Saturday, September 14, 2013

Yoga and hypermobilility

What is hypermobility? People whose joints have a more-than-normal range of motion are called hyperflexible or hypermobile - the clinical term is joint hypermobility syndrome (HMS), which may also be an expression of the more serious Ehlers Danlos Sydnrome.

Research suggests that up to 3 in 10 adults may be hypermobile to some degree, with women being more likely to be affected than men due to the relaxing effects of female hormones. Many people with hypermobility have a 'harmless' variety: that is, they experience no unusual effects except being more bendy than the rest of us. But for others, HMS can be debilitating, causing chronic pain.

In either case, people who are hypermobile are generally more prone to injuries, fractures and dislocated joints, because their joints have more mobility than stability.   

Yoga and hypermobilility
Hypermobile people may come to yoga because of an injury, one of those inexplicable "I was just walking/running/surfing/playing tennis and then I felt this pain..." injuries that are common among the super-flexible. Or they naturally gravitate to yoga because of their flexibility. Once in a yoga class, super bendy people are often told they are "amazing" by teachers who don't recognise or understand their hypermobility. 

Some may even quickly want to become teachers themselves, since after only a few months of practice they find themselves doing "advanced" poses with ease. And in a yoga culture that increasingly idolises the physical performance of postures that require extreme flexibility (just do a pinterest search for yoga if you don't believe me!), it may be hard for people to believe that extreme bendiness is not actually what yoga is all about.

However, underneath that ease in bending a hyper-flexible body is the danger that hypermobile joints are lacking the muscular resistance to properly support the joints in the range of motion that yoga puts us through. This may manifest slowly, through unexplained aches and pains after a seemingly "easy" practice; or it may manifest all of a sudden through an injury: a dislocated joint, a chronic pain, or a repeatedly inflamed muscle or tendon.

And yoga is not a miracle-cure:

over time, the sustained practice of yoga without counter-balancing hyperflexibility can lead to a dangerous instability in the joints, that can manifest in chronic joint pain and even symptoms of early arthritis.

How can I tell if I'm hypermobile?
You may be hypermobile to some extent if any of the following sound familiar to you:

  • You have always been able to place your hands flat on the floor in a forward bend or flop into the splits
  • Your friends and family all remember your "crazy" flexibility as a child
  • You feel a constant need to stretch but it never seems to satisfy you
  • You are deep in a pose that is supposedly challenging, but you don't "feel" anything
  • After hardly any time at all, you put your body into the positions of 'advanced' yoga poses such as the splits, one-legged king pigeon pose, or touching your head to the ground in wide-legged standing forward bend
  • You sometimes feel fatigued after simply stretching or doing gentle yoga
  • You find it hard to sit comfortably in a chair for a long time and are constantly folding yourself into different positions
In addition, you may be hypermobile in some joints while having a normal or less than normal range of motion in others.

So, should hypermobile people do yoga?
It's easy to understand why many doctors and physiotherapists who work with hypermobile people advise against doing yoga. 

However, many hypermobile people find that the right yoga practice can help them a great deal by building body awareness and helping them to develop the strength that they will need to balance their natural flexibility. The key thing to remember is that yoga is about balance: in this case, achieving a balance between flexibility and strength.

Guidelines for choosing a yoga class if you are hyper flexible:

