I met Lisa last year when she attended a 2009 PYT training in San Francisco I gave on medical therapeutic yoga and the lumbopelvic spine. One of the topics I addressed was myofascial release and yoga, and Lisa recently asked me to elaborate on it.
The Mission There is a high level of stress experienced by professionals who practice within the medical model today, and I believe it is associated with the skewed belief that we must or should “fix or cure” people. As a physical therapist who strives diligently to dive below the surface of a diagnosis in order to treat the whole person, I practice a different model. My day to day vision is to empower individuals, equip them with the tools they need for self-healing, and to be a facilitator rather than a clinical magician who “fixes or cures the patient.”
I believe our job as rehabilitation professionals is to provide a safety net and supportive environment for healing. Perhaps the most important value we can possess as a health care professional is to seek to play offense (prevent injuries and disease) rather than only being available (or able) to play defense (curing injuries and disease). This is the model I use when caring for someone whose is trying to prevent, or whose life is already impaired by, spinal dysfunction or disease.
The Living FasciaThe “Living Spine” refers to the role of fascia in spinal health. In my practice I apply the evidence base on fascia to yoga , which in 15 years of practice has evolved into a kind of hybrid medical therapeutic yoga that combines physical therapy and my other training in manual therapy, orthopaedics, Pilates, and women’s health.
I look at myofascial restriction often and early on in the evaluation process. In our hyper-stimulated, hyper-mobile society, I rarely focus on yoga as a way to mobilize clients. I mostly use yoga to stabilize them – physically, psycho-emotionally, energetically, socially, and spiritually. “Yogic” myofascial release then, I use only after I have addressed the individual’s static and dynamic functional stability. Myofascial release works beautifully with yoga as they are both proven to lower sympathetic activity.5
Fascia is defined as “dense, irregular connective tissue sheets in the human body, such as apneuroses, joint capsules, or muscular envelopes like the endo-, peri-, and epimysium.”1
Thirty years of research supports that the lumbodorsal fascia is indeed alive and exhibits an active and contributory connective tissue role, secondary to intrusion of muscle fibers2. Smooth muscle cells have been found embedded within the collagen fibers of the fascia cruris in humans.3 This finding suggests fascia affects postural stability and can limit spinal mobility in the individual, especially since the tension transmission occurring between the epimysium contributes to generation of muscle force.3,4 The same authors suggest that local thickenings of fascia can exhibit force on tendons and ligaments as well.
Fascia and You Pain from myofascial restriction is multi-faceted, and can be caused by surgical incisions, medical conditions or disease, accidents, injury, inactivity, neural tension, stress, or poor breathing habits. Since tone of the fascia can be influenced by the autonomic nervous system, Staubesand states “any work on the fascia then, is work on the autonomic nervous system (ANS).”
One way I facilitate self myofascial release is through identification and correction of poor breathing habits, which directly affects the ANS. Although I also practice passive myofascial release (MFR), or me treating the patient, I prefer to have the individual take a more active role. An active role allows the individual to cultivate confidence, awareness, and it puts them in charge of managing their own health. Schleip calls this approach that of a “humble midwife rather than a heroic technician,” and in my years of experience I have found it also greatly reduces stress and risk of clinician burnout.
One of the precepts of the Professional Yoga Therapy method is that the breath receives priority. I always begin and end with the breath; and, I revisit it as often as needed during a session to help a person soothe the nervous system and down-train their actions/reactions to movement and life.
The abdominal breath is the long accepted gold standard for relaxed, diaphragmatic breathing. However, I only use this breath during passive, restorative type yoga postures and not for active yoga or ADL completion. The abdominal breath is absolutely the first step toward myofascial freedom (and freedom from pain!) in the individual. This breath type can be progressed later into the three or four part breath (dirga pranayama). Both breath types focus on alveolar ventilation, elongation of the breath, decreasing sympathetic activity, and equalization of the inhalation/exhalation. They also encourage metering of the breath – or conscious control.
You can download a free copy of the abdominal breath practice here. (also included is an excerpt of research on how abdominal breathing impacts postpartum health)
Comfort MeasuresWhen starting a yogic breath practice it is important to create a comfort zone for the individual. Seated meditation poses may not, and often do not, typically work for the average American without much experience in yoga. I typically begin with supported corpse using blankets and bolsters. For their home practice I educate them on a comfortably reclined posture in bed. I use a blanket fold I call the “three tier approach,” which a person can adapt to hundreds of postures. (the three tier approach is shown in the abdominal breath download)
In addition, it’s important to use appropriate (non-fluorescent) lighting and create a peaceful décor and atmosphere in your practice. Lastly, use of imagery, mottos (mantras) or inspirational quote, or guided meditation further helps relax a person into their breath and their center of being.
For more information: Other methods that can be used are taught in the 2 day
Spine course, and include “pre-asana,” yoga posture application, a model for evaluation of the client, as well as a study of pelvic floor interaction and relationship (“bandha” or lock work) with the lumbopelvic spine.
Ginger Garner MPT, ATC, ERYT is a licensed physical therapist, athletic trainer, and professional yoga therapist specializing in women’s health. She is a longtime advocate for mothers and women, and is the author of Breathing In This Life at www.gingergarner.blogspot.com and a forthcoming book on prenatal and postpartum fitness. Ginger is founder of Professional Yoga Therapy, an integrative rehabilitation and medical yoga continuing education program for licensed health care professionals. www.professionalyogatherapy.org Ginger can be reached at www.gingergarner.com. Ginger lives on Emerald Isle, off the coast of North Carolina, with her husband, two young sons, and her 15 year young Labrador retriever, Owen.
*Photo is of the author in her late third trimester during her second pregnancy, practicing a breathing practice she designed for labor and delivery during ball assisted squat/backbends. It is a functional example of the way the author employs self-myofascial release using breath and posture for the prenatal season of women’s health.
Sources
1. Schleip et al 2005
2. Schleip 2003, Schleip 2005, van den Berg and Cabri 1999, Manuel et al 2008, Kruger 1997, Rolf 1977, Yahia et al 1993
3. Staubesand and Li 1996, Schleip et al 2005, Garfin et al 1981, Huiking, 1997
4. Schleip et al 2005, Barker et al 2004
5. Schleip 2003, Van den Berg and Cabri 1999
6. Garner 2005-10 Medical Therapeutic Yoga for Evaluation and Management of the Lumbopelvic Spine.
