faq | yogabook

Not such a simple but exciting question. Basically, running is a highly complex process and there are many parameters that can deviate from the ideal.

To start with an example: in his 9.58 second 100 m world record run, you can clearly see in slow motion that Usein Bolt’s legs are anything but moving in line with his axis, especially at the beginning. On the contrary, he pulls his knees inwards as he moves his leg forwards, which corresponds to a combination of adduction and endorotation of the thigh in the hip joint. Until the foot touches down, however, the thigh rotates out a little and abducts a little so that the foot actually touches down in a position that corresponds to a slightly rotated and slightly abducted leg. This allows him to use the gluteus maximus, probably the most important muscle in the entire race, as the main force extender of the hip joint and the muscle largely responsible for propulsion, in a slightly larger ROM than with a completely axial movement.

Particularly in the acceleration phase, this muscle must develop an immense amount of power (work per time) to achieve the desired increase in speed. In addition, this procedure is beneficial in order to keep the changes in the center of gravity in the transverse plane as favorable as possible for maximum torque development in the hip joints. He is not the only one with this axial deviation. At least part of this very noticeable axial deviation can be attributed to his great body length, but many principles remain the same even for smaller sprinters. As the race progresses, the movement of the legs straightens out. Anything else would hardly be possible at a speed of up to 12.19 m / s and a stride frequency of 270 / min. In addition, the hip joints no longer need to apply the immense torque required for acceleration at the start, but „only“ that required to maintain speed.

This should make it clear that, on the one hand, axial guidance of the legs does not have to be optimal in all situations, and on the other hand, it does not happen regularly at world-class level. After this brief digression, let’s return to the average recreational athlete, who wants to use his musculoskeletal system in a healthy way with as few side effects as possible, while practicing one of the most beautiful forms of mental hygiene and one of the best forms of cardiopulmonary training with preventive effects against many important serious illnesses. The recreational athlete will strive to move the legs as axially correct as possible when cross-country skiing, and there are good reasons for this.

Regular exorotation of the legs before the foot touches down, for example, leads to hypersupination during the rolling phase, which is anything but beneficial for various joints and also increases the risk of supination trauma. A twisted leg, for example, would lead to hyperpronation, which also has at least as bad consequences, especially as the range of motion in the direction of pronation is much smaller in humans than in the direction of supination. In the same way, if the leg is aligned with the thigh and lower leg, a foot that is too supinated or too pronated is anything but uncritical; hyperpronation is a known consequence of tibialis posterior dysfunction and is itself a risk factor for many disorders. Hyperpronation is often a euphemism for or a disguise for a fallen arches foot, which in turn predisposes to other disorders such as splayfoot, metatarsalgia, Morton’s neuroma and hallux valgus.

However, if the lower leg is exorotated in the knee joint, the lateralized attachment of the patellar ligament causes the patella to be rotated in the frontal plane, pulled caudally to the lateral and laterally to the dorsal, which disrupts its physiological guidance in several ways and usually results in PFPS (chondropathia patellae). The constant rotation of the lower leg in both directions also increases the friction of the iliotibial tract on the lateral femoral condyle and predisposes to runner’s knee.

When searching for causes, the only musculature that rotates the lower leg in the knee joint is the hamstrings (apart from the popliteus as the elevator of the final rotation). The biceps femoris, which covers the outside of the knee joint, is the only exorotator in the knee joint; the two semimembranosus and semitendinosus muscles on the inside, together with the gracilis, which is not part of the hamstrings, cause the final rotation of the lower leg. Just as the supinator of the ankle, the posterior tibialis, and its antagonists, the fibularis brevis and fibularis longus, form a restraining system for the foot, which holds it neutral, pronated or supinated depending on the pull, a higher tension of the inner muscles of the ischiocrural group pulls the lower leg into endorotation, while a higher tension of the biceps femoris pulls it into exorotation. Only balance keeps the lower leg neutral.

