Next, flex the shoulder as far as possible while maintaining neutral thoracic spine. Stop the shoulder flexion as soon as you notice tilting of shoulder blade and mid to low thoracic spine arches upwards into extension. Hold the position and stabilize spine by activating transverse abdominals. See if you are able to flex the shoulder overhead a little further and hold for 5-30 seconds. With good flexibility, you should be able to slide the palm between the shoulder blades. Release and repeat 2-3 times.
ii) With good scapula-thoracic and lumbar spine stabilization, this stretch may be done in seated or standing position. Sit upright in a chair without back support or stand with feet hip width apart and maintain neutral spine. First stabilize the spine through trunk corset activation (transverse abdominals, multifidi, and obliques) by 2-3 breathing cycles. Trunk and spine should be steady with no movement with inhalation/exhalation and notice movement of rib cage and abdomen only. Next, flex the right arm at elbow, and cup the shoulder with the hand. The upper arm is still in line with the trunk. Next, flex and elevate the arm at shoulder joint to overhead position and slide hand between shoulder blades, if possible. Stretch may be deepened by bringing the left hand to the right elbow and gently pulling right arm back and to left. Hold position for 5-30 seconds. Release and repeat 2-3 times.
Active Dynamic Stretch:
i) Gomukhasana: This is an advanced yoga pose and must be done with proper guidance. The starting position is Vajrasana. Initially come to sitting on the right side, with both feet pointing left. Keeping the legs bent at the knees, rotate the left hip outwards as you stack the left knee on top of the right so that you are now sitting on both the sit bones. The feet are resting on the floor. Bring the heels as close to the hips as possible. Trunk is stable in upright position. The left arm is rotated inward at the shoulder while bending the elbow and the back of the hand is placed between the shoulder blades from below. The right arm is rotated outwards at the shoulder while bending the elbow and the arm is lifted overhead placing the palm between the shoulder blades from above. Once the two hands are behind the back, the triceps stretch on the right side may be deepened by interlocking the fingers of both hands in hook grip behind the back and gently pulling downwards with the left hand. Trunk needs to be stabilized further as the pose is deepened, to prevent the thoracic spine from arching.
Stretching with tools
i) One may use a tennis ball for releasing the triceps brachii by placing it between the back of upper arm and wall or on a table and release trigger points by simply holding the pressure for few seconds and moving to a different point along the muscle. It may help to first palpate the muscle belly with the finger pads prior to employing the tennis ball to determine the areas needing release. Rolling the ball gently between the back of the upper arm and wall/table, is another way to identify trigger points and release by focusing rolling (small circles or up and down) over tender points.
(P.S: Anatomy picture from Wikimedia commons)
Page URL:
https://commons.wikimedia.org/…/File%3A1120_Muscles_that_Mo… 
By CFCF (Own work) [CC BY-SA 4.0 (http://creativecommons.org/licenses/by-sa/4.0)], via Wikimedia Commons

The trapezius muscle is composed of three parts and based on the originating fibers, termed the upper trapezius, middle trapezius and the lower trapezius, respectively.
The lower trapezius fibers are stretched when stretching the mid-back as in child’s pose with arms outstretched, or unilaterally with spinal twist postures as in the ardha matsyendrasana. The middle trapezius fibers are stretched with the interscapular stretch and also with the triceps stretch which is coming up in the next post. 
This leaves us with the upper trapezius which is the topic for this post. The upper trapezius muscle originates from the spine of the C7 vertebra, the external occipital protuberance, the medial third of the superior nuchal line (back of the head) and the ligamentum nuchae. The fibers converge laterally and insert onto the posterior border of the lateral third of the clavicle. 
Remember as a baby, lying on the stomach and attempting to lift the head up, yes? That was your upper trapezius which enabled you to do that. How about the umpteen shrugs in your lifetime? That is your upper trapezius, also. 
This muscle plays a big role in both posture maintenance and movement of the neck and scapulae. Since the head is anterior heavy, the upper trapezius counterbalances the pull of gravity towards cervical flexion. When the bilateral muscles work in synchrony, they extend the neck. Unilaterally activated, it elevates the scapula as in a shoulder shrug or accomplishes same-sided side bends of the neck. Together with the same sided lower trapezius fibers, it rotates the scapula upwards for overhead activities.
