The fourth and ninth asana in Surya Namaskar is the equestrian pose or the ashwa sanchalanasana.
• Position: From the hasta padasana, or forward bend, keep the right foot between the hands on the floor and extend the left leg back as you slowly lower yourself into a deep lunge. The left knee should come in contact with the ground, and the foot should be relaxed and plantarflexed (push toes out as far away from the shin as you can) so that the dorsum (top of foot) is touching the ground. Further stretch in posture can be achieved by arching the trunk or spine backwards and looking upwards with cervical extension. This increases the stretch in the left groin and anterior trunk while allowing deep hip flexion on right side. The shoulders should be relaxed or depressed with chest pushed out for pectoral stretch. Assuming this posture from the previous one involves large body movement and hence takes practice for smooth and graceful execution. • Muscles: As you lower to the floor by bending(flexing) the right leg at hip and knee joints, the psoas, pectineus, and hip flexor synergists as well as adductors contract to keep the bending leg knee in line with the toes. The hamstrings contract at the right knee and dorsiflexors of the foot provide continued forward flexion of the knee and ankle joints. As always, the trunk stabilizers (transverse abdominus and multifidi) keep the spine neutral during the move. The extensor muscles of the right hip- the gluteus maximus, gluteus medius, long head of biceps femoris, and the semimembranosus and semitendinosus- work in synchrony. The quadriceps extend the left knee and the plantar flexors allow the dorsum of foot to come in contact with the ground. If the pose is further deepened through trunk extension, the erector spinae contracts, and the latissimus and lower trapezius helps depress the shoulder blades with the palms open and hands firmly on floor. • Breathing: During the transition of posture from hasta padasana to ashwa sanchalanasana, breathe in deep and long, even when you arch your back. This posture contains breathing in and out. In the final posture, chest is pushed out, arching the back, and so the anterior lobes of the lungs fill up with air in the alveoli for gaseous exchange. Breathe out as you hold the pose or transition to next posture. Fourth Posture: “Om Bhanave Namaha” I bow to thee, one who diffuses light. Ninth Posture: "Om Adityaya Namaha" I bow to thee, who is God of gods.
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Happy December! Hope you have had a good week.
The third (and the tenth) posture in 12 pose Suryanamaskar is the forward bend or the hasta padasana (hand to foot). • From the hasta uttanasana /backward bend or the 2nd (and 11th) posture, keep arms stretched overhead and slowly reverse the spine from extension to a neutral spine, rolling the pelvis to neutral. The feet still rooted on the floor, the legs as a unit (ankle to hip joint), move back at ankle joints, shifting weight posteriorly making adjustment for the torso to bend forward. The shoulders may be taken through an entire rotation to incorporate scapular and gleno-humeral mobility and to add smoothness and grace to the movement, while prolonging the breath out. The pelvis progresses into anterior rotation with hip flexion, while maintaining knees in neutral or minimal flexion, as the hands reach for the big toe of feet. It is important to keep the shoulders neutral and not attempt to pull oneself down through arms (shoulder protraction) or spine (by flexion) in order to reach for the floor. The movement comes from hip hinge with good hamstrings flexibility and uniform spinal curve. If the hands do not touch toes, it is alright to start by bringing hands to knees and sliding them down shin of lower legs with the knees flexed about 10°-15°. • Muscles: Initially the transverse abdominus and multifidi stabilize the spine. The rectus abdominus and gluteus maximus contract, to bring the spine and the pelvis respectively, to neutral. The gastroc-soleus contracts with hip flexors(iliopsoas and pectineus) to move body segments and maintain center of gravity over the base of support. The quadriceps contracts to keep knee in extension and bring about reciprocal inhibition of the hamstrings allowing them to stretch maximally. In the alternative position if the knees are flexed to bring hands to toes, hamstrings are active with quadriceps relaxed initially. However, it is important to slowly attempt to straighten knees by activating quadriceps. • Breathe out slowly and steadily during the forward bend, reaching to complete exhalation at end of movement. The diaphragm flattens as it contracts and curves upwards into the thoracic cavity as it relaxes. During the breath out, the pelvic floor muscles contract assuming an upward convexity and pushing abdominal organs towards diaphragm to push air out as lungs recoil. Here the chest is compressed anteriorly, so it expands posteriorly and laterally and gaseous exchange takes place primarily in the posterior, lateral, and apical basal lobes of the lungs. "Om Suryaya namah" (I bow to thee, one who induces activity) Happy Thanksgiving!
The second (and eleventh) asana in the 12 posture Suryanamaskar is the overhead backward bend or hasta uttanasana. • From pranamasana, raise hands upwards overhead with the elbows extended, palms open and stretched out, and upper arms in line with ears as you arch the spine backwards in a backward bend. • As you begin the movement, the legs start moving forward at the ankle joints as a unit from lower legs to the hips with the hip joints in extension, the pelvis rotates anterior and the spine from the sacrum to the cervical region starts a gradual and uniform extension movement, the shoulders are neutral with shoulder blades rotated upwards as the gaze fixes upwards on hands or ceiling. • Muscles: The transversus abdominus contracts initially for stabilization, and back extensors, like multifidi and erector spinae, contract to bring about extension, the gluteus maximus contracts as do the dorsiflexors with eccentric elongation of gastric-soleus to allow forward translation. Multiple muscles provide lateral stability like gluteus medius at pelvis and obliques at trunk to produce symmetrical movement. • Breathe in slowly during this movement, expanding the chest wall anteriorly and laterally. As you breathe in, the diaphragm flattens with the contraction and pelvic floor muscles relax to accommodate the abdominal organs. Hold breath 2-3 seconds at end of completing posture. “Om Ravaye namaha” (I bow to the one praised by all) This week I am focusing on the Suryanamaskar in detail with the subtle nuances and considerations of each posture.
