Intervertebral Discs lie between the vertebrae. There are 23 discs which account for approximately 20-25% of the length of the spinal column. There are 6 in the neck, 12 in the middle back and 5 in the lower back. The fluid, gelatinous inner part of the disc is the nucleus pulposus, and is confined by a fibrous ring called the annulus fibroses. Disc herniation occurs when the disc gets squeezed and the core leaks out of the outer ring and pushes on the spinal nerve roots. Posterolateral herniations are often caused by excessive flexion/rotation and account for approximately 90-95% of herniations with 95% of those are between the L4-L5 or L5-S1. IV discs become circumferentially broader when the spine is compressed and thinner when stretched (as in hanging or suspended).
Forward flexion and rotation can create disc shearing. End range flexion because it can force the disc more posteriorly.
Herniated Discs respond to extension and may be worsened with flexion. This is opposite about 5-10% of the time and flexion is good for herniated discs which have an anterior herniation. Build core strength with a focus on the multifidious muscles which stabilize the vertebrae and attach to the spinal process.
The canal of the spinal cord can narrow from osteoarthritis and/or other degenerative changes which restrict the space for the spinal cord and spinal nerves as they exit the canal. Cervical and lumbar stenosis are the most common.
Indications: Flexion, Core strength, Posterior pelvic tilts
The forward slippage of one vertebrae over another one. There are 1-4 progressive grades with grade 4 having a 75-99% slippage. It can be age, injury and trauma related. Surgery is recommended with slippage over 50%.
Contraindications: avoid lifting, bending, and sports.
Indications: Develop core strength with deep abdominal muscles and paraspinal muscles to stabilize the spine. Improve muscle balance to maintain good posture.
Spinal fusions are procedures whereby vertebrae are fused together to form one larger, less moveable bone. The vertebrae are immobilized with screws and/or small plates, and often rods, screws or plates are attached to the vertebral pedicles to stabilize the fusion and enhance new bone growth. There are several approaches to spinal fusions: anterior, posterior and lateral.
A brace may be worn after surgery for up to 3 months when the patient is out of bed. Patients are allowed basic exercises, including routine walking, during the first several weeks after surgery.
Contraindications: Avoid range of motion at fusion level, bending, twisting, or lifting anything heavy until bony fusion process established, approximately 3 months. Lifting and activity restrictions will be gradually removed as the healing process takes place.
Indications: Rehab focuses on core stabilization, pelvic strengthening, leg stretches, dynamic balance and postural retraining. Two important concepts are the maintenance of a neutral spine and core stabilization. Stabilization can be defined as a balance between strength, flexibility and postural control and a neutral spine can be thought of as a dynamic position between flexion and extension, making it possible to maintain a neutral spine with functional movement and transfers.
Total Hip Arthroplasty:
Advantages: don’t have to cut through muscle, no hip precautions, lower rate of dislocation. Disadvantage: may lack hip extension.
Posterior approach: Higher rate of hip dislocation. Hip Precautions last approx. 4-12 weeks : no femoral internal rotation or adduction beyond neutral, no hip flexion beyond 90 degrees.
Lateral approach: Advantages: good exposure of acetabulum, low risk of hip dislocation (no damage to post capsule or short external rotators). Disadvantage: less femur visualization, hip abduction weakness.
Hemiarthroplasty: femoral head articulates with acetabulum.
Total Knee Arthroplasty:
516,000 in 2006, 3.48 million by 2030. TKR’s last approx. 90% 10 years and 78% 20 years. Aggressive PT is required with an emphasis on regaining as much active flexion as possible.
Transfers (all done towards stronger side initially):
1) Sit to stand (with arms and without)
2) Chair to floor (2 techniques)
3) Floor to chair (2 techniques)
The ability to get onto and off of the floor is important not only for yoga practice, but also in everyday life, and especially in the event of an accident or fall. Difficulty with transfers can result from surgeries, low back/hip pain, generalized weakness, joint instability, and also accompany the natural process of aging. In this workshop, Laura and Paul will help you explore various ways to get on and off the floor safely with good body mechanics and joint protection. You will practice multiple transfer techniques, practice teaching transfers to others, and strategize transfer options in suboptimal environments. You will also learn lateral transfers from wheelchairs to chairs and safe transfers using a rolling walker and straight cane.
This workshop is open to all levels of students and yoga teachers who wish to better understand the practice of safe transfers.
The Skeletal System:
Decreased bone density through increased osteoclast activity
Decreased alignment from weakened bone health
Higher Risk of Fractures
Muscles and Joints:
Migraines/ tension headaches
Chronic joint pain
Low back pain
The Respiratory System:
Constricts bronchi making breathing difficult
Shallow breathing patterns
Panic attacks (characterized by not being able to “catch your breath”)
Insufficient tidal (full) breathing and decreased use of respiratory muscles
The Cardiovascular system:
Increased heart rate
Blood vessels to large muscles and the heart dilate and can elevate blood pressure.
Chronic increase of heart rate and hypertension increase risk of heart attack & stroke.
Inflammation in the circulatory system and coronary arteries increase risk of heart attack
The Endocrine System:
Glands of the endocrine system release hormones effecting health of the entire body.
Endocrine glands include: hypothalamus, pituitary, thyroid, parathyroids, pancreas,
adrenals and the reproductive organs (ovaries and testes)
The main stress hormones are cortisol, adrenaline and norepinephrine.
Adrenalin: released by the adrenal glands and increases heart rate, energy & attention.
Norepinephrine: released by the adrenal glands & brain and primary function is arousal.
Considered kind of a back up to adrenalin.
