UNIT 4: The Spine. tasya saptadha prantabhumih prajna. UNIT 4: The Spine

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weight travels in your spine, or anything else that came up for you during the movement exploration.

1 UNIT 4: The Spine 4.1 PHYSICAL EXPLORATION: THE CURVES OF THE SPINE KEY POINTS Use this space to reflect on your experiences of the curves of your spine, where the weight travels in your spine, or anything else that came up for you during the movement exploration. Be prepared to discuss in class CERVICAL THORACIC LUMBAR tasya saptadha prantabhumih prajna Yoga Sutras of Patanjali, 2.27 The attainment of clarity is a gradual process. as translated by T.K.V. Desikachar The Breathe Trust and Embodied Asana LLC Unless Otherwise Noted Illustrations by Sharon Ellis or Lydia Mann Unit 4-1

4.2 A BRIEF HISTORY OF THE SPINE Here are some images that help highlight Leslie s brief history of

PSEUDOPOD >> Developed the ability to locomote via movement.

PLATYHELMINTH >> Developed a simple nervous system to organize and coordinate movement and other

The articulated nature of the spine allows for movement.

Limbs and spine remain low to the ground and undulation remains lateral, similar to the fish.

This shape is stronger than a flat spine.

earlier, increasing mobility and raising senses higher off ground.

When supported on hind legs, its forelimbs are freed to be used to manipulate its environment.

2 4.2 A BRIEF HISTORY OF THE SPINE Here are some images that help highlight Leslie s brief history of the spine. SINGLE-CELLED ORGANISM >> Takes in nutrients and releases by-products. PSEUDOPOD >> Developed the ability to locomote via movement. BACTERIUM WITH FLAGELLA >> Developed specialized structures for locomotion. PLATYHELMINTH >> Developed a simple nervous system to organize and coordinate movement and other activities. PRIMITIVE FISH >> Developed a bony, articulated spine to protect the nervous system. The articulated nature of the spine allows for movement. SALAMANDER >> Developed limbs to move on land. Limbs and spine remain low to the ground and undulation remains lateral, similar to the fish. LIZARD >> Developed a primary curve in the spine, resembling the shape of a Roman arch. This shape is stronger than a flat spine. CAT >> Develops a secondary curve in the cervical spine, in addition to the primary curve present earlier, increasing mobility and raising senses higher off ground. PRAIRIE DOG >> Developed ability to sit on hind legs to raise senses still higher. When supported on hind legs, its forelimbs are freed to be used to manipulate its environment. PRIMATE >> Not a true biped. Does not exhibit the 2nd secondary curve, which is unique to spines in humans. HUMANS Developed the unique trait of having a lumbar curve, which brings our center of gravity over our legs. Our upper limbs are free to be used to manipulate the environment. The Breathe Trust and Embodied Asana LLC Unless Otherwise Noted Illustrations by Sharon Ellis or Lydia Mann Unit 4-2

The more critical the central nervous system becomes to a living organism, the more important it is that it evolves to develop a protective structure.

3 The more critical the central nervous system becomes to a living organism, the more important it is that it evolves to develop a protective structure. In the case of the human spine: you need sthira, protection, the boundary to protect it from damage, as well as sukha, the ability to change shape, move and respond to your environment. KEY POINTS Be prepared to discuss in class The solution nature came up with was an articulated series of bony structures stacked one atop the other that created a space within them. What an elegant solution to the contradictory demand for sthira and sukha! Leslie Kaminoff The Breathe Trust and Embodied Asana LLC Unless Otherwise Noted Illustrations by Sharon Ellis or Lydia Mann Unit 4-3

