key points unit 4: the spine -...
TRANSCRIPT
© The Breathe Trust and Embodied Asana LLC | Unless Otherwise Noted Illustrations by Sharon Ellis or Lydia Mann Unit 4-1
UNIT 4: The Spine
UNIT 4: The Spine
4.1 PHYSICAL EXPLORATION: THE CURVES OF THE SPINE
CERVICAL
THORACIC
LUMBAR
tasya saptadha prantabhumih prajna— Yoga Sutras of Patanjali, 2.27
“The attainment of clarity
is a gradual process.”
—as translated by T.K.V. Desikachar
KEY POINTSUse this space to reflect on your experiences of the curves of your spine, where the weight travels in your
spine, or anything else that came up for you during the
movement exploration. Be prepared to discuss in class
© The Breathe Trust and Embodied Asana LLC | Unless Otherwise Noted Illustrations by Sharon Ellis or Lydia Mann Unit 4-2
UNIT 4: The Spine
4.2 A BRIEF HISTORY OF THE SPINE
Here are some images that help highlight Leslie’s “brief history of the spine.”
SINGLE-CELLED ORGANISM >> Takes in nutrients and releases
by-products.
PSEUDOPOD >>
Developed the ability to locomote via
movement.
BACTERIUM WITH FLAGELLA >> Developed specialized structures for
locomotion.
PLATYHELMINTH >>
Developed a simple nervous system to
organize and coordinate movement and
other activities.
PRIMITIVE FISH >> Developed a bony, articulated spine
to protect the nervous system. The
articulated nature of the spine allows for
movement.
SALAMANDER >>
Developed limbs to move on land. Limbs
and spine remain low to the ground and
undulation remains lateral, similar to the
fish.fish.
LIZARD >>
Developed a primary curve in the spine,
resembling the shape of a Roman arch.
This shape is stronger than a flat spine.
CAT >>
Develops a secondary curve in the cervical
spine, in addition to the primary curve
present earlier, increasing mobility and
raising senses higher off ground.
PRAIRIE DOG >> Developed ability to sit on hind legs to
raise senses still higher. When supported
on hind legs, its forelimbs are freed to be
used to manipulate its environment.
PRIMATE >>
Not a true biped. Does not exhibit the 2nd secondary curve, which is unique
to spines in humans.
HUMANS
Developed the unique trait of having a lumbar curve, which brings our center of gravity
over our legs. Our upper limbs are free to be used to manipulate the environment.
© The Breathe Trust and Embodied Asana LLC | Unless Otherwise Noted Illustrations by Sharon Ellis or Lydia Mann Unit 4-3
UNIT 4: The Spine
“The more critical the central nervous
system becomes to a living organism,
the more important it is that it evolves
to develop a protective structure. In
the case of the human spine: you need
sthira, protection, the boundary to
protect it from damage, as well as
sukha, the ability to change shape,
move and respond to your environment.
The solution nature came up with was
an articulated series of bony structures
stacked one atop the other that created
a space within them. What an elegant
solution to the contradictory demand
for sthira and sukha!”
—Leslie Kaminoff
KEY POINTSBe prepared to discuss in class
© The Breathe Trust and Embodied Asana LLC | Unless Otherwise Noted Illustrations by Sharon Ellis or Lydia Mann Unit 4-4
UNIT 4: The Spine
4.3 GEEK OUT: VERTEBRAE
Please use the space below to draw the two views of a vertebra along with Amy.
Then, use the bolded terms to label your drawings.
