yoga sandbag

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Physiology of Respiration
• Respiration, Stress, and the ANS
• Recognition of normal vs. abnormal breathing patterns
• Relationship between breath and core
• Trunk cylinder & pelvic floor‐
diaphragm piston
Intro to PYT: Part 2
• Practice of functional yogic breathing
• Relevance of breathing patterns to common PT populations
© 2013 Ginger Garner. Living Well, Inc. excerpt from PYT Texts ©2001-2012. All rights reserved.
Respiration, Stress, Emotion, and the Autonomic Nervous System
• Stress may be caused by:
•
•
•
•
•
Sustained Stress and Allostatic Load
• Allostatic load:
Poor breathing patterns
Negative emotions
Environment
Poor lifestyle choices
Illness39
• Stress= alarm in a homeostatic system.
• Fight, flight, or freeze‐ necessary arousal of SNS to prepare for perceived threat.
• Sustained states‐ unnecessary; may cause chronic, maladaptive ANS activity and poor health in multiple body systems.39‐41
• Wear and tear on the body resulting from its attempts to return to homeostasis.42
• Sustained stress ↑’s this load.
• Can cause/ exacerbate multitude of disease processes.
• Affects GI, musculoskeletal, neuromuscular, immunological, endocrine fxn, etc.40,42
Yogic Breathing Evidence Base
• Vagus nerve stimulation via long, deep breathing is the first breath technique learned in practicing yoga.
• Vagus nerve = main 39Clifton Smith T, Rowley J. Breathing pattern disorders and physiotherapy: inspiration for our profession. Phys Ther
Rev. 2011; 16(1): 75‐86.
peripheral pathway to parasympathetic nervous system.
•Stimulation of vagus
nerve ↑’s parasympathetic activity.
•Restores homeostasis
•↓’s allostatic load42
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Stress Related Imbalances Corrected by Yoga‐
Based Practices
•Corrects GABA underactivity.42,43
•↓ GABA levels are commonly found in PTSD, depression, epilepsy, and chronic pain.
•Corrects excessive hypothalamic‐pituitary‐adrenal axis activity.
•HPA axis is implicated in chronic stress.42
BONUS! Anti‐inflammatory Effects of Yogic Breathing on Cardiovascular System
•Lowers multiple risk factors:
•HTN
•Cholesterol
•Stress hormones
•Blood Sugar44,45
• Far‐reaching implications for use of yoga in tx of broad array of disorders exacerbated by stress!40,42
Streeter CC et al. Effect of Yoga on the autonomic nervous system, gamma‐aminobutyric‐
acid, and allostasis in epilepsy, depression, and post‐trauamatic stress disorder. Medical Hypotheses, 2012 May; 78(5): 571–579. Summary: Yogic Breathing Clinical Focus16
The focus in yogic breathing is on:
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•
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Vagus nerve stimulation
↓ ing sympathetic stimulation
↑ ing alveolar ventilation & o2 saturation
The intention of yogic breathing
is to gain control of previously labeled “autonomic functions” for systemic health:
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•
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Psychophysiology
Psychoendocrinology
Psychoimmunology
Observe for Abnormal Breathing Patterns
QUIZ: How many breaths does the average person take per day?
• Hyperventilation: > than 12‐20 BPM46
• Alters CO2 balance • Stimulates SNS → fight or
flight40,46,47
• Thoracic or Chest Breathing • Mask Breathing
• Paradoxical Breathing
• Chest/ abdomen move superoposterior during inhalation39,40,48
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Observe for Abnormal Breathing Patterns16
Normal Diaphragmatic Movement OBSERVE THE FOLLOWING FOR YOUR PARTNER:
1. Evidence of normal or abnormal breath pattern(s) using the respiratory pathophysiology 2. If compensatory actions are used (use of secondary muscles or respiration), identify and document them.
3. Separately document the duration of inhalation and exhalation, in seconds.
4. Document any postural changes which occur as a result of any breath pattern.
Functional Breath Practices16
1.
2.
3.
4.
Abdomino‐diaphragmatic breath
Sandbag breathing
Three part breath
Transversus Abdominis Assisted Thoraco‐
diaphragmatic assisted breath (TATD)
Pranayama Begin on Exhale
End on Inhale
Precept 3
The breath must be mastered before attempting to perform the pose (asana) in which the breath will be used.
