“. . . according to the Yoga Sutra (3.1), the term [Bandha] refers to the ‘binding’ of consciousness to a particular object or locus (desha), which is the very essence of concentration.”
Georg Feuerstein



Tuesday, January 17, 2012

The Benefits of Engaging the Quads in Forward Bends (and the risks of misguided cautions)

In our last post we mentioned that true caution is based on accurate knowledge and wisdom; practicing it in yoga enhances benefits and minimizes risks. In this post, we talk about misguided caution and provide a couple of examples. This type of caution is usually based on fear: If you do “this”, a bad thing will happen. In fact, misguided cautions can enhance the risks and diminish the benefits of yoga because following them, among other things, diverts your focus from what is important. In a sense, this is a type of passive aggressive way to decrease benefits and increase risks.

Two widely circulated examples of misguided caution relate to engaging the quadriceps in various yoga poses. One is that people with strong quads and misaligned kneecaps experience rapid progression of arthritis, and the second is that we should avoid contracting the rectus femoris in forward bends because it can cause “congestion”. Neither of these misconceptions has any basis in science, yet they are prevalent and have been incorporated into the curriculum of yoga, creating a conflict among teachers and practitioners. This has resulted in many teachers discouraging students from engaging these important muscles for fear of potential injury. I’ll address each of these “cautions” in turn later in the post, but in order to help resolve this conflict, let’s go over some of the basic science for the muscles and joints and then look at the benefits of engaging the quadriceps in a forward bend like Marichyasana I.

As I discuss in my books, joint stability is determined for each individual articulation by a combination of three factors: bone shape (ball and socket vs. hinge, etc.), the capsule and ligaments, and the muscles. At the joint, the bones are covered with articular cartilage. This cartilage and the ligaments surrounding the joints should be protected during a stretch. Stretching ligaments beyond about 6% of their normal length (from which they still recoil) can result in loss of their contribution to stability, especially if done on a regular basis. Unstable joints become incongruent; their surfaces do not match perfectly according to their design. When joint surfaces become incongruent, this can damage the articular cartilage and lead to arthritis. The muscular stabilizers form a type of dynamic sleeve around the joints and aid in protecting them by maintaining joint congruency. This concept is well supported, especially by experts in body weight training (a time-honored system similar to gymnastics that uses the body weight itself for conditioning, rather than external weights).

The beneficial effect of activity—which necessarily includes muscular engagement, especially the quadriceps—on joint cartilage is also supported by the peer-reviewed medical literature, including a recent review1 of articles evaluating the effect of activity on the knee joint. The theory behind this is that cartilage responds positively to judiciously applied forces. One of the reviewed articles states:

In conclusion, we demonstrated a protective effect of past and current vigorous physical activity on knee cartilage in healthy, community-based adults with no history of knee injury or disease. 2


quadriceps in marichyasana I
The quadriceps stabilizing the knee joint in Marichyasana I.

Next, let’s take a look at the cascade of beneficial effects that ensues when you do engage the quadriceps of the extended knee in Marichyasana I. This includes: 1) improved joint alignment and stability at the knee; 2) release of the hamstrings through reciprocal inhibition (so that lengthening occurs in the muscle belly, rather than overstretching in the tendons); and 3) the rectus femoris synergizes the psoas in flexing the hip and tilting the pelvis forward. This aids in preventing hyperflexion of the lumbar spine in the pose through joint coupling (lumbar-pelvic rhythm). (For those who tend to hyperextend the knee, use co-contraction of the quadriceps and hamstrings to maintain alignment).

rectus femoris in marichyasana I
The rectus femoris synergizing anterior tilt of the pelvis.

This is only one example of one muscle benefitting a pose; obviously we don’t engage all of the muscles at once in any given pose and may even relax completely in certain restorative poses. What I recommend is incorporating periodic muscular engagement into your practice—I call this “walking around the pose”. In addition to the benefits described, practicing in this way establishes the mind-body connection and focuses attention, thus creating a meditative state within a hatha yoga practice. The Mat Companion series takes you through the muscles involved in stabilizing the joints in the asanas as well as cues for engaging them—and much more. Feel free to browse through this collection at the Bandha Yoga website.

Now, let’s look at the two examples of misguided caution that we cited earlier:
The first states that “people with strong quads and misaligned kneecaps experience rapid progression of the disease” (arthritis). This is apparently a distorted interpretation of a peer-reviewed article (to put it charitably) that was circulated in 2011. I discussed it in a previous blog post.