In order to restore a disturbed balance of the muscles, both sides, medial and lateral, can be addressed by increasing or decreasing the tone. There are therefore a number of intervention options. If there is a relative overtension of the biceps femoris, this can be corrected primarily by

3. hip opening with less bent front leg
hip opener at the edge of the mat with less bent knee joints

are reduced. In postures that stretch the hamstrings intensively, it can often be observed that one class of postures stretches its inner muscles more intensively than the outer biceps femoris and the other class stretches the biceps femoris more intensively than the inner muscles. These two classes can be identified by the abduction of the leg in which the hamstrings is stretched:

If it is in further exorotated abduction as in trikonasana, ardha chandrasanavasisthasana and similar postures, the inner hamstrings is stretched more intensively
with abduction-free wide flexion of the hip joint, the biceps femoris is stretched more intensively, for example in parivrtta trikonasana, parivrtta ardha chandrasana, 3rd warrior pose and parsvottanasana

This observation can also be used for intervention in two ways: on the one hand, as expected, to stretch and reduce tone on the hypertonic side. On the other hand, the weaker, less toned side can also be strengthened with the help of this distinction, but the corresponding postures must be modified. If the biceps femoris in particular is to be strengthened, only the relevant postures are practiced in a reduced ROM and, if possible, with external weight, e.g. the parivrtta trikonasana with a small dumbbell in the contralateral hand (to the front leg) and reduced ROM from a vertical to 45° flexed hip joint. The angle is of course relative: a very flexible person can flex up to a slightly larger angle, while a less flexible person may not reach 45° at all.

In practice, exorotation of the lower leg tends to occur together with endorotation of the thigh in the hip joint, as the center of gravity of the legs is less disturbed or need not be disturbed at all. An exorotation of the thigh in the hip joint that goes beyond the line of the foot is not to be expected. On the one hand, the resulting valgus stress in the knee joint would cause knee pain after a short time. On the other hand, an axis-right exorotated leg would reduce the possible use of both the hip flexors and the gluteus maximus, so that this method would be „intuitively“ rejected.

The opposite of what is described above, i.e. exorotation of the thigh with endorotation of the lower leg in the knee joint, should also rarely occur in practice. On the one hand, exorotation of the thigh again reduces the force exerted by the gluteus maximus; on the other hand, the endorotation capacityin the flexed knee joint is significantly lower than the exorotation capacity, which would be more likely to lead to reaching the limit and the pathogenic effects and pain that occur there.

Cramp in the deltoid muscle

Question:

I often have a cramping and burning sensation in my shoulder in some positions, e.g. the head down dog position, the handstand and the raised back extension.

Answer:

This is due to the way these muscles work in these positions. They perform in short sarcomere lengths, i.e. in the area of approximately maximum concentric contraction (in terms of length, not strength), i.e. exactly at the limit of their capabilities. Here they no longer develop any strength for further contraction but go into active insufficiency because the actin and myosin filaments have already fully intertwined. Almost all muscles of the musculoskeletal system have a tendency to spasm. This applies most to biarticular and polyarticular muscles. Even if the deltoid is not one of them, it also tends to show this effect. The better the training condition of the muscles, i.e. their flexibility, fitness and strength with the lowest possible resting tone, the more this phenomenon disappears, although it is not completely eliminated as a possibility. Here we are talking about the most important shoulder muscle, the deltoid, and its tendency to spasm in overhead movements, which are characteristic of postures such as downface dog, handstand and the like, or to take on an uncomfortably high tone through frequent practice of these postures, even to the point of becoming irritable, making it painful to perform these movements. This state of irritation is not atypical for ambitious beginners and slightly advanced performers of asana, which is why it is also observed in participants of yoga teacher training courses if no precautions are taken against it.

As the overhead position of the arms can be assumed in different ways, which varies depending on the posture to be assumed, a distinction must be made here: If a head-down dog position is adopted from the head-up dog position, the degree of frontal abduction (also known as anteversion) is increased to the limit of mobility. The same applies to the bridge, except that more work has to be done against gravity, i.e. a significant amount of potential energy has to be added to the body (also from the strength of the shoulders). In contrast, an urdhva hastasana from tadasana is usually performed via lateral abduction (or just abduction, depending on the literature).