Let us look at upper trapezius stretches. As usual, we will consider right sided stretch for consistency and ease of understanding.
Passive Stretch
As with the levator scapulae, manual techniques work wonders on the upper trapezius muscle. It is possible to release these muscles by yourself as they are easily accessible with your own hands. Static neurological release by holding onto a trigger point and gently increasing the pressure through finger pads for duration of 30 seconds and up to 2 minutes is very effective. Slow circular motion as in kneading also releases these muscles. This should be followed by manual stretching as in side bending and shoulder depression movements to retain the gains made.
Active Static Stretch
i) In early stages, it is best to do stretches in supine as the supported position allows the postural scapular and trunk muscles to relax as well as the upper trapezius to relax maximally as it is not holding the head up countering gravity. To stretch the right upper trapezius, gently depress the right shoulder and hold the position for a full breath cycle. Maintaining this position, slowly tilt the head and neck to the left side and hold for 5 -30 seconds. Repeat 2-3 times.
ii) Seated upper trapezius stretch: It is important to be seated upright with good posture, both feet supported on the floor, weight transfer through the ischial tuberosities with neutral spine and shoulder blades gently pulled back (no squeezing). Next, gently lower the right shoulder down as in depression and tilt head to the left. The cervical side bend to left may be facilitated by gentle pressure using the left hand with palm over the parietal and occipital bones and fingers spread with finger pads below the occipital protuberance. Hold the stretch for 5- 30seconds and release. Repeat 2-3 times.
Active Dynamic Stretch
i) Seated upright with good posture as mentioned above, initiate stretch by pulling shoulder blades back gently and depressing or lowering the both shoulders. Bend the head and neck to the left and hold for 3 seconds, return to the center and bend head and neck to the right for a 3 second hold, all the time maintaining the shoulders in depression. This is a bilateral stretch with alternating side bends. You may do anywhere from 5-10 repetitions. 
Unilateral right upper trapezius stretch may also be performed by depressing only the right shoulder and bending head and neck to the left for 3 second hold, bringing head back to neutral and repeat 5-10 times.
Stretching with tools or equipment: 
i) Foam Roller: Place the foam roller sideways on the mat or floor. Lie on the foam roller with both the shoulder blades resting on the foam roller with feet on the mat/floor as in hook lying position. Move the body down as the foam roller rolls upwards from the mid-back to the neck region. You may lie down with legs lowered in supine with the foam roller under the curve of the neck and slowly turn the head from side to side, releasing the upper trapezius at the scapular insertion and C7 origin. Roll the foam roller slightly higher and let the occiput rest on the roller. Just hold the position and let the weight of the head release the upper origin of the muscle. Next turn the head from side to side to release the fibers along the occipital protuberance and superior nuchal line.
ii) Tennis ball: This muscle release may be targeted by placing a tennis ball between the wall and the upper shoulder neck area. Slowly roll the ball along the neck to release fibers from the ligamentum nuchae along length of cervical spine.
P.S. Anatomy picture from Wikimedia Commons
File:Cunningham's Text-book of anatomy (1914) (20789827456).jpg

Proceeding further cranially, let’s consider the neck stretches. Today we will look at the levator scapulae.
The levator scapulae is a thin and flat muscle that originates from the transverse processes of the first four cervical vertebrae and inserts into the medial border of scapula from the superior angle to the junction of spine of the scapula. 
This muscle functions to rotate the neck and side-bend to the same side and extend the neck. When the cervical spine is stationary, it rotates the scapula downwards with unilateral action, and working bilaterally elevates the scapulae as in a shoulder shrug. 
It tightens when there is a forward head posture with a rounded upper back thus resulting in the muscle being used for postural purposes when it is a phasic muscle designed for movement. It is also tightened orat unease when one holds neck in prolonged lateral flexion with rotation- like when holding a phone hands-free between the shoulder and ear. 
We will consider the right levator scapulae stretch to keep things straightforward. To stretch the left muscle follow instructions contralaterally.
Passive Stretch
By far the most effective way to release a tight levator muscle is to have a physical therapist or a trained professional use manual techniques for immediate relief. And then perform a passive stretch to bring the released muscle through the available range of motion.
