correcting movement imbalances with yoga therapy€¦ · demonstrate the practical application of...

Abstract

Yoga teachers and therapists recognize the need forcorrect postural alignment. The quality of movement isequally important. When a person moves incorrectly,joints deviate from their centers of rotation. Mechanicalstress occurs with repeated incorrect movement andresults in degeneration of the joint and eventual painfrom repetitive stress. Yoga therapists and teachers influ-ence the movement patterns of their students by theirchoice of âsanas. By identifying an incorrect pattern ofmovement, a Yoga therapist can be more specific in theselection of âsanasto alleviate pain and to help studentsavoid pain in the future. This article offers an introduc-tion to the principles of movement balancing and a clas-sification of movement patterns in the low back todemonstrate the practical application of movement bal-ancing in Yoga therapy.

Balance, Not Strength

Quality of movement refers to the way that werecruit muscles to perform an action. Every time wemove, we make choices in a way that is unique. Liftingan arm or taking a step involves many joints and manymore muscles. The quality of every move we makedepends on how much power we apportion to differentmuscle groups. Sometimes, out of habit, we move inways that are damaging. A movement that is performedrepeatedly (sitting down, standing up, reaching into thecupboard, and especially the way we walk) could be

slowly eroding the joints, leading to arthritis and avoid-able pain.1–3 This article will discuss variations in move-ment patterns, and it presents a system for identifyingand correcting movement imbalances with Yoga therapy.

Here is an example of how a movement imbalancedevelops: When you play tennis, your shoulder mayeventually tire. A certain amount of stress is beneficial,as it keeps you in shape, but if you play too long youmove into a level of stress that causes some muscles toshorten and thicken and others to become longer than isideal. Once these changes in muscle length occur, yourshoulder no longer moves precisely on its axis of rota-tion. The stronger and shorter muscles pull harder, caus-ing friction between the ball and socket. This is amovement imbalance. It causes wear each time yourepeat the motion, not just when you overexert. Themechanical stress of repeatedly moving incorrectly iscalled repetitive stress.

Most people are not aware of a movement imbalanceuntil they develop symptoms of pain, weakness, ornumbness. Weight training can worsen a movementimbalance in the arms and legs as it increases both thefrequency of repetition and the forces that are causingmechanical stress. This hastens the progression of softtissue and joint damage.

Repetitive stress can also damage the back, which isdesigned to be the solid and stable center of the body.Without spinal stability (also called pelvic stability), theback moves more readily than the hips. Or, the back willmove every time the hip moves. This contributes to the“wear and tear” kind of arthritis—osteoarthritis.

Movement balancing expands the common use of

INTERNATIONAL JOURNAL OF YOGA THERAPY — No. 11 (2001) 15

Correcting Movement Imbalances with Yoga TherapyMarie Janisse, P.T., R.Y.T.

16 INTERNATIONAL JOURNAL OF YOGA THERAPY — No. 11 (2001)

the term “repetitive stress” to includeany stress caused from the repeatedmovement of a joint that is not mov-ing with precision. This applies totrue joints such as the spinal jointsand the shoulder joint, as well as the

scapulo-thoracic joint—the glidingof the scapula across the rib cage.This latter joint is a “functional”joint that also has an optimal patternof movement that must be preciselymaintained in order for the ball-and-socket joint of the shoulder to moveprecisely on its axis of rotation.

Movement balancing is based onan understanding of joint structureand muscle function, supported byengineering principles. Its centralpremise is that mechanical efficiencywill increase the longevity of ourbody’s movement system. Whenmechanical precision is lost, the jointsurfaces wear unevenly and the softtissue develops small tears (cumula-tive microtrauma).

Shirley Sahrmann, P.T., Ph.D.,F.A.P.T.A., professor and associatedirector for doctoral studies in theProgram in Physical Therapy atWashington University School ofMedicine, St. Louis, Missouri,developed Movement System Bal-ancing as a method for identifyingand treating movement imbalancesfor the pelvic girdle (low back,pelvis, and hips) and the shouldergirdle (shoulder and scapular area).Sahrmann’s work suggests that

“many of the syndromes that areseen clinically are the result ofcumulative microtrauma and are notsimply cases of ‘age-related degen-eration’ or the result of a single rela-tively trivial incident as is so oftendescribed.”5 Her system has beenused and adapted by physical thera-pists around the world, and this arti-cle demonstrates an application ofthis knowledge.

