Archive for stability

Shoulder Rehabilitation

Shoulder Rehabilitation

Recently I had the opportunity while in India to work with a variety of people.  In the video that follows, this person was well recovered from a fracture of the proximal humerus.  They were still experiencing pain upon end range movement.  Here we will look at only one of the functions that proved bothersome–overhead movements with the left arm.  Their range of motion in this direction (shoulder flexion) was fairly good, though lacked the last 10 degrees–which were also a bit painful.

One thing to check is to see if the shoulder blade is participating sufficiently in these movements.  Since stretching of the arm overhead proved painful and since her prior rehabilitation had taken her in this direction, I thought we would explore more approximation or pressure into the shoulder joint.  (and this compressive movement was not painful and helped her to improve)

This concept of compressing the joint in these weight bearing positions that you will see in the video is a very good alternative for improving pain free terminal flexion.  Often in hatha yoga where there is today and emphasis in stretching, the stability work that is needed is often marginalized.  (This post is not about yoga but focuses on a case example of rehabilitation).

Another important aspect here is the emphasis on testing before and after exercises.  This testing can be accomplished quickly and easily before and after your session.  You will see it at the beginning of the video.  It would be wonderful if people found out things that they could not do easily and then determine the exercises that would help them function better (i.e. less pain and more gain).  In other words don’t just perform a bunch of exercises without seeing if they are appropriate and giving you the results that you want and need.

Also this is not a complete program, it is a first example of where one might start out in their journey of recovery.

Lets take a look at the video:

 Mobility

You can see there is not an emphasis on stretching out the shoulder at this point.  The place that we try to increase mobility is at the thoracic spine or rib spine.  This associated area of the middle back is often left out with rehabilitation of the shoulder.  Of course one should test the ability of rotation to take place here before prescribing the exercise.  Do note how much shoulder mobility is asked for in the down shoulder.  For some people you will need to support the space between their armpit/rib area and the floor.  For some people, without using the support–they will have too much stress on the bottom shoulder in flexion and abduction–they will not be able to relax or benefit from the spinal rotation.

It is interesting to note that in the side lying movement of reaching and rolling of the upper body–this person had difficulty in stabilizing the pelvis and lower trunk while accessing the middle spine area.  Again this difficulty is fairly typical.  We often over move from the lumbar and pelvic area especially in the side lying position.

There are many variations in sidelying that can be very helpful here.  This is only one of them.

Stability

From the above instability of the pelvis and lower trunk, you can see that this area will need to be addressed in follow up routines.

Notice the weight bearing aspect of being on hands and knees and prone on elbows (supported cobra asana).  These are just excellent positions to stimulate the shoulder complex and begin teaching stability.  Always consider there to be 3-5 ways to regress and progress any exercise.  That gives you a much wider appreciation of the functional relationships that are involved in rehabilitation.  It is also quite a challenge to come up with this range of movement possibilities.  This challenge is mainly for those who are teachers, trainers and therapists.

Conclusion

Do try out some of these movements.  You will find out that working with the mini-bands in the prone on elbow position can be fairly challenging.  Many people are quite weak in external rotation when the elbows are away from the body.  This variation opens up so many more ways to activate the rotator cuff musculature and the scapular stabilizers than just the standard “cuff” exercises with the elbow fixed to ones side.

This routine is only a beginning.  I hope it will be a continuation of the progress that has been made.

Best in Training–peter

 

Relaxation of Effort

Proper Practice

In all training we are guided by certain principles.  The Yoga Community often places proper emphasis on proper practice.  One of the keys to skillfully practice is to relax ones effort.  Today we are often mindless doing and exercising.  Often the accumulated tensions of the day and life are held during our practices.  Therefore it would seem proper to point out this dis-stressful style.  Lets look at when you would emphasize this “relaxation of effort” in your practice.  Your practice could be Yoga asanas, Meditation or any movement endeavor/exercise or performance.

Enjoy It

When we start practicing an asana (again it could be a musical instrument or learning to run hurdles), we start doing something.  Often in the context of yoga asana, people are taught to do a form and then  learn to relax into it and enjoy it.  That sounds just fine.  In practice for most of us, it obviates the basics that need to be established primarily.