ELEMENTS OF A VERTEBRA, BIRDS-EYE VIEW:
body of the vertebra where most of the weight travels, made of
spongy bone
articular arch creates a space called the “vertebral foramen,”
through which the spinal cord travels
pedicles (there are 2 in this view)
the “feet” of the articular arch
transverse processes (there are 2 in this view)
spinous process / posterior process both names for the bumpy part of the spine
that we feel when we run our fingers down someone’s back
spinal cord bundle of nerves that carries information to
and from the brain
ELEMENTS OF A VERTEBRA, FROM THE SIDE:
body of the vertebra
superior articular process articulates with the inferior articular process
of the vertebra above
inferior articular process articulates with the superior articular process
of the vertebra below
© The Breathe Trust and Embodied Asana LLC | Unless Otherwise Noted Illustrations by Sharon Ellis or Lydia Mann Unit 4-5
UNIT 4: The Spine
4.4 GEEK OUT: DISCS
Please use the space below to draw the two views of an intervertebral disc along with Amy.
Then, use the bolded terms to label your drawings.
ELEMENTS OF AN INTERVERTEBRAL DISC:BIRDS-EYE VIEW FROM THE SIDE
Nucleus pulposus inner jelly-like substance, receives and distributes the force that comes into the disc
outwards in every direction
Annulus Fibrosus outer ring of fibrous material (fibrocartilaginous connective tissue) arranged in diagonal spiraling rings; contains and resists force from within from every direction
© The Breathe Trust and Embodied Asana LLC | Unless Otherwise Noted Illustrations by Sharon Ellis or Lydia Mann Unit 4-6
UNIT 4: The Spine
KEY POINTSBe prepared to discuss in class
◻Describe the two regions of a single vertebra, and how they work together, in terms of sthira and sukha.
(Additional reference chart on page 22 of this document,
showing the varying shapes of vertebrae in specific regions of the spine.)
◻Describe the two parts of an intervertebral disc that we explored here, and how they work together, in terms of sthira and sukha.
© The Breathe Trust and Embodied Asana LLC | Unless Otherwise Noted Illustrations by Sharon Ellis or Lydia Mann Unit 4-7
UNIT 4: The Spine
4.5 GEEK OUT: LIGAMENTS
Four ligaments that run the length of the spine:
KEY POINTSBe prepared to discuss in class
◻Shade in the four longitudinal ligaments to correspond with Amy’s colored tape in the video:
◻Our four lengthwise spinal ligaments play both a sthira and a sukha role in the spine. In your own words, describe one way in which they support each quality.
▶ Anterior Longitudinal Ligament (purple in video)
▶ Posterior Longitudinal Ligament (blue in video)
▶ Ligamentum Flavum (yellow in video)
▶ Supraspinous Ligament (red in video)
In addition to these lengthwise ligaments there are shorter intervertebral ligaments that connect processes of
one vertebrae to the next, included in the diagram below:
interspinous ligaments: connect adjacent spinous processes
intertransverse ligaments connect adjacent transverse processes
© The Breathe Trust and Embodied Asana LLC | Unless Otherwise Noted Illustrations by Sharon Ellis or Lydia Mann Unit 4-8
UNIT 4: The Spine
4.6 PHYSICAL EXPLORATION: PRIMARY AND SECONDARY CURVES
Leslie will lead us through the following
movement exploration:
“(…in savasana) put your awareness
into the shape of the curve of the
back of the heel. Notice that it curves
towards the surface of the floor. If you move your awareness upwards
from that shape, you’ll notice that
there’s a curve that goes in the
opposite direction.
The Achilles Tendon region curves
away from the floor. We’re going to keep paying attention to this
alternating series of undulating
curves as we travel up through the
body. These shapes are going to
be a reflection of the primary and secondary curves of the spine.”
EXPERIENTIAL NOTESUse this space to record any impressions from the
movement exploration.
◻Which regions of your spine exhibit a “primary curve”? Which regions of your spine exhibit a “secondary curve”?
◻Did this exploration of primary and secondary curves in other parts of your body influence your experience of the curves of your spine? Please explain.