Not only is it important to do the 12 postures 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. As important as it is to complete the entire cycle of 12 postures, equally important is the execution of a single posture with simplicity, dedication, and attention to detail. Ideally 12 cycles of 12 postures is a beginning goal. There are masters who have the ability to do 108 cycles in close to 1 hour. Different approaches like mastering one posture before moving onto the next or learning all 12 and then working on fine tuning the movement pattern are acceptable. You have to know how you learn best and pick your own approach. When you have no prior exercise routine and are not doing so regularly for about 15-30 minutes at least 3 times a week, you may have to build the endurance to do maybe one cycle, then 3, then 5 increasing up to 2 cycles per week, till you build up to the 12 cycles of 12 postures, for example. Today I will brood on the first posture, which is the pranama asana. This is also the 12th asana. It is basically tadasana with the hands folded in “namaste”. “Talk to yourself once in a day … otherwise you may miss meeting an excellent person in this world”-Swami Vivekananda. When doing the Suryanamaskar, it is basically coming into touch with your own being by looking deep within yourselves. The folded hands may be placed with thumbs close to the heart and head bowed down to touch the fingers. When done in presence of a teacher, one bows in reverence to the soul present in the heart of the other and so may the divine relationship blossom. Considering the posture in terms of joint position, the spine is neutral and elongated with natural curves- cervical (neck) and lumbar (low back) lordosis or convex forward, and thoracic(mid-back) kyphosis or concave forward, neutral pelvis, shoulders relaxed and shoulder blades slightly pulled back symmetrically(retraction), to open chest. When bowing head, gently tuck chin in while elongating back of neck, instead of reversing the natural lordosis of the cervical spine. Muscles: Low level co-contraction of the trunk stabilizers to maintain upright spine. The dorsiflexors and plantaflexors balance the moment of force around ankle joint. The knees relax, with quadriceps and hamstrings balancing the moment around knees, hip joints are balanced by the glutei and iliopsoas, neck stabilizers which are the deep neck flexors. Breathing should be natural, and, gradually as the body and mind relax, it becomes deeper. Be aware of your breathing pattern. The abdomen moves out while you breathe in, with the flattening of the diaphragm as it contracts. The diaphragm slowly returns with breath out as it relaxes into a dome shape, expelling air from the lungs. The transversus abdominus (abdominals) are contracted throughout with intensity slightly more during exhalation. Multifidi (back extensor) co-contract providing spinal stability. Diaphragm and pelvic floor muscles work like a piston. “Om Mitrayah namaha” (I bow to thee, my friend) I am wondering what I should write in this post? Hmm… now let’s see.
I presented Health and Wellness: A Physical Therapy Perspective at New Seasons Market in Evergreen on Saturday, 11/12/16 amidst supportive family and friends. This was the very first presentation with a power point slide show and interactive session, getting everyone present involved in increasing awareness of their movement patterns. It was a fairly simple or basic session with emphasis on healthy movement, the 3 main pillars of which are: 1)Spinal Stability 2)Good Functional Movement Patterns and 3)Stable Foundation and Balance I also spoke about the goal being either: 1) working on dysfunction in existing movement pattern to improve it or 2) taking the health to a new fitness level During a yoga class this Sunday, one of the asanas is danda asana, kind of long sitting with emphasis on lumbar extension and forward pelvic rotation, with hip at 90 degrees. This calls for strong contraction of back extensors including multifidi and transverse abdominus for stability. This was particularly hard for me and I feel reinforcement coming from hand support and using elbow extension and shoulder girdle retraction to weight bear through arms instead of natural ability for weight transference from lumbar spine to pelvis. Hence it is an example of working on existing movement pattern for improving it. There were a lot of new asanas that I learned today which involved increasing upper and lower trunk rotational mobility, something that I notice I have to work towards. So, overall participating in a one and a half hour active yoga class is in itself a journey for taking my health to the next fitness level. Weekend is almost done. Have a good week ahead. Posture is very much a sub-conscious activity. We automatically do what is needed without putting thought into it. However, it becomes imperative to bring it to the conscious level in order to make adjustments and corrections deliberately, as in the case of correction required for postural deviations. If allowed to go unnoticed for long, such deviations can cause muscle imbalances and eventually alter joint alignment and biomechanics.
