“. . . 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



Thursday, September 26, 2013

Refining Your Forward Bends With The TFL


"God is in the Details"--Ludwig Mies van der Rohe

Attention to detail integrates mindfulness meditation into your Hatha yoga practice, enhancing the benefits. This blog post  illustrates a detailed tip for engaging the TFL in the forward bend Upavista konasana, its biomechanical basis and the benefits of utilizing this important muscle in your forward bends.

Here’s the anatomy…

The tensor fascia lata originates from the front part of the iliac crest and outer surface of the anterior superior iliac spine (ASIS). It inserts onto the iliotibial tract (IT band), which continues on to the front outside of the tibia (lower leg bone). It is considered a polyarticular muscle because it crosses both the hip and knee joint. Thus, contracting the TFL can influence both the hips and the knees, as we illustrate below.

Here’s the cue…

I always begin by taking the general shape of the pose. In the case of Upavista konasana this means taking the legs apart (abduction) and extending the knees. Then I actively engage the quadriceps to straighten the knees. This initiates reciprocal inhibition of the hamstrings, preparing them for the stretch. Next, I bring in the tensor fascia lata (TFL). The cue for this is to press the heels into the mat and then attempt to drag them apart (abduction). This causes the TFL to contract, which you can feel by placing your hands on the sides of the hips as shown below. Pressing the sides of the feet with your hands augments this cue (see figures 1 and 2 below--click on image to enlarge).

Figure 1 illustrates pressing the heels down and attempting to drag the feet apart. Figure 2 shows how you can feel the TFL contract. Figure 3 is an intermediate version of the pose.

Attempting to drag the feet apart with the heels fixed in place on the mat uses the primary action of the TFL (hip abduction) as a cue to access its secondary actions—knee extension, and hip flexion and internal rotation. Knee extension synergizes the quadriceps and helps to align and protect the knees. Hip internal rotation counteracts the thighs rolling outward as a result of the pull from stretching the gluteus maximus. The TFL synergizes the psoas for hip flexion and contributes to femoral-pelvic and lumbar-pelvic rhythm. You can learn more about the concept of joint rhythm and its effect on the spine from our blog post “Preventative Strategies for Lower Back Strains in Yoga”. Figure 4 illustrates these actions in Uppavishta konasana.

Figure 4 illustrates the action of the TFL on tilting the pelvis forward, internally rotating the thighs and synergizing the quadriceps to extend the knees.

Once you get the hang of this cue in seated angle pose, try it in other forward bends like Janu sirsasana (figure 5). This illustrates the concept of “portability” for these cues. For many more similar tips, check out the Yoga Mat Companion book series. Learn about the individual muscles in the context of yoga from The Key Muscles and Key Poses of Yoga (you can use the "page through" feature to see the entire books).

Figure 5 illustrates the action of the TFL on tilting the pelvis forward, internally rotating the thighs and synergizing the quadriceps to extend the knees in Janu sirsasana.


If you would like to learn more about combining modern Western science with the ancient art of yoga, please join us for a week in paradise at Blue Spirit Costa Rica for our second annual intensive on anatomy, biomechanics and therapeutics for Hatha yoga. I will be teaching state of the art techniques on these subjects, including much new material relating to therapeutic applications of yoga--all with great 3-D illustrations, excellent food, beautiful facilities and expertly taught daily Hatha yoga classes. We encourage you to register soon, as this workshop is nearly full.

Thanks for stopping by the Daily Bandha. Stay tuned for our next post when I'll go over a common condition affecting the shoulder joint and its yoga solution.  Also, we greatly appreciate when you share us on Facebook, Twitter and Google Plus.


Namaste'

Ray and Chris

Friday, September 20, 2013

Plantar Fasciitis, Myofascial Connections and Yoga

The therapeutic benefits of Hatha yoga arise from whole body energetic balancing combined with distinct biomechanical adjustments. We gave an example of this in our last blog post, where we looked at the disorder known as adult acquired flatfoot deformity, its biomechanical basis and how to utilize yoga to maintain healthy foot arches. In this post we focus on the plantar fascia of the foot and examine the most common cause of heel pain—plantar fasciitis—to see what happens when things go wrong. Finally, we consider how yoga can be used to bring things back into balance and even to prevent this condition. First, let’s look at fascia in general.