In both cases, the upper arms are maximally exorotated (rotated out) in the shoulder joints at all times, so there is no difference in this respect. The achievable limit value is essentially the same. „Essentially“ because the postures behave discontinuously in the mathematical sense, i.e. the limit value does not have to be exactly the same from different sides. This also explains why the tendency to spasm does not have to be the same if you take urdhva hastasana via the frontal abduction instead of the usual lateral abduction. In the case of lateral abduction, there is a further difference: up to around 90° abduction, the arm is lifted primarily by the supraspinatus after the shoulder joint has been constructed before the deltoid can actually develop its strength. Below 90°, the deltoid contracts but hardly transmits any force, so that powerful muscular work in the sense of visible movements of the body both eccentrically and concentrically is only limited there, which favors the tendency to increase tone.

Irrespective of which abduction(lateral and frontal) was used to assume the overhead posture, there is a need for continuous intensive contraction in the medial and dorsal direction in the case of restricted mobility of the shoulders in order to minimize the incorrect angle compared to the target posture. The deflection moments caused by the shortened adductors of the shoulder joint must therefore be continuously neutralized by the deltoid. As a reminder: the shoulder joint has three dimensions of movement:

Endorotation and exorotation
Lateral abduction and adduction
frontal abduction and adduction and, in continuation of the movement, also retroversion

The evasive movements associated with mobility restrictions basically affect all three dimensions, but their specific manifestation depends on where and how intensively they are counteracted. At this point, it is important to dispel a common misconception: it is not only the triceps that extend the arms in the head-down dog position and other postures with complete frontal abduction and hands fixed (usually on the floor), but the deltoid muscle also contributes with its pars clavicularis and its medial movement of the arm, which makes it particularly susceptible to spasms in a degree of contraction close to active insufficiency. The described state of irritation manifests itself primarily in the area of the origin of the deltoid pars clavicularis at the collarbone and the pars acromialis at the acromion (shoulder level). It usually recurs quite quickly with every exercise, can be reduced by prolonged abstinence from exercise, but quickly returns to its original level, very similar to tibial plateau syndrome or irritation of the origin of the hamstrings (Proximal Hamstring Tendinopathy, PHT).

So what can you do to get to grips with this? Basically, increased muscular „resilience“ is an advantage; strengthening training of various kinds, preferably not vigorous, can help. However, it should not be done predominantly in an overhead position. On the contrary, the entire angle range far below 180° abduction should be practiced preferably, the smaller the abduction angle and the more powerful the work, the more helpful. For our teaching and training practice this means, for example, that the transition from the dog position head down to the dog position head up and back in its most intensive form is a fixed, regular part of the practice and that the transition back to the dog position head down should be practiced mainly using shoulder strength and not, for example, using the strength of the hip flexors to save energy. In the same way, the transition to the head-up dog position should be achieved by using the hip extensors to counteract the maximum possible work of the shoulder muscles, which push the body backwards.

Taken together, these two transitions are likely to have a unique position in that they

offer any potential for strengthening, as the hip extensors will always be stronger than any muscle of the upper limb
Exercise concentric and eccentric contraction in constant alternation, which counteracts an accumulation of tone
Strengthen over the entire angular range from approximately standard anatomical position to maximum frontal abduction

In addition to this ingenious transition, postures with retroversion such as

purvottasana
namaste on the back
gomukhasana with the arm down where the cramp occurs (may no longer work for this purpose for people who are very mobile in the shoulder),
prasarita padottanasana, with arms behind the body,
uttanasana, with arms behind the body,

good opportunities to allow the shoulders to work at much smaller angles (exactly opposite here), which counteracts hypertonus and irritation, both preventively and curatively. Another important measure is, of course, the promotion of mobility, which reduces the resistance to frontal abduction and thus the necessary contraction force that the affected shoulder muscles have to exert. A whole range of postures can be used for this purpose, here is just a small selection:

In principle, the „dips“ variations of different poses are also worth a try.

