Therapeutic Yoga for the Hip

Transcription

1 Therapeutic Yoga for the Hip Wisconsin Athletic Training Association Annual Symposium 2018 Heidi Dix MEd, LAT, ERYT

2 The hip joint, is the joint that determines symmetry - Ida Rolf

3 Presentation Overview Yoga definitions Brief yoga history Aspects of Yoga (8 limbs) Integration with Athletic Training The yoga of awareness Practice (awarenss, breath, postures)

4 Yoga: The basics

5 Yoga teaches us to cure what need not be endured and endure what cannot be cured. - BKS Iyengar

6 Yoga defined Yoga= yuj : to yoke, to unite, to bring together

7 What is Yoga? A complete how to live system originiating in Asia. The purpose is optimal physical, emotional, and spiritual health.

8 What is Yoga? Yoga is a systematic technology to improve the body, understand the mind, and free the spirit Timothy McCall, MD Yoga as Medicine

9 Yoga History Pantanjali: Scholar from India- 500 BC Compiled the Yoga Sutras outlining the Yoga path: summarizing the process and tools that can bring peace, wisdom and well being Main text to study for Yogis Hatha Yoga: physical practice of yoga

10 Elements of Yoga 1. Yama rules of social conduct 2. Niyama rules of personal behavior 3. Asana - poses 4. Pranyama- Breathing exercises / optimize energy 5. Pratyahara conscious movement of attention away from senses 6. Dharana- 7. Dhyana - 6-8: Meditation/ mindfulness present moment 8. Samadhi -

11 Holistic/ Yoga versus Medical Philosophy Defines health as a state where all systems function optimally Define health as the absence of symptoms/ disease Considers all levels of human being: physical, mental/ emotional, spiritual, as interrelated (koshas) Views human body in compartments and physical symptoms mostly as either mechanical or chemical in nature

12 Purpose of adding yoga to AT practice Improved relaxation Reduce muscle tension Reduce pain Improved coping skills Reduce inflammation, promote healing Increased awareness To create more choices To notice what causes/ worsens relieves pain to become aware of/ change thinking patterns that my add to symptoms

13 Integrating yoga techniques into AT Practice Therapeutic Exercise/ Asana Breathing techniques/ Pranyama Relaxation techniques/ Mindfulness

14 Yoga Approach to Exercise Focus on mindfulness Constant awareness of how the mind and body react to movement and position Focus on relaxation Even during strenuous movements Linking breath with movement Linking breath and movement using breath to relax in the stretch Optimize movement with alignment principles

15 Yoga Approach to Exercise Postural Alignment Increase Structural Stability Increase pain free ROM Strengthen Weak Release Chronic/ overreactive muscles Balance muscular asymmetries Develop healthy movement patterns Goal: Strengthen weak, release the tight, symmetry

16 Yoga Approach to Exercise Functional Movement Principles for optimal alignment in all postures Base Dynamic Tension Soften and Aligned Knees Core Aligned Spine Scapular Retraction and depression Hip Hinge Lever Length

17 Yoga Approach to exercise Develop strength, stability, mobility and flexibility in the simple postures All yoga can be therapeutic Less is more Simple yoga postures use fewer joints Important to have gained the mobility, stability, strength and flexibility in the simple postures to create awareness and injury

18 Yoga Approach to Exercise Developing Core Stability Core stability is a balance of strength and mobility Core stability created through bandahas Bandahs: energetic locks located at specific locations in the body. Although they are energetic, they can be acceded through out physical anatomy

19 Yoga Approach to exercise Developing Core Stability Three primary bandhas: Mula Bandha pelvis (urogenital diaphragm, hip adductors, peroneus and tibialis posterior Uddiyana Bandha 3 beneath navel Mula bandha contraction + TA and lower fibers of int oblique and multifidi Girdle like affect Jalandara Bandha- deep neck flexors Tennis ball and hold it Two secondary bandahs: Pada Bandha- feet Hasta Bandha- ha

