Most of us know that asana practise (the physical poses) of yoga are just a small part of what yoga is truly all about. I’ve been aware of this for quite some time, as evident in my ‘yoga journey’ story
that outlines the numerous benefits that my personal yoga practise has gifted me over the past 2 decades or so. This was a project that my dear friend, yogi mentor, and talented photographer, Naresh King, asked me to be a part of. It allowed me to not only reflect on my life, but it also shed light on how my yoga practise had evolved over the years. It revealed that the ‘reasons why I practise’ had also changed over the years. I realized that yoga had benefitted me on so many levels (or ‘koshas’): physically, mentally, emotionally, energetically and spiritually.
My training as a Professional Yoga Therapist with Ginger Garner
guided my career as a Physical Therapist, ensuring it was evolving alongside my personal practise and included addressing all the koshas in my client assessments and treatment plans.
Yoga, once again, paved a refreshing way for me to guide my patients to look within themselves and discover the power of self healing on their journey to health and wellness. My own yoga practise deepened each year, even each day. If you read my ‘yoga journey’
, you will see that in 2012, I shared that ‘yoga’, for me, is really all about love
. I discovered that the power of love and connection can also heal, and was the ultimate force for healing. I thought I had it all figured out.
However, to my surprise, I recently discovered yet another new ‘gift’ that yoga has to offer. I was attending Eoin Finn’s Yoga Teacher Training
with an amazingly consciously aware group of 28 yogis and we had several days of deep intellectual discussions about defining labels such as ‘love’, ‘God’, ‘truth’, ‘soul’, ‘energy’, ‘source’ and ‘gratitude’. We all dug deep and revealed our own dharma statements (life purpose and mission). For those that are familiar with Eoin’s work, you know that he has an amazing gift and skill of being able to combine these deep philosophical conversations together with education about biomechanical alignment principles and safety in asana practise.
Before I explain this additional ‘gift’ that yoga has presented to me, I need to first discuss the basis for which it was founded on, the concept or social movement of “Blissology”
by Eoin Finn. Eoin defines his term, Blissology as ‘the art of living a full life by awakening a deep joy inside of us and using it to build harmonious relationships with our body-mind, our personal relationships, with our communities and with nature’. Basically, the more we can find and connect to that ‘space’ inside of us that is the stillness, the light, the truth, the force (or whatever we want to label it as) the more we can be aware and connected with our own true selves and bodies, resulting in a deeper connection with others, with our community and ultimately with nature and the planet. This opens us up to a kindness and a purpose that is bigger than ourselves. As a result, we end up discovering that we treat ourselves, others, and nature with much more love and respect than we ever could have imagined. As Eoin states: ‘the line between where we end and nature begins becomes blurred’.
So it was 9 days into the intensive training, and with this new “Blissology” movement in mind, the Tuesday morning topic was ‘how does grief fit into Blissology?
Ironically, that same morning, my grandma died.
It was that morning when I started to learn about a new gift that yoga had to offer. For me, yoga was a portal that led and allowed me to deeply and courageously be aware of and feel pain, loss, and also experience grieving in a raw and authentic way by first helping me to connect to that ‘space’ and ‘truth’ within me. That, in turn somehow allowed me to connect with others on that same level. It was this connection and awareness that seemed to bring me peace, joy, comfort and love at the exact same time as I was experiencing sadness, pain, loss and grief. It was something I had not experienced so intensely before. I have certainly felt something similar, but never have felt it quite like this. It was like I gave myself full permission to shamelessly and whole heartedly accept and feel the darkness: to be sad and to grieve, and to be okay with it, without resistance. In a sense, I suppose I was practising the niyama of santosha, full acceptance and contentment of the truth, with gratitude. Although I’ve experienced this to a lesser degree in the past, this time there was a difference, and I feel it was the connection to community and nature that tipped this experience towards a more ‘blissful’ one, even at a time of deep sadness.
The morning my grandma died, I experienced a moment in Savasana (relaxation at the end of asana practise) when I felt extremely vulnerable and scared. In Savasana, we lie on our backs with our palms and chest open to the sky. I felt so sad and the thoughts of losing my grandma felt so painful that I could hardly breathe and I had feelings of fear, anxiety, and felt physically sick. I felt weak. But I somehow sensed a welcoming and supportive force from the group. For some reason I felt the need to roll onto my right side during Savasana. So, without thinking, I just curled up into the fetal position, let go, and just started crying. The person next to me, whom I had only known for 9 days silently held and gently squeezed my hand and supported my head. I felt a deep sense of non-judgement, acceptance, connection and most importantly, love. I felt safe again. It felt good. It all came together. I just experienced an intense “a-ha” moment.
was what Eoin maybe was talking about: “the importance of grief”, he says, “is that when we plug into grief, we plug into a network of human experience and realize what it means to be fully human – it connects us to a force that binds us all… LOVE.”
Later on, another soul from our group connected with me after our traditional round of blissology hugs and reminded me to be a ‘witness and observe’ all that I am experiencing throughout this time of sadness and to light a candle for my grandma and do a dance and celebrate. The group reached out and dedicated a special meditation and chant in support and love.
There were many more examples of support and reaching out as the day progressed before I returned back home to be with my
I believe that yoga helps me to be open to experiencing my emotions without censorship or shame, and therefore helps me to be completely present and ‘real’ with my family. I believe that this has a ripple effect, and in turn, has the power to radiate a sense of acceptance, support and love to others around me as well. I feel that the result is an even deeper level of interconnectedness with my family, friends and the surrounding community.
So that’s the most recent addition to ‘my yoga journey’ story for now.
In honour of my beloved and amazing grandma, Lena Prosko, I’d like to share some of the gratitude intentions that I had the privilege of sharing at her memorial service:“Grandma, thank you for your comforting words and advice when we were troubled and confused. Thank you for consistently dedicating your prayers to your family, friends, and all those who suffered around the world. Thank you for the way you taught us to love and support each other.
