Yoga Academy Romania

Yoga Therapy for Yoga Teachers I with Ann da Silva

DAY 1
Lower back, hips, knees and the feet
Common causes of aches & pains in the lower body:
Lower back pain, knee pain, knee injuries, issues in the hips & feet

YOGA as THERAPY
What role does yoga have in terms of wellness or therapeutic treatments?

From a yogic point of view, problems in the body arises from imbalances of the mind

Undigested emotions / feelings accumulates: depletes prana, the vital energiesLow prana
weakens the body, toxins accumulate both mentally and physically

Disease develops
Mental: Loneliness, isolation, depression, tension, stress, anger, jealousy
Physical: Over-eating, over-working, drugs, alcoholic ways to numb feelings and emotions
Emotional stress / tension = physical
- Neck & shoulder stiffness
- high blood pressure / heart diseases
Suppressed expression / emotions = physical
- sore throat
- heart diseases
How Yoga can help
BODY
Asana physical poses for mobility, strength & stability
BREATH
Pranayama breath modification with mental focus to help facilitate circulation & healing
MIND
Meditation, visualization & chanting to remove
negativity & bring in positive thoughts

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Yoga Therapy for Yoga Teachers I with Ann da Silva

Physical benefits of Yoga Therapy:

stretches, tones and strengthens the body

- brings nourishment and rejuvenation of the muscles, tendons, ligaments, bones & joints
- encourages circulation, stimulates metabolism
- increasing stamina in the body and clarity in the mind; youth & vitality

Assists recovery in common physical injuries

Prepares the body for sports, e.g. marathon, triathlons, golfing etc

Physical & Mental benefits of Yoga Therapy

When the body starts to benefit from the asana practice:

- the mind starts to settle down
- letting go of unnecessary burden & thoughts
- relieves tension & stress
- restores mind (mental) & body (physical)
to optimal balance and
well-being

What is Pain?
An indication that something is not right
A perception of pain in the brain, can be mental tension
Not muscle soreness, which is fatigue or giving too much force to the muscles, usually dull
ache esp. when pressed, comes afterwards
Pain usually happens when you are doing it
Back off if it is painful
Pain from stretching should not exist
Pain from Tension /stretching is not right
Tension: tissues are not elastic enough for the bones to move apart,
i.e.
not flexible enough can lengthen in time
Pain from Compression may not cause damage but should still be avoided cannot change!
Compression : bones hitting against bones, stopping any further movement
Cramps or Spasms: not long term damages, only a protection mechanism of the body
- response to sudden movements or out of use: spasms freezes up muscles to protect body
from movements that may hurt the body
- bad blood circulation or muscle fatigue, dehydration
Can also be caused by lack of minerals such as magnesium, potassium & calcium
Rare, but can be due to nerve malfunction, such as spinal chord injury
Gently stretch to release the spasm
Ensure adequate hydration before exercise
Ensure balanced intake of minerals such as magnesium, potassium and calcium
ease into your practice slowly
Relax, breathe!

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Yoga Therapy for Yoga Teachers I with Ann da Silva

ACHES & PAINS

Age & hereditary: born with (scoliosis), growing older / degeneration

Pathologies / Illness
Posture / Alignment: habit of sitting, standing, improper alignment during exercise
Injuries: lack of endurance & stability from lack of use & misalignment
Wear-and-Tear: Daily life & exercise
Mental Tension & Anger

Injuries during Yoga

often when going in and / or out of an asana
The 3 most vulnerable areas for injury in Yoga: Neck, lower back, & knees
The 2 main ways of injury:
- doing something wrong fast; hits right away,
e.g. over stretching/ tearing hamstrings
- doing something wrong repeatedly, no immediate pain, damage builds up,
e.g. Wear-Tear in incorrect twisting of knee
PREVENTION & TREATMENT OF INJURIES

Maintain proper Alignment at all times

Before any movement of the spine, always activate the Core Muscles to protect lower back
Be Mindful & present during practice
Breathe

1. RICE: Rest Ice Compression Elevation

Rest when there is any Inflammation!!!!
2. REHABILITATION: Yoga Therapy
SAFETY IN YOGA

I can go more, I can go more, I can go more, I can go more..can I?