When you go to a physical therapist, they look at your static standing posture, dynamic standing posture or posture in motion, (for example, gait assessment, heel walking, and toe walking) as well as challenge the base of support to assess balance/stability (single leg stance, tandem standing, etc.). A functional movement assessment looks at both static postures and dynamic movement patterns. A good posture in various positions is the basis of all functional movement. Hence in physical therapy sessions, posture is the first consideration towards fitness, not speed or number of repetitions of movement, as is popularly thought. A good static posture is the foundation on which you superimpose all other movement patterns. While looking at a good dynamic posture, there are certain basic movement patterns that we employ for all activities. These activities are variations of these basic movement patterns or building up of more complex movements over the basic patterns. The basic patterns consider biomechanics with good joint alignment and muscle function. Progression for training of any activity or movement is necessarily from good static posture to basic or fundamental movement patterns followed by training of specialized or complex patterns needed for particular sport or dance. Repetitions and speed for fitness come only after these basic postural requirements are achieved. It is much like acquiring the motor skills in infancy. The young child puts the entire being into learning the new skill, be it rolling, coming up on arms in prone position, learning to shift weight and sit up, moving from sitting to standing, and so the list goes on. The baby will rock the weight till balance is achieved, then repeatedly practice that posture to build strength and agility and eventually master it with sufficient speed, till it is a sub-conscious activity. There are some common traits we share in terms of basic posture like an upright spine and normal curves in the spine (lordosis in cervical and lumbar spine, and kyphosis in thoracic and sacral spine). Though “normal” here includes a range of joint mobility (about 10°-15°) when measured using an inclinometer. From observation, it is evident that each of us is comfortable in a particular posture and the muscles around the spine are in equilibrium at a different point in the range for each individual. Therefore, posture is an individual consideration. Basic factors such as spinal curves are common to all, however tuning should be done on an individual basis after detailed evaluation and should be adjusted as needed on an ongoing basis. There are certain key muscles which are predominantly active to maintain upright position. Spinal stabilizers (erector spinae, multifidus, transversus abdominus, obliques), scapular stabilizers (rhomboids, serratus anterior, levator scapulae, trapezeii), and postural leg muscles (gastrocnemius-soleus, tibialis anterior, gluteus medius) play a vital role in static postures as well as in movements. Co-contraction of trunk muscle groups offer proximal stabilization and the leg muscles enable fine tuning to maintain a steady stance. Posture is more or less dynamic. Subtle body movements and weight shifts are happening all the time (one cannot stop breathing!) which cause the muscles to be in constant flux to balance the moment of force around a given joint. To consciously make changes to posture, it is essential to improve muscle flexibility / joint mobility to allow greater range of motion than existing in case of soft tissue tightness / joint stiffness, or, to stabilize a hypermobile joint by co-contraction of muscles around the joint and challenging static holds. Manual therapy offered during physical therapy sessions can target specific deficits and impact those effectively as per individual needs. Once change is made consciously and repeated, this movement pattern is learned and recorded in the brain. Repetition and speed help strengthen the nervous pathway and permit ease of signal transmission to make this change “sub-conscious” or “automatic.” Soon this no longer requires conscious attention and a good movement pattern becomes the norm. Thus, this five-part series on posture comes to conclusion after discussing basics of posture, basic postural positions and how to make changes to posture. The decision to make that change, and for the change to be effective, should come from you. Once committed, it is only matter of “when” and not “if” the change happens. And as always, the emphasis is on the journey made to change a habitual posture. In yoga, it is said “The study of asana, is not about mastering the posture. It is about using the posture to understand and transform yourself.” Can a series on posture ever be complete without considering the sleeping or lying down posture? The best posture lying down is the supine posture, that is lying on your back, in anatomical position or with arms and legs relaxed and legs turned out slightly at hip joints. This enables maximum support to the body, allowing the postural muscles engaged in maintaining the upright position to relax. A pillow under the head and neck supporting the cervical curve allows muscles in this region to relax. If the hamstrings or hip flexors are tight, it helps to put a pillow under the knees to relieve tension in these muscles and maintain the spine in neutral position. In a physical therapy clinic, supine posture is employed for manual therapy on various limb joints and muscles, to train the abdominals as well as, increase awareness of diaphragmatic breathing. Side-lying is another position one can assume in recumbent position. While lying on the side, a straight (neutral) spine and slightly bent knees is ideal. To maintain a neutral spine, it may be necessary to place a pillow between the knees to prevent side bending. Yoga practitioners say lying on the left side post-lunch helps the liver function well and aids in food digestion and making one alert. Also, when lying on the left side, breathing occurs predominantly through the right nostril and when lying on the right side, it takes place through the left nostril. In a physical therapy clinic, side-lying position is employed to balance and bring awareness to asymmetries. The prone position is when one lies in face-down position, on the chest or stomach. It helps open the alveolar sacs in posterior lungs, which have a large surface area. This position may predispose to stress in the lumbar spine if the trunk muscles have decreased tone, putting uneven pressure on the inter-vertebral discs and nerve roots as they exit from the foramen. In this case a small, thin, pillow under the abdomen/pelvis helps maintain the curve in lumbar spine and prevent excessive lumbar lordosis. Also in this position, the head needs to be turned to one side, which impacts the cervical spine. In a physical therapy clinic, the prone position is employed to train the back extensors and upper quadrant muscles, including the scapular muscles and cervical extensors and in stretching the chest/pectoral area if tight. Often times prone exercises are encouraged on exercise ball, which is found to decrease trunk muscle co-contraction by nearly 1/3rd as similar exercises on a mat, and is obviously beneficial in gentle and progressive strengthening in case of back injury. A lot of studies are conducted on sleep and the profound impact poor sleep can have on an individuals’ life. Whatever the posture adopted in lying down, it is essential to be comfortable to allow deep sleep so that all the cells in the body can rest and rejuvenate. In authentic yoga, it has been observed sleep requirement naturally decreases and body rejuvenates faster and effectively with fewer hours of sleep. Ever wonder when you go to a physical therapy clinic, why there are plinths or mats? Though evaluation of posture in various positions reveal many things to the trained eye, the muscles are most relaxed in the lying position and hence allow a true assessment of the range of motion of joints and in some instances, it helps determine whether the problem lies in the joints or in the soft tissue surrounding them. In the lying position, the soft tissue and joints can be influenced and worked with employing manual therapy, allowing the individual to experience a normal functional movement and increasing awareness of the same, thus making conscious change possible. This very much determines the effectiveness of therapy and has significant bearing on the outcome. Lying down is the position which allows you to focus attention on your breath. It is very helpful in increasing awareness of dysfunction and re-training a good breathing pattern or even in aerating selective parts of the lungs by lying on one side or orienting the lungs and airways to inflate maximally. This is because the effort, which goes towards maintaining stability in an upright position such as sitting or standing, is eliminated. In other words, the surrounding trunk postural muscles relax, making it easier to shift attention to muscles and motion involved in breathing. In summary, lying down and going into restful sleep allows rejuvenation, both physically and mentally. Lying down in the wakeful stage enables one to make conscious changes to breathing, posture, and movement. As the saying goes “Let him sleep for when he wakes, he will move mountains.” Discussion of posture cannot be complete without the standing stance. Most of our activities are done in some variation of standing posture. In fact, standing posture is very closely related to balance and agility.