Pain in the outside of the elbow

Question:

In the head-down dog position, but also in handstand, the outside of my elbow joints often hurt, for example where the bones meet. I think this comes from „overstretching“ the arms.

Answer:

{Due to its scope and relevance, the article on hyperextension of the knee and elbow joints is also available as a PDF}

Of course, hyperextension tends to produce pain. Strictly speaking, and contrary to frequently expressed opinions, it is not a question of „unhealthy angles“ in the elbow joint, but of unhealthy pressure conditions (triggered by corresponding moments ) in the joint, which always occur at these angles if the performer is unable to control the forces in the joint, i.e. in almost all beginners with the ability to hyperextend in the arms, the more pronounced the tendency to hyperextend, the more.

The solution to the problem lies structurally in using the muscles that can bring the elbow joint out of hyperextension, i.e. the biceps brachii muscle, the arm biceps and its synergists. The biceps become active and reduce the pressure on the outside of the joint, for example by pushing the hands together forcefully in the head-down dog position or in a handstand. This is a strenuous but rewarding exercise that sooner or later leads not only to increased strength in the biceps, but also to complete control of the joint in every posture.

Another way to master the problem without pushing the hands towards each other is to use the biceps and their synergists against the strength of the triceps. Just as bodybuilders work muscles against their antagonists when posing with maximum force, causing the muscles to tense and swell, it is also possible here to work one muscle(the biceps) against its antagonist (the triceps) and control the pressure ratios in the joint from their force balance.

Compared to the first option, however, the second requires considerably more body awareness and control, which the typical beginner usually does not have. Voluntary control of the joint can generally be considered achieved when the performer is able to switch from flexion of the arms to hyperextension (and vice versa) without the muscle tension decreasing significantly or even breaking off in between. To learn how to tense the biceps in every arm position, the following pre-exercise will help:

sit comfortably and extend the right arm with the inner elbow and biceps pointing upwards
Bend the arm to 90° at the elbow joint and tense the biceps very strongly, as bodybuilders do when posing, for example. Naturally, the biceps and triceps work equally as agonist and antagonist in a fixed angle position, otherwise a movement in the elbow joint would result. The tension in both muscle groups should be easy to feel.
slowly extend the arm without losing the tension in the biceps. The further the arm is stretched, the more difficult it will be to maintain tension in the biceps
turn the forearm into pronation (palm down), again without losing the tension in the biceps. This step also requires a lot of attention and strength. Most people are completely unaccustomed to tensing the biceps when the elbow joint is extended, especially when the forearm is pronated.
suddenly release the tension in the biceps and restore it in a flash, i.e. interrupt it for as small a fraction of a second as possible. Repeat this several times and gradually extend the time the biceps are not tensed
When releasing and tensing the biceps, keep the elbow joint extended and the forearm pronated and slowly bring the arms into an overhead position. Practice this with each arm separately before practicing it with both arms at the same time.

On the subject of overstretching the arms, see also this entry in the FAQ.

Irritation of the muscle insertion on the ischium (PHT)

Question:

During forward bends such as uttanasana, parsvottanasana and also prasarita padottanasana, I have had pain in the upper part of the back of my leg under the ischial tuberosities for some time. This doesn’t get any better with forward bends.

Answer:

This may simply be a symptom of irritation(insertional tendinopathy) at the muscle origin of the hamstrings at the ischialtuberosities (ischial tuberosity), which can occur when practicing forward bends in a certain way. In sports and fitness training, this problem is also known from sprinting and lunges. This is also known in English as PHT (Proximal Hamstring Tendinopathy). Caution: in German, the abbreviation often stands for other things such as pulmonary hypertension, pulmonary hypertension, sudden cardiac death. This phenomenon usually occurs in people who are not yet very practiced in forward bending and are also not very mobile. It is the result of an unfavorable relationship between the mobility of the hamstrings and the resilience of the muscle origins at the ischial tuberosities, which is particularly – but not exclusively – the case when forward bends from bent knee joints are rarely practiced. The fact that it mainly affects less mobile beginners is not only due to the possibly lower load capacity of the tendons of the muscles of the hamstrings, but also to the favorable gravitational effectthat the partial body weight of the head, arms and upper body (assuming the affected leg is a standing leg) has on less mobile people: if the pelvis does not yet tilt to the horizontal, the center of gravity may well still be approximately level with the center of rotation of the hip joint, which ideally constitutes a 100% gravitational effectcorresponding to the maximum of the cosine function of the angle of the connecting line(center of rotation-centerofgravity) to the direction of gravity(vertical). For example, if the hip joints tilt 150°, the gravitational effectof this partial body weight corresponding to the cosine of 60°, i.e. the value 0.5, is just half as great.

PHT is one of the insertional tendinopathies, i.e. irritation phenomena at tendinous origins and insertions of muscles, whether these have an inflammatory component or not. This also includes well-known conditions such as golfer’s elbow, tennis elbow and jumper’sknee/patellartendinopathy, all of which must be considered to be associated with overuse. Runner’s knee/(ITBS) and tibial plateau synd rome, on the other hand, are not insertion tendinopathies, but are not dissimilar: they also require very similar rest and structural improvement.

The pain-triggering „overuse“ of an existing PHT is smaller than the impact that led to the development of the phenomenon. In other words, once a weak point has been created by overstressing, it later becomes apparent even with comparatively low-threshold stimuli. This stimulus depends both on the force applied and on the sarcomere length of the hamstrings, with the latter being the predominant factor. The sarcomere length increases with flexion in the hip joint and decreases with flexion in the knee joint, whereby flexion in the hip joint has a greater influence than flexion in the knee joint, as its lever arm is greater than that of the latter.

In moderate cases, the pain phenomenon usually occurs in uttanasana with the knee joint extended to the last possible angle of hip flexion. If an additional external force is used for flexion (supporter, external weights), the pain can already be triggered at lower angles.

These explanations also provide a key to getting rid of this phenomenon. If it is not very pronounced, it may be sufficient to practise forward bends more gently and differently for a certain period of time, namely from a bent knee joint (such as dog pose head down, uttanasana, prasarita padottanasana) and only rarely and only in a completely (muscularly) warm state to practise normal forward bends, provided that the pain described does not occur. In general, there is no recognizable level of this specific pain sensation that could still be considered tolerable. In contrast, we regularly experience that any tolerance of a strain that triggers this pain is likely to maintain the irritable state, i.e. strict avoidance of the trigger is required. Other postures such as trikonasana and ardha chandrasana can also be modified accordingly.

Another key is to strengthen the muscles and their tendons. Depending on the type of training, tendons may not become more robust as quickly as their muscles increase in strength. This is one of the possible side effects of rapid muscle or strength growth. A more moderate or varied training program, which also contains a sufficient number of submaximal training stimuli, is less dangerous. Incidentally, PHT is one of a whole series of other phenomena of this kind, such as training-related compartment syndrome or bony tendonavulsion.

Some of the triggers are characterized by further specifics: lunges, for example, bring the hamstrings to the absolute limit of its muscular capacity in an eccentric contraction when the falling pelvis is intercepted with a maximum eccentric contraction of the hip extensors of the front leg. It is well known that greater tendon strength is achieved eccentrically than concentrically, which means that the load on the tendon and its bony insertion is also higher. The speed at which the falling pelvis is intercepted is disproportionately high, as the required muscle power increases hyperbolically over time. This is aggravated by a wide flexion in the hip joint. The degree of hip flexion and, above all, the utilization of maximum muscle power is also responsible for the development of the sprinter, who performs the reversal of the forward accelerated leg from the hamstrings, among others. The time factor is also very important here. The stride lengths of top-class professional athletes range from around 1.6 m (marathon runners) to 2.5 m (sprinters). The world’s best sprinters therefore only take a good 40 steps over 10 meters in 10 seconds, but that still means 4 steps per second, which in view of the stride length results in an enormous speed and even more so the reversal speed of the legs. This results in a corresponding strain on the tendons, especially as the tendon also stores kinetic energy in its elasticity.