The Yoga “Couch”‐
Three Tier Approach49
General Yogic Respiration Guidelines16
1. Practice daily in the AM or before your yoga practice, preferably.
2. Be comfortable. Sit against the wall if free‐sitting becomes uncomfortable, or perform in bolstered reclined supine lying in lateral left side‐lying. 3. Begin on exhale, end on inhale.
4. Work to equalize the inhalation with the exhalation.
5. Work to reduce RPM to < 12.
6. Repetitions: 5‐10 cycles each or a minimum of 2‐
5 minutes of breathing practice.
Abdomino‐diaphragmatic Breath
• Medical “gold standard” breath • Should be taught prior to all other breath techniques or types http://www.gingergarner.com/?s=yog
a+couch
• ↑’s alveolar ven la on
• ↓’s sympathe c input16, 50‐52
• Use in chronic pain management, poor breathers, as introductory breath
• Also for relaxation and sleep • Used for restorative yoga postures only16
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Common Positions for Abdomino‐
diaphragmatic Breath Practice16
Abdomino‐diaphragmatic Breath Entry and Exit16
Entry ‐ Inhale and allow the abdomen to expand.
Exit ‐ Exhale and allow the navel to draw back toward the spine gently. Repeat for several minutes or until you are comfortable with this breath or achieve the desired effect.
© 2012 Ginger Garner. Living Well, Inc. excerpt from PYT Texts ©2001-2012. All rights reserved.
Sandbag Breathing16
Benefits and Description:
 Teaches A‐D breath
16
 Equalization of inhale/exhale
 Deepens respiration for ↑ O2 exchange, ↓sympathetic/↑ parasympathetic input16,53
 Augments performance of diaphragm via improved length‐tension relationship.16,53  Weighted supine abdominal breathing preferentially trained the diaphragm in a study of patients with chronic tetraplegia.54
Three Part Breath16
• Intention ‐ This breath is beneficial in alveolar ventilation and increasing lung capacity. It facilitates metering of the breath, which can decrease sympathetic input while also encouraging breathing into the deeper lobes of the lungs. • Action • Sitting comfortably, exhale completely.
• Inhale through the nostrils as if your lungs were a glass of water and you were filling them with air.
• Exhale through the nostrils as if you were lungs were a glass of water and you were pouring out the “water” (air).
Sandbag Breathing16
Entry




Assume corpse (savasana) position.
Place sandbag over lower abdomen
 on and below the navel
 below the ribs  above the pelvis
Breathe steadily and slowly.
Feel the rise of the sandbag on the inhale and the steady descent of the sandbag on the exhale. Exit
• Drag sandbag off belly on the left side.
• Remain here and notice any changes. • Inhale and exhale several times.
• Transition to right sidelying
position.
• Finish with seated meditation.
• Spend several breath cycles in seated meditation.
Three Part Breath Entry & Exit16
• Inhale for 2‐3 counts into lower abdomen and lumbar spine.
• Continuing the inhale, take 2‐3 counts into rib cage.
• Continue the inhale, taking remaining 2‐3 counts of the breath into upper lobes of the lungs under the clavicles (without using secondary muscles of respiration/ compensatory actions).
• Exhale in the exact reverse order. Empty the glass of the lungs from the top – exhale from the upper lobes of the lungs for 2‐3 counts, followed by the rib cage for 2‐3 counts, followed by the lower abdomen and lumbar spine for 2‐3 counts. • Repeat for at least 3‐5 breaths and then return to a normal full breath and notice any changes.
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Transversus Abdominis Assisted Thoraco‐diaphragmatic Breath (TATD)16
• Utilized to provide safety in all dynamic posture practice in PYT method. • Supports spinal neutral.
• Increases trunk/ lumbopelvic stabilization for injury prevention. • Fully engages diaphragm – pelvic and respiratory. • Intended carryover for ADL and work task performance.
Role of Transversus Abdominis in Trunk Cylinder or “Core”
• TA contractions of as little as 1‐2% of the MVC can provide stability for the “healthy spine” (2‐5% for “compromised spine,” and as much as 25%).68‐70
• This “drawing in” action allows fuller rib cage expansion via fixation of central tendon of diaphragm.62‐67 Trunk Cylinder or “Core” & Diaphragm‐Pelvic Floor “Piston”
• When core is functioning properly, there is a parallel motion with the respiratory diaphragm (top of cylinder) and the pelvic floor (bottom).75
• Abdominals and back muscles provide a solid force on side walls of core cylinder.76
Role of Transversus Abdominis in Trunk Cylinder or “Core”
• TA activation:
• precedes limb movement
• is continuous during all trunk movements55‐58
• is controlled independently of other trunk muscles59
• is required for trunk stability60,61
• lends stiffness to the trunk via increased IAP (intra‐
abdominal pressure)62‐67
Role of Diaphragm in Trunk Cylinder or “Core”
• Diaphragm forms roof of trunk cylinder.