  • Find an experienced and well-qualified teacher, preferably someone with some yoga therapy experience or someone familiar with hypermobility, and make them aware of what you are working with. Get them to help you create some goals for your practice that don't rely on flexibility alone.
  • Avoid styles of yoga that emphasise short, fast movements, such as ashtanga or vinyasa flow, until you have built up a solid foundation of strength that will keep you stable and safe from injury in these movement-oriented styles.
  • Instead, choose styles of yoga that emphasise proper alignment, stability and strength, such as Iyengar yoga.
  • Complement your yoga with strength and resistance training, and with core strength building  exercises like pilates (again, with an experienced teacher) that will help you isolate important muscles and begin to build strength in key areas.
Advice for practicing yoga if you are hypermobile:
  • Focus on harnessing muscular energy: engaging your muscles in a pose, instead of 'flopping' into it. For example in any forward bend, strongly engage your quadriceps and feel as if you are trying to "suck" the floor up through your leg muscles.
  • Make sure you always put a micro-bend in your knees and elbows to avoid putting too much stress on your joints - combine this with the muscle engagement above, and you will be properly supporting your joints!
  • Always keep your head supported by your neck muscles, and avoid the temptation to let your head flop back in upward-looking poses or backbends.
  • Avoid the temptation to go as deep as you can into a pose, and instead focus on engaging your muscles as much as you can. Consider 'gapping' your joints - for example placing a small rolled up towel in between your belly and your thighs in a standing forward fold, or placing your hands behind the backs of your knees in a seated forward fold.
  • Avoid hyper-extending backwards in backbends by strongly engaging your abdominal muscles and focusing on the sensation of lengthening your spine.
  • If you can, see a qualified yoga therapist for a one-on-one session to get a personalised assessment and advice.
  • Avoid starting a practice on your own or with a DVD: until you have more experience, you should work with a teacher who can tell you if you are hyper-extending.

Tai chi helps reduce stress and anxiety

Tai chi helps reduce stress and anxiety. And it also helps increase flexibility and balance.
If you're looking for a way to reduce stress, consider tai chi (Healing). Originally developed for self-defense, tai chi has evolved into a graceful form of exercise that's now used for stress reduction and a variety of other health conditions. Often described as meditation in motion, tai chi promotes serenity through gentle, flowing movements. 

What is tai chi?

Tai chi is an ancient Chinese tradition that, today, is practiced as a graceful form of exercise. It involves a series of movements performed in a slow, focused manner and accompanied by deep breathing. 

Tai chi, also called tai chi chuan, is a noncompetitive, self-paced system of gentle physical exercise and stretching. Each posture flows into the next without pause, ensuring that your body is in constant motion.
Tai chi has many different styles. 

Each style may have its own subtle emphasis on various tai chi principles and methods. There are also variations within each style. Some may focus on health maintenance, while others focus on the martial arts aspect of tai chi. 

Who can do tai chi

Tai chi is low impact and puts minimal stress on muscles and joints, making it generally safe for all ages and fitness levels. In fact, because tai chi is low impact, it may be especially suitable if you're an older adult who otherwise may not exercise. 

You may also find tai chi appealing because it's inexpensive, requires no special equipment and can be done indoors or out, either alone or in a group.
Although tai chi is generally safe, women who are pregnant or people with joint problems, back pain, fractures, severe osteoporosis or a hernia should consult their health care provider before trying tai chi. Modification or avoidance of certain postures may be recommended. 

Groin Strain

What is a groin strain?
A groin strain is a relatively common condition characterized by tearing of some or all of the adductor muscle group.
The muscles at the inner aspect of your thigh are known as the adductor muscles (groin). These muscles originate from the pelvis and insert into the inner aspect of the thigh (femur) and lower leg bones. 
The groin muscles are responsible for stabilising the pelvis and moving the leg towards the midline of the body (adduction). They are particularly active during running (especially when changing direction) and kicking.

During contraction of the groin muscles, tension is placed through the groin. When this tension is excessive due to too much repetition or high force, one or more of the groin muscles can tear. 

This is known as a groin strain and can range from a small partial tear of the groin muscle(s) whereby there is minimal pain and minimal loss of function, to a complete rupture of one or more groin muscles resulting in severe pain and marked loss of function. 

Groin strains range from a grade 1 to a grade 3 strain and are classified as follows:

Grade 1
a small number of muscle fibres are torn resulting in some pain but allowing full function. 
Grade 2:  
a significant number of muscle fibres are torn with moderate loss of function. 
Grade 3
all muscle fibres are ruptured resulting in major loss of function.

The majority of groin strains are grade 2. The most commonly affected muscle involved in a strained groin is the adductor longus muscle. 

Causes of a groin strain

A groin strain commonly occurs due to a sudden contraction of the groin muscles often when they are in a position of stretch. This typically occurs during rapid acceleration whilst running (particularly when changing direction) or when a footballer performs a long kick. 