4 4.3 GEEK OUT: VERTEBRAE Please use the space below to draw the two views of a vertebra along with Amy. Then, use the bolded terms to label your drawings. ELEMENTS OF A VERTEBRA, BIRDS-EYE VIEW: ELEMENTS OF A VERTEBRA, FROM THE SIDE: body of the vertebra where most of the weight travels, made of spongy bone articular arch creates a space called the vertebral foramen, through which the spinal cord travels pedicles (there are 2 in this view) the feet of the articular arch body of the vertebra superior articular process articulates with the inferior articular process of the vertebra above inferior articular process articulates with the superior articular process of the vertebra below transverse processes (there are 2 in this view) spinous process / posterior process both names for the bumpy part of the spine that we feel when we run our fingers down someone s back spinal cord bundle of nerves that carries information to and from the brain The Breathe Trust and Embodied Asana LLC Unless Otherwise Noted Illustrations by Sharon Ellis or Lydia Mann Unit 4-4

5 4.4 GEEK OUT: DISCS Please use the space below to draw the two views of an intervertebral disc along with Amy. Then, use the bolded terms to label your drawings. ELEMENTS OF AN INTERVERTEBRAL DISC: BIRDS-EYE VIEW FROM THE SIDE Nucleus pulposus inner jelly-like substance, receives and distributes the force that comes into the disc outwards in every direction Annulus Fibrosus outer ring of fibrous material (fibrocartilaginous connective tissue) arranged in diagonal spiraling rings; contains and resists force from within from every direction The Breathe Trust and Embodied Asana LLC Unless Otherwise Noted Illustrations by Sharon Ellis or Lydia Mann Unit 4-5

6 KEY POINTS Be prepared to discuss in class Describe the two regions of a single vertebra, and how they work together, in terms of sthira and sukha. Describe the two parts of an intervertebral disc that we explored here, and how they work together, in terms of sthira and sukha. (Additional reference chart on page 22 of this document, showing the varying shapes of vertebrae in specific regions of the spine.) The Breathe Trust and Embodied Asana LLC Unless Otherwise Noted Illustrations by Sharon Ellis or Lydia Mann Unit 4-6

4.5 GEEK OUT: LIGAMENTS Four ligaments that run the length of the spine: Anterior Longitudinal Ligament (purple in video) Posterior Longitudinal Ligament (blue in video) Ligamentum Flavum (yellow in

7 4.5 GEEK OUT: LIGAMENTS Four ligaments that run the length of the spine: Anterior Longitudinal Ligament (purple in video) Posterior Longitudinal Ligament (blue in video) Ligamentum Flavum (yellow in video) Supraspinous Ligament (red in video) In addition to these lengthwise ligaments there are shorter intervertebral ligaments that connect processes of one vertebrae to the next, included in the diagram below: interspinous ligaments: connect adjacent spinous processes intertransverse ligaments connect adjacent transverse processes KEY POINTS Be prepared to discuss in class Shade in the four longitudinal ligaments to correspond with Amy s colored tape in the video: Our four lengthwise spinal ligaments play both a sthira and a sukha role in the spine. In your own words, describe one way in which they support each quality. The Breathe Trust and Embodied Asana LLC Unless Otherwise Noted Illustrations by Sharon Ellis or Lydia Mann Unit 4-7

4.6 PHYSICAL EXPLORATION: PRIMARY AND SECONDARY CURVES Leslie will lead us through the following movement exploration: ( in savasana) put your awareness into the shape of the curve of the back of the

8 4.6 PHYSICAL EXPLORATION: PRIMARY AND SECONDARY CURVES Leslie will lead us through the following movement exploration: ( in savasana) put your awareness into the shape of the curve of the back of the heel. Notice that it curves towards the surface of the floor. If you move your awareness upwards from that shape, you ll notice that there s a curve that goes in the opposite direction. The Achilles Tendon region curves away from the floor. We re going to keep paying attention to this alternating series of undulating curves as we travel up through the body. These shapes are going to be a reflection of the primary and secondary curves of the spine. EXPERIENTIAL NOTES Use this space to record any impressions from the movement exploration. Which regions of your spine exhibit a primary curve? Which regions of your spine exhibit a secondary curve? Did this exploration of primary and secondary curves in other parts of your body influence your experience of the curves of your spine? Please explain. The Breathe Trust and Embodied Asana LLC Unless Otherwise Noted Illustrations by Sharon Ellis or Lydia Mann Unit 4-8