In day to day life, we perform many activities while standing that require bending, turning on stable feet, and overhead reaching while standing on ball of feet. Athletes, dancers, and gymnasts may even perform these activities on a single leg, challenging balance and the ability to stay stable and execute these motions smoothly on a narrow base. Over the years, sports (such as football and basketball), dance forms (such as ballet and folk dances from around the world), and gymnastics/acrobatics have reached new levels of evolution- Cirque du Soleil shows such as the “O”, “Ka,”and “Mystere” are vibrant example of feats the human body can achieve. In daily life, the feats achieved by the human body, the wonderful and utmost sophisticated machine that it is, are no less. Let’s take a look at the normal standing posture: • Feet are the base of support and a good base is keeping the feet hip/shoulder width apart • Hip, knee, and ankle joints are in a straight-line alignment when viewed from the side. • Feet are face forward with toes and heel in line, although a slight outward pointing of feet (5-10°) is within normal limits. • The plumb line through the center of gravity (COG) of the body falls slightly in front of the ankle joints. Good feet arches help distribute weight equally over balls of feet and the heels. • The spine has the natural curves and is free of stress while facing straight forward. This allows the spinal cord to pass through the spine stress free and function optimally. • The shoulders are neutral and relaxed with the neck elongated (chin tuck). How about trying this out practically? Choose a firm, level surface to stand on. Bring your awareness to the position of your feet. Are they hip/shoulder width apart? Are both feet pointing forwards? Did you notice if you are taking more weight on one leg than the other? • In this case, the leg with the hip jutting out and a straight knee is doing more weight bearing, while the other leg is relaxed with some bending(flexion) at hip and knee. • Common deviations may be a narrow base of support or knees touching each other. Bring your awareness to the spine. Is it elongated? Good natural curves? Are shoulders rounded? • This indicates excessive kyphosis in thoracic spine • If you notice this, see if you can imagine a string from the ceiling pulling you upwards from the crown of your head. Then squeeze the shoulder blades a little closer. Is your chin tucked in and cervical spine elongated? • If not, you likely are thrusting head way forward as is the case with people having desk jobs or working on computers when seated for long periods. Tuck the chin and elongate neck upwards while maintaining a straight forward gaze. Is breathing regular or shallow? • Normal respiratory rate is 8-16 breaths/minute. If you are breathing faster, you are probably not getting in as much atmospheric air in lungs as needed for good air exchange. A bad posture can impact functioning of other body systems. A good static standing posture translates to overall well-being with body systems, such as the respiratory, nervous, and digestive systems, functioning efficiently. "An ounce of prevention is worth a pound of cure." And in fact truth be told, sitting is really effortless. When the spine is stacked properly one segment over another, it needs the least energy and muscle work to maintain upright position. The ligaments and other soft tissue relax and are rejuvenated through oxygen exchange, during this still period. When one does not pay attention to good posture, joints and ligaments are taxed, muscles are stretched at places and tightened at others. Hence the importance of a “neutral spine.” A neutral spine is not a rigid or fixed position and does not mean maintaining a specific joint angle. It varies from person to person. Then how do you know when you have a neutral stress free posture? You simply know it is good since you are most relaxed in that position.
It is important to differentiate this, (and I cannot stress this enough), from a temporary relaxed posture, which may feel good at the time (perhaps even put you to sleep when you should not), however is not based on awareness of good body position or neutral joint position. If you have experienced any sort of back discomfort/pain, (do you wake up from sleep with pain or discomfort?) you know what I am saying. Good posture actually means being alert and attentive to the present moment allowing one to put in their best at work. Ready to try the seated posture? Cross legged sitting on the floor is best for you. If you like, you can pull a chair- the intention here is to sit without back support. • Base of support should be wide and stable- here it is all the area between feet on the floor to ischial tuberosity (bony prominence of the pelvis in buttock area) • Spinal column should be elongated so that the intervertebral discs between the vertebrae are decompressed- imagine a string hanging down from the ceiling to the crown of your head, pulling you upwards. This results in normal spinal curves with neutral spine- lordosis in cervical and lumbar spine and kyphosis in thoracic spine and sacrum. It is only a matter of bringing awareness to a neutral spine. • Gaze should be fixed straight ahead. • Now breathe. Inhale and make sure the lungs are able to inflate to their maximum. Slowly exhale as long as you can and let air out- consider analogy of inflating/deflating(slow) balloon. You could be reading or working on computer in this position. Be aware of posture and neutral spine and get up or change position, stretch if you have to. You may start sitting for 5 minutes and build it up to 15-30 minutes. The longer you hold, the better, since at that time, your body is converting white fast fibers into slow, red postural fibers and it only gets easier to sit longer periods. Concurrently, you will see effortless translation of this good posture into activities of daily life and that you do not have to do anything special - your awareness in general will increase when at work, or seated at home. Enjoy the weekend! What is posture? “Posture may be defined as, ‘the position of one or many body segments in relation to one another and their orientation in space’ (Ham et al, p.26).” It is the position in which one holds the body while standing, sitting or lying down. Traditionally these three positions are the main ones adapted by the body, however there are multitude of intermediary postures to assume these three final positions. Postures can also be classified as static or dynamic based on whether you are moving or relatively in a still position. Posture can be impacted by several factors, most basic of which are joint position, muscle tone and gravity. Nowadays a lot of attention is being given to good posture since, with all the technology available, we are doing