Saluting Beauty

Despite the poor video quality and lighting, this video is worth a watch. It is a stunning interpretation of the sun salutation performed by two dancers. Their strength and grace is amazing. The music is nice too.

If this inspires you to try out partner yoga, check out this reference: Equal Partner Yoga

Or perhaps you’ll be inspired to explore AcroYoga, a brand of partner yoga that is an amalgam of yoga, thai massage, and acrobatics and a whole lot of fun.

Enjoy:

The Grateful Body

Today's post comes from Physical Therapist and Yoga Teacher, Crystal Frazee. With Thanksgiving only two days away, her article reminds us to treat our clients, patients and ourselves with extra TLC during the upcoming holiday season.

As physical therapists and yoga teachers we are trained to teach people about their bodies. We help them to understand their personal movement patterns and to develop postural awareness so that they may heal and prevent future injury. But as the holidays grow near many of our clients will need more than healing at this physical level and we are in a unique position to assist them.

People will come into our clinics and studios feeling flustered, fatigued, and overwhelmed from the rigor of the holiday season. Our clients will be bombarded by marketing messages, increased social intensity, and family expectations over the next 6 weeks. It becomes essential that we remind them to listen to their bodies’ signals and be compassionate with themselves. But with well crafted, considerate instruction, our clients can leave us feeling not only more relaxed, stretched, and energized, but reconnected in body, mind, and spirit. We can help remind them to be compassionate with themselves and grateful for their bodies.

You may find all or just a few of the suggestions below helpful in supporting your clients feel more self affirmation and gratitude during the holiday season. Take what works for you and your teaching style.

• “I CAN!”
We can have a remarkable impact just by being present to what our clients say. When you demonstrate a pose and a student comments that they won’t be able to do it or expresses some other form of self doubt, try to validate their apprehensions and attempt to either break down the movement to smaller components or physically assist them as they try it. Create building blocks for success and convey confidence in your students and they will feel more comfortable being playful in their practice.

• Recovery
Notice if your client is breathing hard or tensing during a challenging pose. Instruct everyone to come out of the pose and rest in child’s pose or another restorative position. Encourage them to feel the effects of exertion in their bodies and to notice where they may still be holding tension and to relax there. Suggest they take a ‘recovery’ breath to reconnect to their full breath rhythm so they feel fueled to succeed in the next pose. Learning to take a ‘time-out’ in practice helps us learn when to acknowledge that we need a rest in real life.

• Balance
When students are struggling with a standing pose due to difficulty with balance, remind everyone that balance is achieved when there is harmony between our inner and outer states. Encourage students to first ground their attention by tuning in to the depth of their breath and to select a focal point with their eyes. If they continue to feel challenged in the pose suggest they move into an easier pose and focus on what may be distracting them emotionally.

Try reminding students that the same techniques used for balancing in class are used when they are out in the world. If they find themselves getting caught up in the hectic pace of daily life, they can stop, find a focal point, and connect to the breath at any time. Remind them to scan their body for where they feel out of balance and to wait until the sensation of frenzy subsides.

• Gratitude
The end of class is the perfect time to share something that might be inspiring to your students. They are in a relaxed, receptive, and introspective state. Ask yourself what message you would like your students to take with them as they roll up their mats and walk out into the world? This can be a beautiful gift for you to offer your clients that will help them thrive until the next session.

For me, if the only thing a student gets from my class is a sense of groundedness and appreciation for themselves, then I’ve done well. When I bring students out of savasana, I ask them to take a slow, deep breath in honor of their bodies and all it does for them without even having to think about it. I ask them to thank themselves for the gift of time that they have invested in their practice knowing that they are better for it. In a world where most people focus on their shortcomings and imperfections, learning personal gratitude can be like emotional armor.

*These same concepts apply for Physical Therapists as well. Given the objective nature and restraints of the medical system it can be easy to forget to actually connect to the patient. Taking a moment to ‘hear’ the patient each visit and validate the impact of the healing journey on their life can greatly improve outcomes, increase attendance/ compliance, and promote patient autonomy. Patients can easily focus on the impairments and functional limitations, but it’s our job to help them zoom out and see the bigger picture that our bodies are more than the sum of their parts.