The information in this article isintended to offer an understanding ofwhy certain âsanasare helpful inalleviating pain while others mayincrease pain in certain individuals.It explains the use of movement testsand offers suggestions for preventivetherapy. Sahrmann’s system allowsus to assess the direction of move-ment that causes the repetitive stressbefore symptoms occur. With thisinformation, we can avoid âsanasthat would cause a joint or spinalsegment to wear and instead selectâsanasthat stabilize the joints.

Joint stability requires a balanceof active and passive forces actingon a joint. It is balance, not strength,that allows the body to functionsafely and freely. Specific movementtests inform us when this balance islost.

The neuromuscular basis forunderstanding movement imbal-ances has three parts:

a) Motor controlb) Muscle length/tension c) Relative flexibility

Motor Control—Teamwork

Motor control refers to the waythat muscles work together. It issomewhat like the wizard behind thecurtain (in the brain) who determineswhich muscle fires, how strong aplayer it is, and when it comes intoplay. These choices are at the heartof movement quality. If one muscle

dominates another, there is an imbal-ance in the forces around a joint.This imbalance will cause the jointto deteriorate more quickly andbecome painful.

A common example of muscledominance results in patello-femoralpain. This condition arises from animbalance of forces acting on theknee cap (the patella). The musclespulling the knee cap from the outsideof the knee (vastus lateralis) oftenpull harder than the muscles pullingfrom the inside of the knee (vastusmedialis). When this happens, thekneecap is pulled off its “track.” Itrubs against the edges of the groovethrough which it was designed to

glide.6 This example of poor motorcontrol is corrected by retraining thetwo muscles to work as a team, eachpulling with an optimal force thatbalances the other.

Pain also can be caused by animbalance in the work done by twomuscles with similar functions. Forexample, there are two muscles thatabduct the hip: the gluteus mediusand the tensor fascia lata (TFL). TheTFL also flexes the hip and rotates itinwardly (medially). When the TFLdominates the gluteus medius, theperson acquires a “habit” of walkingand performing most upright move-ment with the hip rotated medially.7

This is an example of poor motorcontrol. It is a choice made by the

Most people are notaware of a movementimbalance until theydevelop symptoms ofpain, weakness, ornumbness.

Movement balancingexpands the commonuse of the term “repeti-tive stress” to includeany stress caused fromthe repeated movementof a joint that is not mov-ing with precision.


brain unconsciously (i.e., subcorti-cally). It can cause pain in the hipand knee. Often the imbalance is notidentified until after the person hashad hip or knee replacement surgery.The pattern usually persists after sur-gery and can be modified only to adegree because of the structuralchanges that have occurred. Years ofpain and arthritic deformity couldhave been prevented with early cor-rection of the movement imbalance.

Quality of movement requires aprecise timing and degree of partici-pation from muscles to keep jointshealthy. When movement imbal-ances are not identified throughmovement testing, âsanas canincrease patterns of dominance asthe strong muscles become stronger.Correction involves reestablishing ahealthy pattern of movement byretraining specific muscle groups(muscle reeducation). It is necessaryto integrate the correct way of mov-ing into every part of the daily rou-tine—standing up and sitting down,getting into and out of the car, goingup stairs, etc.

Muscle reeducation requires thatthe movements be performed slowly,with full attention and with minimalforce. Yoga therapy is thus ideallysuited for both muscle reeducationand the body awareness needed tointegrate the corrected movementsinto the day’s activities.

Muscle Length—Too Short,Too Long, or Just Right

A muscle’s length plays a signif-icant role in determining how muchit will participate in a movement.The quality of movement is changedas one muscle shortens and thickensor becomes excessively long. A mus-cle that is too short will pull too hardon a joint; one that is too long willhave less control over the joints that

it influences.8–10 The motor controlwill be affected.

The length of a muscle in thelegs and arms is discussed in termsof the range of motion of the joint(s)that the muscle crosses. For exam-ple, the length of the hip flexors isdetermined by the number ofdegrees that the hip moves intoextension. Muscles of the trunk aremeasured by the alignment of thebones to which they are attached(scapulae, pelvis, ribs, and spine).