less walking and upright activities and more sitting. Heard of the popular phrase, “Sitting is the new smoking?” This phrase was coined by Dr. James Levine, director of Mayo-Clinic at the Arizona State University. This is not literally true. In fact, “sitting” is being compared to “smoking” to bring home the point that the side effects of sitting for more than 6 hours a day are equivalent to the health hazards caused by smoking. For example, their study reveals prolonged sitting can predispose to heart disease, and even certain types of cancer. In that context, standing desks may be a blessing. From a physiological point of view, our body has different types of muscle fibers. And since prolonged sitting calls for holding a posture, it employs what are the slow-twitch (type I) muscle fibers, or the red fibers, which have a profuse blood supply to permit aerobic metabolism. The other type of muscle fiber, the fast-twitch (type II), or white muscle fiber, (so called due to fewer blood vessels and anaerobic metabolism), is employed for power activities needing greater force and speed like sprinting. The good news is that with endurance training, human skeletal muscle fibers can show increased blood supply. Studies on fish’s white muscle fibers show these fast twitch muscle fibers, when subject to slow low frequency stimulation, behave like slow red fibers with increased blood supply. This is where training comes in and thus, listen to your physical therapist when they say practice for “x” repetitions and do “y” number of sets. With early intervention, the process, if followed diligently, can reverse effect on the muscle fibers! That is why it gets easier to sit, or the achiness and soreness experienced in muscles decreases with postural exercises. Extrapolating this, sitting may actually be a boon- ever wonder why meditation (in other words maintaining a posture for prolonged periods) is found to have beneficial effects? The body never ceases to amaze us, does it? Anyway, the point I want to make is don’t get hung up on what the body does, go beyond. For exercises, while it is true that repetition helps commit to memory, I am not for that “magic number” theory of “20 repetitions and you got it.” I love the fact that we are all unique, so is it any wonder that the number of repetitions it may take one to memorize may not be the same as anyone else? Then how do we know how many repetitions are enough to have the effect an exercise is meant to have or visualize the outcome it is supposed to produce? Basically, it all depends on the intent of exercise or in other words the goal of exercise.
Exercises are classified on basis of the effect- strengthening, increasing endurance, or range of motion- which used to be primary goals. Nowadays, the goals have diversified to include stability and achieving a good movement pattern in addition to the prior goals. We now have the tools to precisely gauge and progress these objectively as our knowledge of biomechanics, kinesiology, and neurosciences deepens. Spinal stabilization exercises are probably most widely prescribed, and rightfully so, as all other movement depends on this fundamental ability on which other movements patterns are based. Consider it to be the foundation on which the rest of the body structure is built and given freedom to move. Once the stabilizing muscles fire properly, repetition is key to set this pattern on which any other dynamic movement is based. Even though there may be a foot or knee discomfort or injury, the root cause may lie in the improper spinal stabilization. A physical therapist is hence required to consider the body as a whole and detect where the dysfunction originates. In that context, I love Sherlock Holmes’ quote on elimination: “Once you eliminate the impossible, whatever remains, no matter how improbable, must be the truth.” Functional Movement Assessment does precisely that. It looks at whole movement patterns for dysfunction, and then breaks down movements to specific joints and considers surrounding soft tissue to determine where dysfunction originates. That is more often than not a work in progress, and one should be very flexible in making ongoing changes without losing sight of the end goal. So that, for example, if it is the foot or knee with symptoms, while it should be addressed and local symptoms treated, the spinal stability must also be looked into. If not, the symptoms may eventually reoccur or show up at another site, since the fundamental issue may not be resolved. To achieve an end goal, the exercise prescribed must be specifically tailored to the individual. While finding dysfunction is like detective work, determining which exercise must be utilized is an art. A physical therapy gym/clinic must be equipped with different choices based on each individual’s preference. For example, a housewife who is a homemaker, may do well without much equipment and is more likely to follow through with the home exercise program with simple exercises just activating the muscles (maybe using the wall or easily available things within the home: tennis balls, strap/belts, cans/bottles, etc). On the other hand, an athlete used to various equipment in a gym may be proficient with foam rollers, balance discs, weights, bands, and multiple other tools employed by a physical therapist and may be likely to follow through with a set home exercise program if it employs such equipment. Broaching on the topic of home exercises, it forms a very prominent part of the rehabilitation process, since you see a physical therapist only 1-2 per week. The journey back to wellness is based on an efficient, engaging, and workable home exercise program. A good understanding of the exercise patterns and repetition is key. Sometimes one is diligent with exercise, yet the rehabilitation program may not achieve the goals because of incorrect movement patterns. Ask questions if needed, study your body well, and go with the guidance from the physical therapist. Only you can make that difference in your wellness, and with sincerity and constant eye on the goal, one cannot fail. This week I did not have to think at all about what I would write. Of course it would be on the back, after having written about stability in the last post, and backache being one of the foremost ailments generally experienced. Backache can be caused by a multitude of factors, which may range from habitual bad posture and movement patterns to trauma and injury with surgical component. Interestingly, as I am writing this post, I have come across an article in the Wall Street Journal regarding meditation as an option for pain relief in lieu of narcotic pain killers after a back surgery. In my opinion, pain killers overdose acts much in the same way as antibiotics overdose. That is, it eventually decreases in effectiveness.