The second implies that contracting one of the heads of the quadriceps, the rectus femoris, causes “congestion”. Congestion, in the medical sense, is caused by an upstream blockage to the flow of blood (or lymph). A blood clot within a vein or a mass lesion (such as a tumor) pressing on it from the outside can cause congestion. It can also be caused at the capillary level through various pathological processes. Congestion is not caused by muscle contraction.

rectus femoris in relation to femoral artery, vein and inguinal lymph nodes
The rectus femoris in relation to the femoral artery and vein and inguinal lymph nodes.

In fact, engaging muscles (like the rectus femoris) produces a “pumping” effect on both the lymphatics and veins, which improves venous flow and relieves “congestion”. One of the reasons that we mobilize patients as soon as possible after surgery is to access the pumping effect of muscle contraction and so prevent the development of venous thrombosis (a clot forming due to venous stasis).

one-way valves within muscles
Diagram of veins with one-way valves demonstrating pumping action of muscle contraction.

Furthermore, the rectus femoris shares the same innervation as the other three heads of the quadriceps (the posterior division of the femoral nerve). Therefore, you cannot relax it without relaxing the rest of the quadriceps (even if you wanted to). Thus, attempting to relax the rectus femoris in isolation (to avoid “congestion”) is an example of attempting the impossible, out of fear of the imaginary, while at the same time avoiding the beneficial.

The risks of following either of these misguided cautions include: 1) diminished alignment at the knee, with potential adverse effects on the cartilage and ligaments; 2) overstretching of the hamstring tendons; 3) decreased anterior tilt of the pelvis resulting in lumbar hyperflexion (in forward bends); 4) loss of the pumping effect on the veins; etc. You get the picture.

Basing your practice and teaching on unsound theory has the potential to contribute to the risk of injury, especially considering the number of people doing yoga today. Conversely, basing it on sound theory has the potential to provide some relief.

If you do suffer from knee pain or an injury, consult your physician; always work under a physician’s guidance to manage your condition.

Great to see you all and many thanks for your support and comments on our last post! Be sure to visit us on Facebook for your free Chakra poster and e-book. See you next week, when we’ll go over a technique for improving muscle control and proprioception that you can learn in Chaturanga and then apply to any pose!

Namaste’

Ray and Chris

.1. Urquhart DM, Tobing JF, Hanna FS, Berry P, Wluka AE, Ding C, Cicuttini FM. What is the effect of physical activity on the knee joint? A systematic review. Med Sci Sports Exerc. 2011 Mar, 43(3):432-42.

.2. Racunica TL, Teichtahl AJ, Wang Y, et al. Effect of physical activity on articular knee joint structures in community-based adults. Arthritis Rheum. 2007, 57:1261–8.

.3. Uyen-Sa D.T. Nguyen, DSc; Yuqing Zhang, DSc; Yanyan Zhu, PhD; Jingbo Niu, MD, DSc; Bin Zhang, ScD; and David T. Felson, MD, MPH. Increasing prevalence of knee pain and symptomatic knee osteoarthritis: Survey and cohort data. Annals of Internal Medicine. December 6, 2011, 155(11): 725-732.

21 comments:

  1. Thank you for the knowledge and beautiful graphics! as a nurse, both are very helpful.

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  2. I'm mostly self-taught for circumstantial reasons; having your books and this blog for reference is so helpful and empowering. Thank you. Please see http://www.khanacademy.org/. The teaching is on all levels: it's accessible and self-directed, it's visual, it's oral, it's applied. I hope someday you can offer a similar format for your Bandha yoga lessons.
    Thanks again!

