“. . . 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



Sunday, November 11, 2018

Trikonasana Part Three: Foot Arch Mastery

Hello Friends,

William Blake said you can see the world in a grain of sand. Similarly, fundamental principles you master in one asana are portable to others. With this in mind, let’s look at the key elements for activating your foot arch in the front leg foot in Trikonasana (Triangle Pose). Here’s the cue…

First, press the outer edge of your foot into the mat. This engages the tibialis anterior and posterior muscles of the lower leg (figure 1).


Figure 1


Maintain that action as you press the ball of your foot into the mat. This engages the peroneus longus and brevis muscles on the outside of your lower leg (figure 2).


Figure 2


Co-activating the muscles that invert (supinate) and evert (pronate) your foot creates an opposing force between these two antagonistic actions that stabilizes your ankle.

These same muscles work together (as synergists) to lift your foot arch (figures 3 and 4).


Figure 3


Figure 4



Click here to learn about another antagonist/synergist combination. Click here to learn more about your foot arch…

Review the last two posts to see how to connect the foot arch to your core.

I hope you enjoyed this blog post. Page through the Key Muscles and Key Poses of Yoga and the Yoga Mat Companion Series to learn more about anatomy and biomechanics for yoga. See you next week when I will post another tip on anatomy and biomechanics for yoga.


Best,

Ray Long, MD


Sunday, October 28, 2018

Trikonasana Part Two: Your Sacroiliac Joint

Hello Friends,

In this post, we continue our journey through Trikonasana (Triangle Pose) with a cue that connects the forward leg psoas with the back leg glutes, thus stabilizing your pelvis.

First, take a quick look at the cue from my previous post on co-contracting the psoas and quads of your forward leg. Engage the forward leg psoas and quads and then add contraction of the rear leg gluteus maximus (and quadriceps) as shown here in figure 1.


Figure 1: Co-contracting the psoas and glutes in Trikonasana.

The psoas creates a force that tilts the forward leg side of the pelvis (hemipelvis) forward (anteversion) while the gluteus maximus creates a retroversion force on the back leg side hemipelvis. You will feel how combining these opposing forces creates stability. Figures 2 and 3 illustrate this concept.


Figure 2: The opposing forces of the glutes and psoas and the posterior SI ligaments stabilizing the pelvis.

Figure 3: Opposing forces of the psoas and glutes and the anterior SI ligaments stabilizing the pelvis.

Click on the image below to learn more about the sacroiliac joint.

The ligaments of the sacroiliac joint.

Engage the muscles that create the form of the asana and the asana will emerge, along with its benefits. Learn more about this concept, along with other powerful cues for your practice from the Yoga Mat Companion Series and The Key Muscles and Key Poses of Yoga book series.

Thanks for stopping by and also thanks to all who helped out with Hurricane Michael Relief. Check in next week for the next cue for Trikonasana…


Best,

Ray Long, MD

Saturday, October 20, 2018

Co-activate Your Psoas and Quads in Trikonasana

Hello Friends,

Sometimes doing just one pose can set you up for the whole day. Let’s look at Trikonasana or Triangle Pose and a powerful cue for stabilizing your pelvis and lumbar. Understanding tips like this one also sharpens your knowledge of anatomical and biomechanical principles.

The principle at work here is that of muscle co-contraction. This cue co-contracts or activates two separate muscles, namely, the psoas and quadriceps of the forward leg. As a consequence, you will feel a deep stability in your hip joint and a connection from your leg to your lumbar spine.

Here's the cue:

Extend your forward leg knee by contracting the quadriceps. At the same time, press down with your torso through the arm into the hand, and onto your shin. This activates your psoas (and iliacus), tilting the pelvis over the forward leg and, by lumbopelvic rhythm, drawing the lumbar out of hyperflexion. Feel how this connection stabilizes your pelvis and lumbar and awakens the forward leg in the pose.


Figure 1:Co-activating the psoas and quads in Trikonasana


In the beginning, it may be difficult to get the hang of activating your psoas. Get a feel for this by bending the knee and pressing down on the thigh through your elbow as shown here. Click here for an entire series of poses you can use to awaken your psoas.

Figure 2: Activating your psoas (and iliacus).


I hope you enjoy this cue. Think about what's happening biomechanically while you work with this. Thanks as well to everyone for your support of the folks in Panama City who were affected by Hurricane Michael. Check back next week to see how to integrate the back leg into this cue for Trikonasana.