• Serves a dual role
• Respiration
• Postural Stability63, 71‐75
Parallel Motion:
Diaphragm‐Pelvic Floor “Piston”75
• Inhale : both descend
• Exhale: both ascend
Inspiration
Expiration
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Cylinder/Piston’s Role in Core Stability
• For optimal core function and to prevent problems such as incontinence and pelvic pain…
• all sides of the cylinder must be in balance77
• pelvic floor must be able to move through entire ROM (fully relaxed to fully contracted.)
• TATD breath equally engages all sides of cylinder.16
TATD Breath Entry & Exit16
• Entry
• Place hands on your ribcage in a C grip.
• Draw the belly button into the spine lightly but firmly enough to create a gentle internal tension.
• Inhale and feel the ribcage expand, particularly posteriorly.
• Exit
• Exhale and appreciate the ribcage diameter decrease. VIDEO:
http://www.gingergarner.co
m/2013/03/26/breathing‐
better‐for‐a‐safer‐spine‐the‐
yogic‐tatd‐breath/
TATD Breath Relevance
to Patient Populations: LBP
• Patients with LBP demonstrate diaphragmatic dysfunction.
• Abnormal diaphragm position.79
• ↓ contrac on, ↓ post. excursion, and breath holding habits.80
• > susceptibility to diaphragm fatigue.81
• Impaired postural compensation for respiration.82
Summary: TATD Breath Optimizes TA and Diaphragmatic Relationship
•If force exerted by abdominals is > that of the pelvic floor, this will push too much pressure up and down in the container – either disturbing breathing patterns, causing incontinence, or both.36,37,39, 61,62,78
www.juliewiebept.com
•In TATD breath, respiratory and pelvic diaphragms work together to provide trunk stiffness and stability, while equally supporting all sides of trunk cylinder.16
TATD Breath Relevance
to Patient Populations
Balance dysfunction
Idiopathic scoliosis Back/SIJ/ sciatic pain
Women’s Health
Respiratory disorders
Shoulder and neck pain
TMJ
Athletes
TATD Breath Relevance
to Patient Populations: LBP
• Disorders of breathing and continence have a stronger association with back pain than obesity and physical activity.83
• Preparatory spinal control via trunk muscle recruitment is altered in subjects with chronic LBP.84‐85
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TATD Breath Relevance to Patient Populations: Head, Neck, Jaw, and Shoulder Pain
• Patients with neck pain commonly have faulty breathing patterns.86
• Forward head posture to facilitate breathing is associated with TMJ, neck pain, and head aches,87 and shoulder pain/ rotator cuff dysfunction.88
TATD Breath Relevance
to Patient Populations: Women’s Health
• Pelvic floor dysfunction shows correlations with other disorders.
• Idiopathic scoliosis94
• Sciatic‐like symptoms95
• Pelvic/ abdominal pain, irritative voiding, chronic constipation, and LBP radiating to thighs or groin can be indicative of a pelvic floor that won’t relax96
• Core instability is a risk factor for LE injury in female athletes.97
Resources for Practitioner Development
• www.professionalyogatherapy.org Links to PYT courses including online and onsite training.
• http://www.masserypt.com/publications.html List of publications on breathing and posture by Mary Massery, PT, DPT, DSc, some with full text.
• http://lermagazine.com/article/biomechanical‐precepts‐define‐21st‐
century‐yoga Online article in LE Review; makes case for biomechanical standardization of postures.
• Integrative PT’s:
The Integrated Model of Joint Function (Diane Lee, PT) http://dianelee.ca/
Matthew Taylor PT, PhD http://www.matthewjtaylor.com/
Ginger Garner, PT, ATC www.gingergarner.com
Liz Gillem Duncanson, MPT, ATC, CSCS , PYT http://www.bodytemplept.com/
Christine Roper, MSPT, PYT and Lynne Ray CSCS, PYT http://www.professionalyogatherapyapproach.com/
• Julie Wiebe, PT www.juliewiebept.com
• Stefanie Foster, PT, FAAOMPT www.asanaintelligence.com
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TATD Breath Relevance to Patient Populations: Balance Dysfunction
• Balance deficits are correlated with trunk cylinder/ piston function.