20 Yoga Breathing Principles Inhalation Inhalation is more active Inhale when expanding front of body Inhale to lengthen the spine before rotation or side bending Exhalation Exhalation is more passive typically used to aid in relaxation or deepening of stretch Exhale when contracting front of body Exhale to facilitate abdominal or pelvic floor muscles of contraction

21 Breathing should be effortless and deep Ideally through nose

22 Breathing Exercises 3 part yoga breath Breath awareness Paced breathing Alternate nostril breathing Breath of Joy! Breath linked to movements (count breaths instead of movements) All effective in reducing activity of the sympathetic nervous system

23 Relaxation Techniques Body scan Breath awareness practice Mantra practice Yoga Nidra Moving Meditations (poses, walking..etc) Purpose: relaxation, enhancing PNS activity, reducing anxiety, impove sleep

24 Suggestions for integrating Yoga Slow and deep, synchronized breathing during exercise Count breaths instead of seconds keep attention focused on the body during rehab Teach basic breathing techniques a part of home exercise program

25 Documentation Neuromusclular re-education- instruction and performance of relaxation techniques for the purpose of reducing muscle tension and pain Patient was instructed in and performed manual assisted breathing exercises with purpose of restoring proper coordination of trunk muscles.. Patient performed their ex with synchronized breathing patterns to facilitate optimal relaxation of target muscles during stretched

26 Skeletal Variations Paul Grilley Slides on skeletal orientations of the pelvis and femur

27 Two Physical Factors which can limit how open our hips are Flexibility/ Tightness muscles, tendons and fascia in and around the joint This is what yoga poses can work on Skeletal Differences Ultimate limit to range of motion in hip openers (and all poses). Bone should not/ will not move past bone no matter how much we work on it! People s skeletons vary in width and angles of pelvis and femur and how they meet together. we are all asymmetrical, one side will generally feel easier in a pose than the other.

28 Moving Joints in Optimal Range of Motion Joints need to move optimally If move too far- injury occurs If we don t move far enough- the full benefit of practice is not enjoyed

29 Moving Joints in optimal range of motion Move only as far as joint allows Relaxed Able to breathe Not forced Pain free No other joints (or muscles) compensating with movement

30 The Hip Joint & Yoga

31 Hip Adductors Stretching/ Strengthen will bring increased stability and increased freedom into gain Whether stretching or strengthen they are crucial in yoga practice

32 Hip Adductors The hip adductors are responsible for which of the following common yoga issues: Difficulty holding your legs together in inversions Knees pop up in sitting poses Bound Angle Pose Legs slip down your arms in arm Crow Pose Your legs won't separate very Wide-Angle Seated Forward Bend

33 Hip Adductors Strengthen- Yoga block Poses: Mountain, Bridge, Boat, DFD, Wheel, Stretch- shortness in these muscles limits your horizontal abduction, or your ability to spread your thighs apart when your hips are flexed Poses: Butterfly, Head-of-the-Knee Pose, Warrior Pose II, Side Angle Pose, moonflower/ sunflower Co Contract with Abductors in standing balancing poses Adductors/ Abductors work together in balance postures

34 Hip Abductors Abductors and other hip muscles are strong and accustomed to toning throughout the day Abductors are one of the most important groups of muscles for stabilizing the weight of the body when you stand on one leg Strengthen: triangle (back leg), side plank (top leg lift), balancing half moon (top leg), table top Stretching: pigeon (front leg), figure 4, seated twist like half lord of fishes, seated double pigeon, cradle the baby, Side Notes: when paired with ER Listen to body- injury rate high in some of these poses Sciatic pain/ piriformis

35 Hip Internal Rotators Main muscles : tensor fascia latae (TFL) and gluteus medius, gluet min Internally rotated hip movements are vital to counter the external rotation Yoga Poses: Mountain (feet parallel), Tree (standing leg), Eagle, Warrior III (NWB), extended hand to big toe, bow pose (feet parallel), Warrior I (both legs), Cows Face

36 Hip External Rotators 6 external rotators piriformis best known When tight, forward folds are limited causing head of femur to ER and pelvis to rotate superiorly Strengthened: Warrior II (on the bent leg), Side Angle Lunge (on the bent leg), yogi squat, tree Stretched: Seated Bound Angle Pose, Double Pigeon, seated figure 4, Squat, or Child s Pose.