An example of the effects ofmuscle length on posture is seen in“square shoulders,” which refers to aposture wherein the scapulae andshoulders are held in an elevatedposition. This mal-alignment makesit clear that the upper trapezius, leva-tor scapulae, and rhomboid musclesare too short. These shortened mus-cle cause premature aging of the cer-vical spine by the excessivepressures created on the disks andvertebral joints.

In the general population, thehamstring muscle is frequently tooshort. In the population of dancers,gymnasts, and Yoga teachers, it isfrequently too long. Most teachersare aware of the pain that can resultfrom hamstring muscles that are tooshort; however, excessive hamstringlength can also be damaging.

Hamstring length is measuredby lifting the leg with the kneestraight (Figures 1A, B, C, and D).The optimal length is reached atapproximately 80º of straight legraising. When the hamstring muscleis too long, it affects the quality ofmovement. Even a very strong ham-string muscle that is significantlyoverstretched has altered its controlover the segments that it influences(knee, hip, and low back).11–13 Whenthis happens, the joint deviates fromits center of rotation and pressurepoints develop in the joint (repetitive

stress) with each step. A person whois young or inactive may show nosymptoms at first. However, withtime, and especially with a physi-cally demanding lifestyle, soft tissueand joint damage from the repetitivestress will eventually cause pain andinflammation.

The length of the back muscles(paraspinals) and abdominals (espe-cially the external oblique) is partic-

ularly important to the health of theback as we will see in the next sec-tion.

Relative Flexibility—Keepthe Torso Stronger than theExtremities

Relative flexibility refers to therelationship between two segmentsof the body. When comparing move-ment between the torso and extremi-ties, the sturdier joints of theshoulder and hip should move morereadily (be relatively more flexible)than the smaller facet joints of thespine. It is extremely important tothe health of the back that it is stable(unmoving) at least at the beginningof hip motion. This depends on mus-cle length and motor control asexplained above; i.e., relative flexi-bility reflects how muscles are beingrecruited (motor control), and motorcontrol is affected by the length of a

In the general popula-tion, the hamstring mus-cle is frequently tooshort. In the populationof dancers, gymnasts,and Yoga teachers, it isfrequently too long.


muscle. Stability in the spine reducesthe repetitive stress that leads to pre-mature degeneration of the disks andvertebral joints, and it is similarlyimportant to the health of the shoul-der joint that the scapula remainsfixed during the first part of shouldermovement.

Relative flexibility means thatone segment is more eager to movethan another, some tissues contractmore readily than others, some tis-sues yield more to movement thanothers. In the case of a shoulder, thescapulo-thoracic “joint” (shoulderblade sliding across the ribs) maybecome relatively more flexible(quick to move) than the gleno-humeral joint. This means that themovement occurs at the scapula too

soon after the shoulder begins flex-ion. This “unstable scapula” canbecome a source of pain.

Now that we have understoodhow the three neurological princi-ples (motor control, muscle length/tension, and relative flexibility)affect our movement, we will con-sider a classification system thatallows movement imbalances to betreated in a very specific and preciseway.

The classification system belowdescribes the directions in which thelow back becomes relatively moreflexible than the hips. We will seethat the direction of relative flexibil-ity in the spine is the same directionof movement that will cause pain.Pain caused by repetitive stress in

the spine will be located in the seg-ment that is too mobile.

Classification of Mechani-cal Low Back Pain

A movement assessment identi-fies the direction of movement thatconsistently causes pain. It is com-mon sense to avoid that whichcauses pain and to choose thosemovements that decrease pain. Byclassifying the direction of a move-ment imbalance, that specific move-ment can be retrained. It is thisability to be specific that preventsthe recurrence of pain by: 1) creatingstability where there is too muchmotion and 2) integrating the cor-rected movement into daily activ-ity.14–17

The movement classificationsare based on the movements of thespine and their combinations: flex-ion, extension, rotation, flexion/rota-tion, extension/rotation, and flexion/extension.

