Keeping the Doctor Away
Ten Doses of Yoga Alignment for Preventative Physical Therapy
Dr. Jonina Turzi is aiming to put a dent in her own business. In addition to being a physical therapist specializing in functional manual medicine since 2007, she is also a certified yoga teacher through the Himalayan Institute and the founder of West End Yoga Studio in Lancaster, Pennsylvania. She teaches intelligent, playful yoga classes that focus on remodeling students’ inner architecture in a way that supports the greatest possible spaciousness: the state wherein there is no impingement upon joint space, organ movement, or the nervous system. In short, she aims to prevent or undo the kind of wear and tear that brings many of her clients to physical therapy in the first place.
This is what she recommends that we all do on the mat now to save ourselves pain later.
1. Untuck your tailbone.
Having seen the deleterious effects of the misguided “tuck your tailbone” cue, which only emphasizes the posterior (backward) pelvic tilt many of us are already in thanks to habitual chair-sitting, Turzi is on a one-woman “functional tailbone decompression project.” A tucked tailbone means the loss of the lumbar curve (“your best friend,” according to Turzi). A diminished lumbar curve may lead to disc problems in the lower back, sciatic pain, and even shoulders that are too far forward. It also has dire consequences for the lower organs, which need space to move. And, from a subtle-body perspective, when we put a “clamp” on the tailbone, we interfere with apana, the downward movement of energy. Better to allow the tailbone to move back and to be responsive and mobile, “like the tail of a kite,” says Turzi. How far can we let the tailbone move back? “When the pelvis is properly positioned, the lowest lumbar vertebrae will move in and up,” says Turzi. “Too much anterior (forward) pelvic tilt, and the vertebrae will move in and down.” Instead of instructing tucking—or even directing the movement of the tailbone in a constrictive way—in the hopes of anchoring a pose, Turzi suggests, “Make whatever is on the ground the new tailbone. Root there. That’s the anchor.”
A diminished lumbar curve may lead to disc problems in the lower back, sciatic pain, and even shoulders that are too far forward.
Explore: How does it feel to root down with whatever you’ve got on the floor and to allow the tailbone to move back in mountain pose? Table? Chair? Low Lunge? Warrior two? Bridge? Headstand?
2. While you're at it, move your head back.
Forward-head posture causes muscle strain, disc problems and nerve impingement, and effectively increases the weight of the head on the spine. It also restricts the movement of udana (the upward movement of energy). How far should you take the head back? “As far back as your tailbone,” says Turzi. “In poses where the spine is in its neutral shape, the head and the tailbone should be in line.” Turzi places a dowel along her back to illustrate this principle, or slants it along the backs of her students to give them feedback. To prevent students from just lifting their chins to bring the head toward the dowel, Turzi often encourages them to draw the “scruff of the neck” back. She additionally instructs moving the tip of the tailbone and the back of the head as far apart as possible while bringing those points to the dowel. When the spine is thus elongated, the very bottom and the very top of the thoracic spine will move toward the dowel as well, though the middle of the thoracic spine, right between the shoulder blades, will move in toward the heart. (See the next cue for more on the thoracic spine.)
Explore: How does it feel to draw the head and the tailbone back equally in table pose? Downward dog? Plank? Chaturanga? Chair pose? Low lunge? Warrior two? Warrior three?
3. Draw your thoracic spine in.
Turzi believes that the common depictions of the “normal” kyphosis (rounding) of the thoracic spine are exaggerated, reflecting what is common rather than what is ideal. This excessive kyphosis can, over time, lead to cut off nerves, herniated disks in the cervical spine, and breathing problems. It can also confine the movement of prana (the inward-moving energy associated with respiration and receptivity). Instead of countering the tendency of the upper back to round, many yoga teachers unwittingly urge their students to exaggerate that rounding by having them draw the rib cage too far back in neutral-spine poses (for instance, instructing them to lift their upper and mid-back in plank until there is no visible crease in the thoracic spine). How much should we draw the thoracic vertebrae in? Turzi says that when the spine is in its ideal shape, all the vertebrae, even those in the thoracic spine, will be slightly indented, though the indentation will be slightly deeper at the lumbar spine and the cervical spine than at the back of the rib cage. Indent the thoracic vertebrae “until the AC joints at the top of the shoulders are sitting directly on top of the rib cage, like big fat ‘80s shoulderpads,” says Turzi.