A fascia is a fibrous structure that is formed from sheets of connective tissue. The deep fascia covers and invests muscles, tendons, ligaments and blood vessels throughout the body. An important example of a deep fascia is the thoracolumbar fascia. All yoga practitioners should be familiar with this structure and its myofascial connections, as it forms a critical support system for the lumbar spine and sacroiliac joint. Other types of fascia include the superficial fascia of the subcutaneous tissue (under the skin), and the visceral and parietal fascia, which surround organs such as the heart and lungs. Figure 1 illustrates the deep fascial elements of skeletal muscles. Click here to see this in the context of stretching and Hanumanasana (front splits).


Figure 1: The deep fascia covering and investing skeletal muscle.

The plantar fascia or plantar aponeurosis (you can use either term) originates from the medial tubercle of the calcaneus (heel bone) and continues forward to attach to the proximal phalanx of each of the toes (via the plantar plates). Extending (dorsiflexing) the toes tightens the plantar fascia, thus elevating the foot arch. During this process, the metatarsal heads act as pulleys to form a “windlass” that tightens the plantar aponeurosis. The plantar fascia has elastic qualities in that its fibers are somewhat wavy in the relaxed position. These fibers straighten in response to forces applied (like the heel-off phase of gait). Thus, the plantar fascia can store energy like a spring. Figure 2 illustrates this concept.

Figure 2: The windlass mechanism of the plantar aponeurosis (fascia).

The plantar aponeurosis also forms a myofascial connection with the muscles of the calf (gastrocnemius and soleus) via the Achilles’ tendon and, by extension, the hamstrings (and potentially other muscles of the posterior kinetic chain). Forces that stretch the plantar fascia are distributed along these muscles. Conversely, tightness in these muscles can adversely affect the function of the plantar fascia and thus the arch of the foot. Figure 3 illustrates these myofascial connections in Downward Facing Dog pose.

Figure 3: The myofascial connections to the plantar fascia in Downward Dog pose.

Plantar fasciitis is an overuse injury related to repetitive overstretching of the plantar aponeurosis. In this condition the forces of gait are concentrated where the plantar fascia attaches to the calcaneus, instead of being distributed over the fascia and the muscles at the back of the legs. This results in microtrauma to the plantar aponeurosis near its origin, causing inflammation and heel pain. Risk factors for developing plantar fasciitis include tight calf muscles and hamstrings, endurance-type weight bearing activity (such as running) and a high body mass index. Figure 4 illustrates plantar fasciitis. Click here to see a reference MRI image of this condition. 

Figure 4: Plantar fasciitis (note the inflammation at the origin of the plantar aponeurosis).

Note that there are other conditions that can cause heel pain. An example of such a condition is a stress fracture of the calcaneus, which is also seen in runners. This problem is treated differently from plantar fasciitis. Accordingly, if you have heel pain be sure to consult a health care practitioner who is appropriately trained and qualified to diagnose and manage such conditions. Use your knowledge of pathological conditions to deepen your understanding of the body and to work with yoga as an adjunct in prevention and treatment. 

Since one of the most important aspects of managing this condition is stretching of the plantar fascia, heel cords (gastrocnemius/soleus complex) and hamstrings, yoga offers an ancient preventative solution.  For example, Downward Dog pose stretches both the hamstrings and heel cords. Click here to see how to use reciprocal inhibition to release the gastrocnemius and soleus muscles and allow the heels to lower to the floor in Downward Dog. 


Figure 5: Stretching the plantar aponeurosis (fascia) in Chaturanga dandasana.

Chaturanga dandasana (figure 5) stretches the plantar fascia itself. Use this image to aid in visualization of this process while in the pose. One of our previous posts gives some tips on how to ease into Chaturanga and another describes a key muscular co-contraction in this pose.

Uttanasana illustrates a stretch of the posterior kinetic chain, linking to the feet (figure 6). Click here for a tip on integrating the hip abductors to access sacral nutation to refine Uttanasana. Thus, we can see that the Sun Salutations (Surya Namaskar) offer an ancient self-contained method for working with the plantar fascia and its myofascial connections to maintain a healthy foot arch. For many more tips and cues like this, check out the Yoga Mat Companion book series and The Key Muscles and Key Poses of Yoga.

Figure 6: The posterior kinetic chain and its connection to the feet in Uttanasana.

We conclude with a step-wise technique on using biomechanics and physiology to lengthen the heel cords in Janu Sirsana (seated forward bend): 

Step one: Bend the knee about 15 degrees to release the gastrocnemius muscle at its origin on the posterior femur.