• TA thickness89 and recruitment90
is correlated with balance performance.
• Lumbar stabilization training improves balance performance.91,92
• Balance deficits are more prevalent in women with stress urinary incontinence, or continent women with a full bladder.93
PYT Breathing Summary16
• Abdominal breath: • Teaches engagement of diaphragm.
• Used for relaxation.
• Teach 1st to beginners. • TATD breath: • Creates a state of alertness, focus, and greater use of diaphragm. • Allows for optimal respiration and trunk stabilization during yoga postures and ADL’s.
• Should be perfected before continuing into posture progressions.
Resources for Practitioner Development
• Link to 219 articles in PTJ on WHO’s ICF Model http://ptjournal.apta.org/search?fulltext=icf&sub
mit=yes&x=0&y=0
• Link to 99 articles in PTJ on biosychosocial factors or approach http://ptjournal.apta.org/search?fulltext=biopsych
osocial&submit=yes&x=16&y=8
• 75 Conditions Yoga Benefits (Dr. Timothy McCall) http://www.drmccall.com/uploads/2/2/6/5/22658
464/yam‐‐75conditions.pdf
• Yoga For Chronic Pain‐ Latest Research and Developments radio podcast‐ with Neil Pearson, PT
http://www.blogtalkradio.com/painwavesradiobyp
ainbc/2014/03/14/yoga‐for‐chronic‐pain‐‐latest‐
research‐and‐developments‐with‐neil‐pearson‐
pt#ixzz36cXtYaIY
• Motivational Interviewing (Behavioral Change) resources
• http://www.motivationalinterview.org/
• http://www.amazon.com/Motivational‐Interviewing‐
Health‐Care‐
Applications/dp/1593856121/ref=sr_1_4?s=books&ie=
UTF8&qid=1404585898&sr=1‐
4&keywords=motivational+interviewing
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Resources for Patient Care
• http://www.gingergarner.com/tag/breathing
/ Free resources, EB handouts, and videos on PYT yogic breathing methods
• http://www.positivityresonance.com/
Multiple, short free meditations for download
• http://www.gingergarner.com/category/garn
er‐yoga‐podcast/ Free recordings of meditation classes taught by Ginger.
• Yoga DVD (Ancient Yoga, New You) • Wholesale Pricing –
[email protected]
• On Amazon.com http://www.amazon.com/Ancient‐Therapy‐
Relief‐Ginger‐Garner/dp/B000H78Z6M
Resources for Patient Care
• Psycho‐emotional health‐
“Contentment Quotient” http://www.gingergarner.com/tag/
happiness‐inventory/
• Non‐violent Communication
• http://www.amazon.com/What‐Say‐
Matters‐Practicing‐
Communication/dp/1930485247/ref=
sr_1_10?ie=UTF8&qid=1404590360&s
r=8‐
10&keywords=non+violent+communic
ation (Easy read on practicing NVC in relationships)
• http://www.cnvc.org/learn/nvc‐
foundations (Center for Non‐violent Communication)
• http://www.nonviolentcommunicatio
n.com/
Nutrition/ Anti‐Inflammatory Lifestyle Resources
Links:
• PBS NOVA Special on Epigenetics (How diet and lifestyle change our gene expression) http://www.pbs.org/wgbh/nova/body/epigenetics.html
• WebMD: Anti‐Inflammatory Diet http://www.webmd.com/food‐
recipes/features/anti‐inflammatory‐diet‐road‐to‐good‐health
• Garner G. Secrets to Longevity: The Anti‐Inflammatory Lifestyle. Yang‐Sheng Magazine《養生》(Vol 2, No. 6) December 2012. http://www.gingergarner.com/2011/02/08/secrets‐of‐longevity‐
living‐a‐longer‐fuller‐life/
• Choices for Longevity and Immunity, Avoiding Chronic Disease, Clean Food: http://www.gingergarner.com/informed‐healthy‐living‐
links/
• Includes handouts from the University of Arizona Center for Integrative Medicine, MD Anderson’s (Anti)Cancer Center, and University of Wisconsin’s Department of Medicine and Public Health 8