© The Breathe Trust and Embodied Asana LLC | Unless Otherwise Noted Illustrations by Sharon Ellis or Lydia Mann Unit 4-9
UNIT 4: The Spine
4.7 STHIRA AND SUKHA OF THE SPINE
ANTERIOR COLUMN (FRONT)
Primary responsibilities:
▶ weight-bearing
▶ weight-supporting
▶ weight-redistributing
(sukha quality within the sthira)
▶ resists compression
More sthira:
▶ bodies of vertebrae +
discs +
ligaments
POSTERIOR COLUMN (BACK)
Primary responsibilities:
▶ redistributing forces created in movement
▶ providing space for the spinal cord
▶ protecting spinal cord
(sthira quality within the sukha)
▶ resists tension
More sukha:
▶ processes of vertebrae +
synovial joints +
ligaments
“When you move your spinal column in any direction out of
neutral, you are generating forces within the discs and ligaments
that want to return it to where it came from. We refer to this as
the ‘intrinsic equilibrium of the spinal column.’”
—Leslie Kaminoff
© The Breathe Trust and Embodied Asana LLC | Unless Otherwise Noted Illustrations by Sharon Ellis or Lydia Mann Unit 4-10
UNIT 4: The Spine
KEY POINTSBe prepared to discuss in class..
◻Describe the anterior and posterior columns of the spine in terms of sthira and sukha.
◻Describe how the vertebrae and discs work together in the spine in terms of sthira and sukha.
◻Leslie introduces the idea of the “intrinsic equilibrium of the spinal column” by offering the idea that the spine is a “neutral-seeking structure” on a mechanical level. In your own words, please explain why this is true.
EXPERIENTIAL NOTESUse this space to record any impressions from the movement exploration
◻ROLL-DOWN, ROLL-UP: Please reflect on the movement experience led by Leslie. You don’t need to answer all these questions, rather use them to get your creative juices flowing:
◾ What did you notice when you watched Leslie lead the student through this exploration?
◾ What about when you did it, yourself? What was easy? What was hard?
◾ What felt like it was moving a lot? What felt like it didn’t want to move as much?
◾ Did you have a different experience from other “roll-down, roll-up” experiences because you were
focusing on the back, and then the front of the spine?
© The Breathe Trust and Embodied Asana LLC | Unless Otherwise Noted Illustrations by Sharon Ellis or Lydia Mann Unit 4-11
UNIT 4: The Spine
4.8 EMBRYOLOGY: THE WHOLENESS OF THE SPINE
“The idea that we are many separate pieces
that are somehow put together with a little
cushion in between does not reflect the way that our spine developed. The spine had, as
its first experience, a wholeness to it that then, with the development of the bony
support, segmented itself into the vertebra.”
—Amy Matthews
KEY POINTSBe prepared to discuss in class.
◻Does the idea of the “wholeness” of the spine change or reinforce ideas you had?
◻Does the information in this module change how you experience your spine?
© The Breathe Trust and Embodied Asana LLC | Unless Otherwise Noted Illustrations by Sharon Ellis or Lydia Mann Unit 4-12
UNIT 4: The Spine
4.9 SPINAL MOVEMENTS AND RANGE OF MOTION
We’ll focus on 5 movements of the spine:
▶ Flexion
▶ Extension
▶ Lateral Flexion
▶ Axial Rotation
▶ Axial Extension
4.9 SPINAL MOVEMENTS AND RANGE OF MOTION
We’ll focus on 5 movements of the spine:
EXPERIENTIAL NOTESWhat was your experience in the movement exploration? Please use this space to record any impressions.
◻You may use the questions below to get your creative juices flowing, but you don’t need to answer them all:
◾ What did you notice about your spine in movement? Asymmetries? Places that move easily? Places of congestion?
◾ What are your preferences in these movements? Which spinal movements were more or less comfortable, enjoyable, familiar for you in this exploration?
◾ What about your experience of lateral flexion (side-bending). Did a slight twisting between your vertebrae help you to create that shape?
◾ Did your experience change when Leslie offered the idea of imagining the 3-dimensionality of your movements?
◾ What about the idea of finding “a little movement in a lot of places”?
◾ How was your experience of spinal flexion? Is this a shape you normally avoid, or one that you explore as much as spinal extension? How did it feel in this instance?
◾ What was your experience of a neutral spine after spending time exploring all the other movement possibilities?