I will keep this post simple- backache, as a result of poor postural habits and non-traumatic back pain, and an insight into its prevention. At birth, the spine is c-shaped or “kyphotic.” After birth as the child lifts the head and starts walking, the “lordosis” (convex forward curve) in cervical and lumbar curves develop. The primary “kyphosis” (concave forward curve) is preserved in thoracic and sacral vertebrae. The sacral vertebrae are 5 in number, however they are fused into 1 bone, “the sacrum.” Pretty interesting? Moving on then, in an adult human being, the spine is made up of 33-35 vertebrae (7 cervical, 12 thoracic, 5-6 lumbar, 5 sacral, and 3-4 coccygeal). With all daily activities which have an impact, like walking, running, jumping, the spine must transmit forces multiple times that of the body weight. To absorb the magnitude of these forces there are the intervertebral discs or IVDs, which are made of cartilage and a soft gel-like center. The muscles and ligaments as well as the “taken for granted/forgotten” fascia allow a smooth movement during any activity. Fascia is the soft tissue that is semi- fluid and very forgiving, providing much needed flexibility, protection, and freedom of space to move to all structures like muscle, nerves, blood vessels, and even organs, which it completely surrounds. Now with habitual poor postures (static posture), the soft tissue may shorten and tighten at certain places and stretch at others, straining nearby structures including ligaments and joints/bones, causing visible postural deviations. The adapted soft tissue alters the movement patterns (dynamic posture) in slow and steady progression (over months to years) and eventually, at a “critical point” the system fails and may be experienced as discomfort or pain, predisposing to further micro- injuries. Once injured, any healthy, soft and flexible tissue can be replaced with non-flexible, cord- like collagenous tissue. This continues and is cyclical, leading to recurrence of back pain. This then is the most prevalent and most benign form of chronic backache with episodes of acute exacerbations. The point I am making here is not to create fear, albeit amplify that, if alert (and there is plenty of time and opportunity to do so), this is totally preventable at any point in the cycle. The simple answer to that: “awareness and stability before mobility.” Sound familiar? I will consider some examples here: this being the “Silicon Valley,” a large population is made of professionals spending majority of time on computers or at the desks, sitting with slumped posture. How about the students and children writing and involved in use of technological devices? How about impact caused by improperly done yoga or other popular fitness routines nowadays? Technology is not good or bad in itself, it is just a tool in our hands. Good posture lies not in the desk and chairs we use, but within us. To keep your back healthy and strong: *Be aware of the sensory signals that your back, the neck, legs, and hands/arms send to the brain. *Listen to the body and make that important decision to stand and stretch frequently (every1-2 hours), keeping the muscles and ligaments supple, flexible, and happy. *Proactively engage in spinal stabilization exercises maintaining a healthy back. Recently there was a young girl who reached the finals in America’s Got Talent. The amazing flexibility she demonstrated was “beyond this world.” Bending backwards and folding in half, hanging onto a ring by the neck, shooting an arrow with amazing accuracy with the feet, and so on. One statement she made impressed me. She said “People often wonder does it hurt? No, it does not hurt at all.” One does not need to go to such lengths to prove anything. However, it is possible to do all this if it is our calling and train to be the masters of our bodies in our own way. As contributing members in society, we each play a valuable role. Being healthy and to continue doing what each one of us does the best, it is important to not only to respect the body, which is one of the instruments along with our minds and hearts being the others, but also to keep it efficient to serve the best we can. There is a lot more awareness nowadays to stay “fit.” Popular fitness lays emphasis on movement mainly, undermining the stability aspect. Let us then bring our awareness to the important function of stability underlying all mobility/movement, and enjoy being ourselves. Our back has an important role to play here. So let us bring the “backbone to the forefront of our awareness.” The last post was about functional movement patterns. Here I will lay emphasis on stability. So what do we mean by stability? The dictionary defines stability as:
“1. The state or quality of being stable, especially: a. Resistance to change, deterioration, or displacement. b. Constancy of character or purpose; steadfastness. c. Reliability; dependability. 2. The ability of an object, such as a ship or aircraft, to maintain equilibrium or resume its original, upright position after displacement, as by the sea or strong winds” In physical therapy, as in other allied health fields, the focus is shifting to a wholistic approach. When one visits a PT and develops goals, it involves all of the above. In this case it would mean balance or the body’s ability to maintain an upright position at rest or after displacement, or in other words- shift of the center of gravity(cog) of the body. It also means, however difficult the task may seem, stay steadfast on the set goal for achieving that stability and that you may rely on, or depend on, your physical therapist to guide you through the process. The center of gravity is a hypothetical point where the mass or weight (mass on which gravity is acting) of the body is concentrated. The cog of the human body lies just in front of the S2 vertebra, very close to the navel or belly button. In order for a body to be stable, the plumb line (simply a string with weight at the end-easily made at home) through the cog must fall within the base of support (BOS), not merely within, but rather at the center of the BOS. Let’s consider static stability in the standing position with the area under and in between the feet being the BOS. (Please refer to the pictures 1. and 2. below). Now, if we drop a plumb line from the cog or for practical purposes from the navel, it falls in the area between the 2 feet, in front of the ankle joints. In this position we are fairly stable. Consider a displacement of the cog forward, for example, when we walk or bend forward. This movement brings about a shift in the BOS, yet we do not fall at every step. This then forms the dynamic stability, with a constant change in BOS and muscular forces bringing about movement to maintain cog over the BOS. Very efficient is it not? Who knew? Well, don’t just sit and read, go ahead and try it for yourself-find out where your cog is within the BOS. Now let’s consider the dynamic muscular forces responsible for stability. Our trunk and spine is the central core from which extend our extremities. Trunk musculature is therefore extremely critical to maintaining stability, while the limbs are freely moving and reaching out during activities. We have all heard about the “core muscles” in this respect (I think “trunk stabilizers” or just “stabilizers” is a better term to refer to these muscles). Though there are several muscles in the trunk, we will consider only the prime stabilizers. The muscles that form a sort of corset around the trunk/waist are the Transverse Abdominus (abdominals) in the front, the Multifidi (back extensors) in the back and the Internal and External Obliques (also part of abdominals) and Quadratus Lumborum along the sides or flanks. (Please refer to picture 3. below). Also included are the pelvic floor muscles which sort of form the floor or base of the bucket, and the diaphragm, which is like the lid, with the corset being the sides of the bucket. This brings us to the importance of breathing and stability, and also explains why yoga and other forms of exercises use breathing techniques to train the stabilizers- it is because the stabilizers and diaphragm as well as pelvic floor muscles work in synchrony. For stability, it is not only the strength in these muscles that matter, as is popularly believed. The timing at which these muscles contract during movement is very crucial to stability and efficient functional movement patterns. For example, for a back ache, your PT trains you to increase awareness of these stabilizing muscles by having you lie down when your body weight is supported and muscles are relatively relaxed. Therefore you can focus on “isolating” these muscles initially to activate them voluntarily. Stability must always come before mobility, and these trunk stabilizers must essentially fire first prior to those prime movers by as little as a fraction of a second. This allows you to experience an effective, efficient, and purposeful movement pattern. Once your muscles fire in the right pattern, this pattern is repeated in different positions through various exercises, and finally strengthened with the use of thera-bands, weights etc. Frequently, the latter two happen simultaneously. Hope this gives some insight into the importance of keeping the trunk stable while the peripheral limbs are engaged in motion. Till next week… You see a lot of “functional movement patterns” mentioned on the StableMovement Physical Therapy website: www.stablemovement.com. So what is this “functional movement pattern” all about?