They are commonly seen in running sports such as football, hockey and athletics (particularly sprinters, hurdlers, and long jumpers) as well as skiing, horse riding and gymnastics. Groin strains tend to occur more commonly in the older athlete and particularly following an inadequate warm-up.

Signs and symptoms of a groin strain 

Patients with this condition usually feel a sudden sharp pain or pulling sensation in the inner thigh or groin during the provocative activity. In minor cases, the patient may be able to continue the activity only to have an increase in symptoms upon cooling down. In more severe cases, the patient may be unable to continue the activity and will often limp or be unable to walk off the playing field.

Patients with a groin strain usually experience an increase in pain during activities which place load on the groin muscles. 

These activities may include: 
walking (especially on uneven surfaces or stairs), running (especially changing directions), twisting, jumping, and kicking. 

It is also common for patients with this condition to experience pain or stiffness after these activities with rest, especially upon waking in the morning.Squeezing the legs together and performing a groin stretch may also cause pain in patients with a groin strain.
Patients with this condition may also experience swelling, muscle spasm, weakness, tightness, tenderness and bruising in the inner aspect of the thigh and groin.

Diagnosis of a groin strain

A thorough subjective and objective examination from a physiotherapist is usually sufficient to diagnose a strained groin. Further investigations such as an MRI scan or Ultrasound may be required, in rare cases, to confirm diagnosis and assess the severity of injury.

Prognosis of a groin strain
With appropriate management, patients with minor groin strains can usually recover in one to three weeks. With larger tears, recovery may take four to six weeks or longer, depending on the severity. In cases of a complete rupture of the groin, long term weakness and reduced function may occur.

Contributing factors to the development of a groin strain

There are several factors which can predispose patients to developing a groin strain. These need to be assessed and corrected with direction from a physiotherapist. 

Some of these factors include:
  • poor groin flexibility
  • muscle weakness (especially of the groin or gluteals)
  • inadequate conditioning of the groin muscles
  • muscle tightness
  • inappropriate training or technique
  • poor biomechanics
  • poor posture
  • decreased fitness
  • fatigue
  • inadequate warm up
  • joint stiffness (particularly the lower back, hip and knee)
  • poor pelvic and core stability
  • inadequate rehabilitation following a previous groin injury
  • neural tightness
  • muscle imbalances

Physiotherapy and Osteopathy for a groin strain

Physiotherapy and Osteopathy for patients with this condition is vital to hasten the healing process, ensure an optimal outcome and reduce the likelihood of future recurrence. Treatment may comprise:
  • soft tissue massage
  • electrotherapy (e.g. ultrasound)
  • stretches
  • muscle energy techniques
  • joint mobilization
  • ice or heat treatment
  • the use of a compression bandage or strapping
  • education
  • biomechanical correction
  • the use of crutches
  • dry needling
  • progressive exercises to improve strength, flexibility, core stability, pelvic stability and balance
  • activity modification advice
  • technique correction
  • anti-inflammatory advice
  • prescription of orthotics
  • devising and monitoring a return to sport or activity plan

Other intervention for a groin strain
Despite appropriate physiotherapy management, some patients with a strained groin do not improve adequately. When this occurs, the treating physiotherapist or doctor can advise on the best course of management. 

This may include investigations such as an X-ray, ultrasound, CT scan or MRI, or referral to appropriate medical authorities who can advise on any intervention that may be appropriate to improve the condition. In very rare cases, of complete groin rupture, surgical intervention may be considered.

Exercises for a groin strain

The following exercises are commonly prescribed to patients with this condition. You should discuss the suitability of these exercises with your physiotherapist prior to beginning them. Generally, they should be performed 3 times daily and only provided they do not cause or increase symptoms.
Your physiotherapist can advise when it is appropriate to begin the initial exercises and eventually progress to the intermediate and advanced exercises. As a general rule, addition of exercises or progression to more advanced exercises should take place provided there is no increase in symptoms.

Initial Exercises

Groin squeezes: 

Begin this exercise by lying in the position demonstrated with a rolled towel or ball between your knees (figure 2). Slowly squeeze the ball between your knees tightening your groin muscles (adductors). Hold for 5 seconds and repeat 10 times as hard as possible pain free.