While on the mat, obstacles are overcome similar to those we face at work and home, such as keeping balance, focus, calmness, strength, patience, and self-acceptance. Let your clients know that you have respect for their efforts and individual human journey. Let them know you are grateful to see them today and invite them to share a moment of gratitude for all they experience in their life. Regardless of physical injuries, disabilities, anxieties, or unexpected changes in life, if we allow our walls to fall down we can rekindle a sense of aliveness and union with ourselves, others and the world. That is true healing. That is something to be truly grateful for this holiday season.

Image: Health Spa Blog



Crystal Frazee is the owner and director of Stillwater Body in Grand Haven, MI. She is a Doctor of Physical Therapy and yoga teacher who specializes in outpatient orthopedics. Her focus is developing yoga based physical therapy programs for patients in the health care setting and sees clients privately for Therapeutic Yoga. She works with people to develop personal programs to shift from surviving to thriving in their bodies. She also creates programs to educate yoga teachers on the mechanics of movement and how to adapt yoga practices for special populations.

Fundamentals for a Healthy Spine, Part 1

I’m taking a break from my Asana Analysis posts in order to spend some time reviewing more general concepts important for a healthy spine in any pose.

All clients who have had back pain (or who want to prevent its occurrence) should master the following:
*Learn basic anatomy of the spine, including how to achieve ‘neutral spine position’ in quadraped (hands and knees), supine
(lying face up), seated and standing postures.
*Understand how to locate and engage core muscles: transverse abdominus, pelvic floorm multifidi, and longus coli muscles
and their relationship to the Bandhas.
*Learn appropriate breathing techniques: Victorious/Ujjyi or TATD Breath , to be done with asana and Diaphragmatic Breath, for relaxation.
*Incorporate above concepts in Asana practice.
*Learn the benefits of Relaxation and Restorative postures

Today we’ll review spinal anatomy and ‘neutral spine postition.’

All PTs and most yoga teachers are familiar with the concept of normal spinal curves but we often neglect to spend a lot of time helping clients to really master the ability to find and maintain these curves. I use the phase ‘neutral spine position’ or NSP to indicate a natural inward curve of the lower back (lumbar lordosis), a slight outward curve between the shoulder blades (thoracic kyphosis) and an inward curve of the neck (cervical lordosis).

These curves are important because they provide the optimal alignment of the facet joints of the vertebrae, the least amount of pressure on the discs, the most space for the nerve roots exiting the spinal canal and the best length-tension ratio of the trunk muscles. Ultimately they help us to acheive strength without tension.

Spine Universe is a good resource for reviewing more detail about the structure of the spine. They have great pictures that show the joints, ligaments, nerves and blood supply of the spine.

Asana & Back Pain:
When a client is recovering from a back injury, one of the safest ways to resume asana is to limit poses to those they can do with a neutral spine position. However, sometimes patients are unable to even get into a neutral position due to a mechanical block, pain or both. These are the people who need manual physical therapy and/or medical intervention before attempting to practice asana. A yoga practice that includes meditation, pranayama and review of yamas and niyamas is helpful and should be encouraged during periods of limited physical activity.

When practicing neutral spine position, the first goal is to be able to find the posture independently. Initially this best done with a teacher or partner who can observe and give feedback about spinal alignment because even the most experienced yogis are often not fully aware of subtle shifts in posture. The next goal is to improve stabilization and muscular endurance while holding NSP in various postures.

Asanas in which you or your clients can practice actively holding a neutral spine position, in order of difficulty:
Mountain/Tadasana
Hero/Virasana
Tree Pose/Vrksasana
Plank or Plank on the Wall
Hover/Chaturanga Dandasana- This pose requires a good deal of core strength as well as arm strength. It can be modified by practicing in a kneeling position or by using a bench or tabletop.
Warrior III/Virabhadrasana III - This pose also requires good core strength as well as adequate flexibility in the hamstrings in order to achieve NSP.
Half Moon/Ardha Chandrasana - Adequate flexibility of the hamstrings and adductor muscles is necessary for NSP. This pose can be supported with props and/or a wall.

Supine asanas in which you or your clients can be supported in a neutral spine position by placing folded blankets, towels or small bolsters under the lumbar and cervical curves:
Reclined Hand-Foot /Supta Padangusthasana
Legs on the Wall/Viparita Karani
Savasana

Next time I’ll review the anatomy of some common diagnoses and how they relate to spinal curves.