Our bodies move at joints, and it is the muscles that facilitate movement from a mechanical perspective. The brain sends out a message and nervous tissue conducts these as electrical signals to essential joints and muscles, which bring about precise movement within seconds. All this is so automatic to the point, that unless we keenly observe and bring our awareness to it, it is near impossible to make any changes to fine tune it. A movement is functional when it achieves a purpose. For example, sitting to standing from a bed or a chair. We are all able to connect with this as we perform this several times in our day. Go on and try it, only this time, bring your awareness to the movement instead of doing it “automatically”. Notice how the trunk muscles fire first, stabilizing the spine and then the limb muscles fire in a coordinated pattern to allow the joints to have a smooth movement rising up? A symphony of orchestrated muscles firing; the static stabilizers, the dynamic stabilizers, the prime movers, the tuning muscles. The trunk stabilizes foremost, as weight is shifted forward onto the feet which will now serve as the base of support. The shoulder blades may be stabilized in order to push up with the arms, or the arms may not be used at all if one has good stabilization at the spine and strong legs to support. Next the hip and knee joints flex, the ankles dorsiflex, then hip and knee joints extend and elongation of spine takes place for an upright posture. The body’s center of gravity (weight)shifts upwards and translates back towards the heel for even distribution on the feet so that the body’s line of center of gravity falls within the base of support (the area covered by the 2 feet and space in between). You are now in the standing posture. Well done. You just brought your awareness to this simple, taken for granted pattern. It is fun to do this in slow-motion, and then fast speed. What needs more muscle control? What needs increased muscle restraint? See how the 2 movements are alike, yet different in the muscular demands? Want to have some more fun? Break down the pattern at the joints at particular parts of the motion. Hold that posture for a few seconds. You will really bring awareness to the most active muscles during that posture in the pattern. For example: the trunk stabilizers, quadriceps, hamstrings, calf muscles, or back extensors. The functional movement is actually made up of many such “dynamic postures” performed in series for a smooth movement pattern, much like a film is made of many frames of pictures. If any one of these dynamic postures is “faulty” due to lack of adequate joint range of motion or muscle tightness, the pattern changes or compensation at different joints takes place to complete the motion. This pattern change may be subtle and go unnoticed or ignored. Over a period of time, these changes accumulate until it reaches a critical point when the individual is aware of discomfort or even pain in the movement. That may be the point when you decide to see a doctor or health care professional, while all along, your body knows what is going on and all you need do is bring awareness to this pattern. Once you get a good grasp, this awareness translates into everything you do, and you start noticing subtle nuances in movement. In fact, that is what gymnasts, dancers, or athletes are doing as they train. A physical therapist, having studied the norms of movement range for various joints (anatomy) and muscle action (kinetics) and analyzing human motion (biomechanics and kinesiology), simply applies this to your movement patterns. To change a faulty movement pattern, the movement is slowed down first to bring awareness to the appropriate joint and muscles in question. The pattern may even be broken down into its components, and other functional movements that employ a similar pattern may be used to train the corrected pattern. Once mastered, attention is focused on repetition and speed so that this relearned movement pattern is performed subconsciously, without thought-which indicates true mastering of a skill, kind of like being in the drivers seat in a self-driving car. TGIF and welcome to the long weekend. Here is the weekly post. Hope you enjoy reading.