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  3. Dear Ray and Chris,
    You are making a wonderful job here. I am a physician (otolaryngologist) and I medically backup your approach. There is a lot of sound medical knowledge here and it is very important to offer blind studies and reviews. The significance of engaging the reciprocal inhibition mechanism is ingenious and enhances safety. I have ordered all your books and can't wait for amazon to deliver. I hope there are more to come. I would really like to see a blog post on recommended routines for warm-up and specific areas ie routines for knee or back enhancement.
    Keep up your excellent work!
    Nikos

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  4. thank you!! It is really helpfull!
    I forward for other helpful information.
    thanks again!
    pat

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  5. Hello Ray and Chris... I so appreciate and love your blogs and books and all the great information you give us on your site. I teach approx 14 to 16 classes a week and continue to search and crave more information and confirmation on my highly tuned instincts. I just have a simple and slightly embarrassing request. I do understand most everything you tell us but would appreciate a little more layman terms so I can really grasp every morsel!
    Thank you so much... ox

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  6. Hello Nikos, Thanks for your comment and support for our work! I'm looking at some warm-up routines--will keep you posted. All the Best~Ray

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  7. Hello Anon,

    Thanks for your comment and appreciation for our work! I will work on your suggestion for using more layman terminology (pls check back for the next post). Namaste'~Ray

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  8. It is so encouraging to hear this, especially with the recent media coverage about yoga and injuries (thank you New York Times, among others!). So a massive thank you for sharing your knowledge to help us teachers and practitioners to deepen our understanding of the physical asanas. I recently read an opinion implying that yoga teachers don't need qualifications, they only need experience. Much as I find my personal yoga experience invaluable for teaching others, I am limited to but one body (in this lifetime at least), so it is both fascinating and educational to learn more about other bodies and potential issues we may come across. Namaste x

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  9. Thanks for your comment, Helen!

    I think the goal is finding ways to improve, both through experience and continued study. We are always doing this in medicine and should do the same in yoga. My personal experience has been that using knowledge of the body vastly improved the benefits of my practice--and I see that I'm just scratching the surface of what is possible. Thanks for adding your thoughts!

    Namaste'

    Ray

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  10. Thank you so much for your generous knowledge and information which I personally find very helpful in my yoga teachings & all my other classes. Please continue to send me any current info that will help me to improve in various ways. Truly appreciate you. Thank you, Your friend

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  11. I love your internal visualization illustrations.
    These really help everyone with visual learning.

    Peace,
    David

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  12. So, are you saying that the fundamental premise of Yin Yoga is wrong? (sustained 4-7 min stretches of connective tissue)

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  13. Nope, not saying that. I like to differentiate connective tissue that forms the sheath around muscles (fascia), etc. from the connective tissue that forms the cords and band-like structures of the ligaments. We lengthen the myofascia all the time in yoga and it is generally a good thing--even permanent changes. On the other hand, ligaments perform a different function at the joint. It is generally accepted that ligaments recoil from a stretch of no greater than 6% of their length--after that they begin to tear. When they get damaged like that they can start to lose their contribution to stabilizing the joint. So you want to avoid stretching ligaments beyond 6% of their length.
    I also use periodic gentle muscular engagement (of the quads, for example, in a forward bend) when I am practicing longer duration relaxed stretch that is directed towards lengthening myofascial sheaths. Periodically engaging the agonists--or yang side of a stretch--does not diminish lengthening on the antagonist (yin) side. In fact it can enhance it both biomechanically and physiologically. This engagement also re-establishes alignment and mental focus. For Yin Yoga, you should talk to someone trained in that to find out their fundamental premise. Or get their new book.
    Best~Ray

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  14. Thanks for you in depth conversation about the asana's. I love your asana images !!
    Question ......When you speak of engaging the quad, do you mean
    a quad set kind of engagement or a softer version such as simply dorsiflexing the foot? Sometimes students get very focused on intense quad muscular tensing that they are like rocks and/or the hip stabilizers go completely unnoticed and unengaged (in various poses, not speaking of only seated forward bends).

    Thanks for your time!!!!!!!

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  15. Hello Anon,

    I mean applying controlled engagement of the muscle, not rock hard quads. I apply gradual activation and release--so that it is a dynamic process. With a bit of practice (not a lot), the engagement becomes "Strong yet supple" for stabilizing the joints and creating the form of the pose.

    Thanks for commenting! Ray

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  16. Thanks for contacting attention to these concerns. I believe men and women should be skeptical of another drug program, and possibly request for non-pharmacological treatment options just before accepting drug treatments. Regrettably, with mass-advertising of drugs within this nation, we've arrive at accept routine drugs as being a standard of care instead of the exception.

    Regards,
    Nathalie
    Arthrose Behandlung Expert

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  18. Nicely seeing that care continuously is giving of yourSelf. Namaste vivid satatmane. Amour.

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  19. You done a great job by write this article about yoga :)

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  20. Thank you! I've always wondered why teachers would say "engage the quad," now I understand.

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