Cortisol: a steroid hormone released by the adrenal glands helps to maintain fluid
balance and blood pressure (Too much cortisol can suppress the immune
system, increase blood pressure and sugar, decrease libido, produce acne
and contribute to obesity etc)
The Nervous System:
Comprised by the Central Nervous System & Peripheral Nervous System
Peripheral Nervous System is comprised of Autonomic and Somatic branches
Autonomic branch is comprised of Sympathetic (SNS) and Parasympathetic (PNS)
Stress hormones are released by the SNS through the flight or flight response and the
subsequent cascade of hormones ensue increasing heart rate,
respiration, vasodilation, glucose and decrease digestion.
The parasympathetic is a the “rest and digest” branch of the nervous system and is
complimentary to the SNS. It remediate stress hormones and increase homeostasis.
The Immune System
Chronic Inflammatory response through the over load of Cortisol
Autoimmune Disorders such as fibromyalgia, rheumatoid arthritis, lupus and thyroid
The Digestive/Eliminatory system
Controlled by the Enteric Nervous System
Increases stomach acid
Inflammation of the intestines
Irritable Bowel Syndrome
Pranamaya kosha is the energy breath body and stress immediately impacts this kosha as it changes with stress. We use breath to manage stress and we lose our breath when we under stress or in fear. With conscious work in yoga or meditation, we learn tools to identify our breath patterns, what they are telling us, and how to become more conscious of our selves and managing the energy body. The parapsympatheic nervous system is also effected though breath so it is an effective way to calm down the SNS when in a state of fight or flight. Separation in this kosha begins with a lack of awareness of the breath and how it affects the pranavayu of the energy body.
Manomayakosha is profoundly effected by stress. Hyper-vigilance, hyper-arousal, PTSD, depression, isolation, numbing behaviors (cutting, substance abuse. etc) are just a few of the psycho-emotional responses to stress. Stress interrupts our ability to connect with who we are and interrupts healthy adaptive emotional responses to events in out life. Our behaviors have an immediate impact on our relationships with others so separation within this kosha is vital for the individual to understand or patterns will just repeat unconsciously throughout or lives.
Vijnanamayakosha, or the witness mind, is difficult to discern when under stress, because our stress keeps us from being able to have healthy perspective. The klesha, Avidya, is pronounced because stress keeps us from seeing what is going on around us and from our truer nature.
Anandamayakosha is murdered by profound stress. Individuals are often not able to connect with joy, good feelings or a sense or purpose outside themselves. The separation of this kosha from stress is quite complete, and can best be worked on when other acute stressors have been managed. I relate this kosha to Maslow’s hierarchy of needs which are physiological needs, safety needs, love and belonging needs, esteem needs and finally self actualization. Maslow believes that “One must satisfy lower level basic needs before progressing on to meet higher level growth needs. Once these needs have been reasonably satisfied, one may be able to reach the highest level called self-actualization.Every person is capable and has the desire to move up the hierarchy toward a level of self-actualization. Unfortunately, progress is often disrupted by failure to meet lower level needs.” It important to still work with this kosha when dealing with stress, but it would not be the primary kosha to focus on.
The Endocrine System is considered the “second great control system” of the body and interacts closely with the nervous system to produce and regulate hormones. Endocrine glands secrete hormones into the blood stream while exocrine glands have ducts and secrete non hormonal substances such as tears or oil or sweat. Hormones are chemicals responsible for regulating the metabolic functions of cells in the body and drain into the bloodstream and the lymphatic system. There are 9 glands (or organs) which produce hormones and these glands comprise the endocrine system and the study of these hormones and glands are called endocrinology.
In our May 16-17th Teacher Training, Baby Om was pleased to host an amazing group of yoga trainees (and one man!) from all over the globe. We were honored that our students came from as far away as Hong Kong, Poland, Argentina (via Florida), California, Tennesee and DC to learn Baby Om techniques. We look forward to staying connected with this talented group an seeing what they will do in the future. Lior Farkas, a current Lulu OT & Yoga IYT 200 Hour trainee attended the training in anticipation of her imminent move to Isreal as did Francesca Zaccheo who will be subbing for the Brooklyn Baby Class.
June 2015 Update
IYT Teacher Training Month 8. We studied the nervous system’s response to stress – particularly the sympathetic/parasympathetic branch of the autonomic nervous system. Of course we focused primarily on restorative work and had a relatively stress free weekend. J. Brown was our dynamic guest yoga artist and shared both his process and his work with our enthusiastic group. Thank you Jason and great job group!
Mr. Iyengar died early this morning (8/20/14) at the age of 95. Although I never got the chance to study yoga with him, I have been a student of his techniques for over 15 years. As a trained modern dancer, his techniques went beyond the joyful movement of asana, (which I naturally loved), and taught me to go deeper into the experience of the body. His techniques brought together the physical body as a whole world: the skin, the organs, the muscles, and the bones. They also brought in the energy of the body with the breath, the weight, the multi-directions and the great miraculous extension the Iynegar technique is famous for. Every yoga class, every yoga pose, was a full diet.
Two weeks ago, for a cable special on yoga for seniors, I was interviewed at Staten Island University Hospital along with 2 current and one former patient. Each of us was interviewed and the students very eloquently discussed the reasons and health considerations that brought them to yoga. Some memorable moments included Josephine reporting that she was so “brainwashed” by the surgeons, regarding the hip precautions following her total hip replacement, that she has had to slowly unlearn them again to equalize her hamstring length. Mary, very politely stated that her daughter (an OTR/L and colleague) had suggested she begin yoga because she had a “hunchback”, and Irene, who did yoga in inpatient rehab, said when she did yoga she just “felt better”.