Let’s delve into stretches and how important they are by drawing a parallel between exercise and music or art. For example, just as you hold your notes prior to singing, or recognize lines, edges, angles and various shades/tones prior to drawing, stretches are a must prior to exercise, a prerequisite to any exercise program for the best possible movement pattern. I will cover only general stretch principles in this post. You probably have noticed how you begin your day with a stretch, as you get out of bed, stretching simply feels good: stretching arms up overhead, or stretching the torso, even leg and foot stretches feel good. How about yawning? It stretches the muscles around the mouth and chest cavity. These are what I call the “informal” or “spontaneous” stretches. After a period of restful sleep, these stretches gently guide your awareness towards the body and allow you to safely navigate in your surroundings. Then there are the “deliberate” stretches we perform to achieve a certain effect. The stretches we are looking into fall in this category. One key to stretches, whatever category they belong to is that when done correctly, they feel good. With some of the popular forms of exercise to stay fit these days such as walking, running, hiking, bicycling, or participating in specific sports or dance forms, muscles tend to tighten in certain patterns, slowly decreasing available range of motion and creating new movement patterns unbeknownst to the exerciser. Yoga, gymnastics, and such forms of fitness methods on the other end of the spectrum, come with probability of increased flexibility, sometimes to the point of hypermobility, which needs a different solution: one of stabilization. The point I am making here is moderation is important in any activity. Putting the aforementioned points together, it now makes a lot more sense that, done in moderation, stretches feel good. Underdone stretches on one hand are ineffective and may lead to pain and injury by persisting on improper movement patterns due to stressing some joints to limit of available movement and then compensating demand for remaining movement at other joints which may be needed to provide stability. On the other hand, overdone stretches may become a source of pain and injury for lack of proper movement patterns as well, recruiting the increased range available from joints that are meant to provide stability. Now that we have some basic information, let’s consider techniques in stretching. Simple stretches involve acquiring certain body positions and holding the muscle in stretched position, progressively increasing the time from a few seconds to minutes. This ability differs from person to person and hence it becomes important to establish an ideal individualized stretching program. During stretches, physiologically, muscle tissue, due to elastic properties, lengthens according to its tensile strength. There are mechanisms in our body which tell us the appropriateness of stretch: done slowly it allows muscle tissue to adapt and lengthen in healthy fashion. When done quickly and with large amplitude, stretches may lead to pain/injury by causing micro-tears in the muscle fibers. Eventually the body heals the micro-tears by laying down collagen tissue (which is not as elastic as original muscle tissue) and increasing the tightness. Hence, technique of stretch is important in achieving flexibility goals. As I mentioned in a previous post, our bodies are a gateway to knowing ourselves better, and stretches are a valuable tool in that respect. Increasing awareness may help in mastering the skill of gradual and progressive stretches based on your goals. After a certain period of stretching and performing activity to take the muscle through that newly acquired range of motion, it becomes a “way of life” so to speak, and further stretches may not be needed for that activity. For the achievers amongst us, the next goal awaits, and for those content, you have arrived at your desired lifestyle, at least for the moment. I will dedicate this post to my all-time favorite and all-encompassing exercise, the Surya Namaskar. If you are a yoga buff, you already know what I am talking about. Surya Namaskar, when done as it was meant to, sincerely and reverentially dedicating it to the omniscient as also to the spirit within oneself with gratitude, does the body and mind wonders.
Though there are shlokas one may recite prior to commencing suryanamaskar, they are not mandatory. Simply doing them with reverence is beneficial. So here it is: the 12 poses, each accompanied with a “suryamantra”, or one of the many names of the sun. Again, the mantras are not essential, but I am including them as I do them. It is best to breathe in during those postures which stretch the torso/open the abdomen, as in backward bending or arching, and breathing out with forward bending postures when the stomach is compressed. Please note: prior to commencing any exercise program, consult your doctor/healthcare practitioner. It may be contraindicated for some who have back problems and should be done under supervision from a professional to do it correctly, with good movement patterns from the start. Refer to the corresponding pictures below. 1) Begin in standing prayer pose, feet together and hands folded as in Namaste. “Om Mitrayah namaha” 2) Slowly raise extended arms upwards, stretching overhead and gently arch back backwards, while feet stay together. “Om Ravaye namaha” 3) Start bending forward with arms stretched and reach for the floor, hands reaching/resting besides feet as per flexibility. Bring stomach/chest close to thighs. “Om Suryay namaha” 4) With both hands on the floor, and right hip/knee bent to about 90 degrees, with right foot between hands, extend left leg behind with ball of foot in contact with ground, keep back straight or arch backward if possible , extend neck and look upwards “Om Bhanave namaha” 5) Bring right leg behind together with left leg and assume plank position with arms extended at elbows, feet resting on ball of feet. “Om Khagaya namaha” 6) Next, bring the hands next to torso, palms flat on floor, assume posture touching chin, chest, both hands, both knees, and balls of both feet to the ground. Stomach is slightly (2-3 inches only) off the floor. “Om Pushnae namaha” 7) From prone position, bring palms on floor, lifting torso by arching back, up to waist, pelvis should be resting on the floor and not lifted off. Look upwards by extending neck. “Om Hiranyagarbhaya namaha” 8) Lift torso off the floor, and form a mountain with both feet and palms flat on floor, pulling chest towards thighs and flexing neck forward (chin toward chest). “Om Marichay namaha” 9) With both hands on floor, left hip/knee bent to 90+ degrees, and left foot between hands, extend right leg behind with ball of foot in contact with ground, keep back straight or arch if possible, extend neck and look upwards. Basically this is the same as 4), with feet position in reverse. “Om Adityaya namaha” 10) Stand up and bend forwards with arms stretched and reach for the floor, hands reaching/resting besides feet as per flexibility. Bring stomach/chest close to thighs. Basically same as 3). “Om Savitrae namaha” 11) Slowly raise extended arms upwards, stretching overhead and gently arch back backwards, while feet stay together. Basically same as 2). “Om Arkaya namaha 12) Return to standing prayer pose, feet together, hands folded as in Namaste. Basically same as 1). “Om Bhaskaraya namaha” For those of you who are into this more dedicatedly and would like to precede with shlokas for invoking the sun, there are some+ different ones I have learned and include here. These are in Sanskrit so important to have some background knowledge of pronunciation: “Hiranmayena patrena satyam saphitam mukham tat tvam apvarnu pusan, satyam dharmaya drishtaye” “Om namaha Suryaya devaya, sarva roga vinashine Ayur, ayusha, arogyam dehi deva jagatpatem” Or Aadityasya namaskaraan ye kurvanti dine dine Ayuh prajnam balam viryam tejastesan cha jayate As I think of publishing this post, there is one more shloka I came across and will share here Om dhyey sada Savitrae mandal madhyavarti Narayana sarasija sanasanni vishtah Keyuravana makarkundalvana kiriti Hari hiranmaya vapur dhritashankha chakrah |
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AuthorAmi 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. Archives
March 2018
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