4. Lift your shoulder blades along with your arms.
Rotator-cuff injuries abound in experienced yoga practitioners who have been encouraged to move their shoulder blades down the back when the arms are lifted overhead. As soon as the elbows are lifted above shoulder-height, the scapulae (shoulder blades) must elevate and upwardly rotate. Though there is a downward spin of the ball in the socket of the shoulder joint when the arms lift, that movement is distinct from that of the shoulder blades, which should be allowed to shrug upwards. This upward-shrugging action hoists the rib cage up, decompresses the ribs and spine, and takes pressure off the heart and lungs, while giving prana the space to play. How much should you lift the shoulder blades? “As high as they can go and still take the rib cage with them,” says Turzi. If the shoulder blades are lifting without the rib cage (manifesting as neck-scrunching), try either squeezing into a block between your inner forearms or pushing out into a strap around the forearms, as you reach your arms overhead. If you work those squeeze/push actions while lifting the shoulder blades, the muscles of scapular stabilization will engage, and the rib cage will accompany the scapulae on their way up, lengthening the spine. Bracket the action from the front, preventing rib-popping, by dropping the bottom of the sternum down as the shoulder blades lift up.
As soon as the elbows are lifted above shoulder height, the scapulae (shoulder blades) must elevate and upwardly rotate.
Explore: How does it feel to lift the shoulder blades, along with the rib cage, in poses like upward-reaching mountain pose? Warrior one? To lift the shoulder blade belonging to the top arm in extended side angle? Cowface? To move the shoulder blades down toward the hands in downward-facing dog? Child’s pose?
5. Forget about bringing your hands and elbows close to the rib cage in chaturanga.
In chaturanga, having the hands close to the rib cage and the elbows hugging in and deeply bent may not only cause the wrists to twist, impinging upon the carpal tunnel, but also set the stage for shoulder injuries by causing the fronts of the shoulders to drop down. This oft-instructed alignment may also hinder the progress of vyana, (the outward movement of energy) from the heart space to the limbs. How close to the body should you bring the hands and elbows? “Only as close as you can go while keeping the base of the index finger and thumb pressing into the floor, hugging in with the inner wrists, and staying broad across the collarbones,” says Turzi. Instead of teaching a typical chaturanga, Turzi has students drop to their knees, set up their hands as wide as they need to in order to root through their inner hands—even encouraging them to turn their hands in if need be—and bend their elbows only slightly. She teaches this rooting down (or reaching through) the inner hands not only in poses where the hands are weight bearing, but also in poses where the arms are up, out, or down to the sides of the body in order to facilitate the healthiest possible shoulder placement.
Explore: How does it feel to root (or reach) through the inner hand, firm the inner wrists in, and broaden across the collarbones in a chaturanga on your knees? Chair pose? Warrior two? Locust?
6. Turn your knees further outward than you think.
Poorly tracked bones in weight-bearing stances are “tendonitis and arthritis waiting to happen,” according to Turzi. But "kneecap toward the second toe," as often instructed in poses like warrior two, may not be enough to track the thighbone where it belongs, over the center of the foot. “The kneecap is a dirty liar,” Turzi says. “There can be up to a 50-degree discrepancy between the direction the thighbone is moving and the direction in which the patella is pointing.” To get the thighbone aligned, you might need to feel as though you are turning the knee toward the pinky toe. How vigorously should you work to track the knee outward? “As much as you can while staying rooted (or reaching) through the base of the big toe and hugging the inner ankles in,” says Turzi, adding, “If the foot is working in this way, and the thighbone itself is pointing over the center of the foot, it doesn’t even matter if the knee goes past the ankle.” Turzi also teaches the prone backbends like cobra, sphinx, and locust with the knees both pressing down into the floor and pushing back to decrease the chances of injurious distortions in knee-to-ankle tracking.
Poorly tracked bones in weight-bearing stances are “tendonitis and arthritis waiting to happen,” according to Turzi.
Explore: How does it feel to turn the knees out while rooting down (or reaching) through the base of each big toe and hugging the inner ankles in, in warrior two? Triangle? Warrior one? Locust? The bow poses? Pigeon and double pigeon?
7. Send your inhale down, and your exhale up.
The length that we cultivate with the inhale is length we want to maintain, and even emphasize, on the exhale in order to help engage the “core stabilizing” muscles—the tonic muscles closest to the bone, whose activation relieves pressure on the inner body by lengthening the spine. Inhaling down and exhaling up also activates samana (the assimilating energy that moves in to the center of the body). “Try rooting into whatever part of you is on the ground during each inhale, and sending the exhale up the length of your spine, as if squeezing a tube of toothpaste,” Turzi instructs. (You might also continue pressing down during the kumbhaka, the pause, after the inhale, and lifting up during the kumbhaka after the exhale.) How much should you use the breath to maximize our height? “As much as you can and still allow the spine to move with the breath,” Turzi says, emphasizing that none of these directions are meant to be incarnated rigidly; any action becomes counterproductive when worked to the extent that it creates stress or interferes with the ability of the vital organs to dance and glide.