The levator scapulae is stretched passively in the supine position with the head supported on a mat. This position allows the muscles in the scapula-thoracic area and in the cervical spine to relax. The therapist then sits with chest at level of mat and cradles the occiput within the left cupped hand. This hand then rotates the cervical spine about 45 ° to the left and lifts it up into cervical flexion while the heel of the right hand simultaneously placed at the superior angle of the right scapula, pushes it downwards and away from the cervical spine, thus stretching the muscle fibers through both the insertions. This stretch is held for 15-30 seconds and is essential for the therapist to support the elbows on the mat to hold a sustained stretch, safely, permitting the patient to be at ease.
Active Stretch
To stretch this muscle, it takes a small amount of movement at the neck and scapula, however, the starting position with a neutral upright spine is of paramount importance to achieve the stretch accurately.
Active Static Stretch:
i) This is done in an upright seated posture on the chair or edge of mat with the feet firmly supported on the ground. The knees are hip width apart with thighs parallel. The ischial tuberosities are weight bearing with the pelvis in neutral position and a natural lumbar lordosis. The shoulders are directly over the hip joints while the spine is maintained in elongated position with the scapulae gently pulled back. This automatically puts the cervical spine in good starting position. The head is turned to the left about 45 ° or with the chin pointing to left knee. Next bend the neck forward and slightly to the side (as in bringing the ear closer to the left shoulder). The right arm is extended behind the trunk and the scapula is depressed or lowered to experience the stretch. Hold this position for 5-30 seconds and release. Repeat 2-3 times.
ii) A slight variation to the above stretch is when the right arm is elevated overhead and then flexed at elbow with the hand reaching the medial border of the right scapula. This rotates the glenoid fossa of the scapula upwards and in the process the superior angle moves down, pulling the scapular insertion of the levator away from its origin in the cervical spine, thus stretching it.
Both the above techniques cause the reciprocal inhibition of the levator scapulae by engaging the lower trapezius (scapular depressor) and the upper trapezius and serratus anterior (scapular upward rotators), respectively. Holding the stretch for a prolonged period also causes autogenic inhibition of stretched muscle fibers.
(P.S.- the 2 pictures of seated levator stretch and its variation show left levator stretch)
Active Dynamic Stretch:
i) This may be done at a wall in the standing position, feet hip width apart and few inches from the wall. Stand with the back along the wall and the scapula retracted to make maximal contact with the wall. The scapulae are then depressed bilaterally and this position is held for 1-2 breath cycles. Next turn the head 45° to the left and look down with a slight side bend and forward flexion to left so that gaze is directed to left big toe. Bring the left hand behind the head with fingers on the occiput and hold the head position firmly. Without elevating the right scapula (no shoulder shrug), raise the right arm overhead and into shoulder elevation. Hold end position for 2-3 seconds as you breathe in and exhale as you lower the arm beside the trunk. Repeat 4-5 times for 1 set. Do 2-3 sets.
Stretch with Equipment and Tools:
i) A foam roll placed on floor perpendicular to the spinal column at the level of the shoulder blade or scapula does wonders to stretch the upper back muscles. Slowly move the foam roll upwards while lying on it, face up. When the foam roll is just a few inches below the neck, rest the back on the floor with the legs bent at hip and knees, feet on floor (hook lying position). Hold the foam roll at the upper scapular border and let the body weight sink you into the roll. Move the roll up further along the spine till the base of cervical spine and hold for few seconds. Turn the neck side to side when the roll fits into the lordosis of the spine to release the muscle insertion on the transverse processes of the vertebrae.
ii) The foam roll may be arranged vertically along the spine and rolled side to side to release the muscles along the medial border of scapula. 
iii) Tennis ball progression is also very effective and gives more precise release by rolling the ball in the vicinity of the levator scapulae insertion at superior angle of scapula while lying face up on the tennis ball on a mat on the floor or even standing with the ball between a wall and the upper back.

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This week we will look at inter-scapular stretch.