Thank you for showing us how to be accepting and non-judgemental of other people, no matter what. Thank you for living such an amazing life of courage and immense strength because it is through your bravery and sacrifices that we (your family) all have the privilege of living such enriched and abundant lives.
Grandma, thank you for your generous heart and bright smile and shining eyes that you always shared to radiate and connect your spirit to us and the world. Thanks for showing us what love really is.”
There has recently been a surge in popularity of a type of rehabilitation service that some of us Physical Therapists are offering. The surge was a result of an article
that was posted in “Yahoo! Shine”
about how actress Kim Cattrall claimed “Fizzy Yoga” saved her life. She was referring to “PhysiYoga”, a term that her Physical Therapist uses to describe her brilliantly combined skills and services of Physical Therapy and Yoga Therapy. Since I also offer the same type of therapy services, which I label as “Physio Yoga Therapy”, the reporter contacted me and included a quote
from our interview. This has led to an influx of inquiries that has been nearly impossible for me to keep up with the replies, so I thought I would answer the most common questions here in this month’s blog!What is PhysiYoga?
PhysiYoga, Physio Yoga, Yoga Physio, YogaPhysical Therapy, Medical Therapeutic Yoga and Professional Yoga Therapy, are just a few of the titles you may come across when Physical Therapists try to define and label the art and science of combining their Physical Therapy skills as licensed health care professionals with their years of training as Yoga Therapists and ongoing self yoga practise. All of these titles can be interpreted as offering similar services; however, each Physical Therapist may slightly differ in their approach depending on the type of Yoga Therapy training they have received and experienced. So what IS Physio Yoga? As a collective group, we haven’t come up with a formal definition (or ever discussed or agreed upon what to even name it!) However, this is how I try to describe and define what we do:Physio Yoga Therapy
is a type of rehabilitation therapy that combines two professions: (1) Physiotherapy
(synonymous with ‘Physical Therapy’
) and (2) Yoga Therapy
. The combination of these two professions results in a more holistic approach to your rehabilitation experience. Physical Therapy
is a well respected health care profession that uses evidence-based treatment methods to help clients restore and maintain optimal movement and function, as well as provide education on health maintenance and injury prevention.
Yoga is an ancient system of health that encourages you to address and nourish your body, mind, breath and spirit as ‘one’. A truly holistic approach that promotes a balanced lifestyle of health and well-being. Furthermore, Yoga Therapy
applies yoga (including yoga philosophy, pranayama (breathing methods), asana (postures), meditation and more) to specific acute or chronic illnesses or states of disease or imbalance.
Physio Yoga Therapy differs
from yoga or yoga therapy, because it is delivered by licensed health care professionals. As Physical Therapists, we have several years and thousands of hours of extensive training, knowledge, and clinical experience to have the competency to assess, diagnose and treat a variety of injuries, dysfunctions, disease symptoms, disabilities and imbalances. We use specialized manual skills in addition to a variety of other methods as part of treatment intervention.
Physio-Yoga Therapy differs
from regular Physical Therapy intervention, because it uses yoga (as described above) to guide the treatment approach, which results in a more holistic approach to healing. The focus is placed more on self empowerment and self healing. One of the main reasons that Physio-Yoga Therapy has been effective for my clients, I believe, is because it empowers my client to take an active approach to create their own health, instead of the passive 'fix it' approach that our current health care system has a tendency to promote.What are the benefits of Physio-Yoga Therapy?
Yes, there are a plethora of benefits that can be experienced and enjoyed with this type of approach. However, my hope is that we all can appreciate that there are many factors that influence whether or not any form of treatment intervention has certain benefits associated with it. Therapeutic results can vary from person to person and can depend on pre-existing and current conditions, mind-body awareness, dedication to one’s practise, mindset, personality, current lifestyle situation, personal choices, and of course, the type of guidance being received from the therapist. Remember this is a journey of self-discovery and wellness; not a one or two session 'cookie cutter' exercise program or asana (yoga pose) prescription for your specific condition!
Some of the benefits that physio-yoga therapy can offer are:
Physically, it can improve muscular strength, endurance, flexibility, postural alignment, body awareness, circulation, digestion, hormonal balance, respiration, immune function, strengthen bones, normalize blood pressure and reduce or normalize body weight. Mentally, it can improve your alertness, concentration, sleep patterns; reduce stress and anxiety and improve your ability to relax. This is just a small list of many more benefits that physio-yoga, physiyoga, medical therapeutic yoga or professional yoga therapy can offer. The key benefit is an overall state of health and wellbeing.Some of the common conditions addressed are:
Back and neck pain, other musculoskeletal injuries (shoulders, hips, knees, etc), chronic pain, osteoarthritis, osteoporosis, pelvic pain disorders, rheumatoid arthritis, diabetes, fibromyalgia, high blood pressure, Irritable Bowel Syndrome, migraines/headaches, pregnancy, anxiety, rheumatoid arthritis, scoliosis, urinary stress or urge incontinence. It is worthy to note the role that physio-yoga also plays in injury prevention and overall health and wellness! Dr. Timothy McCall
, has recently published a list of 75 health conditions
that yoga has benefitted that has been supported by RESEARCH! This is a noteworthy list. An entire organization and many dedicated individuals and groups have been working hard for several years, some for even decades, in efforts to bridge the gap between therapeutic yoga and our current healthcare system. Where Can I Find a Physio-Yoga Therapist?
There is currently no public directory exclusively for Physio Yoga Therapists. The Medical Therapeutic Yoga program that I graduated from is called “Professional Yoga Therapy Studies”
(PYTS) founded and directed by Physical Therapist and Professional Yoga Therapist, Ginger Garner
. It is currently the only yoga therapy training program that is exclusively for licensed health care professionals. However, not all graduates of PYTS are Physical Therapists. Some are Physicians, Occupational Therapists, Psychologists, Dentists, Chiropractors, Massage Therapists, etc.