Step two: Use the hands to gently draw the ankle into dorsiflexion and stabilize it in this position by engaging the biceps to flex the elbows. The cue I use for this is to "draw the top of the foot towards the front of the shin (dorsiflexion)."

Figure 7: Steps to release and then lengthen the calf muscles in Janu sirsasana.

Step three: Hold the foot in place and gradually engage the quadriceps to straighten the knee. Ease into this position. Maintaining the ankle in some dorsiflexion with the arms and extending the knee distributes the stretch throughout the calf muscles (the gastrocnemius and soleus) as illustrated here. 

Figure 8: The myofascial connection between the plantar fascia, heel cord and calf muscles.

You can add a facilitated stretch to the calf by gently pressing the ball of the foot into the hands for 8-10 seconds and then taking up the slack by further dorsiflexing the ankle. This activates the Golgi tendon organ at the muscle tendon junction, resulting in relaxation of the contractile elements. We describe a similar technique to lengthen the hamstrings, as well as the physiological basis for facilitated stretching in our blog post on how to lengthen the hamstrings in Janu sirsasana.

Thanks for stopping by the Daily Bandha. Stay tuned for our next post when I'll go over a common condition affecting the shoulder joint and its yoga solution.  Also, please be sure to share us on Facebook, Twitter and Google Plus. Also, click here to browse through our collection of books on anatomy, biomechanics and yoga.


Namaste'


Ray and Chris



References:

1) Neufeld SK, Cerrato R. “Plantar fasciitis: evaluation and treatment.” J Am Acad Orthop Surg. 2008 Jun;16(6):338-46.

2) Digiovanni BF, Nawoczenski DA, Malay DP, Graci PA, Williams TT, Wilding GE, Baumhauer JF.  “Plantar fascia-specific stretching exercise improves outcomes in patients with chronic plantar fasciitis. A prospective clinical trial with two-year follow-up.”  J Bone Joint Surg Am. 2006 Aug;88(8):1775-81.

3) Riddle DL, Pulisic M, Pidcoe P, Johnson RE“Risk factors for Plantar fasciitis: a matched case-control study.”  J Bone Joint Surg Am. 2003 May;85-A(5):872-7.

4) Pohl MB, Hamill J, Davis IS. “Biomechanical and anatomic factors associated with a history of plantar fasciitis in female runners.” Clin J Sport Med. 2009 Sep;19(5):372-6.

5) Harty J, Soffe K, O'Toole G, Stephens MM. “The role of hamstring tightness in plantar fasciitis.”  Foot Ankle Int. 2005 Dec;26(12):1089-92.

6) BolĂ­var YA, Munuera PV, Padillo JP. “Relationship between tightness of the posterior muscles of the lower limb and plantar fasciitis.”  Foot Ankle Int. 2013 Jan;34(1):42-8.

7) Labovitz JM, Yu J, Kim C. “The role of hamstring tightness in plantar fasciitis.”  Foot Ankle Spec. 2011 Jun;4(3):141-4







Friday, September 6, 2013

Connecting To Your Feet In Yoga

Greetings Friends, 

Welcome back to The Daily Bandha. I’m just now returning to the blogosphere after completing an intensive year of study in Sports Medicine and will be sharing with you some of the knowledge I gained about the body and how to apply it to your yoga practice and teaching. Our first post in this series looks at a common disorder that can affect the foot.

You can learn a great deal about the normal function of the musculoskeletal system by looking at what happens when things go wrong. This knowledge can be used to deepen your practice, prevent injuries and to understand the role of yoga as a therapeutic adjunct in the management of various disorders. With this in mind, let’s focus on the condition known as adult acquired flat foot deformity, it’s anatomical basis and how to work with yoga to maintain a healthy foot arch.

As I discuss in "The Key Muscles of Yoga" and "The Key Poses of Yoga", mobility and stability about the joints is a function of three variables; the shape of the bones, the capsuloligamentous structures that connect the bones to each other at the joints, and the muscles that surround the joint. Adult acquired flat foot deformity is a disorder that relates to a muscular insufficiency of the tibialis posterior muscle, which in turn leads to weakening of the calcaneo-navicular ligament and then collapse of the bony arch.

The underlying muscular imbalance in acquired flatfoot deformity is between the weakened tibialis posterior muscle on the inside of the foot and it’s stronger antagonist, the peroneus brevis muscle on the outside. This imbalance places undue stress the calcaneo-navicular ligament that can lead to pain and collapse of the medial foot arch.