A Virtual Birthday

The Pragmatic Yogi is a year old today!


This is my 80th post since I started writing about yoga and physical therapy and a few other random thoughts along the way. It hard to believe it all started when I went to a local bookstore last year and took a workshop on blogging, taught by a lovely 14 year-old girl and her mother.

It’s been a lot of fun and I am delighted and encouraged when I hear from you, my readers. What a pleasure to know that I have readers across the country and throughout the world, including Japan, Australia, Finland, the Netherlands, Nicaragua and Canada. It’s been great to connect with other PTs out there who also believe that yoga complements our profession. And it’s been an honor to hear from yoga teachers who have let me know that my insights on asana have been valuable to them.

I intend to keep writing regularly and I hope you will all keep reading. Please share your thoughts and ideas with me, comment on my posts, and get in touch with me if there is anything in particular you want to read about. And don’t forget to tell your friends about the Pragmatic Yogi too!

Thank you everyone, Thanks y’all, Gracias, Domo arigato!

Pushing Pills for Pain

Interesting news:
FDA Approves Cymbalta for Chronic Musculoskeletal Pain.

According to the Wall Street Journal, the FDA's decision is based on three studies, only two of which showed better results than a placebo after three months. These studies were conducted by the company that sells the drug, Eli Lilly. I wonder what the results would be if they did a study comparing these drugs to physical therapy treatment, including manual therapy, exercise and postural re-education? How would it compare to 3 months of a comprehensive yoga program? What would the results be 6 months later, a year, or five years later?

On the other hand, I know that the right medication is often the 'magic bullet' that can help people with chronic pain to break up a vicious cycle of pain, depression, and lack of motivation. It can help them to be able to tolerate a physical therapy program or to be able to be embrace a more active lifestyle.

Is this welcome news for those with chronic pain or another scheme for for drug companies to push more pills? Tell me what you think.

Pragmatic Yogi posts referring to pain:
Why See a PT?
It Hurts to be Sad and Angry
Yoga Heals: Update on Fibromyalgia and M.S.
The Living Spine
Evidence to Support the Validity of Acupuncture

Photo credit: Discovery Health

Asana Analysis: Standing Forward Fold/Uttanasana

Standing Forward Fold can be wonderful way to release physical and mental tension. It is an intense stretch for hamstrings but is also a good posture for quieting the chatter of the mind and sharpening an inward focus. But Uttanasana is not for everyone. See ‘PT Notes’ below for a discussion of the risks and contraindications for this pose.

Muscles Stretched: Hamstrings, gluteals, piriformis, other small external rotators, errector spinae,

Points of Body Awareness:
*Notice how the weight is distributed in the feet. Have you shifted back onto your heels? Are you carrying more weight on one side than the other? Have the arches of your feet collapsed?
*Distribute the weight evenly and maintain neutral foot posture (arches slightly lifted with good contact in the four ‘corners’ of the feet: inner and outer heel bone, ball of the big toe and of the pinky toe).
*Maintain muscular support in the legs and belly. The quadriceps lift the kneecaps up and the navel draws in toward the spine.
*Relax the upper body. Let the head hang down. Let gravity provide traction to the neck.
*You may feel some discomfort in the back of the legs however it should not feel like a sharp or shooting pain. If you notice sharp pain or numbness that increases as you hold Uttanasana, stop or modify the pose.
*Breathe into the connective tissue and muscles of the lower back. Hold for 3 to 6 slow, steady breaths.
*Do you notice a subtle rising and lowering of the torso that is in sync with the breath?
*Inhale as you rise back up with a long, strait spine.

To Modify: Take pressure off the hamstring muscles and sciatic nerves by bending the knees slightly. Or bend the knees a lot and rest the belly on the thighs in order to feel a deep release of the lower back.

For an intense stretch of the hamstrings with less spinal flexion, use blocks under the hands and keep the head and shoulders lifted. Try to tip the pelvis forward (move hip points/ASIS closer to the thighs) and maintain length in the spine.