PYTS has a directory of Professional Yoga Therapists
that have graduated from the program, so you can see who is offering services in or near your area.The International Association of Yoga Therapists (IAYT)
was founded in 1989 and has continued to evolve as an organization that “supports research and education in Yoga, and serves as a professional organization for Yoga teachers and Yoga therapists worldwide” (www.iayt.org
). IAYT’s mission is to ‘establish Yoga as a recognized and respected therapy.’ IAYT has a directory of yoga therapists that you can search. However, not all members of IAYT are licensed health care professionals. And not all licensed health care professionals, or Physical Therapists, are members of IAYT. So, unfortunately it can get a bit confusing if you are solely looking for a licensed rehab professional that is using yoga as therapy.
I also belong to a group called “Bridgebuilders to Awareness in Healthcare.”
We are a group that consists exclusively of licensed rehabilitation professionals worldwide that are passionate about “sharing ideas on how to deliver holistic healthcare and how to foster awareness of creating relationships with our patients and healing through yoga.” Physical Therapists/Yoga Therapists, Chrys Crawford Kub
and Matthew Taylor
, founded the group in 2011. It started with 4 licensed health care professionals, and has grown to 214 to date. We currently do not have a formal public member directory for this group. However, it is something that I think we potentially could address in the near future.
So for those of you interested in finding a ‘physio-yoga’ therapist in your area, I would recommend contacting one of us from our Bridgebuilders group (some contacts are included below), and we can help find one in your area. Or if you are looking for any type of licensed health care professional that includes yoga as a treatment approach (not necessarily exclusively a physical therapist, but other licensed health care professionals as well), I would recommend searching the PYTS directory.
Where can I find a physio-yoga class?
It is important to note that if you suffer from an injury, dysfunction or imbalance and have a desire to use yoga as your choice of intervention, that signing up for a series of yoga therapy classes without first having an assessment or private physio-yoga therapy treatments could lead to an increased risk of exacerbating your injury, or inviting a new injury to occur. Overall, in my clinical experience, I have seen a rise in injuries in people participating in yoga classes, and even specialty therapeutic yoga classes, that are not appropriate for them. This is why I believe it is so important to ensure you have an accurate assessment of your dysfunction performed by someone who has adequate training in the area of your dysfunction so that an appropriate, safe,
and effective treatment plan can be developed and implemented.
For example, if your dysfunction is a mental health disorder or imbalance, it would be optimally beneficial and safe for you to see a yoga therapist that is also a mental health practitioner that specializes in your dysfunction. If your issue is a physical imbalance, then a yoga therapist that is a Physical Therapist or other rehabilitation related licensed health care practitioner, would be an effective and safe choice. Of course, many times clients have a combination of issues. So finding a therapist that suits your needs may take some time to research. Once you've had proper guidance and individualized treatments, then transitioning to a class setting is perfectly safe and appropriate. Physio-Yoga Therapists Near You:
As previously stated, we do not currently have a directory system in place that outlines locations of all Physical Therapists that are using yoga as therapy. However, I will include at least some of them that are from our Bridgebuilders group
in all of the locations that people inquired about when they contacted me after the “Fizzy Yoga” article
was published:United States:
Scottsdale, AZ:Matthew Taylor
Tucson, AZ:Jaimie Perkunas
Southern California:Sherry Brourman
(Santa Monica)Lori Rubenstein Fazzio
(Los Angeles)Rachel Krentzman
California Bay Area:Liz Gillem DuncansonTianna Meriage-ReiterLisa Bollheimer Minn
Manchester, CT:Marlysa Sullivan
Palm Beach County, FL:Emily Schaeffer Large
Charlotte, NC:Lissette HollandLynne RayChrys Crawford Kub
Emerald Isle, NC:Ginger Garner
NYC, NY (midtown/Manhatten) & CT:Sharon Gary
Calgary, AB:Shelly Prosko
Edmonton, AB:Shelly Prosko
Red Deer/Sylvan Lake, AB:Shelly Prosko
Golden, BC:Kristie McGregor
Kelowna, BC:Shelly Prosko
Penticton, BC:Neil Pearson
Vernon, BC:Shelly Prosko
Saskatoon, SK:Shelly Prosko
Winnipeg, MB:Leslee Watt
If you don't see a therapist in your area, it doesn't mean that there isn't one! Please contact me, or one of us above, if you are interested in finding one near your location. We will do our best to help you find one! We may also be able to recommend yoga instructors or yoga therapists in your area. So even if there isn't a 'physio-yoga' therapist nearby, perhaps you can connect your local Physical Therapist with a local yoga instructor, and they can work together to deliver a more holistic approach to your care!