Groin Squeezes
Figure 2 – Groin squeezes

Groin Stretch: 

Begin this exercise by standing tall with your back straight and your feet approximately twice shoulder width apart. Gently lunge to one side, keeping the other knee straight, until you feel a stretch in the groin (figure 3). Hold for 5 seconds and repeat 10 times at a mild to moderate stretch provided the exercise is pain free.

Groin Stretch
Figure 3 – Groin Stretch (left leg)

Other Exercises:

Wednesday, September 4, 2013

When You Have a Bulging Disc How to safely Practice Yoga

Yoga will not "cure" a bulging disc. In fact, unless you are working one-on-one with a teacher, I wouldn't recommend yoga with an active disc bulge. However, once your doctor has cleared you for physical activity, you can use modifications in yoga class and in your workouts to help alleviate - or at least not worsen - any lingering discomfort associated with your injury.
What Is a Bulging Disc? To understand modifications, first take a moment to understand what a bulge is. It is exactly what it sounds like. In between the vertebrae on your back, there are soft layers of cartilage and fluid to cushion your bones - these are commonly called discs. 

They should remain in line, but occasionally can slip into a space they are not supposed to occupy. This space is supposed to be, and is likely still, occupied by nerves. When the disc protrudes into this space, it can create discomfort ranging from mild to extreme.

Disc bulges can be caused by sudden trauma, such as a car accident, or repeated misuse. Bulges are often referred to as herniated discs or slipped discs, and all these terms refer to the same condition. It is critical to take rest in the case of a severe bulging disc. If the problem is not treated appropriately, surgery may be required. In most cases, though, athletes can return to working out and practicing yoga even in the presence of a bulging disc.

Basic Rules to Remember
herniated disc, slipped disc, bulging disc, yoga bulging disc, lifting low back
Most bulging discs occur in the lumbar and cervical spine:
Cervical spine bulges are far more dangerous as the neck is highly mobile and houses main nerves and blood supply to the brain. This article will not deal with bulges in the neck; we are specifically referring to spinal injuries occurring in the low back. 

Most lumbar bulges protrude toward the posterior:
This forces the discs into the spinal column of nerves, which causes the painful sensation. 

Tell your teacher that you have a bulging disc:
Show them where and let them know if your bulge is atypical (i.e., protruding to the side or front). 

Think of a spring with a tube of play-dough inside:
If you were to bend the spring, the play-dough would be pushed away from the bend. It would potentially squeeze through the side of the spring that became longer, rather than the side that became shorter. This is how a bulging disc works and why most bulges go out the back!  

Bulges are made worse when we bend our "spring,” i.e. our back, forward:
Therefore, it is best to avoid this movement when you have a bulging disc. 

As a general rule, do not use flexion in the hips: This means the front of your hips should never bend more than ninety degrees. Specifically, we want to avoid any deep flexion of more than 135 degrees. 

Back bending should be not only okay but also actually therapeutic in treating bulging discs: However, make sure you have spoken with your doctor before moving forward with back-bends.

Modifications for Yoga and Lifting
In yoga, there is a lot of folding forward! Every forward fold involves flexion of the hip beyond 90 degrees.  

Try these modifications:

Forward fold: Keep your knees bent and place your hands on your thighs. Keep the chest lifted away from the thighs, assuring the low back is long and not bent forward. 

Lunges: Lunges are okay, as the hip does not flex beyond 90 degrees, but avoid stepping the foot forward from downward facing dog. Instead, lower to your knees first. Place your hands on blocks or your hips to keep your chest upright, and step a foot forward without bending at the waist.  

Triangle pose: Use a block under your hand to keep your chest elevated away from your waist. Do not try to bend deeply into the pose; rather, engage your leg muscles and core in order to boost yourself out of the low back. (pictured below)

Apply these same principles in your lifting practice. This will mean abstaining from certain motions until you are healed:

Avoid cleans until you have been cleared for this activity:
--This is one of the most precarious motions for a bulging disc.

