Friday, March 21, 2008

Getting the word out about Yoga Physical Therapy

Day 2. I started this blog because I want to get the word out about Yoga Physical Therapy. Sometimes I come home after working with a patient with a great idea that we discovered during the day that I want to share. So this is a way to get me started writing about the work, to explain what it is that we do in Yoga Physical Therapy.

First and foremost, I look at the body with the eyes of a Physical Therapist. The training was the best I know of for understanding the components of the human body and how the body moves in space. From my background in dance, I became a PT because I was fascinated with muscles, joints, the nervous system, and how it all fits together. Then, by studying the pathology of injury and disease, I learned what happens when something goes wrong. My job as a PT is to find a way to help the injured body recover. These 17 years of working with injuries and disease have only increased my understanding and intuition.

Yet, as great as the Physical Therapy training was, it didn't give me a way to deal with the whole person. Often I would find people were tense, upset and holding tension in their bodies, especially those with back and neck pain. (I also see people hold tension in their feet, their knees, their hips.) I didn't know what to do with it. I wasn't trained in how to deal with the psychological components of disease and injury.

However, once I began incorporating Yoga and meditative breath work into the sessions, I began to be able to help people help themselves with the effects of stress being held in their bodies -- whether physical, emotional or psychological. The introduction of the breath, not only into the exercises, but as a separate activity in itself, began to transform the effectiveness of the our sessions, especially in those with chronic back pain.

By helping someone breathe into the injury and pain, it gives her the mental space, first of all, to become aware of holding and tension in that area of the body. On a physical level, getting breath into a tight or tense area literally begins to open up the area. As the muscles relax, they loosen their hold on the bones. The affected bone(s), pulled out of line by an overactive muscle, can begin to relax back into place. When the muscle, then the bone(s), release back into a relaxed state, then the affected joint can begin to realign itself. Yes, one can learn to breathe into a specific muscle or muscle group.

Secondly, blood cannot flow freely through a tense muscle. So, another result of using a mindful breath is that once a muscle relaxes, more blood can flow into and out of that muscle. With more blood flow, more oxygen gets to the area. More oxygen equals more healing. The healing molecules and chemicals can now get to get to the injured, or previously held and tense, area. At the same time, the byproducts of injury can move out of the area more quickly.

On the psychological level, meditative breathing is documented to lessen the effects of stress, including lowering blood pressure, decreasing heart rate and lessening the effects of cortisol, the stress hormone of the fight-or-flight reaction. As a person becomes more aware of the bodily tension and learns to breathe into it, often the emotions or thinking that contributes to that tension begin to loosen their hold as well. As the mind begins to relax, so too does the body. Once the body begins to relax, so do the mind and emotions. It's a dynamic, interactive process.

I've had patients thank me for helping them to identify and learn to work with the stress that is contributing to their injuries. Once they developed an awareness that they were holding tension in their backs, necks, feet or hips, they were able to begin working with, and begin lessening, that tension.

Awareness is key. With aware breathing into an injury, combined with specifically targeted positioning or stretching of the body, the healing process is supported. Using a gentle and mindful breath also gives us an effective tool to support the entire healing process, body and mind.

Click here to learn more about Yoga Physical Therapy.

Thursday, March 20, 2008

Let's talk about back pain



Part I - Coming to the Floor

Yoga can be an excellent modality for managing and healing low back pain. Just as many poses in Yoga are ideal for healing certain kinds of back pain, other poses may make back pain worse. It depends on the nature and cause of your back pain.

We might intuit that poor posture plays a role in back pain. Other than admonish ourselves for poor posture and occasionally tell ourselves to stand up straight, we try, but do not know how, to make our posture better. Where can you get help for it? Who can help you?

I agree with Robin McKenzie, a New Zealand Physiotherapist, that poor postural habits play a big role in most back pain. McKenzie has developed a body of work that successfully treats back pain. Many of the exercises that are prescribed by the McKenzie are the same postures that can be found in many gentle or beginning Yoga classes. (Unfortunately, many of these same postures have been dropped from more advanced Yoga classes today.)

We live in a world in which we are sitting -- at our desks, in front of the television, at our computers -- for many hours of the day and night. We sit in slouched postures, with our spines rounded forward, our heads jutting forward (check out your posture right now). The position of the spine in this curved forward "C" position is called flexion. We have four natural spinal curves, at the neck, the thorax, the lumbar and the sacral spines which form a gentle S from the top down. However, with the demands placed on us from early childhood, when we begin to sit at uncomfortable desks, we begin to alter our natural spinal curves. We begin to lose our ability to find a neutral, or comfortable, position. We begin to slouch. We slouch when we're sitting. We slouch when we're standing up.

We slouch because we can't find a comfortable position in which to counter gravity, a constant force pulling on our bodies. When we give into dysfunctional postural habits, then we end up fighting gravity, one of the strongest forces in the Newtonian universe. What happens next is that the anti-gravity/postural muscles in our necks, extending to the entire length of our spines begin to overwork. As they overwork, they fatigue. As they fatigue, they begin to hurt. It's not that we don't try to sit up straight, but we end up slouching because we don't have the strength to maintain an upright position anymore. It becomes a vicious cycle.

These long muscles, the erector-spinae muscles, extend in series from the base of the skull to the sacrum. In a slouched posture, not only do they overwork and become tense, but at the same time they become over-lengthened, weak and painful. They are not able to do their jobs in holding the trunk upright against gravity. Once these muscles become weak and over-lengthened, other muscles in the hips try to compensate. The hip muscles, working to keep the body upright against gravity, depending on their placement and your anatomy, become short, tight, weak and painful.

At the same time, the Core muscles, the deep abdominal and pelvic stabilizing muscles surrounding the hips, become weak and flabby. Breathing is often shallow. With a slouched posture, the ribs are compressed in the anterior body and the diaphragm, the primary muscle in breathing, is placed in a disadvantageous position.

The body may feel tense and tired. Trying to sit or stand erectly becomes more and more difficult. Our bodies are out of balance and out of sync with gravitational pulls. The body ends up fighting gravity rather than working efficiently within the gravitational field.

How do we restore balance to our bodies?

The best way is to go to the mat, to the floor, where the body can rest into gravity, without having to fight it. The flat surface of the floor provides maximum support and feedback to a body out of sync. Once lying on the floor, you can begin to realign yourself, front-to-back, right-to-left, head-to-toe. The four spinal curves are supported. Where the spine is rotated, a common occurrence in people who suffer from back pain, it can begin to unwind.

The body craves balance. Coming into the floor, embracing gravity and relaxing into it, combined with breathing mindfully, is the beginning of healing your back pain.

Click here to learn more about Yoga Physical Therapy.