To Challenge: Keep the feet together, rather than hip-distance apart. This is more difficult because the hamstrings and sciatic nerve are under more tension. This is also true for a another standing forward fold, Padahastasana/Hands under Feet Pose.

PT Notes:
This posture is one that may feel like a cardinal sin from the perspective of a PT. How often have we taught people to ‘bend with you legs, not your back!” Who doesn’t remember that chart of how much pressure is placed on the discs when the spine is flexed? But in our zeal to teach ‘correct’ posture and body mechanics, we may inadvertently cause rigidity in minds and bodies. Teaching a patient that it is never okay to let the spine flex may lead to a pattern of stiffness and hypertonicity of the superficial erector spinae muscles.

Years ago I realized that people can not and should not stop flexing their spines. However they should have a spine that is able to flex in a healthy and efficient manner. Repetitive and prolonged spinal flexion is harmful. Lifting, pulling and twisting with spinal flexion is risky. But allowing the spine to bend with good muscular support, with adequate segmental motion, and with a conscious intent to relax tense, overworked muscles can be very therapeutic for many people.

Observing a patient in a standing forward fold posture can reveal a lot. How much do they flex in the lumbar spine or in the hips? Is all their motion occurring in the thoracic spine? Do they weight shift to one side? Does the torso sidebend? Do they have scoliosis? Equally important is how they move into and out of the posture. Is it smooth or is there a juddering quality? Do they have a hitch to one side? All of this information can be useful in selecting appropriate variations of Uttanasana and other poses for your patient.

Uttanasana is obviously contraindicated for anyone with a symptomatic disc herniation or with acute neurological signs elicited by lumbar flexion. It is also contraindicated for those with glaucoma, detached retina, high blood pressure or any other condition that is exacerbated by a head-below-the-heart posture. For those patients, Down Dog on a Wall is a good alternative pose for stretching hamstrings. Anyone with a history of a low back injury or with osteoporosis should proceed cautiously.

Tips to Minimize Stress in the Low Back:
*Do not attempt Uttanasana unless you have good mobility in the hips. Practice anterior pelvic tilts, cow pose, and child’s pose to improve the mobility of the lumbo-pelvic-hip complex.
*Know how to engage transverse abdominis properly and do so as you move in and out of the pose and while you hold it.
*Keep the knees bent.
*Let the spine lengthen. If the spine (including thoracic region) feels rounded, try a modification that will allow for greater length of the torso.
*Do not hold the pose longer than 30 seconds.

See Roger Cole’s article in Yoga Journal for more information about protecting the lower back.

Photo credit: Yoga Journal

Yoga Rocks

Yet another sign of the growing diversity of yoga lovers was embedded in the pages of the New York Times on Sunday. The frontwoman of the heavy metal band, Salome, is a yoga teacher. (She’s apparently also an aspiring physical therapist.) Her name is Kat Katz and she considers singing to be part of her spiritual practice. She says, “When I sing, it allows me to be present. I think of music as a way to connect. In yoga they believe that emotion is just energy, and if you raise your energy, you can get closer to reaching God.”

Heavy metal music and yoga, even physical therapy, seem to be antithetical. Heavy metal is loud, angry and defiant while yoga and PT are typically soothing, healing practices. And PTs, in particular, tend to be chipper and happy people, eager to please. But that is precisely the beauty of being a heavy metal-singing yoga teacher. To be able to embrace a full spectrum of human experience and to appreciate the paradoxical nature of light/dark, good/bad, and silence/noise is an essential lesson in yoga.

Several yoga blogs have recently debated the merits of music versus silence in yoga classes. I wonder if Ms. Katz uses music in her classes? Is there ever a place for heavy metal music in a yoga class? I certainly wouldn’t find it relaxing but a quick Google search revealed that Ms. Katz has a particularly good rapport with teens. I can see how a woman who embraces heavy metal music might be more in touch with the teenage mind. She is probably a wonderful teacher for kids who feel a range of intense emotions and who struggle with self-identity, whether or not she incorporates her music in her classes .

A few weeks ago I wrote about country music singer Jennifer Nettles of the band Sugarland. Both of these singers represent a subculture that isn’t typically associated with yoga. Okay, yes, they are both white women which is very typical of yoga in America but country music lovers and heavy metal rockers are not who you might expect to be on the mat next to you or in front, leading the class. Their enthusiasm for yoga is evidence that it is a universal practice that appeals to people from all walks of life. They are opening doors for those who might otherwise never experience the bliss of yoga and for that I say...