The tests are performed in sit-ting, standing, side-lying, prone,supine, and in table (quadruped)position. If pain is produced consis-tently when the spine moves intoflexion and rotation, then it is calleda flexion/rotation fault. This infor-mation directs the choice of move-ments and âsanas to correct andprevent the movement imbalanceand to relieve the symptoms ofpain.18

In the movement test that fol-lows, it is possible to determinewhich is relatively more flexible(yielding), the back or the hips. Thistest is one of several used to detectrepetitive stress in the low back inthe direction of flexion:

With no prior instruction, a per-son is asked to bend forward. If themovement is initiated from the hipswhile the back remains in the posi-

Figure 1A

Figure 1C

Figure 1B Figure 1D


tion of neutral spine, then the spine isstable. The hips are relatively moreflexible than the back. However, ifthe back is too quick to round withlittle to no movement in the hips thenthe spine is unstable. The back is rel-atively more flexible than the hips. Itis an indication that the low backmay be receiving repetitive stress inthe direction of low back (lumbar)flexion. If other tests confirm this,the imbalance would fall into theflexion category.

A person in the flexion categoryis likely to stand, sit, and performdaily activities with a flat back (lum-bar flexion). The flattened lumbarspine indicates that the muscles thatrun along either side of the spine(paraspinal muscles) are over-stretched. Cyclists commonly fallinto this lumbar flexion category dueto their position on the bicycle.

If the person in the flexion cate-gory were to perform uttana-âsanain lumbar flexion (flat or roundedlow back), he or she could damage adisk.19 However, modified uttana-âsana could be used to train the lowback to move correctly in the follow-ing way:

With hands on a table to supportthe weight of the upper body, andwith knees bent, the person isinstructed to maintain a neutralspine (slightly bowed in) and slowly

bend forward at the hips. He or shemust stop the motion as soon as theback loses the neutral position. If theback is allowed to flatten (lose neu-tral), the flexion fault will beencouraged rather than corrected.Performed slowly and with fullawareness, this is one step towardreturning the relative flexibility tothe hips. The spine is receiving itsfirst lesson in stability.

A person is placed in the flexioncategory when: a) the majority oftests confirm that the low back (lum-bar spine) consistently moves intoflexion with certain movements ofthe hips and knees, b) if there is pain,then the pain would be consistentlyincreased with tests that move thespine into flexion, and c) the painwould be lessened when the spine isstabilized (above example of for-ward bending at the hips only).20,21

A person in the flexion categoryis demonstrating that the muscles ofthe back are more yielding (rela-tively more flexible) than the mus-cles of the hip. The hamstringmuscles are relatively stiffer. Thus itwould not be reasonable to use theforward bend to lengthen the ham-string muscles (Figure 2A) unlessthe back can be protected in a posi-tion of neutral spine. Without a posi-tion of neutral spine, the forwardbend in this category would only

serve to increasethe length of thealready over-stretched lowback muscles(Figure 2C). Inaddition, it couldcause excessiveflexion of theupper back (Fig-ure 2B).22

S e a s o n e dtennis playerstend to stand andmove with their

spine in extension, and their hip flex-ors are often too short. Testing maydemonstrate a movement fault in theextension category. If this is true,and especially if they experiencepain, repeated backward bendingâsanaswould reinforce the incorrectway of moving. They would be atrisk of developing stenosis (narrow-ing of the vertebral canal) and/ordamage to the facet joints andnerves. They would need to avoidbhujânga-âsanaunless it is per-formed over a bolster and only to aposition of neutral spine. Unfortu-nately, the damage occurs so slowlythat the person has no way to corre-late the bony changes to the perform-ance of backward bends.

Correcting a movement fault inthe extension category would beginwith lessons in finding and holdingneutral spine at the wall. This wouldprogress to table pose and all thestanding poses, especially those witharms overhead. The abdominal mus-cles, in particular the externaloblique muscles, would need to bestrengthened and shortened to bal-ance the strength and shortness ofthe muscles in the low back (lumbarextensors).

Correcting MovementImbalances

To summarize using the aboveexamples, the corrective strategiesare:

1. Stabilize the low back and pelvisby reeducating the muscles towork as a team. The first priorityis to reeducate the dormant mus-cle (e.g., the external obliquemuscle). This is done with aminimal load, or the dominantmuscle will do the work.

2. Strengthen the newly trainedmuscles. In the second step, theFigure 2


overstretched muscle is short-ened through strengthening, andthe shortened, dominant muscleresponds by becoming longer. Itmay receive additional lengthen-ing if needed.

3. Integrate the corrected move-ment into all the day’s activities.This needs to be addressedthrough every level of trainingand requires constant vigilance.

The following case history willhelp clarify these steps.