I had the privilege of assisting Ginger Garner
, founder and director of Professional Yoga Therapy Studies
, (the Medical Therapeutic Yoga School exclusively for Health Care Professionals) in the Learning Lab portion of her presentation to the National Athletic Trainer’s Association Annual Conference in Las Vegas in June. The title of the track was “Yoga Pulls Double Duty: Developing Controlled Flexibility in Athletes.” However I feel that a more fitting title would have been, “Yoga Pulls Multiple Duties: More Than Just Flexibility for the Athlete.” One of the many messages that I received from Ginger’s presentation was that Yoga is one of the few systems of stretching that simultaneously affects many other physiological systems in the body, as well as positively influences the athlete’s overall health and well-being, which is essential in optimizing performance. Several participants came up to us after the session and commented on how surprised they were that yoga had the ability to serve such a wide variety of the population: from a high functioning elite athlete, to an injured athlete, to a client functioning at a lower level who has trouble with regular activities of daily living. The presentation also reminded us that Yoga is an effective treatment tool and system that trainers and therapists can use to help empower their clients and athletes. Often times many clients and athletes are looking for a passive ‘fix it’ approach to healing, health and wellness. Yoga offers an extremely successful and effective active empowerment approach, which also helps to prevent practitioner burnout. Another added bonus to using yoga with clients is that the therapist doesn’t have to buy any gadgets, gimmicks, or equipment. The only investment is learning more about yoga, which not only benefits the clients, but the practitioner’s health and wellness as well.Controlled Flexibility:
“Controlled Flexibility” is a refreshing term. I have a new found knowledge and appreciation for what flexibility actually is and means. This presentation has enabled me to better understand and therefore explain to my clients why and how flexibility isn’t just all about ‘stretching’. The vast majority of people that attend my yoga classes, workshops and private sessions, initially sought out yoga because of its reputation for ‘improving flexibility’. However, there is so much more to flexibility than just stretching the muscles. The concept of the ‘Integrated Model of Joint Function’ is extremely beneficial for me to review and explore in more detail, particularly as it relates to flexibility and the athlete. For me, discussion of this model was most helpful in explaining why controlled flexibility is so essential. When stretching, or performing any activity with the goal of increasing flexibility, forces or loads across the joint surfaces must be appropriately distributed in order to ensure stability across the joint surfaces. Stability is first priority over mobility. Without stability, flexibility (or any mobility) activities can potentially lead to injuries and joint or tissue damage. The Integrated Model of Joint Function (Vleeming/Lee) considers: 1) Form Closure:
integrity of passive structures such as bones, joints, ligaments.2) Force Closure:
active forces applied by muscles.3) Motor Control:
timing of muscle action and release in a refined, co-ordinated manner such that stability is maintained, and loads are distributed evenly.4) Emotional State and Awareness:
“Emotional Motor System” (Holstege et al, 1996). Thoughts and emotions can significantly influence movement patterns, therefore affect performance.
An athlete’s flexibility training program is most effective and safe if these 4 components are adequately addressed. All 4 of these components are considered and included in a typical yoga posture or practise, which again shows the effectiveness of yoga in optimizing not only flexibility, but overall functional performance in an athlete.
New information I gained from Ginger’s presentation was the research behind the increased effectiveness of proprioceptive neuromuscular facilitation (PNF) stretches when combined with other methods (compared to PNF stretching alone). PNF stretches were shown to be more effective to improve flexibility when combined with motor imagery (Williams et al 2004), Butler’s neural mobilization (Wolny et al 2010), or when used with 65% of a muscle’s maximum voluntary contraction (Sheard & Paine 2010). This is important information because the system of yoga can combine all of these methods (PNF, motor imagery, neural mobilization, 65% MVC) in just one pose! It was useful for me, and I’m sure for the participants as well, when Ginger demonstrated the example of one pose, Utkatasana (Chair Pose), and outlined the numerous physiological concepts and benefits that could be applied to just one pose.
Ginger also took some time to outline the benefits that yoga has on the neuroendocrine system. The discussion of psychoneuroendocrinology (the profound link that your mind and emotions have to your nervous and hormonal systems) and
the adverse effects of elevated cortisol on the human body was an important reminder that we can’t simply look at the athlete’s injury as a ‘structural problem’ when developing a treatment plan. Insomnia and inflammation are just two examples of the consequences of prolonged elevated cortisol levels in the body due to chronic stress. Both of these can significantly reduce healing times of various injuries. Various yogic breathing and meditation methods have been shown to effectively reduce the physiological effects of stress, improve mental clarity, focus, and sensory awareness, all of which can translate to improved athletic performance. Effective stress management methods are therefore an important part of any athlete’s rehabilitation or training program. Interestingly, the ‘yoga’ that may have been initially introduced to help improve the athlete’s flexibility, can now also be addressing so many more factors essential to the athlete’s performance.Learning Lab Experience:
As an assistant, I felt like I contributed a great deal by facilitating correct alignment and movement, answering participant questions, re-emphasizing lecture content as it applied to the lab, and also offering my skills, knowledge, and experience to each of the small groups as appropriate. It was a tremendous honour and privilege to be a part of something so in line with my mission to inspire, educate, and empower people to take an active approach to their healing and wellness through yoga, in order to ultimately create their own health. Being a part of this lab team also gave me the opportunity to connect and reconnect with peers that I respect and am passionate about keeping in contact with and learning and collaborating with in the future.
This experience also proved to be a great networking event and it provided me with the opportunity to promote my own core business values and attain some personal and professional goals. This experience has also inspired me to create another new workshop that I will be adding to my repertoire: “Yoga for the Athlete: Treating & Preventing Injuries, Optimizing Performance, Creating & Sustaining Overall Health” in which I will definitely be adding the concept of ‘controlled flexibility’ into the presentation.Recommendations:
There was so much valuable information in a short period of time. I felt that Ginger did an amazing job at including such valuable information in such a clear and concise manner. However, I would recommend changing the topic to something more ‘all encompassing’ (as the presentation was so much more than just about controlled flexibility). I hesitate to recommend spending less time on the details of some of the other systems (adverse effects of cortisol or vagus nerve stimulation effects) because this is how and why yoga differs from any other system the athletes are using. So to suggest focusing more time on the specific topic of ‘Controlled Flexibility’ would be a disservice to authentically representing ‘yoga for the athlete’. The information about the other benefits of yoga is crucial as well, but perhaps some of this can be somehow divided up into a series of lectures in the future.
I also think it would be valuable to the trainers to include the discussion of how essential it is to develop their own personal practise to effectively understand yoga and therefore become competent in providing yoga as therapy. There was mention of how using yoga with the athletes does help to prevent practitioner burnout, however, I think that even more focus on the significance of developing a personal practise would be useful. It would also help increase participant interest in pursuing yoga if they haven’t already. I feel it is so important for anyone who is interested in incorporating yoga into their rehab practise to realize and understand that to effectively treat with yoga, one does need to experience it.Future Considerations:
As we move forward in presenting and sharing 'Yoga for the Athlete' in numerous forums and settings, I think a wide variety of topics surrounding how yoga can specifically benefit the athlete could be presented at this conference and others. Some examples:
Optimizing Performance in the Athlete with Yoga: Controlled Flexibility
Optimizing Performance in the Athlete with Yoga: Effects of Meditation Practise
Optimizing Performance in the Athlete with Yoga: It’s All About the Breath
Optimizing Performance in the Athlete with Yoga: Refined Strength & Power
Optimizing Performance in the Athlete with Yoga: Balancing the Emotional Motor System
I suppose this could potentially be succumbing to the reductionist approach that our current system is already guilty of using; however, with limited amount of time in these sessions, this breakdown may prove to be more productive and valuable for each participant. The participants will have an understanding that yoga addresses many layers, but still experience a thorough explanation of the specific topic and are allowed to explore fewer concepts more deeply.