Find our potential for improvement AND
Accept that we do have limitations

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Yoga Therapy for Yoga Teachers I with Ann da Silva

THE SPINE

Four major sections:

Cervical C1 to C7
Thoracic T1 to T12
Lumbar L1 to L5
Sacrum fused S1 to S5

Vertebrae
joints & disks

Curves

Vertebra

Multi-segmented structure
Vertebral Body
Lamina & Pedicle
Spinal Canal
Spinous Process
Transverse Processes x2
Facet joints x4
Separated by Intervertebral discs

Intervertebral Disc

Made of water, collagen, & gel

Annulus
-hard, tough
-rotational stability
-compressive stress

Nucleus
-soft, moist, gel-like
-transmits stress & weight from vertebra to vertebra

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Curves of the Spine

Spring-like, shock absorber

Allows the spine to bend and give
Weight bearing Strength
Better muscle attachment for flexibility,
momentum & stability
Flat spine = harder working muscles
Big range of normal curve angles

Cervical
curve

Lumbar
curve

Thoracic
curve

Sacral
curve

Exaggerated curves of the spine

Kyphosis
-over curvature of the thoracic
-hunchback
-rounded shoulders, tight chest
Lordosis
-over curvature of the lumbar
-swayback
-hypermobility = risk

Planes of Spinal Movement

Flexion -forward bend

- Restricted by soft tissues, can bend too deep
- Risk of compressing nerves

Extension -backward bend

- Restricked joints & bones, generally safer
- No nerves to compress

Lateral Flexion / Extension

- sideways bend
Rotation
- twists

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Yoga Therapy for Yoga Teachers I with Ann da Silva

Flexion and Extension

Side bends & Rotation

side bends almost always involve rotation

stretching 50% and unloading of the other 50% fibers of the Annulus
Strain on the Intervertebral disc
Intradiscal Pressure raises during sleep due to water uptake = risk!
95% of disc prolapse caused by repetitive Flexion esp. with Rotation

Neutral Spine

Key concept in modern sports rehab

not too curved and not too flat
Weight load is distributed evenly along the whole spine
Maximum force to go forward in sports
Performance & safety
No 100% perfect shape of spine

Common spine problems

Usually in the Lumbar spine as it supports the entire spine = stability!

Also common in Cervical spine as it supports the weight of the skull = stability!
Less frequent in the Thoracic as it is less mobile due to rib cage = mobility!
May or may not manifest in pain along spine
Pain/numbness can extend down arms/legs

Common causes

Usually chronic, keeps coming back & triggered by a particular traumatic incident
Age & Lifestyle: lack of exercise, diet, smoking, causing degeneration, prone to injuries
Injuries from lack of endurance & stability
Poor posture: misalignment, repeatedly
Stability & Mobilization with Alignment is the key to prevent & rehabilitate back
problems

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Yoga Therapy for Yoga Teachers I with Ann da Silva

Common treatment for Back Pain

Anti-inflammatory pain medication (NSAIDS)

Injection of cortisone into the spine
Rehabilitation: Yoga Therapy, Physical Therapy
Chiropractic treatments
Change of habits / lifestyle
Correct posture
Surgery rare: incontinence, weakness or numbness, to relieve compression & pain

Strengthening the Spine Muscles

Strengthening is protective
Stretching is releasing, feels good and helps to prevent immobility
BALANCE between the two!
Strengthen = weight bearing
Endurance & Stamina = lower weight, reps
Erector Spinae
Abdominal Muscles

Key Muscles for Spine Stability

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Yoga Therapy for Yoga Teachers I with Ann da Silva

THE LUMBAR SPINE

Supports the weight load of the whole Spine

The largest segments of the vertebral column
very mobile, needs Stabilization
Most problems appear here
Interconnected to Sacro-illiac joint problems

Sciatica

most common pain and discomfort caused by a problem in the lumbar region
Pain, weakness, numbness or tingling sensations, usually one side
Injury or pressure on the sciatic nerve
A symptom of another medical condition, not a condition on its own

Causes of Sciatica

Disc Herniation
Spondylolithesis
Spinal Stenosis
Piriformis Syndrome
Sacroiliac Joint Disorder
Pelvic injury or fracture
Tumors
Usually only one-sided
Worsen after standing, or sitting,
or when sneezing, coughing

Damaged
Sciatic
nerve

Weakened
knee (pain
running down
back of legs to
toes)

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Yoga Therapy for Yoga Teachers I with Ann da Silva

Disc Herniation

Slipped disc
Disc protrusion
Most often in Lumbar spine
Tear in the Annulus
Bulging out of the Nucleus
Pain due to inflammation/nerve
May cause nerve compression
Can cause Sciatica, but not common

Therapy for Disc Herniation

Pain-free, neutral spine

Extension from neutral
prevent immobilization
Core stability
Movement that extend the pain away spine
- big NO as nerve compression is more severe
Avoid deep ROM in morning due to IDP
Numbness, bladder & bowel control problems

Spondylolysis & Spondylolisthesis

Spondylolysis: fracture of Pars Interarticularis

Spondylolisthesis: forward slippage of the vertebra due to breakage of this boney ring
Usually L5 and Sacrum, sometimes L4

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Spondylolysis & Spondylolisthesis

Hypermobility
Can be Hereditary
Stress fractures typically due to repetitive load
Hyperlordosis gymnasts, dancers
Can be caused by Disc Hernation
Spondylolysis can usually heal on its own
Spondylolisthesis may require surgery

