The Daily Bandha

Protecting Your Knee in Pigeon Pose

Working with the muscular stabilizers surrounding the individual joints is a central tenet of both injury prevention and rehabilitation. In this blog post we illustrate how to work with myofascial connections to protect your knee in Pigeon and Reclining Pigeon pose.

Let’s begin with an experience I had at one of my recent workshops in helping a student recover from a yoga injury. One of the participants mentioned to me that he had sprained his knee a couple of weeks before while overdoing it in Pigeon pose. I examined him and concluded he had a mild sprain. First, I told him to lose the neoprene sleeve he was wearing (which was doing nothing). Then we began working with the muscular stabilizers of the knee, in particular using a progressive series of postures that culminated in Lotus pose—all while paying close attention to engaging the muscles that provide dynamic stability to the knee joint. By the end of the workshop, his knee was completely pain free and felt normal. At which point he made an insightful comment: “injured my knee doing yoga wrong, healed it doing yoga right.” Put another way, “poses don’t injure people; doing poses incorrectly injures people—and doing them correctly heals.” With this in mind, let’s look at how to engage the muscular stabilizers and myofascial connections on the outside of the leg in Pigeon pose.

Here’s the cue…

Maintain the ankle in a neutral or slightly dorsiflexed position, extend the toes and then press the ball of the foot forward (as shown). This engages the peroneus longus and brevis and tibialis anterior muscles of the lower leg, and activates a myofascial connection between these muscles and the TFL and biceps femoris muscles of the thigh. Slightly externally rotating the ankle activates the hamstrings on the lateral (outside) of the thigh. These actions create a type of dynamic “brace” on the outside of the leg, protecting the inside of the knee. Similarly, the outside of the knee is protected from overstretching. You can experience this opening on the inside of the knee even while you are reading this by crossing one leg over the other and activating these cues.

Protecting the knee in Reverse Pigeon: Figure 1 (left) illustrates everting the ankle to access the muscles on the outside of the leg. Figure 2 (right) illustrates the opening on the inside of the knee.

Figures 1 and 2 illustrate this cue for Reverse Pigeon and figures 3 and 4 for Pigeon Pose. Click here for an animated video of the piriformis muscle in Reverse Pigeon pose and click here for an animated video that illustrates joint reaction forces and the beneficial effect of releasing the internal rotators for Lotus pose.

Protecting the knee in Pigeon Pose: Figure 3 (left) illustrates engaging the muscles on the outside of the knee. Figure 4 (right) shows the piriformis muscle stretching in Pigeon Pose.

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

Thanks for checking in. We greatly appreciate when you share us on Facebook, Twitter and Google Plus. For many more tips on combining Western science and yoga, check out The Key Muscles and Key Poses of Yoga and the Yoga Mat Companion series (you can page through each book on the right of this page).

All the Best,

Ray Long, MD

The Piriformis Muscle and Yoga: Part I

If a picture's worth a thousand words, then what is an animated video worth? In this blog post we look beneath the skin to see what happens with the piriformis muscle in Reverse Pigeon Pose and provide an overview of the muscle, its attachments and action, and its role in stabilizing the sacroiliac joint. We also examine the use of joint rhythm to optimize the stretch.

The piriformis muscle originates on the anterior (front) surface of the sacrum and inserts onto the greater trochanter of the femur (thigh bone). Figures 1 (a) and 1 (b) are front and back views of the piriformis muscle. Figure 1 (c) illustrates the stout ligamentous stabilizers of the sacroiliac joint.

Figures 1 (a) is a front view of the piriformis, (b) is a back view and (c) illustrates the ligaments that stabilize the sacroiliac joint. (click on image to enlarge)

Note that the piriformis is a muscular stabilizer of the sacroiliac joint. Imbalances between the piriformis muscles can contribute to subtle asymmetries within the pelvis, which can then be transmitted to the vertebral column. This underscores the importance of achieving a balanced stretch between the two sides when working with this muscle in yoga. Learn more about the stabilizers of the sacroiliac joint and lumbar spine in our post on the thoracolumbar fascia. We discuss the details of the static and dynamic stabilizers of the joints in The Key Muscles and Key Poses of Yoga.

Here's the biomechanics...