Overall, the experience of joining Ginger and the lab team at the NATA conference was an educational and memorable one that helped me grow personally and professionally. It was an honour to be in the company of intelligent, dedicated, and like-minded peers with similar passions. Observing Ginger smoothly and effortlessly complete the difficult task of bringing a brand new topic (and profession) to a national conference, with so much information in such a short time frame, was truly inspiring. I look forward to being involved in more exciting experiences such as this, so please keep your eyes and ears open!
Being physically, mentally, emotionally, and spiritually healthy during pregnancy is something that most women realize is important. As Yoga becomes more popular and mainstream in our western world, it is a natural progression for pre-natal yoga classes to be offered to address a pregnant woman’s health holistically. However, there are some precautions that one should be aware of before participating in a yoga class when pregnant.
Pregnancy results in many physical changes of a woman’s body and consequently can cause issues such as low back pain, pelvic pain, incontinence, postural changes, and balance problems just to name a few. In fact, over 70% of pregnant women experience low back and pelvic pain (Mogren, 2005). One may think that continuing with their regular strengthening, stretching, and core strengthening routine, or enrolling in a pre-natal yoga class may help their current pre-natal aches, pains, and other issues. Unfortunately, simply attending a regular fitness class, yoga or pilates class isn’t always safe and appropriate when you are pregnant. The good news is that there is a great deal of evidence showing that specific exercise programs designed and delivered by physiotherapists can relieve low back pain, pelvic pain and urinary incontinence in pregnant women (Morkved, 2007). A physiotherapist assessment followed by an individual treatment program, which may include yoga postures, can help you safely and effectively participate in a home program or class setting in order to gain the specific strength, stability, flexibility, balance, postural control, and pain management required to maintain a healthy pregnancy.
If you are participating in a pre-natal yoga practise or exercise program of any kind, here are 10 general tips to keep in mind:
1) Do not overheat. Keep body temperature within comfortable limits.
Avoid dehydration, which is more likely to occur in a hot yoga environment.
Fluid losses increase your heart rate and decrease blood volume, potentially causing fetal stress.
2) Keep heart rate from elevating to a high, rapid, uncomfortable rate and always maintain your breath.
You should always have the ability to talk.
3) Do not overstretch muscles. You may feel like you can ‘go deeper’ into many of your yoga postures, but this is only because your relaxin hormone is high, therefore decreasing the ligaments’abilities to stabilize your joints.
Overstretching muscles around unprotected or unstable joints can lead to injury.
A hot yoga environment also potentially increases the risk of injury because the muscles become extremely extensible resulting in possible overstretching beyond the joint’s safe limits.
4) Avoid prolonged supine (lying on back) postures after around 20 weeks or first trimester. This position can potentially occlude the inferior vena cava and consequently compress the subrenal aorta. This compression can then reduce maternal cardiac output (resulting in decrease oxygen to tissues, including fetus).
5) Caution with standing balance postures! Your center of body mass will change dramatically, causing your balance to become altered. Walls and sturdy chairs can be used for extra support.
6) Avoid aggressive forward bends or twists. As always, listen to your body and watch for signs of distress or pain and modify as necessary.
7) Do not perform any pranayama (breath work) that involves retaining the breath or overheating the body.
8) Yoga inversions, such as headstands, are controversial. The main danger during inversions is the risk of falling and injuring yourself or your baby during the fall. As a general rule, if you practised inversions prior to your pregnancy, it is safe to continue IF you are tolerating the pose with great ease and your breathing is not labored. Currently there is no evidence supporting the fact that inversions are dangerous during pregnancy.
9) Postures in the prone (lying on stomach) position are not dangerous, however, they tend to become very uncomfortable and physically impossible, therefore, inappropriate.
10) Pay attention to any ‘warning signs’such as light headedness, unusual nausea or vomiting, increased low back or pelvic pain, or any pain in general, decreased fetal movement, spotting or fluid leakage, or any other symptoms that you are unsure about. Yoga will not necessarily‘cause’ these symptoms, but if you have pregnancy related conditions, you may need to avoid
exertion or certain yoga postures.
Please always inform your doctor before you participate in any pre-natal exercise class or activity, including classes such as ‘pre-natal yoga’.
It is important that you let your therapist or instructor know when you are in pain or feel uncomfortable in any way. As always, know and respect your own limits and ‘listen to your body’.
This article was not intended to diagnose or treat. Please consult with your physician prior to participating in any exercise program or yoga class.
Headaches. If you’ve had one, you understand how debilitating it can be. Did you know that migraine headaches alone are estimated to cost the Canadian economy $500 million annually in lost productivity and absenteeism? (Angus Reid Poll, 1990). This doesn’t even include other types of headaches such as sinus, cluster, or tension. If headaches are so common, why do they appear to be so poorly managed?
Chronic headache sufferers frequently do not receive the proper treatment and education on management because it can be very challenging for a health care practitioner to determine the root cause of the pain. Paying close attention to your headaches, including location, how long they last, quality of the pain and what reduces or triggers the pain, will help your doctor identify the type of headache you are experiencing, which will result in better overall treatment.
Headaches can be caused by a number of triggers such as hormone imbalances, sleep disturbances, foods, odors, smoking, alcohol, light or temperature sensitivities, weather sensitivities, sinus problems, poor postural alignment, muscle tension, and the most common trigger, STRESS.
One of the most effective ways to manage your headaches is to avoid or address these triggers. This is easier said than done.