4.7 STHIRA AND SUKHA OF THE SPINE When you move your spinal column in any direction out of neutral, you are generating forces within the discs and ligaments that want to return it to where it came

9 4.7 STHIRA AND SUKHA OF THE SPINE When you move your spinal column in any direction out of neutral, you are generating forces within the discs and ligaments that want to return it to where it came from. We refer to this as the intrinsic equilibrium of the spinal column. Leslie Kaminoff ANTERIOR COLUMN (FRONT) Primary responsibilities: weight-bearing weight-supporting weight-redistributing (sukha quality within the sthira) resists compression More sthira: bodies of vertebrae + discs + ligaments POSTERIOR COLUMN (BACK) Primary responsibilities: redistributing forces created in movement providing space for the spinal cord protecting spinal cord (sthira quality within the sukha) resists tension More sukha: processes of vertebrae + synovial joints + ligaments The Breathe Trust and Embodied Asana LLC Unless Otherwise Noted Illustrations by Sharon Ellis or Lydia Mann Unit 4-9

10 KEY POINTS Be prepared to discuss in class.. Describe the anterior and posterior columns of the spine in terms of sthira and sukha. Describe how the vertebrae and discs work together in the spine in terms of sthira and sukha. Leslie introduces the idea of the intrinsic equilibrium of the spinal column by offering the idea that the spine is a neutral-seeking structure on a mechanical level. In your own words, please explain why this is true. EXPERIENTIAL NOTES Use this space to record any impressions from the movement exploration ROLL-DOWN, ROLL-UP: Please reflect on the movement experience led by Leslie. You don t need to answer all these questions, rather use them to get your creative juices flowing: What did you notice when you watched Leslie lead the student through this exploration? What about when you did it, yourself? What was easy? What was hard? What felt like it was moving a lot? What felt like it didn t want to move as much? Did you have a different experience from other roll-down, roll-up experiences because you were focusing on the back, and then the front of the spine? The Breathe Trust and Embodied Asana LLC Unless Otherwise Noted Illustrations by Sharon Ellis or Lydia Mann Unit 4-10

4.8 EMBRYOLOGY: THE WHOLENESS OF THE SPINE The idea that we are many separate pieces that are somehow put

The spine had, as its first experience, a wholeness to it that then, with the development of the bony support,

Does the idea of the wholeness of the spine change or reinforce ideas you had?

11 4.8 EMBRYOLOGY: THE WHOLENESS OF THE SPINE The idea that we are many separate pieces that are somehow put together with a little cushion in between does not reflect the way that our spine developed. The spine had, as its first experience, a wholeness to it that then, with the development of the bony support, segmented itself into the vertebra. Amy Matthews KEY POINTS Be prepared to discuss in class. Does the idea of the wholeness of the spine change or reinforce ideas you had? Does the information in this module change how you experience your spine? The Breathe Trust and Embodied Asana LLC Unless Otherwise Noted Illustrations by Sharon Ellis or Lydia Mann Unit 4-11

4.9 SPINAL MOVEMENTS AND RANGE OF MOTION We ll focus on 5 movements of the spine: Flexion Extension Lateral Flexion Axial Rotation Axial Extension EXPERIENTIAL NOTES What was your experience in the

You may use the questions below to get your creative juices flowing, but you don t need to answer them all: What did you notice about your spine in movement? Asymmetries? Places that move easily?

