This post is brought to us by our very own course author - Ginger Garner, MPT, ATC, ERYT500, PYT, CPI. Ginger is an educator and subject matter expert in medical therapeutic yoga and women's health and is both a licensed physical therapist and athletic trainer. As a published author and sought after speaker, Ginger pens the popular blog for mothers, Breathing In This Life (BITL). Ginger's most recent video continuing education course, Medical Therapeutic Yoga is available for purchase now.
Ginger is the founder of Professional Yoga Therapy (PYT), the first post-graduate medical education program for Complementary and Alternative Medicine yoga practice in the US. Her program maintains the highest educational standards and prerequisites in yoga and yoga therapy in the United States.
And now on to Ginger...
Back in 2009 (no pun intended) I was teaching a spine course in San Francisco based on Professional Yoga Therapy and applying yoga as medicine in group and one-on-one settings. One of the topics I spoke about was myofascial release and yoga. Recently, one of my students asked me to elaborate on the subject. Here is my answer to this California based physical therapist.
Preventing Therapist Burn Out
There is no denying that there is a high level of stress experienced by therapists who practice within the medical model today. I believe one of the greatest sources of that stress comes from the skewed belief that we fix or cure people.
As a physical therapist, I strive diligently to dive below the surface of diagnosis in order to treat the whole person. As a result, I practice therapy under a very different model. My day-to-day vision is to empower individuals, equip them with the tools they need for self-healing, and to be a facilitator - rather than a clinical magician who fixes or cures the patient.
I believe our job as therapists is not to cure, but to provide a safety net and supportive environment for healing. Perhaps the most important value we can possess as a health care professional is to seek to play offense (prevent injuries and disease) rather than only being available (or able) to play defense (curing injuries and disease). This is the model I use when caring for someone who is trying to prevent, or whose life is already impaired by, spinal dysfunction or disease. It is also the model that the PYT (Professional Yoga Therapy) method uses.
The Living Spine refers to the role of fascia in spinal health. In my practice, I apply the evidence base on fascia to yoga, which is over 15 years of practice has evolved into a hybrid model (PYT method) that combines physical therapy and manual therapy, athletic training, pilates, and yoga.
I look at myofascial restriction often and early on in the evaluation process. In our hyper-stimulated, hyper-mobile society, I rarely focus on yoga as a way to mobilize clients. I believe yoga is commonly and mistakenly used for flexibility or mobility purposes only, when there is a wealth of resources available through evidence-based application of yoga, through the PYT model, to stabilize the individual.
We, humans, are complex creatures with individual constitutions that are typically not well addressed by the standard medical model. In the course of seeing an individual, I help them discover what kind of physical, psycho-emotional, energetic, social, and interpersonal balance they need to be whole.
Fascia is defined as dense, irregular connective tissue sheets in the human body, such as aponeuroses, joint capsules, or muscular envelopes like the endo-, peri-, and epimysium.1 Then only after I have addressed the individuals static and dynamic functional stability do I use Yogic myofascial release. Myofascial release works beautifully with yoga as they are both proven to lower sympathetic activity.5
Thirty years of research supports that the lumbodorsal fascia is indeed alive and exhibits an active and contributory connective tissue role, secondary to the intrusion of muscle fibers2. Smooth muscle cells have been found embedded within the collagen fibers of the fascia cruris in humans.3 This finding suggests fascia affects postural stability and can limit spinal mobility in the individual, especially since the tension transmission occurring between the epimysium contributes to the generation of muscle force.3,4 The same authors suggest that local thickenings of fascia can exhibit force on tendons and ligaments as well.
Fascia and You
Pain from myofascial restriction is multi-faceted and can be caused by surgical incisions, medical conditions or disease, accidents, injury, inactivity, neural tension, stress, or poor breathing habits. Since the tone of the fascia can be influenced by the autonomic nervous system, Staubesand states any work on the fascia then, is work on the autonomic nervous system (ANS).
Myofascial work and yoga go hand in hand since both directly affect the ANS. One method I teach and use for myofascial release is the identification and correction of poor breathing habits. I may include a passive myofascial release (MFR), however, I prefer to have the individual assume a more active role.
An active role allows the individual to cultivate confidence, awareness, and it puts them in charge of managing their own health. Schleip calls this approach that of a humble midwife rather than a heroic technician, and in my years of experience, I have found it also greatly reduces stress and risk of clinician burnout.
One of the precepts of the PYT method is the breath receives priority. I always begin and end with the breath; and, I revisit it as often as needed during a session to help a person soothe the nervous system and down-train their actions/reactions to movement and life.
The abdominal breath is the long-accepted gold standard for relaxed, diaphragmatic breathing. However, I only use this breath during passive, restorative type yoga postures and not for active yoga or ADL completion.
The abdominal breath is absolutely the first step toward myofascial freedom (and freedom from pain) in the individual. This breath type can be progressed later into the three or four part breath (dirga pranayama). Both breath types focus on alveolar ventilation, elongation of the breath, decreasing sympathetic activity, and equalization of the inhalation/exhalation. They also encourage metering of the breath or conscious control.
When starting a yogic breath practice it is important to create a comfort zone for the individual. Seated meditation poses may not, and often do not, typically work for the average American without much experience in yoga.
I typically begin with supported corpse using blankets and bolsters. For their home practice, I educate them on a comfortably reclined posture in bed. I use a blanket fold I call the three-tier approach, which a person can adapt to hundreds of postures. Refer to the free abdominal breath download for examples.
In addition, it's important to use appropriate (non-fluorescent) lighting and create a peaceful décor and atmosphere in your practice. Lastly, use of imagery, mottos (mantras) or inspirational quotes, or guided meditation further helps relax a person into their breath and their center of being.
For more information: Other methods that can be used are taught in the PYT program offered through Medical Therapeutic Yoga and www.professionlayogatherapy.org The program addresses PYT specific pre-postures or pre-asana, yoga posture application, a new therapeutic model for evaluation and management of the client using yoga, as well as a study of pelvic floor interaction and relationship (bandha or lock work) with the lumbopelvic spine.*Photo is of the author in her late third trimester during her second pregnancy, practicing a breathing practice she designed for labor and delivery during ball assisted squat/backbends. It is a functional example of the way the author employs self-myofascial release using breath and posture for the prenatal season of womens health. Sources
1. Schleip et al 2005
2. Schleip 2003, Schleip 2005, van den Berg and Cabri 1999, Manuel et al 2008, Kruger 1997, Rolf 1977, Yahia et al 1993
3. Staubesand and Li 1996, Schleip et al 2005, Garfin et al 1981, Huiking, 1997
4. Schleip et al 2005, Barker et al 2004
5. Schleip 2003, Van den Berg and Cabri 1999
6. Garner 2005-10 Medical Therapeutic Yoga for Evaluation and Management of the Lumbopelvic Spine
Leave a Reply