To understand why Reverse Pigeon Pose works to stretch the piriformis we need to know that the actions of this particular muscle vary according to the position of the hip joint. For example, when the hip is in a neutral position, the piriformis acts to externally rotate (turn outward), flex and abduct the hip joint. When the hip is flexed beyond about 60 degrees the piriformis becomes an internal rotator and extensor (and remains an abductor). Muscles stretch when we move a joint in the opposite direction of the action of the muscle. In Reverse Pigeon Pose, the hip is flexed and externally rotated, thus stretching the muscle (which extends and internally rotates the hip in this position). This video illustrates the stretch (click on image to open in a separate window).

When viewing the video, note how flattening the back moves the origin of the piriformis on the sacrum further away from its insertion on the femur, thus accentuating and refining the stretch. This is an example of lumbar-pelvic and femoral-pelvic rhythm. The last section of the video, where we have digitally hidden one half of the pelvis to expose the movement of the sacrum, illustrates this concept. Learn more about joint rhythm in our post “Preventative Strategies for Lower Back Strains in Yoga.”

Figure 2: variations for stretching the piriformis muscle.

Figure 2 illustrates some variations for this stretch. Figure 2 (a) is the classic stretch that is typically utilized in yoga. Figure 2 (b) is a modification for persons that cannot practice the full stretch. This variation is also useful to experience the effect of flattening the lumbar in the pose. Figure 2 (c) stretches the piriformis of the lower side leg by adducting and internally rotating the femur. Figure 2 (d) adducts (draws toward the midline) the upper side leg, thus opposing the action of the piriformis for abducting the femur. Figure 2 (e) illustrates a variation commonly employed in physical therapy as part of the regimen for Piriformis Syndrome, a condition that can cause sciatica (we cover this condition in an upcoming post). In this variation, the upper leg crosses all the way over, thus adducting the femur and stretching the muscle. This is a good alternative for those who experience knee issues in the classic stretch. Our next post illustrates a technique for protecting the knee in Reverse Pigeon Pose (and similar asanas).

I typically do several 20-30 second stretches on each side, easing into and out of the pose. We explain the rationale for this length of time in a pose in the blog post on Hanumanasana (front splits). If you experience pain in this (or any) stretch, carefully come out of the pose. Folks with sciatic type pain should consult a health care practitioner who is appropriately trained and qualified to diagnose and manage such conditions. Follow their guidance, working with yoga as an adjunct in prevention and treatment (where appropriate). Click here to learn about Piriformis Syndrome and how yoga can help.

An excerpt from "Yoga Mat Companion 2 - Anatomy for Hip Openers and Forward Bends".

Now you're ready to take the Bandha Yoga QuickQuiz for the piriformis muscle! Click here to start.

Thanks for stopping by. Stay tuned for our next post on protecting the knee in poses like Reverse Pigeon. We also greatly appreciate when you share our posts on Facebook, Twitter and Google Plus.

Namaste'

Ray and Chris

Improving Stability in One Legged Standing Poses

Practicing yoga benefits our activities of daily living. We breathe easier, sit more comfortably and feel stable and strong when standing and walking. For this post, we’ll focus on the muscles that are active during the “mid-stance” phase of walking—which is essentially a one legged standing pose. Then we’ll develop some cues for engaging these muscles to improve stability in poses such as Tree pose and Hasta padangustasana. Improved stability in these asanas in turn enhances the beneficial effects of the practice.

Figure 1: Illustrating the phases of gait with the mid-stance phase highlighted.

The walk cycle is traditionally divided into several phases, as illustrated in figure 1. Researchers have used surface EMG’s to detect which muscles are most active during each of the various phases of walking. For example, during the mid-stance phase, the hip muscles that show a higher level of contraction include the gluteus minimus and tensor fascia lata (figure 2). The gluteus minimus helps stabilize the head of the femur (ball) in the acetabulum (socket). The tensor fascia lata acts to stabilize the pelvis and knee. These muscles engage automatically when we stand on one leg (unless there is an underlying pathological condition). We can improve their function in one legged standing poses by consciously engaging them in a variety of other asanas, including Downward dog, Uttanasana, and Upavista konasana.

Figure 2: The gluteus minimus stabilizing the head of the femur in the acetabulum and the tensor fascia lata (and gluteus medius) stabilizing the pelvis. Note that the TFL also stabilizes the knee.