© The Breathe Trust and Embodied Asana LLC | Unless Otherwise Noted Illustrations by Sharon Ellis or Lydia Mann Unit 4-13
UNIT 4: The Spine
Flexion = shape of the primary curve
▶ increase of primary curves, decrease of
secondary curves)
▶ Anterior part of spine is more convex, posterior
part of spine is more concave
▶ ex: shape of “Cat”
Extension = shape of the secondary curve
▶ increase in secondary curves, decrease in
primary curves
▶ Anterior part of spine is more convex, posterior
part of spine is more concave
▶ ex: shape of “Cow”
Axial Rotation: Often called “spinal twisting”; articulation between vertebrae that results in a twist, with one end of the
articulating vertebrae moving in one direction and the other end in the other direction
© The Breathe Trust and Embodied Asana LLC | Unless Otherwise Noted Illustrations by Sharon Ellis or Lydia Mann Unit 4-14
UNIT 4: The Spine
Lateral Flexion: Often called “side-bending”; articulation between vertebrae that results in some or all of the spine moving
to one side and creating the shape of a ‘c-curve’
In order to keep side bending in the side-to-side plane, a combination of lateral flexion and axial rotation might be involved to accommodate the three-dimensional shapes of the facet joints along the spine.
Axial Extension: decrease (or flattening) of primary and secondary curves; cues such as “flat-back,” “stand up straight,” and “lengthen your spine”* are calling for axial extension
*Note that axial extension doesn’t actually lengthen the spine. It moves the head and tail away from each as
the curves flatten, but the length doesn’t change. Examples of axial extension in asana:
© The Breathe Trust and Embodied Asana LLC | Unless Otherwise Noted Illustrations by Sharon Ellis or Lydia Mann Unit 4-15
UNIT 4: The Spine
“Axial extension is a flattening of the primary and secondary curves. You lose some of the spring-like shock absorbing ability of the spine when you are in axial extension. Neutral spine means you’re not doing flexion, extension, axial rotation, lateral flexion or axial extension. It means that you’re just maintaining your primary and secondary curves in a neutral way.” —Leslie Kaminoff
4.10 BACK PAIN: WHAT TO WATCH FOR
“The question of pain is about both the sensation and what gives rise to that sensation – and about how quickly we begin to try to manage the experience and to figure out what we can do to prevent it. With pain we get reactions to pain, and the anticipation of pain, and ways to shut down around avoiding pain. In engaging with the wholeness of a person we can find other parts of their body where they can engage with a spectrum of movements, and find what actually brings them comfort.” —Amy Matthews
Findings from studies cited and larger images may be found in the charts in page 22 of this document.
KEY POINTSBe prepared to discuss in class.
◻Amy and Leslie challenged some common assumptions about back pain and the diagnoses people receive based on imaging techniques (MRI, etc.)
◾ Did they offer any ideas that support your experience or observation? Did they offer any ideas that seem to contradict your experience or observation?
◻What about ideas offered here about the role of the teacher…
◾ Have you thought about how you might handle students who come to you with pain and other conditions?
◾ What can you offer? What is beyond how you see your role as a teacher?
© The Breathe Trust and Embodied Asana LLC | Unless Otherwise Noted Illustrations by Sharon Ellis or Lydia Mann Unit 4-16
UNIT 4: The Spine
4.11 WHAT HAPPENS WHEN YOU TAKE THE CURVES OUT?
“Play with flattening out your curves and letting them return, and see
as you do this where you feel effort
accumulating, where you feel a familiar
experience, where you feel ease.” —Amy Matthews
EXPLORATION NOTESReflect on your experience during the movement exploration of taking the curves out of your spine, and then allowing them to return.
Be prepared to discuss in class.