Rock on!

Asana Analysis: Warrior I/Virabhadrasana

I must confess, this is one of my least favorite postures. I have struggled with it myself and many patients have had difficulty with this pose. But it is an important pose because it is a part of almost any yoga class and when done well, is a great way to improve strength and flexibility of the legs and spine.

Muscles Strengthened: Front leg - quadriceps, hamstrings, gluteus maximus and medius, piriformis, soleus, peroneals. Rear leg - quadriceps, gluteus maximus, pectineus, posterior tibialis. Torso - obliques, transverse abdominus, errector spinae. Arms - deltoids, triceps, rotator cuff muscles.

Muscles Stretched: Rear leg - iliacus, psoas, adductors, gastrocnemius.

Points of Body Awareness:
*The front knee is directly above the ankle. Be sure the front knee is not forward or to the inside of the big toe.
*The back hip point (ASIS) moves toward the front of your mat but will not be even with the other side.
*Are your shoulders square to the front of your mat? Be sure they are before raising your hands overhead.
*Is the back heel grounded? If not, try a modification to improve the stability of the posture.
*If the back heel is grounded, note the alignment of the mid-foot. Is the inner arch flat? If so, try to draw it away from the floor, creating space about the size of a robin’s egg. (This engages the posterior tibialis muscle).
*Keep both legs strong, sink the pelvis down while lifting and lengthening the spine.
*Can you comfortably drop the head back, behind the arms and gaze up at the thumbs? If not, keep the hands shoulder-distance apart and lift the gaze toward the ceiling with the ears between the arms.
*Hold for 5 or 6 slow, steady breaths.

To Modify: The more the front hip and knee are bent, the more strength is required to hold the pose. Beginners or those with leg weakness will start with about 45 to 60 degrees of hip and knee flexion and over time, progress closer to right angles.

If you feel wobbly or unbalanced in the pose or if you have discomfort in the back hip or lower back, try using a wider stance. Instead of a heel-heel or heel-arch alignment, let the back foot be closer to the edge of the mat.


If you are unable get the back heel on the ground, use a wedge under the heel. This can be a rolled up mat or small towel. Or try pressing the heel onto a wall behind you.

Do High Lunge or Crescent pose as an alternative to Warrior 1. This is particular useful if there are any injuries of the foot, ankle, knee or hip of the back leg.

To Challenge: If you are able to hold this posture with the front thigh parallel to the floor, make sure that all the subtle aspects of the pose are working. Engage the bandhas. Be mindful of your foot posture. In the front foot, try to spread the toes and keep the ball of the big toe grounded as you lift up through the inner arch. In the back foot, ground the outer edge of the heel and lift the arch without drawing that side of the pelvis back. Lift the sternum and lengthen the collar bones while at the same time, draw the lower ribs down and in and keep the tops of the shoulders relaxed away from the ears. That’s a lot to think about for one pose but ‘advanced’ yoga asana is often more about mastery of alignment, the breath and the focus of the mind.

PT Notes: Patient with foot/ankle injuries, SIJ injuries, spinal stenosis, spondylolisthesis or hip injuries should use caution with Warrior I. The rear hip is in a position of end-range extension and it is combined with adduction (narrow stance) and active internal rotation. I typically have patients practice High Lunge instead of Warrior I, until they achieve the strength and flexibility necessary to perform Warrior I properly and without symptoms.

See Warrior II for notes about doing this pose with foot/ankle injuries.

Recent Revelation: This pose is a backbend. Many yogis (including myself until recently) try to maintain a neutral lumbar spine in this pose. I used to feel very uncomfortable in the front of the hip and/or the SI joint of the back leg, especially when cued to further extend the knee. In her latest book, Judith Lasater suggests that you lift the sacrum rather than ‘tucking’ it, allowing for more extension in the lumbo-sacral spine. Once I tried this, I was much more comfortable and able to find more strength in my rear leg.

Top image from Yoga Art+Science.

Photo of Modified Warrior I from 'Yoga & Physical Therapy Workshop' that I taught in Lima, Peru in April, 2006.