Another muscle that is active during the mid-stance phase of gait is the rectus abdominis, which runs from the pubis to the front of the ribcage and xiphoid process of the sternum. This muscle aids to stabilize the lumbar spine and pelvis during this part of the walk cycle (figure 3). Consciously engaging the rectus abdominis during one legged standing poses thus helps to maintain balance. The transversus abdominis also contributes to stability through its myofascial connection to the thoraco-lumbar fascia.

Figure 3: Illustrating activation of the rectus abdominis in Tree pose.

Here’s the cue…

Begin by working with a support, such as a chair or the wall so that you can focus on integrating the muscular engagement without having to also focus on balancing (figure 4). Take Tree pose (Vrksasana) and, on your exhalation, gradually tense the abdomen; a visual cue is to draw the navel inward. Activating the abdominal muscles increases intra-abdominal pressure and tightens the thoraco-lumbar fascia, thus lifting the torso and stabilizing the lumbar spine. Working with the abdominals also amplifies the mind body connection to this region, creating a "functional focal point".

Figure 4: Engaging the abdominals in supported Tree pose.

Cues for stabilizing the core are best worked with over a period of several practice sessions (using a support for balance). The targeted muscular engagement becomes increasingly refined and efficient with each successive session and is easier to use with the final pose.

Figure 5: Engaging the abdominals in Navasana.

Other poses that improve core strength, especially that of the abdominal muscles, include Navasana (figure 5) and Chaturanga dandasana (figure 6). Click here for a tip on co-activating the gluts and abs in this pose. For many more techniques and practical cues on integrating Western science into your practice, check out the Mat Companion Series and The Key Muscles and Key Poses of Yoga (use the “look inside” feature to page through the entire books).

Figure 6: Co-activating the gluts and rectus abdominis in Chaturanga dandasana.

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

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 present another subject on combining science and yoga. Also, we greatly appreciate when you share us on Facebook, Twitter and Google Plus.

Namaste'

Ray and Chris

References:

1) Crommert ME, Ekblom MM, Thorstensson A. “Activation of transversus abdominis varies with postural demand in standing.” Gait Posture. 2011 Mar;33(3):473-7.

2) Winter DA: The biomechanics and motor control of human gait: normal, elderly and pathological, ed 2, Waterloo, Canada, 1991, University of Waterloo Press.

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.

An excerpt from "Yoga Mat Companion 2 - Anatomy for Hip Openers and Forward Bends".

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

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.

An excerpt from "Yoga Mat Companion 2 - Anatomy for Hip Openers and Forward Bends".

An excerpt from "Yoga Mat Companion 4 - Anatomy for Arm Balances and Inversions".

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) Bolívar 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

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, its 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 its 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 its 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 6^th 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 its 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 its 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.

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

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.

All the Best,

Ray Long, MD

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.

3) Imhauser CW, Siegler S, Abidi NA, Frankel DZ. “The effect of posterior tibialis tendon dysfunction on the plantar pressure characteristics and the kinematics of the arch and the hindfoot.” Clin Biomech. 2004 Feb;19(2):161-9.

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

Degenerative Disc Disease, The Sushumna Nadi and Yoga

“A sword by itself rules nothing. It only comes alive in skilled hands.”

Sir Te to Governor Yu in the martial arts classic, Crouching Tiger, Hidden Dragon.

Many myths, legends, and historians hold that human beings in the ancient past were much more connected to their higher selves and power. These sources maintain that, at some point in our distant past, we suffered a primal trauma—an injury that affected us to our core, both biologically and psychically. Some theorize this event affected us on the very level of our DNA. The theory is that this trauma disconnected us from our higher powers and we have been suffering, causing suffering, and trying to heal ever since. Some postulate that yoga—specifically, hatha yoga—evolved in response to this trauma to re-establish this connection, hence, the name “yoga,” which means “to unite” (or re-unite).

Lengthening the Torso in Forward Bends

In “Preventative Strategies for Lower Back Strains Part I,” we discussed femoral-pelvic and lumbar-pelvic rhythm, muscles that influence these rhythms, and the effects of these muscles on the lumbar spine. Here, our discussion progresses as we cover the trunk, the thoraco-lumbar fascia (TLF), Uddiyana Bandha and how accurate knowledge of this can be used to enhance the benefits of yoga and decrease the risk of lower back strains.