All the Best,

Ray Long, MD

Friday, October 19, 2018

Hurricane Michael: View from the Eyewall

Hello Friends,

I’m writing from Panama City, FL. Last week, we got hit by Hurricane Michael. Please share this everywhere.

Most of you know me from writing about anatomy and yoga. My day (and night) job is an orthopedic trauma surgeon. I was on duty in Panama City for Hurricane Michael and wanted to share with you the experience and some things you probably won’t read in the news.

Here’s the timeline:

Tuesday October 9, 2018:

What had started as a tropical depression a few days earlier was now looking like a hurricane headed for the Panhandle of Florida. Folks were beginning to evacuate if they could. I had a busy morning clinic and it was clear that the patients and staff were worried. I had one surgical case I put on for after the clinic, a badly fractured femur in a really sweet lady. I needed to get her surgery done before the storm hit.

I operated on her in the afternoon, bridging the fracture with a retrograde nail. During the case, my phone went off with the caller ID “Mom”. I told my Mom through the speaker not to worry, I’d be in a safe place for the storm and finished up the case. There were a couple more consults to see and patients to round on, so I got home later in the evening and finished my notes from there.

I spent the night at my place on Panama City Beach. Checking the progress of the storm, I saw reports that it was heading for Panama City and coming in as a CAT 3 hurricane, with estimated landfall in the early afternoon EST. I looked at the weather map and, sure enough, it was going to hit my city. Before bed, I packed some extra scrubs in a sports bag and put some bottles of kombucha along with a couple of paleo MRE’s in a cooler in the fridge.

Wednesday October 10, 2018:

I was up at 5:00 AM when my phone beeped with a text from Rob, the senior partner in our trauma group up in Georgia. It was a checklist of things to do and have ready for what might well be a mass casualty situation. For years Rob had been one of Delta Force’s surgeons, deployed to numerous hotspots around the world. He was well versed on these real life scenarios. I went out on the balcony to go over his text.

The sky was grey. There was hardly any wind--just the occasional wispy gust. A light rain was falling. I looked down at the ocean to a mesmerizing sight. Rolling in from the horizon were sets of massive 25 foot waves (the news would later report that they were actually measured at 30 feet--before the measuring device broke).

In the distance, across the expanse of the Gulf, I could see what looked like a massive storm heading in. The ominous view across the ocean, along with Rob’s text, gave me a sinking feeling in my stomach that Hurricane Michael would be bad.

I grabbed my bags and headed out. The condo complex was silent because everyone had evacuated. The only sign of life was a crew of storm chasers, kitted out with weather gear and supplies on their 4-wheel drive, and bivouacked on the ground floor. We exchanged a few words, told each other to stay safe and then I wheeled out onto Thomas Drive. I think this is some of their footage from outside my complex.




The beach town was deserted--not a car or person in sight. I gunned the Hellcat through all of the red lights and got to the Hathaway Bridge. The wind was just starting to pick up. The bridge was empty except for another storm chaser who was parked and measuring wind speed. As I turned off the bridge, Florida Governor Rick Scott sent out a text over the emergency broadcasting system reading: “The time to evacuate has come and gone. Seek shelter now!”

Panama City Florida is a working class town. We have a lot of Mom and Pop businesses. There are a lot of folks here for the military bases. Many of the people who live here are employed by the two major hospitals, Gulf Coast (my hospital) and Bay Medical. As a testament to the strong family values here, they passed an ordinance banning alcohol on the beach during Spring Break, due to the bad stuff that was happening. That probably cost some tourism dollars but they passed the ordinance anyway. We don’t have a Starbucks, or an Apple Store, or a Whole Foods.

I can say that the folks from Panama City are great to have as patients. They nearly always thank me, no matter how dire their circumstances. A day doesn’t go by that I’m not made to feel like a hero. The nurses and other staff are great too, as you will see below.

When I arrived at the hospital a few minutes later, Hurricane Michael had gathered force and was now coming in as a Category 4, with sustained winds in excess of 155 mph. It looked like it would hit us around 1:00 pm EST. I rounded on my patients, including my lady with the femur fracture. She had been too sedated right after surgery the day before, so I explained what I had done for her injury. She patted me on the arm and thanked me. Three new patients had come in overnight, two with hip fractures and another with an elbow fracture (distal humerus). I got them tucked in, planning to do surgery after the storm.

I gave my Mom a call to tell her I was safe and not to worry. The cell phone went dead and, at around that point, the building began to shake. I was heading down to the emergency department when wind and water started pouring through the ceiling of my office.

As I made my way through the short corridor to the main hospital, I caught a glimpse of the hurricane outside. It looked like a fast moving train, with large trees bent over horizontal at their trunks--or flying through the air--and it was going non-stop.