Of course, most sporting activities that strengthen these muscles are also likely to shorten the muscles to a similar extent as they strengthen them, so this effect in turn has a detrimental effect on forward bends. Nevertheless, an increase in robustness can and will outweigh the disadvantage of a possible reduction in mobility, especially if you practise intelligently and use the range of motion right up to the area where the pain occurs. As already mentioned, the triggering of pain depends primarily on the sarcomere length of the hamstrings, which puts the position of the hip joint in relation to that of the knee joint, whereby its position has a greater influence due to the greater lever arm in the hip joint. However, the triggering of pain is also dependent on the force exerted, or more precisely, on the tendon strength of the hamstrings.

In addition to various postures that strengthen the hamstrings as extensors of the hip joint in at least medium sarcomere length, such as

and other comparable postures, in all of which care must be taken to ensure that pain is not triggered, postures in which pain is unlikely to be triggered due to the short sarcomere length are of course also suitable. These include

purvottanasana in all variations, especially those with outstretched legs or with one leg raised, where care must be taken not to trigger the pain
setu bandha sarvangasana
eka pada setu bandha sarvangasana lower leg. Be careful with the raised leg!
urdhva dhanurasana
eka pada urdhva dhanurasana lower leg. Be careful with the raised leg!
salabhasana

Correctly performed strengthening postures from sports such as

Squats with and without weight
Deadlift, again: only until before the pain is triggered; to make it easier, the knee joints can be bent a little
Hyperextensions, even just before the pain is triggered
Leg biceps curls on the machine

Once the structures have been significantly strengthened and the irritation causing the pain has healed, the lost mobility can be restored all the more safely. Another supportive measure is activities such as brisk walking, preferably uphill, and climbing stairs, provided that they do not trigger the pain, or are modified or paratetrized in such a way that they do not trigger it. Of course they stiffen the back of the leg, but they promote healing and strengthen the structures. Running with faster passages should also have a positive effect. However, all jerky movements should be avoided, as should all activities that trigger the pain, including intensive stretching!

Pain in the inner back of the knee

Question:

In trikonasana but also in ardha chandrasana, sometimes also in upavista konasana, also performed as a forward bend, I always have pain in the inner back of my knee; this becomes more intense the longer I stand in it.

Answer:

This is most likely the m. gracilis, which does not want to participate in the unfamiliar stretching. This is a normal reaction and it is regularly observed that the phenomenon disappears if you practise trikonasana quite regularly for a few months. It is important to remember that the gracilis muscle is the most interesting muscle in the entire adductor group in that it is the only biarticular muscle. This means, of course, that the further towards the foot I lean on the lower leg, the more and the more I bring my pelvis into hip flexion, the more I notice the m . gracilis. The latter can be seen beautifully in the execution of trikonasana as a partner exercise, in which the supporter presses the hip bone against the wall. The only thing that helps here is to practise regularly and carefully, i.e. start a little more gently but hold the pose for longer.

Wobbly in standing postures

Question:

In some standing postures, e.g. parsvottanasana, a little less in trikonasana and warrior 2 pose, but then again clearly in parivrtta trikonasana and especially in warrior 3 pose I am totally wobbly.