The thoraco-lumbar complex (TLC) is a multilayered structure comprised of the thoracolumbar fascia and the muscles that connect to it. This composition of passive fascial tissues and active muscular structures acts as a corset-like structure that encircles the torso. It plays a key role in maintaining the integrity and stability of the lumbar spine and the sacroiliac joint and is also important for load transfer from the upper limbs to the lower limbs. Engaging the muscles that connect to the thoracolumbar fascia acts to stabilize the spine and trunk. We give an example of this in a previous blog post on using the latissimus dorsi to lift the lumbar and expand the thorax. Figure 1 illustrates the thoraco-lumbar composite in cross section at the mid-lumbar.

Cross section of the thoracolumbar fascia with its connections to the abdominal core and erector spinae (at L3).

Hanumanasana—Front Splits

To paraphrase the poet William Blake, you can see the world in a grain of sand. Similarly, you can learn a great deal about all asanas by carefully studying one. For this blog post, I focus on Hanumasana, or front splits. I use this pose in workshops to illustrate such factors as pose analysis, agonist/antagonist muscle pairs (and their synergists), physiological reflex arcs, and stretching biomechanics.

First, let’s look at the muscle-tendon unit—the muscle and its tendon—to see what lengthens in the pose. The muscle-tendon (MTU) unit is composed of several elements. These include the contractile structures (sarcomeres) and the fascial elements that surround the muscle fibers and tendons. Although these elements are often presented separately in articles on the science of stretching, in reality they are inextricably linked to one another. All of these elements contribute to muscle contraction and stretching. In addition, many factors contribute to the way a muscle lengthens, including the viscoelastic properties, creep (a type of deformation that has been postulated for fascial elements), neurological/psychological factors (such as muscle memory and tolerance), and extramuscular links to synergists. Individual muscle architecture or shape also plays a role. Below, I include several references from the scientific literature that discuss these factors in greater detail.

Cross-section of muscle illustrating the contractile sarcomeres with fascial elements such as the perimysium

Next, there is the timing of the stretch or how long to hold it.

"Easing in" to Chaturanga Dandasana

In our last post we focused on the hip abductors and adductors and how they can be used to stabilize the pelvis and synergize flexing the hips in forward bends. In this post we zoom out and look at a technique that can be learned with Chaturanga Dandasana and then transported to other poses to improve benefits and safety. I call this technique “ease in, ease out” and it relates to how one approaches the end point of a pose.

For this cue, I take a yoga block and place it at the level of my sternum, then lower down to lightly touch it from plank position. I then straighten my arms to return to plank. The image that body weight practitioners use for this is “kissing the baby” because one touches the block as gently as kissing a baby on the forehead. Working in this manner teaches muscle control and sensitivity.

Figure 1

Preventative Strategies for Lower Back Strains in Yoga: Part Two

In our last post we focused on the benefits of engaging the quadriceps in forward bends. These include reciprocal inhibition of the hamstrings and the contribution of one head of the quadriceps, the rectus femoris, to flexing the hip joint and tilting the pelvis forward. Tilting the pelvis forward helps to prevent hyper flexing of the lumbar spine through lumbar-pelvic rhythm.

This post emphasizes the role of hip adductors and abductors in flexing the hips with a cue for co-activating these muscles. Balanced engagement of these muscles produces a stabilizing bandha about the hip joint and pelvis, while at the same time synergizing hip flexion. This contributes to femoral-pelvic rhythm, which in turn aids to prevent hyper flexing the lumbar in forward bends.

First, let’s look at the anatomy. The more anterior adductor muscles (the adductors longus and brevis) draw the femurs toward the midline, adducting them. The pectineus contributes to this action. The tensor fascia lata (TFL), on the other hand, draws the femurs away from the midline, abducting them. Thus, the TFL and adductors (and pectineus) are antagonists for these actions. These same muscles all flex the hip joint and are synergists of this action. Accordingly, co-activating this antagonist/synergist pair can be used to stabilize the hip (through opposing actions) and synergize hip flexion.

adductors longus, brevis and pectineus - dandasana

The adductors longus and brevis and pectineus in Dandasana.