Case History

A 54-year-old man, T.F., came tome with symptoms that had kept himfrom skiing and surfing for over ayear. He also had so much pain in sit-ting that he could not travel as heshould for his business. He had adiagnosis of osteoarthritis anddegenerative disk disease of the lum-bar spine. X rays showed thinning ofthe disks particularly between thelast two lumbar vertebrae, L4-5 andL5-S1.

Symptoms: 1) pain at time of the evaluation

was at the low back and L but-tocks, 5/10 intensity, increasingto 7/10 with 10 min. of sitting.At 10 min., the pain radiateddown the R inner thigh to thelower leg and to the sole.

2) pain in the R buttocks rangedfrom 0 to 6/10 but patient waspain free at the time of the evalu-ation.

3) pain in the R upper and centralabdomen, intermittent withbloating and occasionally worsewithin one hour of having eaten.

4) pain in R groin was 2/10 at timeof the evaluation and inverselyrelated to R buttocks pain.

5) intermittent bowel and bladder

dysfunction as well as sexualdysfunction.

Onset:gradual over 13 mos. with noknown cause.

Tolerance levels:Sitting: 0—immediate increase

in pain on sitting.Standing: pain increases after 2

min.Walking: pain increases after 4

min. This client had no prior limita-

tions. His work allowed him to fre-quently change his positions toalleviate pain.

Standing posture:The pelvis was tilted anteriorly

causing excessive lumbar extension(back bowed in). The hips weremildly rotated inward. Visually,there was a decreased bulk of thegluteal (buttocks) muscles and mildpronation of the feet (flat feet).

Range of motion limitations: The hip rotators and the ham-

string muscles were shorter thanoptimal:23

Hip rotation, medial: R 10º, L15º; lateral: R 15º, L 20º (activeROM).

Straight leg raising performedactively: 40º R and L (shortenedhamstring muscles).

The hip flexors were shorterthan optimal. (Negative figures showdegrees of limitation in passiveROM):

Rectus femoris: -20ºR and -15ºL(hip flexor crossing 2 joints).Iliopsoas: -10º R and L (hip flexorcrossing 1 joint).Iliotibial band: -5ºR and -10ºL(fascial band along the side of theleg).

Strength:External oblique muscle strength

(abdominal muscle needed to main-tain neutral spine) was 20% of nor-mal when tested in a functionalposition. That is, there was poor abil-ity to maintain pelvic stability.

The gluteus medius and max-imus had less than normal strength.The precise grade was unobtainabledue to pain on testing.

Movement faults:Twenty movement tests were

performed in standing, sitting, prone,supine, side-lying, and quadruped(table) positions.

Pelvic (spinal) instability wasconsistently present in the tests forlumbar extension and rotation, butmost noted in the following twotests:

Prone (stomach lying) knee flex-ion caused the low back to extend(bow in).

Prone hip rotation caused thepelvis and spine to rotate.

In performing these tests therewas immediate movement (instabil-ity) of the low back.

Relative flexibility:The stiffness of the quadriceps

and other hip muscles caused thelow back to move when it shouldhave been stable. That is, the rela-tive flexibility of the low back wasgreater than that of the extremities.The tests indicated that the spinewas receiving excessive wear andtear in movements throughout theday’s activities.

Assessment: A movement fault existed in the

extension/rotation category. Thesymptoms were consistently eithercaused, or increased by, movementinto lumbar rotation or extension.

It is important to note that thepain level decreased from 5/10 to2/10 when the client performed themovement test corrected for spinal


stability. When the pain decreases bycorrecting the movement fault, itconfirms the category. This must bedone with every assessment.

Treatment: The client was taught to stabilize

the low back by correcting the move-ment tests that had demonstratedinstability. In the process, he waslearning how to use his externaloblique muscles. These abdominalmuscles are important for their rolein maintaining a neutral spine.

This patient quickly grasped theconcept of pelvic stabilization. Bythe end of the evaluation, he hadshown improvement in the way heperformed the test positions. In addi-tion, he was able to maintain a neu-tral spine in sitting and in standing.

