W4.3 Adaptations for Vulnerable Areas of the Body
The knees, the lumbar and cervical vertebrae are generally regarded as vulnerable areas of the body. Discuss how you would protect these areas when teaching two different postures
The human body is an amazing piece of design. Our bodies give us a unique combination of strength, function, flexibility and intricacy. The balance between each of these can be precarious, and in order to ensure that we maintain this balance, it is important that we know and respect what our bodies give to us. Yoga is a perfect platform with which to enhance these gifts, but also, a potential area of damage if we do not heed the constant need that our bodies have for balance and harmony. As yoga teachers, it is vital that we maintain the care of our bodies, respecting vulnerable areas and times when we may be more likely to cause damage.
The Knee Joint:
During certain yoga postures, it is vital that we are aware of possible strain that the knee may be under. Misalignment of the knee can lead to uneven wear and tear on the meniscus, which may lead to unbalanced muscle development around the joint. Overworking can stretch the collateral ligaments, which destabilises the joint. Pushing the knee too far – for instance in front of the ankle in a poorly aligned lunge; can put stress on the cruciate ligaments at the back of the knee. Misaligning the feet in trikonasana or any of the virabhadrasana poses can also place strain on the knee. The knee will also be limited by movement at the joints proximal and distal to it. Stiff hips and/or stiff ankles can cause a person to try to compensate using the knees in order to achieve the full posture.
Trikonasana:
because the weight of the body is over this leg. Sensations from the knee joint are a good indication to stop doing the pose and make adjustments. Pain in the lateral knee of the back leg can be from tightness in the muscles at the top of the iliotibial band (tensor fascia lata, gluteus medius and maximus), which needs to lengthen and engage. If these are tight and the leg cannot adduct relative to the pelvis, the spine will flex laterally so that the pose comes from the spine movement rather than the hips. This may also contribute to tightness in the back of the ankle. The more articulate the sacroiliac joints, pelvis and hip joints are, the more purely the spine can stay neutral. For example, if the front leg has a tight pectineus, the pelvis may rotate to the floor and the spine has to counter rotate to open the chest. In this position, the pose becomes more of a slight forward bend than side hip opener. This occurs more often when someone is pushing the posture to the limit. Coming back out slightly, taking the front hand higher on the front leg, and/or bending the front knee, will lessen the strain, improve the side opening and allow for a much better feel of the asana. As yoga is non-competitive and the ethos of ahimsa is so important, it really does not matter if the pose is not quite so deep. Demonstration of the difference between strain and no strain is a good method of demonstrating to students.
Lotus/padmasana:
Blocks and cushions under the knee for support are beneficial, as is adaptation of the pose – half lotus, easy cross-legged position or Siddhasana are all good alternatives. The important thing is for students not to feel obliged to do the posture if it is not for them, not to place their bodies under unnecessary strain and to feel physically and mentally comfortable in the pose. If there is any doubt, do not teach it, or recommend it, but use good alternatives.
The Lumbar Vertebrae:
If the thoracic spine is stiff, compensation comes from the lumbar and cervical vertebrae, which will be put under strain as a result in order to facilitate back-bending using the facet joints. High-risk students will be those with a current history of back pain and back problems, older students who may have shrinkage and osteoporosis, and people with Ankylosing spondylitis. The lumbar spine is particularly vulnerable in forward bends such as paschimottanasana and strong back bends.
Paschimottanasana:
The correct alignment of this pose is to flex forward from the hips, attempting to maintain length in the spine. The biggest obstacle to the pose is tightness in the hamstrings, and sometimes in gluteus maximus. The hip flexors and abdominals will tend to contract to pull the body forward and therefore cause us to compensate by rounding the spine in an effort to reach the feet. However, several alternatives and modifications may be employed. Sitting students on a block in order to tilt the pelvis forward, bending the knees slightly, using straps or theraband to reach for the feet, taking the hands higher up the legs and not grasping to push to the limit can all be useful techniques. The hamstrings will still be lengthened, but in a less stressful and damaging way.
Bhujangasana:
A common fault of this posture is to elevate the shoulders and hunch. It is not necessary to straighten the arms, as seen in the picture. Weakness in the pronators of the forearm or tightness in the supinators will cause flaring of the elbows, which need to remain tucked in to the body. The forearms should stay parallel to each other for the best alignment of action through the arms and into the spine. In breath, it can be useful to enter this pose on an exhale as many people who will be locked into belly breathing, will find that their inhalation will restrict their thoracic extension and rib cage expansion. Talking students through the breath will help this problem. If someone has a known back issue, sphinx is a much safer posture to do. Awareness of the neck is important, as many texts will illustrate cobra with the neck extended – this puts undue strain on the back of the neck and the cervical vertebrae. The legs will remain active and this will need to be verbalised during teaching. Releasing the buttocks and engaging moola bandha will help. Length in the spine and flowing with the breath is important to allow good alignment in this pose.
The Cervical Vertebrae:
If the thoracic spine is tight, the cervical vertebrae will try to compensate. This has a knock on effect because it will in turn cause tightness in the shoulders and neck and then become more vulnerable in other postures – such as shoulder stand. The cervical vertebrae are not built for weight bearing like the lumbar, and high-risk students will include those with existing conditions such as the elderly (osteoporosis) and people with arthritis.
Headstand (sirsasana):
In performing headstand every step should be carefully performed to avoid injuries. In an erect upright posture the gravity line passes through the bodies of most of the cervical and lumbar vertebrae, which bear weight and allow for movements of the spinal column. So, while performing Sirsasana (headstand), it is possible that the load, instead of passing through the bodies of the vertebrae, is transmitted through the weaker portions of vertebral column disturbing the normal spinal biomechanics. This places increased strain at the cervical vertebrae, which, as previously mentioned, are not designed for weight bearing. When performed correctly, most of the dynamics of the posture should be directed through the arms, but without
Breath is important and will be relaxed if performed correctly. Many alternatives can be used instead of full headstand. The dolphin is excellent preparation and introduction to headstand and is good to use with newer students or people with weak core or vulnerable spines. If an inversion is the goal, legs up the wall is the simplest and safest alternative and places no strain on the cervical vertebrae.
Matsyasana/fish:
Blocks can be placed under the lumbar spine and under the head for extra support or a partner can hold and support the head, lessening the strain at the neck. The legs can be straight, or with less tension on the lumbar region, can be in supta baddhakonasana. Psoas major plays a major role in hip flexion and spinal extension when in this pose. This posture is frequently used as counterpose to shoulder stand as it reverses the position of the cervical spine from flexion to extension. This, however, needs to be done carefully to avoid strain or shock to the vertebrae of the neck. It is better to reverse gradually rather than suddenly.
Conclusion:
There are several vulnerable areas of the body, and those discussed here are the most commonly injured. The common theme is that they are all weight bearing and all central. They are designed to be strong, but also need intricacy of movement (apart from the lumbar vertebrae perhaps). This anomaly explains why they are vulnerable. Our job, both as yoga teachers, and in looking after our own bodies, is to achieve and maintain the balance between the two. When this does not happen, injury is much more likely.
References:
Fox, Paul and students (2009), Yoga Diploma Teaching Notes
Kaminoff, Leslie (2007) Yoga Anatomy Breathe Company Human Kinetics USA
Coulter, David H (2001) Anatomy of Hatha Yoga, A Manual for Teachers, Students and Practitioners Body and Breath Publications Pennsylvania USA
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