Answer:

This is normal at first, until you discover what the calf muscles (among other things) are for. There are two groups of these positions, depending on whether you sway forwards and backwards or sideways. There is a tendency to sway to

front/back: e.g. trikonasana, warrior 2 pose
Sideways: e.g. parsvottanasana, parivrtta trikonasana, warrior 3 pose

The reasons for this are obvious: in the group

are lateral hip openings with maximum abduction, i.e. the legs are straddled as far as possible and the pelvis and torso are positioned almost centrally between them. Since one foot is turned out by 90°, only a narrow triangle remains as a base of support in which the gravity perpendicular must be caught. Of course, this is not easy, especially as the main weight on the narrow side is usually on the narrow and round heel. This results in (often almost periodic) weight shifts between the inner and outer foot, i.e. a kind of rotation around the longitudinal axis of the foot. This wobble is transmitted via the pelvis to the other foot, which is naturally much better able to deal with it due to its greater width for this balancing work (in the sense of the triangle described above: this is generally its length). This is also the key to the solution: use the calf muscles on the side of the turned-out leg more strongly in order to involve the balls of the feet (which have at least twice as much contact width as the heel) in the balancing work and prevent rotation around the longitudinal axis of the foot.
are standing forward bends that pose a similar problem of a narrow base of support, but now in the longitudinal direction of the body, resulting in lateral wobbling. This is made more difficult by the fact that in the two-legged standing postures parsvottanasana and parivrtta trikonasana, for example, the back foot is turned further towards the other (front) foot so that the corresponding hip can remain sufficiently far forward, which makes the base of support narrower than in group 1. Another complicating factor is that the strongest muscle groups(plantar and dorsal flexors) of the lower leg cannot, as in group 1, primarily perform the balancing work in the more suitable leg (because the foot is not turned 90°) in the necessary direction, but this work must be performed in a balanced way in combination with weaker and usually not so finely controllable muscles.

Both phenomena clearly reflect some kind of chitta-vrtti, e.g. the kind in which the person, having just assumed the pose and briefly felt stable for the first time, semi-consciously decides that he can now reduce the work in the calf muscles (especially those of the leg turned 90°) in order to save himself effort. This immediately causes an initial shift in weight towards the outside foot, which continues via the pelvis to the other leg, where the person – finally awake – can now react clearly to avoid falling over. Of course, this compensatory measure in turn creates a movement that continues through the pelvis to the first leg, where there is now a renewed need for action… This interplay can lead to periodic weight shifting and balancing or to the realization and its implementation that only through constant work (especially in the first leg) can a certain security of standing and, in particular, the rest adequate to a yoga posture be realized. This is a good place to start,

that a short-term view does not do justice to yoga and
how the chitta-vritti clearly and directly affect the body.

Pain in the Achilles tendon in trikonasana

Question:

In trikonasana I sometimes have problems in the Achilles area.

Answer:

Reduce the distance between the feet until the problem has been reduced to a tolerable level. Sometimes interactions occur between agonists and antagonists, in this case between the dorsiflexors of the ankle that do not want to give way and the plantar flexors that bring about this movement and contract concentrically at the edge of their possible angular range. In general, the intensity of the work of the plantar flexors does not need to be reduced here, but only their working angle in the joint needs to be set a little more favorably or the forefoot placed on an elevation such as a shoulder support plate.

Pain in the upper sides of the wrist (dorsal)

Question:

Every time I do longer or more frequent handstands, I have pain in the tops of my wrists(dorsal: on the back of the hand).

Answer:

This occurs more frequently, is generally harmless and is usually the result of

inadequate stretching of the palmar flexors of the hand or
lack of power or use of the same.

Explanation: The lack of downward pressure on the metacarpophalangeal joints of the hand means that the load, which for the most part should be carried actively by the muscles of the forearms (the palmar flexors), presses passively on the wrists in the absence of their work. This is a frequently observed principle that reflects an important principle of yoga postures:

the muscles should do the work and protect the joints.
In order for the muscles to perform the work with as little fatigue as possible, they must not only have a certain consistency in the development of force, but they (and their antagonists) must also be flexible in order to achieve optimum alignment of the joints with as little effort as possible.