However, finding and knowing what your triggers are is an essential step to successful management. Once you have identified your triggers, you are more capable of avoiding or addressing them. Sometimes this may result in different choices or even lifestyle changes you need to make. Other times, it may appear that there is nothing you can do to avoid your triggers. If this is truly the case, then at least your physician can still use your triggers as a guide for a more successful treatment outcome.
The most common type of headache pain is due to tension (Blanda, 2012) and is the most common type of headache we treat as physiotherapists. It is often associated with tightened muscles of the head and neck and can feel like a dull pain or pressure encircling the head, or at the base of the skull. It will likely be no surprise to you that the most effective way to treat tension headaches is to find out what is causing the muscle tension, and then address it. There could be many reasons as to why your head and neck muscles are tense. Here are just a few:
Muscular imbalances: weak and/or shortened postural muscles from poor postural habits or ergonomics can cause inappropriate head position. This places undue strain on the muscles of the head and neck, causing chronic tension and lack of blood flow to these muscles.
Joint Dysfunctions: If the joints in your neck or your jaw are not moving properly or are stiff, they can cause the surrounding musculature to become tight or guarded.
Vision problems can cause your eyes to strain and as a result, your facial muscles become chronically tense (when is the last time you had your eyes checked?)
Poor STRESS management. Even mild, daily stress can cause chronic tension in the head and neck muscles if you do not have effective stress management techniques. The most common cause of headaches is prolonged tension or stress (MediResource, 2012). Finding effective stress reduction methods that work for you in your daily life are essential in fighting the battle against tension headaches.
When you can give your physician valuable details about your headaches, he or she can then recommend an appropriate treatment approach which may include a referral to a specialized health care professional (neurologist, physiotherapist, pain specialist, massage therapist, yoga therapist, counsellor) to help educate and empower you to take an active role in the management of your headaches!
This article is not intended to diagnose or treat. Please consult with your physician if constant headaches persist.
Spring is here, the park gates are open! Soccer and baseball players are out on the fields and tennis players on the courts. Our clinic becomes busy this time of year as our community becomes more active and the risk for injuries increases. Many of the injuries we see can be prevented, or at least less severe, simply by being more educated about the most effective methods for warming up and cooling down before and after your activity.
You may be aware of the longstanding debate on stretching. In fact, there is some research that implies that static stretching before an athletic performance may actually be detrimental and play no role in decreasing risk of injury. However, we cannot assume that just because static stretching prior to an athletic event may not be recommended, doesn’t mean that static or other types of stretching aren’t beneficial at other times for other reasons; whether you are an athlete or not. Let’s explore what flexibility and stretching are really all about; and if, when, and why we should stretch.
Flexibility is the ability to move a joint smoothly, without injury or damage, through its complete range of motion. Many components can influence flexibility such as muscle lengths, ligaments, fascia, the joint itself, and even skin. We will be
exploring the muscular component.
When a muscle is shortened or tight, your joint will be less able, or unable, to complete its full movement. So if you quickly kicked a soccer ball, it may result in a muscle strain or injury if the hamstring muscles at the back of the thigh are tight. However, if the muscles were ‘flexible’ enough, they would have been able to withstand that range of movement without any tear or injury.
Studies have shown that increasing joint range of motion by increasing muscle flexibility by stretching does indeed reduce the risk of injury (Hartig&Henderson). Improved flexibility of certain muscle groups can also improve postural alignment and body mechanics, therefore reduce incidences of repetitive strain injuries and other conditions such as back, neck or shoulder pain.
So, if we know flexibility and stretching are beneficial, why are many experts questioning it? Actually, they are not saying that stretching isn’t beneficial, but rather, that certain types of stretching are better than others depending on when they are performed.
There are many different types of stretching, but we will discuss two main types of stretching, static and dynamic. Dynamic stretching is when muscle action produces active movement to result in a stretch, such as with gradually deepening walking lunges or increasing amplitude of arm circles. Static stretching is when muscle groups are placed and held for approximately 30
seconds in a lengthened position, and no movement occurs. There are several more subcategories of effective stretching methods within these main categories that your physiotherapist may introduce to you, but for simplicity we’ll stop here.
Research shows that dynamic stretching is preferred over static stretching prior to an athletic event (to improve performance and decrease risk of injury during performance). Research also shows that static stretching is instrumental in increasing overall joint range of motion, therefore decreasing risk of injury, and is most safe and beneficial when performed when muscles are warm,
typically after the activity.
Therefore, the most effective warm up routines should involve actively warming up the large muscle groups by gradually increasing the speed and amplitude of the activity (deep lunges, arm and leg circles, light running drills, jumping jacks, etc). If you are experiencing a particularly tight area, take time to perform a prolonged static stretch to those muscles once you are warm. Post-activity, it is highly recommended to perform prolonged static stretches to help improve and maintain muscle lengths to decrease risk of injury. Your physiotherapist can show you the stretches that are most safe, effective, and specific to your activity.
Maintaining an overall healthy lifestyle including regular stretching, strengthening, balance exercises, a healthy diet, and stress management are often overlooked, but all very valuable, for injury prevention!
Yoga has become extremely popular and trendy in North America. More and more people are using yoga as a means to improve their health physically, mentally, emotionally, and spiritually. Yoga is even being used as a therapy in our western healthcare system. So what is yoga and is it safe to use as a therapy?
Yoga is a system of health that was developed about 5000 years ago that enables you to use your body, mind, breath, and spirit as one unit, therefore enhancing and promoting an overall balanced lifestyle of health and wellness. There are a wide variety of yoga styles, approaches, and teachings. The most common yoga practices in our western world involve yoga postures, breathing methods, meditation, philosophy and principles.
Medical Therapeutic Yoga applies yoga principles and techniques to specific injuries, dysfunctions, or imbalances. It is an emerging profession that has grown because of its effectiveness in delivering a holistic approach to healing with a focus on self-empowerment. Medical research shows that it is among the most effective complementary therapies in treating health problems, including chronic low back pain (American College of Physicians/American Pain Society, 2007).