The word inter-scapular literally means the area between the two scapulae or the shoulder blades. The scapula is a bone that sits on the posterior wall of the rib cage and is held in place by its soft tissue attachments. The scapula-thoracic joint is not a regular synovial joint, hence there is no bone to bone approximation with either the vertebrae or ribs which is enclosed by a joint capsule, and is unique from that perspective. It varies in its placement over the ribs. Normally it lies between the T1-T7 vertebrae with the base of scapular spine at T3 level and the inferior angle at T7 spinous process. It also varies in its placement medio- laterally and usually the distance between the medial borders of the scapulae to the vertebral spinous process at T3 level is 6-10 cm. The left and right scapula in the same individual may be situated differently over the rib cage, given the fact that it does not form a synovial joint and is only held in place by muscular attachments.
As a physical therapist, what is important during examination is whether the left and right scapula are situated similarly within the same individual. Studies in multiple subjects only helps determine a range of “normal “or “acceptable” placement and would alert of gross dyskinesis leading to symptomatic conditions. History in these cases is important as is the overall postural alignment. Fine tuning the scapulae and balancing them bilaterally by releasing the tight muscles and developing smooth and coordinated motor control at scapula-thoracic, shoulder, and acromio-clavicular joints leads to stable movement. 
That being said, we will look at inter-scapular stretch in healthy individuals who are asymptomatic to maintain normal scapular alignment. There are several muscle attachments to the medial border of the scapula, namely, the levator scapulae, rhomboid minor and major, and the serratus anterior. The trapezius muscles originate from the spinal vertebrae, the occiput, and ligamentum nuchae and the various fibers insert into the clavicle, the spine of scapula, and acromion process. In addition, the superficial postural muscles or erector spinae (iliocostalis, spinalis, longissimus) and deep postural muscles (semispinalis, multifidi) also traverse this area. Clinically, a skilled therapist may be able to locate the trigger points or tight muscle/ tendons through palpation. Since the presentation and symptoms may vary widely, what is of significance though is a healthy range of motion in the scapula and shoulder joint which is balanced and bilaterally symmetrical. 
For these stretches our presumption is tightness in the muscles between the shoulder blades with a shorter distance from the spine to medial border of scapula. In this case, the shoulders are drawn back and scapula may appear squeezed or closer together. Generally speaking, when the shoulders are rounded, the pectorals are tight and should be addressed with chest and shoulder opening stretches. When asymmetrical, do the stretches on the tighter side. When one side is tighter than the other, first priority will be to balance both sides by stretching and working on the tighter tissue, then follow up with bilateral stretches when balanced.
Passive Stretching Techniques
Passive techniques will encompass manual release by therapist which is very effective for these muscles. Myofascial release techniques to relieve trigger points and increase flexibility in soft tissue. Passive stretches may be done manually also, since this is a small and freely moving bone which may be manually protracted to get a stretch in the inter-scapular muscles.
Active Stretch:
i) Unilateral stretch in the inter-scapular area may be achieved by lifting the arm up at the shoulder and drawing it across the chest to the other side. The wrist should be slightly lower than the shoulder joint. It is important to keep the shoulder blade neutral (not elevated) when beginning this stretch. This stretch may stretch the posterior shoulder capsule as well. Emphasis should be placed to feel the stretch between shoulder blades by continuing to stretch a little further so the scapula is pulled across the back to the side being stretched. . Hold stretch for 5-30 seconds. Release and repeat 2-3 times.
ii) Another way to stretch the inter-scapular area is in quadruped position with wrists directly below the shoulders and knees below the hips. A good starting position makes the stretch easier by targeting accurate soft tissue. Slowly bring chin to chest while lifting and rounding the upper and mid-back. The scapulae move outwards along the ribs, stretching the inter-scapular area. Hold stretch for 5-30 seconds. Release and repeat 2-3 times.
iii) An additional stretch involves facing a sturdy open doorway while standing with feet hip width apart a few inches from the doorway. With the shoulders internally rotated and forearms pronated hold onto door way on both sides with a hook grip so that the thumb is pointing to the floor. Lean back using body weight as you round the shoulders and upper and mid-back area as if you are hanging on the hands. Hold stretch for 5-30 seconds. Release and repeat 2-3 times.