Therapy for Spondylolisthesis

Stabilize
Avoid Hyper-extension (over back bend)
Core Strengthening!
Avoid SLR (straight leg raising) psoas load
Explore Flexion with awareness
Neurological deficits (paralysis, weakness, numbness, or increasing pain)

Spinal Stenosis

Aging: enlarged joints,

Thickened ligament
Disc Herniation
Facet joint fracture
trauma
Vertebral slip - Spondylolisthesis
Can be hereditary narrow spinal chord
Pressure on the spinal cord or nerves
Can cause neurological deficit:
Pain, numbness, tingling or loss of mobility
Lumbar: when nerve roots in lower back is compressed, can cause sciatica, affects walking,
gait & distance
Cervical: dangerous as spinal cord is compressed, serious symptoms, major body weakness
& paralysis

Therapy for Spinal Stenosis

Emphasis on flexion, may decrease pain
Laminotomy to increase space by removing a bit of the bone / disc
Post surgery:
o -Stabilize
o -Maintain neutral Spine
o -Regain normal function
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Sacroiliac Joint Dysfunction

Pain in the SI joint
Cartilage damaged or worn (degenerative arthritis/osteoarthritis)
pregnancy (hormonal)
Stress of joint (repetitive)
Trauma (missed step)
Common: leg length discrepancy, back pain
Therapy for SI-Joint Dysfunction
Stabilization, strength, endurance of surrounding muscles, e.g. glutes, core
Mindful self mobilization may help to reposition the SI-joint
Reduce / correct load in daily habits
Avoid asymmetric FWD bends, and end range
Warm oil
Avoid too frequent manual adjustments!
Severe cases: surgery to fuse the SI-joint

The MUSCULAR SYSTEM

Three types of muscles tissues:
SKELETAL, SMOOTH, CARDIAC
- elastic, flexible, stretches
Three types of connective tissues:
TENDONS, LIGAMENTS, FASCIAE
less flexible, only gradual lengthening
They make up about half of the weight & bulk of the body
TENDONS connective tissues
Bundles of fibrous connective tissue, collagen
Tough, flexible, gradual lengthening
Dries, shortens, becomes brittle if not used
Connects muscles to bones
Body movement
Example: Achilles tendon, hamstrings
LIGAMENTS
Bundles of fibrous connective tissue, collagen
Tough, flexible, gradual lengthening
Dries, shortens, becomes brittle if not used
Connects bone to bone
Stabilizes, supports & controls movements of the joints
overstretched, double-jointed, risk of injury Example: Anterior Cruciate Ligament (ACL),
Medial Collateral Ligament (MCL)
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FASCIAE
Bundles of fibrous connective tissue, collagen
Bands or layers of stringy elastic tissues, stretches
Dries, shortens, becomes brittle if not used
Surrounds muscles to muscles, covers bones, blood vessels, nerves, everywhere
Some binds structures for stability or protection
Some layers on to allow smooth gliding movements
Example: Plantar fascia
TENDINITIS / TENDONITIS

Inflammation of a tendon, e.g. Achilles

Common in the limbs, not often hips /torso
Repetitive strain injury, mostly wear & tear
Aches & pains, joint stiffness
Burning sensation around joint or inflamed tendon
Can have swelling
R.I.C.E.

MUSCLES OF THE HIP

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The ILIOPSOAS & PSOAS

The Iliopsoas: two muscles
Iliacus: main hip flexor
Psoas: only muscle thatattaches leg to spine
Short psoas: tilts the pelvis, look of shorter leg, knee &back pain,
Wear-tear, over holding
Mindful stretching
The ILIOTIBIAL BAND
fibrous reinforcement of the fascia lata muscles
Assists in moving the hips
Stabilizes the knee inextension & partial flexion
Used constantly in walking, running etc
Overuse = ITB Syndrome
ILIOTIBIAL BAND SYNDROME
Pain in outer knee
Possible pain in hip
Training /overuse
Anatomical (arches, foot supination/strike)
Muscle imbalance
R.I.C.E. then: stretch

The HAMSTRINGS

group of three muscles on back of the thigh, connects the hip to the knee, walking
Biceps femoris, Semitendinosus, Semimembranosus
Extension of the legs
Flexion of knee
Stretches over time
Can be torn
Takes time to heal
R.I.C.E. then stretch

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JOINTS
When two or more bones come together
There are three types of joints:

FIXED JOINTS
Held together by a tough fiber that doesnt allow movement, also called Fibrous Joints
e.g. the skull

SLIGHTLY MOVABLE JOINTS

Separated by cartilage, allowing small range of movement, also called: Cartilaginous Joints
e.g the joints between the vertebrae