The first floor of the hospital was a bustle of activity. A line of people were moving the chairs from the waiting area into the corridor. I joined the line and helped drag some of the chairs and got word that we were evacuating the third floor patients to the first floor, and those that could sit would be in the chairs.

The hurricane had apparently breached the third floor. The nurses had barricaded the doors to the rooms it breached to prevent it from entering the hallway (where the patients had been moved to). The nurses did great work during this crisis situation. Things had to move fast and they got this initial evacuation done, while keeping the patients calm and safe.

By then the outside power was down and we were on generator. Water was also down, due to the uprooted trees. Word came in that Michael had shattered the windows at one of the nearby hotels, causing lacerations to around twenty people. I went to the emergency room to prepare. We put together the things we needed, including suture kits, lap pads, tubs of four by fours for compression. I had the tourniquets ready from the operating room, should I need them. Next, word came through that the roof of a nursing home had collapsed, with patients inside.

The problem was that the storm was still raging unabated like a freight train and the streets were impassable for EMS (or anyone else) due to power lines and trees being down across the roads. There was no possibility of transporting the patients to us--or us to them. All we could do was wait it out.

Finally, the storm passed. I went over to my office, which had about four inches of water on the floor and the ceiling sagging down. The sky showed through a hole in the roof. Then I walked outside to an apocalyptic scene. Trees were down everywhere, entangled power lines covered the streets. Cars were lifted up onto the curbs, trucks on their sides, windows smashed in. My car had sustained a severe bonk from a tree or something on the passenger side and had a jagged crease from a bash across the hood. Normally, that would have pissed me off. After this storm, I didn’t give it a second thought.

Patients started to come in. A woman had been crouched, seeking shelter in her house when the roof blew off. Water poured in and when she tried to get up, she slipped and fell, severely fracturing her wrist. Later, she had wandered out into the darkness to seek help. A police officer patrolling found her, put her in his car and navigated the power line strewn streets to bring her to the hospital. Amazing.

We did our best to comfort her and, under conscious sedation, I reduced the fracture and splinted her wrist. She told me what happened, how she had no means or place to evacuate to and how her roof had been blown off. I mentioned in passing that the roof of my office had been damaged too. She immediately said she would pray for me and thanked me for helping her. This woman had lost everything and was injured and yet was concerned for me. As I said, there are some amazing people in this town.

The Coast Guard brought in a patient that had been extricated from a house by a PJ who had been lowered down with a basket from a helicopter. As soon as the patient was transferred, the Coast Guard team was out the door on another run without batting an eye. We had someone struck by a tree with severe head and other injuries, another person crushed between vehicles, other patients with fractures. I found out that nobody was injured at the nursing home. A few of the laceration patients made it in and were sewn up by the ER docs.

Throughout the build up to and during the storm, the nurses and other hospital staff were staying in the hospital and sleeping in shifts on air mattresses and cots. The cafeteria staff were great. We formed up a chow line and made our way through. The staff made us great meals and always served us with smiles. To put this in perspective, most of the nurses and other hospital staff are local residents, many with young kids. They were working and focused on helping others, at the same time not knowing what was happening to their own homes and families during this raging storm.

Thursday October 11, 2018:

One of the nurses gave me a pillow and, around 3 am, I crashed out on the gurney in the pediatric trauma room. I got up at 6 AM to the news that we would be evacuating all of the patients to Tallahassee and Fort Walton Beach. The nurses lined up, one to a patient, getting ready to take them out to the helicopters that were landing. The head nurse, who must surely be former military, was giving orders to the team leaders, who then organized the teams, twelve patients at a time, each with their nurse. They carried off the evacuation without a hitch.

A few days later I saw an article on the net entitled “Doctors Evacuate Patients from Panama City Hospitals”. I had to laugh. The nurses did it all. It should have read “Doctors stay out of way as patients are evacuated…”

That night I made my way back to my place on the beach. It was a surreal scene snaking down 23rd Street, with high tension lines, trees and telephone poles reducing the road to one lane in some places. When I got home, I saw that there was no power or water, and the darkened buildings were empty. I walked up the eleven flights to my place. It was intact except a little water leakage. The night was like a scene out of “Blade Runner”, a huge building standing silent against a clear starry sky. Looking back at the darkened city, the only lights were the blue flashing lights of police cars and ambulances.