© The Breathe Trust and Embodied Asana LLC | Unless Otherwise Noted Illustrations by Sharon Ellis or Lydia Mann Unit 4-17
UNIT 4: The Spine
Anatomy in Action: ◻Please describe what you see in these images framed by the concept of “balanced joint space” and “a little bit of movement in a lot of places.” When might the position on the left be appropriate and under what circumstances might it be problematic? EXTRA CREDIT: When might the position on the right be appropriate and under what circumstances might it be problematic?
◻“Stand up straight” is a direction that’s commonly given in yoga and other circumstances, and with positive intentions. Does what you learned in this unit make you question that verbiage? Or the results that might emerge? What might be an alternative instruction that doesn’t call for axial extension?
◻When you start teaching, you’ll probably have students who come to you and say, “I have back pain. What poses should I avoid?” What kind of questions might you ask them? What might you recommend?
◻Did any of the information that Amy and Leslie presented in this unit surprise you?
◻Did you learn anything surprising about your own spine during the explorations?
© The Breathe Trust and Embodied Asana LLC | Unless Otherwise Noted Illustrations by Sharon Ellis or Lydia Mann Unit 4-18
UNIT 4: The Spine
Unit 4: Terms and Definitionsaxial extension:
a flattening, or diminishing, of the curves of the spine so that the head and tail move away from
each other
axial rotation: also called spinal twisting; articulation between
the vertebrae that results in a twist, where one
end of the spine rotates one way and the other end
rotates the other way
cervical spine: the seven top vertebrae in the neck; has a
secondary curve
coccyx: the tail; made up of several fused vertebrae below
the sacrum; not weight-bearing
intervertebral disc: fibrocartilaginous structure between the bodies of each pair of vertebrae; plays the role of helping to
absorb weight and transmit movement through the
curves of the spine; includes an inner and an outer
part:
◼ nucleus pulposus inner part; fluid, gel-like structure at center of disc; receives and distributes force outward in
every direction; absorbs some force and helps
pass force/weight on to the next vertebra
◼ annulus fibrosus outer ring of fibrous material made of fibrocartilaginous connective tissue; contains and resists force from the nucleus pulposus
within; strongly connected to the vertebral
body above and below; arranged in oblique
spiraling layers which both allow some
movement in various directions and also
resist too much movement in
any direction
lateral flexion: also called side-bending; articulation between the
vertebrae that results in moving to one side or the
other in a ‘c-curve’
lumbar spine: the five vertebrae in the lower back; has a secondary curve
neutral extension: also called neutral spine; a state where the curves
of the spine are present and balancing each other,
where each curve of the spine is neither being
flattened nor deepened, where the pathway of weight (in theory) can travel through the bodies of
the vertebrae with the least amount of muscular
effort (depending on one’s relationship to gravity)
© The Breathe Trust and Embodied Asana LLC | Unless Otherwise Noted Illustrations by Sharon Ellis or Lydia Mann Unit 4-19
UNIT 4: The Spine
spinal ligaments: ligaments running between the vertebrae
and lengthwise along the spine connecting
help support the wholeness and continuity
of the spine
◼ anterior longitudinal ligament: connects the fronts of the vertebral bodies
and discs from the basilar portion of the
occiput to the front of the coccyx; envelops
the front of the spine; “front of the front”
◼ posterior longitudinal ligament: connects the backs of the vertebral bodies
and discs; inside the articular arch in front
of the spinal cord; “back of the front”
◼ ligamentum flavum: connects along the inside of the articular
arch behind the spinal cord; named
“flavum” because of its yellow color; “front of the back”
◼ supraspinous ligament: connects along the back of spine,
connecting the tips of the spinous
processes together from the skull to the
tail; “back of the back”
◼ interspinous ligaments: connect the spaces between adjacent
spinous processes
◼ intertransverse ligaments: connect the spaces between adjacent
transverse processes
vertebra: the landmarks of a vertebra include:
◼ body: in the front; generally round shape;
composed of mostly bone; where of the
weight travels through.