12 4.9 SPINAL MOVEMENTS AND RANGE OF MOTION We ll focus on 5 movements of the spine: Flexion Extension Lateral Flexion Axial Rotation Axial Extension EXPERIENTIAL NOTES What was your experience in the movement exploration? Please use this space to record any impressions. You may use the questions below to get your creative juices flowing, but you don t need to answer them all: What did you notice about your spine in movement? Asymmetries? Places that move easily? Places of congestion? What are your preferences in these movements? Which spinal movements were more or less comfortable, enjoyable, familiar for you in this exploration? What about your experience of lateral flexion (side-bending). Did a slight twisting between your vertebrae help you to create that shape? Did your experience change when Leslie offered the idea of imagining the 3-dimensionality of your movements? What about the idea of finding a little movement in a lot of places? How was your experience of spinal flexion? Is this a shape you normally avoid, or one that you explore as much as spinal extension? How did it feel in this instance? What was your experience of a neutral spine after spending time exploring all the other movement possibilities? The Breathe Trust and Embodied Asana LLC Unless Otherwise Noted Illustrations by Sharon Ellis or Lydia Mann Unit 4-12

Flexion = shape of the primary curve increase of primary curves, decrease of secondary curves) Anterior part of spine is more convex, posterior part of spine is more concave ex: shape of Cat

13 Flexion = shape of the primary curve increase of primary curves, decrease of secondary curves) Anterior part of spine is more convex, posterior part of spine is more concave ex: shape of Cat Extension = shape of the secondary curve increase in secondary curves, decrease in primary curves Anterior part of spine is more convex, posterior part of spine is more concave ex: shape of Cow Axial Rotation: Often called spinal twisting ; articulation between vertebrae that results in a twist, with one end of the articulating vertebrae moving in one direction and the other end in the other direction The Breathe Trust and Embodied Asana LLC Unless Otherwise Noted Illustrations by Sharon Ellis or Lydia Mann Unit 4-13

14 Lateral Flexion: Often called side-bending ; articulation between vertebrae that results in some or all of the spine moving to one side and creating the shape of a c-curve In order to keep side bending in the side-to-side plane, a combination of lateral flexion and axial rotation might be involved to accommodate the three-dimensional shapes of the facet joints along the spine. Axial Extension: decrease (or flattening) of primary and secondary curves; cues such as flat-back, stand up straight, and lengthen your spine * are calling for axial extension *Note that axial extension doesn t actually lengthen the spine. It moves the head and tail away from each as the curves flatten, but the length doesn t change. Examples of axial extension in asana: The Breathe Trust and Embodied Asana LLC Unless Otherwise Noted Illustrations by Sharon Ellis or Lydia Mann Unit 4-14

15 Axial extension is a flattening of the primary and secondary curves. You lose some of the spring-like shock absorbing ability of the spine when you are in axial extension. Neutral spine means you re not doing flexion, extension, axial rotation, lateral flexion or axial extension. It means that you re just maintaining your primary and secondary curves in a neutral way. Leslie Kaminoff 4.10 BACK PAIN: WHAT TO WATCH FOR The question of pain is about both the sensation and what gives rise to that sensation and about how quickly we begin to try to manage the experience and to figure out what we can do to prevent it. With pain we get reactions to pain, and the anticipation of pain, and ways to shut down around avoiding pain. In engaging with the wholeness of a person we can find other parts of their body where they can engage with a spectrum of movements, and find what actually brings them comfort. Amy Matthews KEY POINTS Be prepared to discuss in class. Amy and Leslie challenged some common assumptions about back pain and the diagnoses people receive based on imaging techniques (MRI, etc.) Did they offer any ideas that support your experience or observation?? Did they offer any ideas that seem to contradict your experience or observation? What about ideas offered here about the role of the teacher Have you thought about how you might handle students who come to you with pain and other conditions? What can you offer? What is beyond how you see your role as a teacher? Findings from studies cited and larger images may be found in the charts in page 22 of this document. The Breathe Trust and Embodied Asana LLC Unless Otherwise Noted Illustrations by Sharon Ellis or Lydia Mann Unit 4-15

16 4.11 WHAT HAPPENS WHEN YOU TAKE THE CURVES OUT? Play with flattening out your curves and letting them return, and see as you do this where you feel effort accumulating, where you feel a familiar experience, where you feel ease. Amy Matthews EXPLORATION NOTES Reflect on your experience during the movement exploration of taking the curves out of your spine, and then allowing them to return. Be prepared to discuss in class. The Breathe Trust and Embodied Asana LLC Unless Otherwise Noted Illustrations by Sharon Ellis or Lydia Mann Unit 4-16