Physio-Yoga Therapy is a type of rehabilitation therapy that combines both evidence-based Physiotherapy and Medical Therapeutic Yoga. Physiotherapists use evidence-based treatment methods to help you restore and maintain optimal movement and function as well as provide education on health maintenance and injury prevention. As licensed health care professionals, physiotherapists have extensive training and knowledge about how the body functions, and use specialized manual skills to assess, diagnose, and treat a variety of injuries, disease symptoms, and disabilities.
Is Physio-Yoga Therapy safe? Yes, as long as the Physiotherapist (PT) has the proper training and credentials as a PT and as a Medical Therapeutic Yoga Practitioner. The knowledge and skills of a licensed healthcare professional, such as a PT, ensures the individual assessments and treatments are safe and effective. NOT all yoga poses are safe or appropriate for everyone. Yoga poses and physio exercises are modified to adapt to each individual’s need. Also, a PT is well trained to know when it is necessary to make a referral to a specialist or back to your physician.
A typical Physio-Yoga Therapy session includes a variety of yoga postures, breathing practices, meditations and lifestyle modifications combined with physiotherapy manual techniques and exercises specifically designed to address your needs.
When practiced regularly and safely, the benefits are numerous. Physically, yoga postures and breathing techniques can improve muscular strength, flexibility, postural alignment, body awareness, breathing patterns, bone strength, immune function, optimal body weight, sleep patterns, digestion, circulation, and normalize blood pressure. Mentally, it can improve your alertness, concentration, reduce stress and anxiety, and improve your ability to relax. Some common conditions that can be addressed are back/neck pain, musculoskeletal injuries (shoulders, hips, knees, etc), osteoarthritis, osteoporosis, fibromyalgia, chronic pain, high blood pressure, Irritable Bowel Disease, migraines/headaches, pregnancy, anxiety, rheumatoid arthritis, scoliosis, urinary incontinence.
It is worthy to note the role Physio-Yoga Therapy also plays in disease and injury prevention.
The key benefit is an overall state of health and well-being!
Shelly is offering a FREE talk about Physio-Yoga Therapy at Sun City Physiotherapy in Winfield on Tuesday, Feb.28 at 7pm. Please call the clinic to reserve your spot at 250.766.2544.
Bring all your questions you’ve ever had about yoga!
It is a fact that 53% of women between the ages of 20-80 years old experience urinary incontinence (the inability to control the bladder) at some point in their lives (Culligan &Heit, 2000). Less than half of these women do not even mention it to their physician (Burgio, 1994) perhaps because they are too embarrassed, or simply because they think it is normal to experience ‘a bit of leakage’ when they sneeze or laugh. Or, that it is normal after pregnancy or with age. Or, that it is normal because their mom, sister, and best friend all experience a ‘bit of leakage’ too. But it is not normal. Yes, it is common, but not normal. Urinary incontinence can be prevented and treated in most cases.
The two main types of urinary incontinence are stress and urge. It is important to know the difference between the two, and know which one you may have, in order to treat it accurately. However, it is common to have a combination of the two as well.
Stress incontinence is what occurs when the pelvic floor muscles(PFM’s) have become too weak to stop the flow of urine during actions that put pressure or stress on the bladder, such as coughing, sneezing, laughing, twisting, or lifting. Pelvic floor weakness can result from the muscles being overstretched during childbirth or even from low estrogen levels, such as during menstruation or menopause.
Urge incontinence is when there is a sudden ‘urge’ to urinate with an inability to control the bladder. This happens when the pelvic floor muscles are chronically tense to the point of fatigue, and consequently give out at inappropriate times. If the PFM’s are consistently tense, without knowing how to relax, release, and control them, other problems in addition to urge incontinence can arise like low back pain, irritable bowel syndrome, interstitial cystitis, and painful intercourse.
Many people believe that the popular Kegel exercises which consist of ‘squeezing’ the PFM’s will solve the leakage problems. However, this is not necessarily the case. If your incontinence is due to chronically tensed PFM’s that are fatiguing (urge incontinence), then simply performing Kegel exercises may actually be worsening your problem! Learning how to release your
PFM’s in conjunction with diaphragmatic breathing would be more beneficial for someone with urge incontinence. If your incontinence is PFM weakness due to being overstretched or inadequately activated, then correctly prescribed Kegel exercises can help. But Kegel exercises do not address all of the muscles that are important for a healthy pelvic floor. Kegels are still only a small part of the overall treatment of this dysfunction.
Treatment of incontinence may begin by learning how to activate, release, and control the PFM’s. PFM training with a physical therapist has been recommended for women suffering from stress urinary incontinence and for prevention of urinary incontinence during pregnancy and after delivery (Britnell, et al 2005). Successful physiotherapy treatment protocols also include hip adductor and deep abdominal muscle strengthening, lumbar or core stability training, and prescription of exercises that address postural mal-alignment or hip tightness that may be contributing to pelvic floor weakness. Education regarding bladder irritants in the diet can also be included in your treatment plan.
Yoga and Pilates have also been shown to improve both types of incontinence due to their ability toaddress the above areas.
A physical therapist trained in this area will be able to help diagnose which type of incontinence you may have, and help develop an appropriate treatment plan. Treatment need not be invasive and usually consists of 4 to 6 visits. The assessment typically consists of a series of questions followed by a physical examination of postural alignment, hip, pelvis and abdominal strength and flexibility testing. Although incontinence is common, it can be treated. So whether you are a new mom or a retiree, you can still continue to enjoy a healthy lifestyle knowing you have confidence in controlling your bladder!
Whether you are preparing to hit the ski hills this season, play golf next season, perform fall yard work, or simply are wanting to continue to walk and perform all your household chores with ease and efficiency, it is important to be knowledgeable about core stability and how to apply it while performing any sports or activities of daily living. Most people have heard of the term ‘core
stability’, but few people actually truly know what it is and how to correctly engage it.