His home program began withmountain pose at the wall for breathand posture awareness. It continuedwith vinyasasto correct the move-ment faults that were most signifi-cant in the testing:

In prone position, the clientallowed his knee to bend withoutbowing his back (lumbar extension).This not only reinforced kinestheti-cally the maintenance of neutralspine, but it also encouraged thelengthening of hip flexors. From thisposition, he moved into hip rotationwhile holding the pelvis stable (notallowing pelvic rotation). This cor-rected the most damaging of hismovement faults, that of rotating thespine with each rotation of the hip. Italso lengthened the hip rotators. Thisprocess of correction requires anincrease in sensory awareness. Theclient thus felt for movement byplacing his fingers on his pelvis, andall movements were performedslowly, mindfully, and coordinatedwith the breath. The use of mûla-bandhasupported the reeducation ofthe external oblique muscle, the keyto pelvic stabilization.

His program also included tworestorative poses to lengthen the hipflexors:

Iliopsoas: Back-lying with thebuttocks at the edge of a bed or table;the low back is held flat by holdingone knee to the chest while the oppo-site leg is lowered, keeping the kneestraight.

Rectus femoris: As above exceptthat the opposite leg is lowered withthe knee flexed 90 degrees.

Both of these stretches were heldone to two minutes, working withthe breath to return these muscles totheir optimal length. (See range ofmotion limitations.)

Most importantly, this client wasgiven instructions to integrate spinalstability into the day’s activities.

At the time of the second treat-ment, this client reported 80% relieffrom pain and that his bowel, blad-der, and sexual dysfunctions were nolonger a problem. He had learned touse the external oblique muscles forstabilization at 60% of normalcapacity. (He originally tested at20%.) At that time, his practice wasadvanced to include a flow seriesthat increases the challenge to theexternal oblique muscle. There arefive levels of strengthening. Allrequire careful monitoring for move-ment at the pelvis in order for themovement fault to be corrected; thatis, if the pelvis moves in strengthen-ing the abdominals, it reinforces themovement imbalance that caused thepain.

Yoga facilitates muscle reeduca-tion by increasing body awarenessand mental focus. Within the contextof a yogic practice, this client learnedmore quickly to sense the movementof the pelvis in and out of neutralspine as the lessons advanced.

In the second week, the cor-rected test movements were inte-grated into a modified dancer’s pose(natarâja-âsana) to actively lengthen

the rectus femoris (quadriceps) andwarrior I pose to actively lengthenthe iliopsoas. Both were performedwith a neutral spine. Table pose wasused to teach neutral spine in rockingforward and then backward with anawareness of when neutral spinechanged to lumbar flexion (bowingout) at the end of hip flexion.

In addition, child’s pose length-ened the low back muscles. Theexternal oblique muscle group wasstrengthened with modifiedûrdhva-prasârita-pada-âsana. A variation oflateral angle (side-lying) posestrengthened the gluteus mediusmuscle at the side of the hip. Andbefore doing shava-âsana, a restora-tive pose was done to lengthen thehamstring muscle.

Approximately two weeks later,the client reported that he was painfree. One month later, the physicianconfirmed that he was completelyfree of symptoms and had normaltolerance for sitting and standing. Hewas planning a ski trip.

Additional Considerations

It is important that the trainingof Yoga teachers include the abilityto identify neutral spine and tounderstand the importance of spinalstability. When twists, forwardbends, and backward bends are per-formed, a counterpose should beused to insure, neurologically, the“habit” of stability in the spine.Based on the movement balancingconcepts, and clinical experience,the incidence of low back pain in theYoga community would be reducedif practitioners maintained their torsostronger and relatively less flexiblethan the extremities. According tosome clinicians, long-term Yogapractitioners who have emphasizeddeep spinal stretches seem to have ahigher than average rate of disk


degeneration.Since a large class setting makes

it difficult to address specific needs,some Yoga teachers create safety byreminding students to listen to theirbodies and move carefully. In thisway, even when performing âsanasin the direction of an imbalance, stu-dents may avoid immediate seriousconsequences. They will, however,reinforce an incorrect pattern thatcauses long-term repetitive stress indaily activities. Optimally, teachersshould be trained to identify imbal-ances and direct students away fromâsanasthat cause joint stress beforean injury occurs.

Conclusion

Modern activities create physi-cal and mental stresses that were notpart of the life of the ancient yogicsaints. Activities such as carryinggroceries, aerobics classes, or repeat-edly lifting a child place great physi-cal demands on us. With anunderstanding of repetitive stress,we can make choices in our fitnessprogram and in our Yoga programthat realistically reflect our needs. Tochoose wisely, we need to considerour age, body type (Ayurvedic), andgeneral physical condition as well asmovement and postural imbalances.