17 Anatomy in Action: Please describe what you see in these images framed by the concept of balanced joint space and a little bit of movement in a lot of places. When might the position on the left be appropriate and under what circumstances might it be problematic? EXTRA CREDIT: When might the position on the right be appropriate and under what circumstances might it be problematic? Stand up straight is a direction that s commonly given in yoga and other circumstances, and with positive intentions. Does what you learned in this unit make you question that verbiage? Or the results that might emerge? What might be an alternative instruction that doesn t call for axial extension? When you start teaching, you ll probably have students who come to you and say, I have back pain. What poses should I avoid? What kind of questions might you ask them? What might you recommend? Did any of the information that Amy and Leslie presented in this unit surprise you? Did you learn anything surprising about your own spine during the explorations? The Breathe Trust and Embodied Asana LLC Unless Otherwise Noted Illustrations by Sharon Ellis or Lydia Mann Unit 4-17

18 Unit 4: Terms and Definitions axial extension: a flattening, or diminishing, of the curves of the spine so that the head and tail move away from each other axial rotation: also called spinal twisting; articulation between the vertebrae that results in a twist, where one end of the spine rotates one way and the other end rotates the other way cervical spine: the seven top vertebrae in the neck; has a secondary curve coccyx: the tail; made up of several fused vertebrae below the sacrum; not weight-bearing intervertebral disc: fibrocartilaginous structure between the bodies of each pair of vertebrae; plays the role of helping to absorb weight and transmit movement through the curves of the spine; includes an inner and an outer part: nucleus pulposus inner part; fluid, gel-like structure at center of disc; receives and distributes force outward in every direction; absorbs some force and helps pass force/weight on to the next vertebra annulus fibrosus outer ring of fibrous material made of fibrocartilaginous connective tissue; contains and resists force from the nucleus pulposus within; strongly connected to the vertebral body above and below; arranged in oblique spiraling layers which both allow some movement in various directions and also resist too much movement in any direction lateral flexion: also called side-bending; articulation between the vertebrae that results in moving to one side or the other in a c-curve lumbar spine: the five vertebrae in the lower back; has a secondary curve neutral extension: also called neutral spine; a state where the curves of the spine are present and balancing each other, where each curve of the spine is neither being flattened nor deepened, where the pathway of weight (in theory) can travel through the bodies of the vertebrae with the least amount of muscular effort (depending on one s relationship to gravity) The Breathe Trust and Embodied Asana LLC Unless Otherwise Noted Illustrations by Sharon Ellis or Lydia Mann Unit 4-18

19 spinal ligaments: ligaments running between the vertebrae and lengthwise along the spine connecting help support the wholeness and continuity of the spine anterior longitudinal ligament: connects the fronts of the vertebral bodies and discs from the basilar portion of the occiput to the front of the coccyx; envelops the front of the spine; front of the front posterior longitudinal ligament: connects the backs of the vertebral bodies and discs; inside the articular arch in front of the spinal cord; back of the front ligamentum flavum: connects along the inside of the articular arch behind the spinal cord; named flavum because of its yellow color; front of the back supraspinous ligament: connects along the back of spine, connecting the tips of the spinous processes together from the skull to the tail; back of the back interspinous ligaments: connect the spaces between adjacent spinous processes vertebra: the landmarks of a vertebra include: body: in the front; generally round shape; composed of mostly bone; where of the weight travels through. articular arch: in the back; provides a protective casing around the spinal cord; includes synovial facet joints to facilitate spinal articulation vertebral foramen: space within the articular arch of each vertebra that creates a lengthwise tunnel within which the spinal cord travels intervertebral foramen: space between the articular arches of adjacent vertebrae that creates an opening for spinal nerves to exit and enter pedicle: the base or feet of the articular arch where it joins the body transverse processes: projections to each side of the articular arch; provide attachment points for muscles and ligaments intertransverse ligaments: connect the spaces between adjacent transverse processes The Breathe Trust and Embodied Asana LLC Unless Otherwise Noted Illustrations by Sharon Ellis or Lydia Mann Unit 4-19