The exact underlying cause of adult-acquired flatfoot deformity is unknown, but is thought to be multifactorial; however, the muscular imbalance I describe is well established. In addition, it is associated with tightness of the Achilles tendon and it’s associated muscles, the gastrocnemius and soleus (so stretching these muscles can be an important factor in management and prevention). This problem affects women more frequently than men, typically at around the 6th decade of life.

Here’s the anatomy:


(Note: if you’re new to anatomy, focus on studying the images.)

The calcaneo-navicular ligament runs between the calcaneus, or heel bone and the navicular bone. The navicular is a boat shaped bone in the medial mid-foot (hence it’s name). This ligament is an important stabilizer of the medial longitudinal foot arch.

The calcaneo-navicular ligament supports the medial arch of the foot

The key muscle providing support for the calcaneo-navicular ligament is the tibialis posterior. This muscle originates from the interosseous membrane, the upper 2/3rds of the posterior fibula and the upper posterior tibia. After passing under the calcaneo-navicular ligament, it splits into two parts: one inserts onto the navicular bone and the other divides again to insert onto the plantar surfaces of second through fourth metatarsals and the second cuneiform bones (of the midfoot).

The bones of the foot with muscle insertions

The principle action of the tibialis posterior is to invert (supinate) the foot, with secondary actions of adduction of the foot and flexion of the ankle. It is an important stabilizer of the midfoot during the “heel off” phase of walking. The tibialis anterior muscle, which inserts onto the inside of the midfoot, works with the tibialis posterior to invert (supinate) the foot.

Pressing down the outer edge of the foot engages the tibialis posterior and anterior

The antagonist to the tibialis posterior is the peroneus brevis muscle, which originates from the lower 2/3rds of the lateral (outer) fibula bone and inserts onto the styloid process at the base of the fifth metatarsal. It acts to evert (pronate) the foot and plantar flex the ankle. The peroneus longus works with the peroneus brevis to evert (pronate) the foot. It also helps to stabilize the transverse arch.

Pressing the ball of the foot engages the peroneus longus and brevis


Here’s the yoga cue…


In standing poses like Utthita Trikonasana, press the outer edge of the foot into the mat to engage the tibialis posterior. Holding this action, then press the ball of the foot into the mat to engage the peronei. Note how the medial (inside) foot arch lifts. This sequence of cues: 1) uses the tibialis posterior to support the medial arch and; 2) uses the peronei (on the outside of the lower leg) to provide resistance to strengthen it’s antagonist, the tibialis posterior. The biomechanical term for simultaneously engaging antagonist muscles is “co-contraction” or “co-activation”. We illustrate many examples of co-activation in the Yoga Mat Companion book series.
Co-activating the muscles that invert and evert the foot

Once you get a feel for this in the back foot, then try the same sequence in the front foot, and then in other poses such as tadasana. To see an example of this in downward facing Dog Pose click here. You can also combine it with engaging the thoracolumbar fascia to lengthen the trunk in Dog pose. Click here for more information on the thoracolumbar fascia.

Working with these types of cues strengthens the arch of the foot. This gives a feeling of lightness in the step as we go through the day. Remember that the feet are important centers in energetic anatomy and physiology and are thought to be the location of minor chakras. Finally, look at the importance of the feet for the mind-body connection, as illustrated by their representation in the brain on the homunculus.

Thanks for stopping by. Be sure to click here to page through our complete books. Stay tuned for our next post on the foot and yoga. Also, please be sure to share us on Facebook and Twitter.

Namaste’,

Ray and Chris


References:

1) Alvarez RG, Marini A, Schmitt C, Saltzman CL. “Stage I and II posterior tibial tendon dysfunction treated by a structured nonoperative management protocol: an orthosis and exercise program.” Foot Ankle Int. 2006 Jan (1): 2-8

2) Imhauser CW, Abidi NA, Frankel DZ, Gavin K, Siegler S. “Biomechanical evaluation of the efficacy of external stabilizers in the conservative treatment of acquired flatfoot deformity.” Foot Ankle Int. 2002 Aug; 23 (8): 727-37.

4) Lin JL, Balbas J, Richardson EG. “Results of non-surgical treatment of stage II posterior tibial tendon dysfunction: a 7- to 10-year followup.” Foot Ankle Int. 2008 Aug;29(8):781-6