Yoga teachers and therapists canidentify and correct movementimbalances just as they correct poorposture. The tests for movementimbalances can be performed as partof a sequence of âsanas. These testsallow the therapist to see the signs ofrepetitive stress before the symp-toms of pain or numbness occur. Thetests direct the choice of âsanassothat the joints once again move pre-cisely on their axis of rotation.

Precision of movement createsstability in the spine and in the jointsof the extremities. This stability

enhances the life of our movementsystem. This process is effortlesslyintegrated into the day’s activitieswith the increase in body awarenessand mental focus that comes withregular performance of Hatha-Yoga.

This article is excerpted withpermission from Marie Janisse’sforthcoming book, Correcting Move-ment Imbalances with Yoga Therapy.

Endnotes

1. Amevo, B., A. Aprill, and N. Bogduk.Abnormal instantaneous axes of rotationin patients with neck pain. Spine, 1992,17:748.

2. Frenkel, V. H., A. H. Burstein, and D.B. Brooks. Biomechanics of internalderangement of the knee: Pathomechanicsas determined by analysis of the instantcentres of motion. Journal of Bone andJoint Surgery, 1971, 53A:945.

3. White, S., and S. Sahrmann. PhysicalTherapy of the Cervical and ThoracicSpine. 2d ed. New York: Churchill Liv-ingstone, 1994, pp. 339–357.

4. The term “movement imbalance” isdefined within the context of MovementSystem Balancing, developed by ShirleySahrmann, P.T., Ph.D., F.A.P.T.A.

5. White and Sahrmann, op. cit., pp.339–340.

6. Frenkel et al., op. cit.

7. Kendall, F. P., E. K. McCreary, and P.G. Provance. Muscles: Testing and Func-tion. 4th ed. Baltimore: Williams &Wilkins, 1993, p. 221.

8. Gordon, A.M., A. F. Huxley, and F. J.Julian. The variation in isometric tensionwith sarcomere length in vertebrate mus-cle fibres. Journal of Physiology, 1966,184:170.

9. Tardieu, C., J. C. Tabary, G. Tardier, etal. Adaptation of sarcomere numbers tothe length imposed on muscle. In F. Guba,G. Marechal, and O. Takacs, eds.,Mecha-nism of Muscle Adaptation to FunctionalRequirements(Elmsford, N.Y.: PergamonPress, 1981), p. 99.

10. Gossman, M. R., S. A. Sahrmann, andS. J. Rose. Review of length-associatedchanges in muscle. Physical Therapy,

1982, 62:1801–1802.11. Kendall et al.,op. cit., pp. 39–47, 334–336.

12. Gordon et al., op. cit.

13. Tardieu et al., op. cit.

14. Maluf, K., S. Sahrmann, and L. VanDillen. Use of a classification system toguide nonsurgical management of apatient with chronic low back pain. Phys-ical Therapy, Nov 2000, 80(11):1097–1111.

15. Marras, W. S., M. Parnianpour, S. A.Ferguson, et al. The classification ofanatomic- and symptom-based low backdisorders using motion measure models.Spine, 1995, 20:2531–2546.

16. Van Dillen, L. R., S. A. Sahrmann, B.J. Norton, et al. Reliability of physicalexamination items used for classificationof patients with low back pain. PhysicalTherapy, 1998, 78:979–988.

17. Riddle, D. L. Classification and lowback pain: A review of the literature andcritical analysis of selected systems.Physical Therapy, 1998, 78:708–737.

18. Maluf et al., op. cit.

19. Gordon, S. J., K. H. Yang, P. J. Myer,et al. Mechanism of disc rupture: A pre-liminary report. Spine, 1991, 16:450–456.

20. Maluf et al., op. cit.

21. Roach, K. E., M. D. Brown, R. D.Albin, et al. The sensitivity and speci-ficity of pain response to activity andposition in categorizing patients with lowback pain. Physical Therapy, 1997,77:730–738.

22. Kendall et al., op. cit., pp. 40–43.

23. Kendall et al., op. cit., pp. 336–339.

© 2001 Marie Janisse

Marie JanisseP.O. Box 31094Santa Barbara, CA 93130Tel: 805-569-1912Email: [email protected]

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