Preventative Strategies for Lower Back Strains in Yoga: Part One

In this post we take a look at one of the leading causes for emergency room visits from yoga—lower back strains—and examine preventative strategies that may help in reducing the risk of this injury while enhancing the benefits of Hatha yoga practice. This series begins with info on joint rhythms and how understanding them can help in preventing injury.

Also, I would like to recommend reading Dana Santas interview in Men’s Health magazine entitled “Will Yoga Really Wreck Your Body?”¹ Dana is an experienced yoga practitioner and teacher who works with elite athletes from a number of professional sports. She is a great resource for information on integrating yoga into sports training regimens. You might also check out Jason Amis’ counterpoint to a recent article published in the New York Times, which includes a clear and in-depth analysis of much of the data that was referenced.

Jason provided me with the NEISS data relating to emergency rooms visits for yoga injuries in 2010 and I’ve done some preliminary analysis, which I will share with you. Data like this is extremely valuable, because it allows us to find ways to identify risks and then reflect on how to prevent them – a variation for the yoga community on the Sanskrit term “Atma Vichara,” or self inquiry. Here are my impressions: first, I was impressed by the relative safety of the practice compared to other activities. Second, it was clear to me that many of the injuries resulting in ER visits were potentially preventable. Think of it this way: there are injuries that are unpredictable, like stubbing your toe (also reported as an ER visit related to yoga), and there are those that are potentially preventable through application of common sense and knowledge of the body. Analysis of data like this provides an opportunity to identify preventable injuries and eliminate unsound practices that may have caused them in the first instance.

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.

Co-activating the Gluts and Abs in Chaturanga Dandasana

In a previous blog post, we discussed the yogic concept of satya, or truthfulness. On this, the sutras say, “When established in truthfulness, one can be sure of the results of action” (Nicolai Bachman’s translation of Sutra II.36).

I mention this because, during a recent workshop series, the question was posed, “What is the difference between caution and fear?” Participants responded without hesitation that caution stems from knowledge, wisdom, and truth. Conversely, fear and fear-based actions come from a lack of knowledge, wisdom, or truth. In other words, fear is an illusion. Caution enables; fear cripples. Satya succeeds because the generational forces of the universe, in some manner or another, line up behind it. Asatya (untruthfulness) fails because those same forces align against it.

Then, some individuals encourage and manipulate the fear of others (fear mongers). Sociopathic corporations and individuals often resort to this form of asatya when they realize that they lack the ability to compete fairly or are afraid that someone else will gain power; they fear losing control or influence over others, mainly for monetary gain. Consequently, the fear monger acts out of fear and heads down the slippery slope of asatya. For example, they might exaggerate or fabricate scientific data to cast a false light onto something or someone they fear. Ironically, in the process, they often succeed in exposing and encouraging their own fears. An entity exposed for abusing its position of trust by deliberately misleading others will lose that position. That is how the spiritually bankrupt become, simply, bankrupt.

Refining the Pelvis in Twisting Standing Poses

Yoga poses are "kinetic keys" that unlock and open the mind/body connection. Precise and accurate renditions of the asanas are more effective for unlocking the doors to the yoga experience. For examle, in a previous blog post we illustrate how to draw the front knee back and the pelvis forward in Utthita Parsvakonasana by pressing the outside of the knee into the arm. This engages the abductor muscles of the hip and brings the pelvis, knee, and ankle into alignment while stabilizing the pose. It also aids to open the front of the body and is an example of using a constraint (the knee against the arm) to create freedom.

Just as the knee tends to drift inward in Utthita Parsvakonasana and Warrior I and II, so the pelvis tends to drift away from the midline in Parivrtta Trikonasana. In this post we explore connecting the upper and lower extremities while simulaneously engaging the hip abductors to draw the pelvis into an alignment with the legs.

Here’s the Anatomy . . .

The upper appedicular skeleton is composed of the shoulder girdle and arms. The lower appendicular skeleton comprises the pelvic girdle and legs. The axial skeleton is made up of the pelvic girdle, spine, ribcage, and skull. Consequently, connecting the upper and lower extremities (the hand to the foot or elbow to the knee) can be used to influence the position of the trunk.

Here’s the Cue . . .