Stretch with equipment or tools:
i) Foam Roller and Tennis Ball Stretch: The best tool to stretch the interscapular area initially is a foam roller. Place the foam roller on the floor and lie on it facing upwards so that the roller targets the area between the shoulder blades. Make sure the transverse abdominus is engaged for a neutral lumbar spine. Roll the foam roller sideways to stretch. As you progress, you may try a tennis ball between the shoulder blades on the floor or in standing position with the ball in the inter-scapular area between the wall and your shoulder blades. Apply pressure gradually to tolerance and roll the ball by small circular motion or just hold in place for 5-30 seconds, when ball is directly over tight spot.
(P.S. The 2 anatomical pictures are modified from Wikimedia Commons.)

One of the large muscles that fans over the chest is the pectoralis major. The other muscles in the pectoral region are the pectoralis minor, serratus anterior, and subclavius. The pectoralis minor lies under the pectoralis major.
The pectoralis major originates from the sternum, 1st -6th costal cartilages, the aponeurosis of the external oblique muscle, the medial half of the anterior surface of the clavicle. It inserts into the bicipital groove of the humerus.
The pectoralis minor originates from the 3rd to 5th ribs and inserts into the coracoid process of the scapula.
Whereas the pectoralis major moves the shoulder into adduction and turns the arm inwards, the pectoralis minor facilitates movement by pulling the scapula anterio-inferiorly into the thoracic wall. Both these muscles are tonic muscles and are prone to tightness and shortening.
While the anterior torso stretches are applicable to stretch the pectorals, let us go through some specific and targeted stretches for the pectorals.
Passive Stretch
This is done in the seated position with the therapist encircling the shoulders from the back and gently elevating and retracting the shoulder blades. This opens the chest and the stretch position is held for 5-30 seconds and released with a 15-30 second rest between stretches.
Active Stretch
Active Static Stretch:
i) This is done while standing and facing the corner in a room. Place both hands, palms facing on each of the two walls at shoulder height. Assume a stride position with the front foot about a foot away from the corner, and engage the transverse abdominus to stabilize the spine in neutral position. The leg forming the back stride leg is kept straight at the knee. Push the palms into the wall engaging the serratus anterior. Slowly move forward over the front ankle joint to lean the trunk into the corner while the chest area opens up and shoulder blades are squeezed together. Hold stretch for 5-30 seconds and release, with 15-30 second rest in between stretches.
Active Dynamic Stretch:
i) This may be done in the standing position or seated on a stool without a back rest. Assume a good seated posture with feet flat on the floor and a neutral, upright spine. Extend both arms at shoulders behind the back, and interlace the fingers behind the base of spine and slowly raise the hands up and away from the back, while squeezing the shoulder blades and opening the chest/shoulder region. Hold the stretch for 5-30 seconds and release, with a 15-30 second rest in between stretches.
ii) Dhanurasana or the bow pose: 
This is done in prone position, lying on the stomach with arms by the side of trunk, palms facing upwards. Bend both the knees bringing the heels of feet to ischial tuberosities or sit bones and hold the feet around the ankles with your hands. As you inhale, lift the heels away from the ischial tuberosities and lift the thigh off the floor as the torso lifts up. Squeeze the shoulder blades by rotating the shoulder out and pulling them back, hence opening the chest/shoulder region. Ensure both knees are no more than hip width apart. Hold for 2-3 breath cycles and release by first lowering the thighs and torso while bending the knees. Lastly release the hand-hold around the ankles and extend knees.
Stretching the pectorals with tools and equipment
i) Foam Roll Stretch:
This may be done on the bare floor or on exercise mat on the floor. Place the foam roll (at least 36 inches or longer) lengthwise along the mat. The spine is supported on the foam roll with the face up and feet on the floor as in hook-lying position. The occipital protruberance (back of head) and the spine to the sacrum should be supported on the roll while the Transverse Abdominus is engaged for neutral spine. It is important to not arch the back and maintain the gentle anatomical curves. Bending the arms at the elbows, bring the dorsum of hands onto the mat on either side of the torso. Rotate shoulders outwards and supinate the forearms with 90° of elbow flexion, and slowly slide the dorsum of hands in an upward arc towards the head maintaining the contact of the hands with the floor at all times. This opens the chest and shoulder region, stretching the pectoral muscles. Hold for as long as possible between 5-30 seconds as far up as you reach with the hands and slide the arms back to release the stretch. Rest for 15-30 seconds in between stretches.