Sometimes a student is working at performing a particular asana (again think exercise or your choice or other skill).  If they have difficulty with it, they may stop working on it.  They no longer feel like they are enjoying it.  It just isn’t fun anymore.  This Yoga stuff isn’t really right for me.  I try something else.

Trying to perform something and then being unable to do it can be frustrating.  If the emphasis at the beginning is to enjoy it and relax and one doesn’t, then do you give up?  The whole act of practicing is not to perform something perfectly, nor to necessarily find it enjoyable and be so relaxed at the beginning.  (If you are a high level person that can hold a perspective truly of joy in the mind, then this article is not for you).

Practicing is about developing ways of sensing and doing that were not available at the beginning.  It is a journey filled with lots of work.  Perfecting this work/practice will give enjoyment and you will develop over time this “relaxation of effort”.

Hard work

Notice that a gymnast that is able to effortless perform a routine on the rings or balance bar does not start with trying to relax their effort as the primary practice.  It is only after much sweat, extreme focus/sacrifice and over a long time that they can look so beautiful and effortless.

Yoga Sutras

This classic text by Patanjali has 4 chapters/padas.  The second pada, 47th sutra starts out talking on how the posture is made perfect.  The first part in sutra 47 states that it is through loosening the effort or relaxing the effort, that then the posture/asana becomes perfected in it’s steadiness  and easefulness.

Note that the sutra before, that is sutra 46 states that a posture is that which is steady and easeful/comfortable.  Again this steady and comfortable is not what you do.  It is what happens as you WORK in asana.  Often people are teaching to become something at the beginning that we are not at the moment.  Once again, practice is needed which will provide these qualities as almost side effects of proper practice.

Now in looking at the first part of the definition of asana (in sutra 46), steadiness in Sanskrit is called sthira.  One of the first places in the Yoga Sutras that speak about sthira is in the first pada, sutra 13.  Loosely restating the Sanskrit (via Swami Veda Bharati)–…this effort towards sthiti/steadiness is called practice.

The next sutra in the first pada, sutra 14, then pretty much lists the qualities for ones practice to become solid.  (The beauty and depth of the Yoga Sutras are not being communicated here–just an introduction to some guiding principles and how they can guide this relaxation of effort in our practice).

Firm practice when:

  • Practice is done for a long time
  • Practice is done without an interruption (think long term here)
  • Practice that is done right and proper (details are 4 and beautiful, but will not be discussed here)
  • Practice is done fully, completely (not haphazard or partial)

Relaxation of Effort

So one can be guided by such a profound text like the Yoga Sutras.  In this case, one is practicing not to perform something perfectly.  One is practicing to create a steadiness and stability of their asana (again think dance performance, faster sprinter, etc).  This control of that which is not under control, is achieved through practice (only in part, see YS 1.12).

This effort to becoming steady and stable is our practice.  This steadiness is not rigidly still.  This steadiness is the absolute control of the mind and sensory motor system.  It is that which provides  the direction to correct practice.  This practice then takes time–often long hours of practice, done in the way outlined above.  It is not something that just happens without these focuses.

Then as our practice develops in these ways of becoming stable and easeful, we automatically find that there is a loosening of our effort.  Relaxation of effort is not prescribed first as a primary methodology here.  Of course practically you work and relax and repeat.  Just do not underestimate the primacy of working as outlined in the first and second padas of the Yoga Sutras.

Continuing Practice

Steady practicing leads to relaxation of effort.  It begins to flow.  (Practicing means you have a goal.  This goal is that which you focus your mind, body and effort on.)

Relaxing is always easier after working fully, completely.  There is a rhythm to relaxing.  It alternates with hard and skillful work.  Later it becomes not hard, but no less work.  One begins only later to appreciate the lessening of struggle of working FULLY.  One then moves into the  joy of “hard work.”  It is no longer an effort.  One starts noticing that they are just more relaxed.  This richness of practicing is worth the work.

Again if there is anyway I can be of service, please feel free to contact me here.