Rescue personnel are still trying to get through the many nearly impassable streets, and the death toll rises daily. The power is still out in much of the area, including much of Panama City, though it is back now on the beach. People are now coming in with the injuries we expect in the aftermath of a hurricane--fractures from falls from roofs, rattlesnake bites, chainsaw injuries, dehydration. The serious have to be transferred to hospitals outside the area.

Here's some video footage that I took during the storm and of the aftermath.



And here's another video right after the storm passed.



The media cycle is moving on but it’s going to be a long road back for this area of the world. Many of the folks who live here, good people who live from paycheck to paycheck, are truly left with nothing. I’m particularly concerned for the incredibly dedicated hospital staff who may have lost much or all in this storm. I just wanted to give you a view of what happened. I have started a GoFundMe campaign in support of the hospital staff affected by the hurricane. All funds collected will go to the HCA Hope Fund, which helps families of staff who are displaced. Click here to help.

Please help out in any way you can and please spread the word around the world.

Thanks,

Ray Long, MD

Monday, January 22, 2018

Shoulder Biomechanics Part IV: The Deltoid--Rotator Cuff Connection

Foundational knowledge gives you power that you can translate into applications for your practice and teaching.

In this blog post, I explore some of the essential biomechanics of the shoulder joint, especially the “force couple” between your deltoid muscle and the rotator cuff. Understanding this relationship helps build your fund of knowledge regarding this complex articulation, which can help you later on in developing cues for your practice as well as well as for therapeutics in yoga.

The “force couple” is a biomechanical concept whereby groups of muscles work together around a joint to produce coordinated movement. The force couple between the rotator cuff and the deltoid muscle works in concert with other muscles around the scapula to produce movements such as raising the arm overhead.

The shoulder joint proper is a ball and socket joint comprised of the humeral head which articulates with the shallow glenoid fossa (socket) of the scapula. The bone shapes of the shoulder joint allow for a high degree of motion. Contrast this with the hip joint, where the socket is much deeper and constraining on motion. In addition to the bony stabilizers, there are also soft tissue stabilizers such as ligaments and the labrum and muscular dynamic stabilizers. Figure 1 illustrates the bones of the shoulder. Click here for more on this in relation to your Down Dog.

Figure 1 - (1) humerus. (2) scapula. (3) clavicle.

In the force couple between the deltoid muscle and the rotator cuff, the rotator cuff stabilizes the humeral head against the glenoid fossa. The deltoid muscle then levers the humeral head off the glenoid fossa to raise the arm. At the same time, the scapula and clavicle rotate to aid in producing movement, a process known as scapulohumeral rhythm (click here for more on this subject).






Figure 2 illustrates the subscapularis and infraspinatus muscles acting together to stabilize the humeral head in the glenoid fossa. Click here for more information on the these muscles of the rotator cuff.


Figure 2 - The Subscapularis / Infraspinatus force couple.


Figure 3 illustrates the force couple between the rotator cuff and the deltoid muscle. Click here to learn about the supraspinatus muscle of the rotator cuff. As the deltoid contracts to raise the arm, the rotator cuff contracts to stabilize the humeral head in the socket. All of this happens automatically--the brain is hard wired for this force couple.

Figure 3 - The Deltoid / Supraspinatus force couple.

Injury to the rotator cuff, such as a tear or inflammation can lead to less efficient stabilization of the humeral head in the socket. As a consequence, when the deltoid contracts, instead of levering the humeral head off the glenoid, the force of the deltoid contraction causes the head of the humerus to shift upwards into the subacromial space. This can lead to impingement of the rotator cuff on the undersurface of the acromion, thus exacerbating the condition. To compensate, the body uses abnormal movement of the scapula in an attempt to stablize the humeral head in the socket. This abnormal movement of the scapula on the chest wall is known as “scapulothoracic dyskinesia”. I examine for this by comparing the movement of the normal and injured side from the back while having the patient raise the arms overhead.

Figure 4 - Raising the arms over the head in Warrior I and Tadasana.

I hope this post helps you build your fund of knowledge regarding shoulder biomechanics. Stay tuned for my next post where I discuss some of the yoga poses that can be used to stretch and strengthen the rotator cuff. Learn more about anatomy, biomechanics and physiology for your yoga in “The Key Muscles of Yoga”, “The Key Poses of Yoga” and the Yoga Mat Companion series. Click on any of these books to page through.

An excerpt from "Yoga Mat Companion 1 - Anatomy for Vinyasa Flow and Standing Poses".


An excerpt from "Yoga Mat Companion 3 - Anatomy for Backbends and Twists".


Thanks for stopping by--look forward to seeing you for my next post!

Ray Long, MD