The ‘core’ is a group of muscles that surrounds the back and abdomen and is best described as a cylinder of muscles. The main function of the core is to stabilize and protect the spine and pelvis when the rest of the body is in motion. There are 4 main muscle groups that make up the inner core: Transversus Abdominus (TA), Multifidus (MF), Pelvic Floor muscles (PFM), and the diaphragm. TA is the deepest abdominal muscle that wraps around your abdomen like a corset, and is connected to tissue surrounding the spine. When TA contracts, it is similar to the corset being tightened, therefore assisting in increasing the pressure inside the abdomen which provides increased stability to the spine. MF is a deep lower back muscle which makes up the back part of the core. It is an important postural muscle that helps keep the spine erect. The PFM’s are the bottom part of the ‘cylinder’ or core. The diaphragm makes up the top part of the cylinder. When all of these muscles contract simultaneously, they help to maintain the pressure in the abdomen which then provides the stability to the spine and pelvis. It is important to note that the timing of these muscles is mandatory for effective core stability. For optimal core stabilization, all the muscles will activate together and just prior to any body movements and are ideally maintained throughout all movement, all day!
A common misconception is that "strong abdominals protect the spine". In fact, as described above, the abdominal muscles make up only one part of the core. Furthermore, only the deep abdominal muscle, TA, is involved in protecting the spine. The famous "6-pack" or Rectus Abdominus muscle that many fitness fanatics train actually plays no role in protecting the spine. Additionally, you may already be performing ‘core stability’ exercises, but instead of activating your TA correctly, you may be using the Rectus Abdominus (as evident by the abdominals ‘tensing’ and popping out and up) to compensate for the TA that you
aren’t quite sure how to find. This is a very common mistake and can lead to back pain. So please ensure you are performing your core exercises correctly!
Adequate core stability not only reduces strain on the spine, but also helps maintain optimal postural alignment which will help reduce risk of injuries whether you are playing sports, doing housework, or sitting and driving. Core stability is also an important part of any rehabilitation program. Not only back or pelvis injuries, but even injuries such as hamstring or shoulder strains should incorporate core stability as part of the rehab process. A strong core means a strong foundation from which our limbs can move more safely, with more power and efficiency, and with less risk of injury.
Core stability is also an essential part of any regular workout routine. Whether you enjoy recreational sports, competitive sports, or simply enjoy working out at the gym, addressing your core can improve your abilities and enhance your overall performance.
To ensure you are correctly engaging your core and to incorporate safe and appropriate core exercises to suit your needs, it is wise to invest your time with a qualified specialist for a few sessions first. If you experience low back pain or are dealing with specific spinal dysfunctions, then a visit to your physiotherapist or other trained health care professional is essential to ensure the most safe and effective core exercises are prescribed for you!
Do you experience pain in your jaw? Perhaps radiating to your ear, face, neck, and even your shoulder? Does this coincide with difficulty opening or closing your mouth while talking, chewing, laughing or yawning, or your jaw locking? You may be experiencing a dysfunction in your temporomandibular joint (TMJ). The TMJ joins the lower and upper jaws and is the joint responsible for opening and closing your mouth, as well as any side to side movement of the lower part of the jaw (which is important for chewing and articulation of speech). You have a right and left TMJ. You can actually feel the movement of the joint by palpating just in front of the ears as you open and close your mouth. There is a disc that is in between the joint that enables a
smooth gliding motion. If this disc does not glide properly, you may experience clicking or popping sounds.
There are a variety of factors that can cause TMJ disorders, and often times it is a combination of factors that need to be
addressed in order for treatment to be effective. Some of the common causes include the following:
1) Poor postural alignment.
If you have habitually poor posture over time, this can greatly affect the position of your head and neck, creating chronic muscle imbalances, which in turn can affect the mobility of your TMJ.
2) Behavioural habits that create muscle tension around the jaw muscles such as grinding or clenching
your teeth, excessive gum chewing or biting your nails. A common underlying cause of poor habits can be stress related.
3) Trauma to the joint.
4) Arthritis in the joint.
5) Dental problems such as abnormal alignment of the teeth when the upper and lower jaws are
brought together (malocclusion).
6) Hormonal changes. Research suggests that estrogen levels can also play a role in TMJ pain (Craft, 2007.)
Treatment of your TMJ disorder may require more than one health care professional due to the nature of the potential causes.
Dentists, orthodontists, ear/eye/nose/throat specialists, physiotherapists, massage therapists, physicians, psychologists, and
endocrinologists may be some of the professionals involved in your treatment. It is essential to ensure your health care professional determines the cause(s) of the origin of your TMJ disorder before effective treatment can begin. Treatment may include the following, depending on the cause:
Addressing your postural dysfunctions by prescribing specific strengthening or stretching exercises specific to your deficits. This also includes education about your alignment and movement patterns at work, whether you sit at a desk or have a more physical job. A physiotherapist can assist you with this. Addressing any unhealthy behavioural habits (grinding, clenching, nail biting) can be challenging. It is helpful to look at the underlying cause, which frequently is related to stress. Learning how to effectively
manage your stress levels is important not only for your TMJ disorder and the muscle tension surrounding the joint, but is also important for many other systems of your body. Relaxation methods, breathing methods, appropriate exercise, regular yoga practise or perhaps some small changes in lifestyle choices can all contribute to improving the way you handle your stress. Physical Therapy can address any TMJ instabilities, inflammation, or stiffness in the joint by manual therapy methods, electrotherapeutic modalities, and prescriptive exercises to address the specific dysfunction. A visit to your dentist is
important to ensure you have a thorough assessment of your teeth/mouth alignment and to determine the need for night splints or guards or any other treatment option. Occasionally, there may be a more serious problem where you need to be referred to another specialist. Symptoms that include loss of hearing, nerve involvement, weight loss, or
persisting pain and immobility despite ongoing treatment indicate a visit back
to your physician for a referral to an appropriate specialist.