--When squatting, avoid going any deeper than 90 degrees in the hip socket until you can keep your low back long.  

Use your core to stabilize your lower back in every single motion:
Core strength will be a leading insurance policy against aggravating your bulge in the future. The more you engage your core, the less your low back will arch or round in any lift. This will keep your spinal column in line, allowing for only your natural lumbar curve.
Taking a moment to talk with a knowledgeable therapist or yoga therapist about your back injury will increase your chances of healing.  

When you understand what is functionally going on in your body, you can intuitively understand the modifications best for you. Ultimately, the goal is to restore a full range of motion. 

However, if you know you have a tendency to over-arch or bend into the lower back, you can consciously limit your range of motion for a safer motion on and off your mat.

Anxiety Disorders

Everybody knows what it's like to feel anxious -- the butterflies in your stomach before a first date, the tension you feel when your boss is angry, and the way your heart pounds if you're in danger. Anxiety rouses you to action. It gears you up to face a threatening situation. It makes you study harder for that exam, and keeps you on your toes when you're making a speech. In general, it helps you cope. 

But if you have an anxiety disorder , this normally helpful emotion can do just the opposite -- it can keep you from coping and can disrupt your daily life. There are several types of anxiety disorders, each with their own distinct features. 
An anxiety disorder may make you feel anxious most of the time, without any apparent reason. Or the anxious feelings may be so uncomfortable that to avoid them you may stop some everyday activities. Or you may have occasional bouts of anxiety so intense they terrify and immobilize you.

Anxiety disorders are the most common of all the mental health disorders. Considered in the category of anxiety disorders are: Generalized Anxiety Disorder, Panic Disorder, Agoraphobia, Social Phobia, Obsessive Compulsive Disorder, Specific Phobia, Post-Traumatic Stress Disorder, and Acute Stress Disorder. 

Anxiety disorders as a whole cost the United States between 42-46 billion dollars a year in direct and indirect healthcare costs, which is a third of the yearly total mental health bill of 148 billion dollars. 

In the United States, social phobia is the most common anxiety disorder with approximately 5.3 million people per year suffering from it. 
Approximately 5.2 million people per year suffer from post-traumatic stress disorder. 

Estimates for panic disorder range between 3 to 6 million people per year, an anxiety disorder that twice as many women suffer from as men. Specific phobias affect more than 1 out of every 10 people with the prevalence for women being slightly higher than for men. Obsessive Compulsive disorder affects about every 2 to 3 people out of 100, with women and men being affected equally. 

Many people still carry the misperception that anxiety disorders are a character flaw, a problem that happens because you are weak. They say, "Pull yourself up by your own bootstraps!" and "You just have a case of the nerves." Wishing the symptoms away does not work -- but there are treatments that can help. 

Anxiety disorders and panic attacks are not signs of a character flaw. Most importantly, feeling anxious is not your fault. It is a serious mood disorder, which affects a person's ability to function in every day activities. It affects one's work, one's family, and one's social life. 

Today, much more is known about the causes and treatment of this mental health problem. We know that there are biological and psychological components to every anxiety disorder and that the best form of treatment is a combination of cognitive-behavioral psychotherapy interventions. Depending upon the severity of the anxiety, medication is used in combination with psychotherapy. Contrary to the popular misconceptions about anxiety disorders today, it is not a purely biochemical or medical disorder. 

There are as many potential causes of anxiety disorders as there are people who suffer from them. Family history and genetics play a part in the greater likelihood of someone getting an anxiety disorder in their lifetime. Increased stress and inadequate coping mechanisms to deal with that stress may also contribute to anxiety. 

Anxiety symptoms can result from such a variety of factors including having had a traumatic experience, having to face major decisions in a one's life, or having developed a more fearful perspective on life. Anxiety caused by medications or substance or alcohol abuse is not typically recognized as an anxiety disorder. 

We have developed the information here to act as a comprehensive guide to help you better understand anxiety disorders and find out more information about them on your own. Choose from among the categories at left to begin your journey into recovery from this treatable disorder.

Reference by: Mark Dombeck, Ph.D.