Explore: How does it feel to inhale down into whatever you’ve got on the floor (your feet, your hands, your pelvis), and exhale up the spine in mountain? Chair? Handstand? Any pose you can think of?
8. Hold your height in transitions.
In order to avoid nerve impingement or joint shearing, as happens when a hip lists outward or drops during a transition, or when the spine slouches, Turzi suggests we move from our core-stabilizing muscles first by keeping inner spaciousness our top priority as we transition from pose to pose. She often says, “Hold your height, and step forward, hold your height and twist.” For instance, instead of casually stepping the right foot forward from downward-facing dog to lunge, which, according to Turzi, “can be at best a missed opportunity to strengthen, and at worst compressive to the tissues of the body” (e.g., hip cartilage, sacroiliac joints, lumbar discs), Turzi encourages students to first root through the left foot, firm the left hip in, then move the right knee toward the navel. From there, she has students reach the sternum forward to bring their shoulders over their wrists, all the while reaching back powerfully through the left heel.
Explore: How does it feel to hold your height as you step into tree? As you pull a knee in while lying on the back? As you bend a knee in toward the nose in plank? Lift up a leg for warrior three? LIft a foot a couple inches off the floor while in bridge?
9. Stay put, and breathe through the shaking.
Adapting the principles of PNF (proprioceptive neuromuscular facilitation), Turzi advocates holding poses long enough, and with enough attentiveness and commitment, for the more superficial phasic muscles to shake and give up, and the deeper tonic muscles to kick in. Shaking is good, in Turzi’s view, though it is a sign of progress rather than an end goal. “It is your body lighting up what used to be a shadow spot in your brain and nervous system," she explains.
In Turzi’s philosophy, there is no end to the improvement possible, and any one pose could be used to go ever-deeper. Yoga is endless and endlessly helpful.
"You could shake during your practice of a certain action in a pose for years, depending on how big the shadow is, while your body adapts to new joint and tissue spaces and gradually assumes its most efficient and balanced state.” How long should we hold a pose and shake? “Two or three minutes seems like long enough for the neural re-education to begin, for the biorhythms to begin to normalize in a new pattern,” says Turzi. Even for the most experienced of practitioners, there is always another layer of attention that could be added to peel back a layer of shadow, another action to work that would elicit shaking, “not because we’re slacking, but because we’re wildly asymmetrical inside,” Turzi says. For instance, in a pose like warrior two, if it becomes easy for you to press down with both the big toe mounds, to hug both inner ankles in, while turning both knees toward their respective pinky toes, you can work on moving the head and the tailbone back equally, then resolve to move the thoracic spine in between the shoulder blades. If that becomes easy, you can press down through the base of each index finger, hug the inner wrists in toward each other without moving the arms, while broadening across the collarbones. You can inhale down and exhale up. And when your body has integrated all those actions, you can go back to the big toes and start again, working each action more. This approach makes seemingly straightforward poses newly, and constantly, challenging. In Turzi’s philosophy, there is no end to the improvement possible, and any one pose could be used to go ever-deeper. Yoga is endless and endlessly helpful.
Explore: How does a long hold feel in table pose? Forearm plank? Reverse table? Chair? Any pose you can think of?
10. Take your yoga with you off the mat.
Turzi says, "It's great if you can move this mindfully in yoga class; it's even better if you can carry that mindfulness with you into life, so that with your every movement, you are using your strength to feed your inner spaciousness." Sitting, standing, walking, driving, lifting a leg to step into your pants, squatting to pick up a dropped spoon, opening a door: these all become opportunities to practice the self-awareness yoga fosters, to root down into yourself and actively reaffirm the tall inner alignment that will best support you throughout your life.
Turzi’s hope is that this sthira, or concentrated effort, in our muscles will lead to more sukha, or ease, elsewhere. When we use muscular effort to take weight into bones that we’ve carefully aligned on their axis, the nervous system will be de-stressed, the fluid dynamics of the body will be balanced, the organs and the joints will have the room they need to function optimally, and we might even discover we have more room inside for the qualities we want more of: compassion, love, joy. Or, as Turzi puts it, “The birds can fly because the trees are there.”
Amber Burke lives in Abiquiu, New Mexico. She teaches alignment-based and restorative yoga privately (and occasionally at Ojo Caliente Mineral Springs), as well as various writing classes at UNM Taos. With her anatomically-focused articles, she aims to broaden the interface between yoga and physical therapy. She and Bill Reif, MPT, are hard at work on a book for yoga practitioners with injuries and pre-existing conditions. She is a graduate of Yale, the Johns Hopkins Writing Seminars MFA... Read more>>