MOVABLE JOINTS
With lubricating synovial fluids inside a
synovial membrane that wraps around the joint
great freedom of movement
Two main types: Hinge, Ball & Socket
Also Synovial Joints
HINGE JOINTS
Allow movement in one direction
E.g. the knees, elbows & fingers
BALL & SOCKET JOINTS
Allow the greatest freedom of movement, the round end of one long bone fits into the
hollow of another E.g. hips and shoulders

OSETOPOROSIS
Progressive bone disease, Porous bones
Production of new bones cannot keep up with the loss of bone mass
Risk of bone fracture, even from sneezing, coughing, falling!
Often in hips, wrist or spine
Stooped posture, loss of height, collapsed vertebrae, fractures
Age, race, sex, family history, menopause, bone reserve from youth
Hormonal and /or glandular issues
Dietary: low calcium, eating disorders, nutrient absorption problems
Medication: long term corticosteroid use can interfere with bone-regrowth
Lifestyle: lack of exercise, alcohol & tobacco use can reduce calcium absorption

Calcium supplements

Moderate & mindful weight bearing, e.g. Standing poses, warriors etc

Lifestyle changes: avoid smoking & alcohol consumption

Being present,

avoid falling!

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OSETOARTHRITIS
Degenerative joint disease, most common type of arthritis, Wear-and-Tear arthritis
Cartilage in the joints are worn down
Often in lower back, knees & hips
Pain & stiffness, loss of flexibility, tenderness
Gradually worsens, no real cure
Can only slow down deterioration, relieve pain & improve function
Glucosamine, supplements
nourish the joints with gently cycles of moderate weight loading & unloading
Mindful rotation & movements to encourage circulation & range of motion
Gentle stretching / pulling of the muscles
ANATOMY OF THE HIP

ISSUES OF THE HIP JOINT

Osteoporosis
Hip Fracture
Osteoarthritis in the Hip:

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THE KNEE JOINT

Femur: Thigh bone
Tibia: Shin bone
Fibula: Calf bone
Patella: knee cap
ACL: Anterior cruciate ligament
PCL: Posterior cruciate ligament
LCL: Lateral collateral ligament
MCL: Medial collateral ligament

Knee cap (Patella): protects the interior parts of the knee joint
Patella tendon: also known as Patella Ligament connects from the quadriceps, through the
Knee cap to the tibia, the shin bone (bone to bone),
it provides and controls extension of the knee joint
Anterior cruciate ligament (ACL): connects the thigh bone to the shin bone in the center
of the knee. Limits rotation and forward motion
- most commonly injured or torn, resulting
in instability of the knee
- E.g. falls that caused the knee
to twist or pivot: skiing, soccer
- In yoga, fast, forceful twist of
knee, or forceful overextending such as lunges
- Immediate symptoms
- Slow healing, or, surgery
Medial collateral ligament (MCL): runs down the inside of the knee, connects the thigh
bone to the shin bone
Lateral collateral ligament (LCL): runs down the outside of the knee, connects the thigh
bone to the calf bone

Together they limit and stabilize sideways movement of the knee

Injured by sideways force to knee
Slow, timely healing process

All soft tissues around & nearest the knee joint, tendons &ligaments, are for stabilizing and
protecting the knee
Meniscus: two pads of cartilaginous tissues in the knee joint, to disperse the weight
of the body & reduce friction during movement
Injured either by acute tearing fromsudden trauma in sports, or a Slow Wear-andTear
In Yoga: misalignment, e.g. hyper-extension or hyper-flexion of knee, esp. when
weight bearing
Symptoms slow or recurring

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OTHER ISSUES IN THE KNEE

Patellar Tendinitis:
Jumpers Knee repetitive overloading
& extending of the knee
Osteoarthritis in the Knee

ISSUES IN THE CALVES

Gastrocnemius Muscle
tearing of inner calves, or Tennis Leg
A pop, sharp pain
Slow healing, depending on severity, surgery
R.I.C.E.
stretching & strengthening

ISSUES IN THE ACHILLES TENDON

Calcaneal Tendon
A pop, sharp pain
Slow healing, according to severity, surgery
R.I.C.E., then stretching & strengthening

PLANTAR FASCITIS
Progressive, degenerative damage to Plantar Fascia Ligament, may not have inflammation
Weight bearing, overuse, inadequate arch support in shoes, esp when running/ flip flops
can cause, possibly caused by Flatfeet

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R.I.C.E.
Stretch Achilles Tendon & Plantar Fascia
Ligament
Strengthen Calves
Orthotics (shoes) with arch & foot support
Surgery (detaching the Plantar Fascia
Ligament from the heel bone) = Flatfeet!!

FLATFLEET
Collapsed Arch in the feet
Related to Plantar Fascitis, age, weight bearing,
improper shoes
Feet Pronation
Can cause pain in back, knees, hips and neck
same treatment as Plantar Fascitis

FEET PRONATION

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