◼ articular arch: in the back; provides a protective casing
around the spinal cord; includes synovial
facet joints to facilitate spinal articulation
◼ vertebral foramen: space within the articular arch of each
vertebra that creates a lengthwise tunnel
within which the spinal cord travels
◼ intervertebral foramen: space between the articular arches of
adjacent vertebrae that creates an opening
for spinal nerves to exit and enter
◼ pedicle: the base or “feet” of the articular arch
where it joins the body
◼ transverse processes: projections to each side of the articular
arch; provide attachment points for
muscles and ligaments
© The Breathe Trust and Embodied Asana LLC | Unless Otherwise Noted Illustrations by Sharon Ellis or Lydia Mann Unit 4-20
UNIT 4: The Spine
◼ spinous process: also called posterior process; projection
on the back of the articular arch; what we
feel as bumps along our spine in the back;
provides attachment point for muscles
and ligaments
◼ articular processes: each vertebra has two superior and two
inferior articular processes; they are the
joint surfaces that participate in synovial
facet joints with neighboring vertebrae;
covered in hyaline cartilage
◼ facet joints: also called zygapophyseal joints; synovial
joints between adjacent articular processes
“As yoga educators, our
primary goal is not to fix what has gone wrong, but to focus
on what’s still going right.”
—Leslie Kaminoff
thoracic spine: the twelve vertebrae with ribs; has a
primary curve
sacrum: the lowest weight-bearing portion of the spine;
made up of several more or less fused vertebrae;
has a primary curve
spinal extension: a spinal action where the back surfaces of the
spine move towards each other; an increase in
secondary curves and a decrease in primary
curves; not necessarily the same
as back-bending
spinal flexion: a spinal action where the front surfaces
of the spine move towards each other; an
increase in primary curves and a decrease in
secondary curves; not necessarily the same as
forward-bending
Suggested Reading in Yoga Anatomy
▶ Chapter 2
▶ Chapter 3, pp 49-50
ADDITIONAL RESOURCES (http://fundamentals.yogaanatomy.net/glossary/):
▶ Video Glossary – Muscles of the Spine
© The Breathe Trust and Embodied Asana LLC | Unless Otherwise Noted Illustrations by Sharon Ellis or Lydia Mann Unit 4-21
Reference Images
UNIT 4: THE SPINE
Form follows function at every level of the spine:
View of vertebrae from the top
© The Breathe Trust and Embodied Asana LLC | Unless Otherwise Noted Illustrations by Sharon Ellis or Lydia Mann Unit 4-22
Reference Images
UNIT 4: THE SPINE
Disc Injury Diagram and Rates of False Positive MRIsTHE BOTTOM LINE:
If we gathered a group of middle-age folks (45 average age) who have NEVER
had back pain before and performed MRI scans on them all, here’s what we
would find:
FALSE POSITIVE RATES FOR LUMBAR MRI
INVESTIGATION:
DISC PATHOLOGY:
Root Deviation or Compression
Bulge Protrusion Extrusion Combined: bulge, protrusion, extrusion, sequestration
Borden et al. – 20% – NA –
Jensen et al. 52% 27% 1% 84% –
Boos et al.* – – 13% – 4%
Greenberg et al. 39% 18% 57% –
Weishaupt et al. 24% 40% 18% – 4%
Wood et al (11)* 53% 37% – 63% –
AVERAGES 38% 29% 9.5% 60.5% 4%
* Because these investigations used a ‘high risk’ asymptomatic group of people, i.e., people whose occupation required frequent heavy lifting, twisting, and bending; frequent exposure to vibration; and sedentary occupations, I have EXCLUDED the results from the averaging above.
COURTESY OF CHIROGEEK.COM © 2002-2006 DR. DOUGLAS M. GILLARD DC
▶ 38% would have disc bulges
▶ 29% disc protrusions (aka: contained herniations)
▶ 10% disc extrusions (aka: non-contained herniations)
▶ 4% of nerve root compression by the disc herniation
▶ 0% disc sequestrations (aka: free fragments, which hurt
IN SUMMARY:
60% of asymptomatic middle-aged people would have findings of disc bulge or worse (protrusion, extrusion) on MRI.