20 spinous process: also called posterior process; projection on the back of the articular arch; what we feel as bumps along our spine in the back; provides attachment point for muscles and ligaments articular processes: each vertebra has two superior and two inferior articular processes; they are the joint surfaces that participate in synovial facet joints with neighboring vertebrae; covered in hyaline cartilage facet joints: also called zygapophyseal joints; synovial joints between adjacent articular processes As yoga educators, our primary goal is not to fix what has gone wrong, but to focus on what s still going right. Leslie Kaminoff thoracic spine: the twelve vertebrae with ribs; has a primary curve sacrum: the lowest weight-bearing portion of the spine; made up of several more or less fused vertebrae; has a primary curve spinal extension: a spinal action where the back surfaces of the spine move towards each other; an increase in secondary curves and a decrease in primary curves; not necessarily the same as back-bending spinal flexion: a spinal action where the front surfaces of the spine move towards each other; an increase in primary curves and a decrease in secondary curves; not necessarily the same as forward-bending Suggested Reading in Yoga Anatomy Chapter 2 Chapter 3, pp ADDITIONAL RESOURCES ( Video Glossary Muscles of the Spine The Breathe Trust and Embodied Asana LLC Unless Otherwise Noted Illustrations by Sharon Ellis or Lydia Mann Unit 4-20

21 Reference Images UNIT 4: THE SPINE Form follows function at every level of the spine: View of vertebrae from the top The Breathe Trust and Embodied Asana LLC Unless Otherwise Noted Illustrations by Sharon Ellis or Lydia Mann Unit 4-21

Reference Images UNIT 4: THE SPINE Disc Injury Diagram and Rates of False Positive MRIs THE BOTTOM LINE: If we gathered a group of middle-age folks (45 average age) who have NEVER had back pain

22 Reference Images UNIT 4: THE SPINE Disc Injury Diagram and Rates of False Positive MRIs THE BOTTOM LINE: If we gathered a group of middle-age folks (45 average age) who have NEVER had back pain before and performed MRI scans on them all, here s what we would find: FALSE POSITIVE RATES FOR LUMBAR MRI DISC PATHOLOGY: INVESTIGATION: Bulge Protrusion Extrusion Combined: bulge, protrusion, extrusion, sequestration Root Deviation or Compression Borden et al. 20% NA Jensen et al. 52% 27% 1% 84% Boos et al.* 13% 4% Greenberg et al. 39% 18% 57% Weishaupt et al. 24% 40% 18% 4% Wood et al (11)* 53% 37% 63% AVERAGES 38% 29% 9.5% 60.5% 4% * Because these investigations used a high risk asymptomatic group of people, i.e., people whose occupation required frequent heavy lifting, twisting, and bending; frequent exposure to vibration; and sedentary occupations, I have EXCLUDED the results from the averaging above. COURTESY OF CHIROGEEK.COM DR. DOUGLAS M. GILLARD DC 38% would have disc bulges 29% disc protrusions (aka: contained herniations) 10% disc extrusions (aka: non-contained herniations) 4% of nerve root compression by the disc herniation 0% disc sequestrations (aka: free fragments, which hurt IN SUMMARY: 60% of asymptomatic middle-aged people would have findings of disc bulge or worse (protrusion, extrusion) on MRI. The Breathe Trust and Embodied Asana LLC Unless Otherwise Noted Illustrations by Sharon Ellis or Lydia Mann Unit 4-22

THE VERTEBRAL COLUMN. Average adult length: In male: about 70 cms. In female: about 65 cms.

THE VERTEBRAL COLUMN. Average adult length: In male: about 70 cms. In female: about 65 cms. THE VERTEBRAL COLUMN Average adult length: In male: about 70 cms. In female: about 65 cms. 1 Vertebral Column (Regions and Curvatures) Curvatures of the vertebral column: A. Primary curvature: C-shaped;