37 Hip Extension Primary Muscles: gluet max, hamstring Strengthen: sunbird, spinal balance, plank with leg lift, low lunges, airplane (top leg), warriors Stretched: (all on the straight leg) Locust, Camel, Bow, and Wheel, Happy baby, standing split, wide leg forward bend, pyramid

38 Hip Flexion Primary muscles :"lliacus, Psoas Major, Rectus Femoris Tight Hip flexors- Common issue Strengthen: Chair, Warriors (front leg), crescent lunge (front leg), Forward folds, kneeling camel Stretch:, cobra, bow, bridge passive w/ block, Warrior I, kneeling lunge, kneeling lunge with twist, pigeon (back leg), pose of dancer, wheel

39 Overactive Psoas Muscle Upper fibers causing flat low back and poor reversal of curves into lumbar lordosis Lower fibers: causing overarched low back and poor reversal of curves into slight lumbar flexion. Lower fibers are stiffer than upper fibers causing increased lordosis

40 Lower Psoas Release Warrior I Combines hip extension with core stability Shorter stance, back foot at 45 degrees to find neutral pelvis Supine half knee to chest Knee to chest stabilizes pelvis and extended leg lengthens lower psoas

41 Lower Psoas Strengthening Full boat Works the lower back, thighs and lower, medial fibers of psoas to maintain arch. Releases upper body and chest, lengthen the upper psoas.

42 Upper Psoas Strengthening Half Boat/ Canoe Lumbar spine is rounded and lower back is flat on floor. Works upper psoas, while neutralizing lower psoas variations Upper Psoas Crunch Lie supine with neutral pelvis, legs can be bent on to chair, do abdominal crunches

43 Upper Psoas Release Passive Supine restorative back bending pose Active Have patient in supine position, knees bent. Slowly raise arms overhead, releasing upper psoas

44 Psoas Buddies Iliacus Mirrors the action of the psoas Quadratus Lumborum Laterally flexes vertebral column Can affect breathing, lumbar spine

45 Quadratus Lumborum To Stretch: Internally rotate extended leg in kneeling lunge, turn torso in opposite direction Examples: Lunge with knee on small block, turn torso Pigeon with inner spiral, torso goes opposite direction

46 Pelvic Alignment Balanced Hips, Hip Elevation, Pelvic Rotation HIP HINGE

47 Anterior Pelvic Tilt Anterior tilt often paired with spinal compression and short hip flexors, increased tightness in quads and leads to a lot of trunk and LE misalignments are potential conditions Yoga for decreasing anterior tilt: cow, passive supine back bending, lunges, warriors

48 Posterior Pelvic Tilt Backward pelvic tilt= anterior compression in lumbar spine Excessive sitting is one of the prime causes Gluteus and hamstrings will get tight and limit how well you can t tilt your pelvis anteriorly Associated with lumbar kyphosis Yoga: be aware of tucking tail, Hip Hinge (demo- seated), forward folds, child s pose, cat, DFD

49 Lateral Tilt: one iliac crest more higher than the other Muscle imbalance: high side hip abductors long, low side hip abductors short Yoga poses: Warrior 2- toward the higher side Yoga pose: Supported Spinal twist- low side across using bolsters under hip and knees, triangle pose, clam shells

50 Rotation: ASIS on one side is anterior to ASIS on side to which the pelvis is rotated Muscle Imbalance: TFL short on side opposite forward rotation. Example: if right ASIS is rotated forward, left TFL is short. Yoga pose: Intense Leg stretch (Pyramid) at wall Yoga pose: Spinal twists

51 SacroIliac Joint & Yoga

52 Sacro- Iliac Joint Twisting is main culprit of SI injury always move pelvis and sacrum together, Yoga poses: supine pelvic tilts, supine hip circles, supine figure four, cat pose, cobra and locust Be aware in triangle, forward folds, twists

53 Heidi Dix MEd, LAT, ERYT

54