Put another way:

The less the muscles work, the more load there is on the joints, which is certainly not very beneficial for them in the short or long term (in the short term, this often leads to discomfort, known as „pain“, and in the long term to degenerative or wear-and-tear damage to the joints)
The more immobile the muscles involved are, the more effort it takes to bring the joints into the optimal position where they have to work less. A good example is the handstand: if I am not able to stretch my arms, they have to remain bent and the arm extensor triceps have to work hard to hold the weight of the body. In addition, it also has to work to ensure that the angle does not become even more unfavorable (which is what gravity wants), which would cost it even more strength. Optimal joint alignment would mean that the shoulders are above the elbows and these two groups are above the wrists, allowing gravity to be dissipated to the ground without much muscular work (and freeing up space for more interesting details).

In many cases, yoga beginners are blessed with a certain degree of immobility, which confronts them with the need for rather rough muscular work over a longer period of time and usually results in a stable, resilient muscle structure. To promote the mobility of the forearms, the following exercises are particularly useful:

Dorsal forearm extension
Palmar forearm stretch
Palmar forearm stretch in upavista konasana

Cramp in the buttock in parsvakonasana

Question:

In parsvakonasana, the pomus muscles on the side of the bending leg sometimes cramp when I try to press the knee back against the arm.

Answer:

This is not an unusual phenomenon and usually disappears again after approx. 20 – 30 seconds. Like many such effects, it has to do with inexperience and extreme conditions. The pomus muscles are responsible for moving the leg backwards. They have to work against the limited mobility of the adductors and are in the angle range of maximum contraction, so naturally they have a tendency to cramp. This usually passes when the muscles have adjusted to a good working mode after 20-30 seconds and are allowed to pull really hard.

Lower back in dog Head up

Question:

I often have pain in my lower back when I am in the upward dog position, especially if I do it for a long time.

Answer:

This is perfectly normal for beginners. The muscles of the lower back, which become very concave in this pose, help with the backbend of the back and are in the angular range of their maximum concentric contraction, thus in a short sarcomere length and close to active insufficiency (another such case, see also: cramp in the buttock in parsvakonasana and cramp in the deltoid) and there they have a preferred tendency to cramp. This sensation should subside after one or two head down dog poses, but at the latest after the first hip opening.

Forward bends after backbends

Question:

I have heard that you should never do straight forward bends immediately after intensive backbends. Is that true? And why is that the case?

Answer:

This is definitely correct until further notice (more on this later). This instruction results from the fact that backbends strongly tone the back muscles (increase the basic tension). If forward bends are performed immediately afterwards, these back muscles are not immediately able to stretch accordingly in order to achieve the desired curvature of the spine. The flexibility of the muscles would be reached after a few minutes at the earliest. As a result, the bending moments that occur when the spine is bent act elsewhere: on the front of the spine, which is compressed as a result. The area of the intervertebral discs located here now receives even more pressure, as the back is less flexible than if no backbends had been practiced previously.

To get a better idea of what is happening, take a rigid plastic tube, such as those used in electrical assembly, and start to bend it so that it becomes convex when viewed from above. As a result of the bending forces, the first surface cracks soon appear on the top (which now becomes convex). These cracks correspond to the tearing sensation in the back muscles that would occur if you were to perform intensive forward bends immediately after intensive backbends. Back to the tube: as these mounting tubes are quite stable, another effect will occur with increasing bending: the underside will begin to fold as a result of the increasing pressure with which it is squeezed together.

Something similar occurs in the human spine: as the weakest link in the spine, the intervertebral discs on the front of the spine are compressed to the maximum. They can certainly withstand this many times when they are young and healthy. However, if they are already damaged (deformed, doctors also refer to this as a visible protrusion of the intervertebral disc) as a result of continuous one-sided strain and are in poor condition due to chronic lack of movement, then these pressures can cause the barrel to overflow and lead to the gelatinous mass inside the intervertebral disc being squeezed outwards. If it hits the sciatic nerve, we have a classic herniated disc, which in some cases can only be treated surgically.

In the lower back, another even more serious pathomechanism is conceivable, which is based on the fact that the lumbar spine has a natural lordosis. If this lordosis is sufficiently pronounced, it is exacerbated by a forward bend with strongly toned or shortened local back muscles, i.e. the lumbar spine is not brought into a convex or at least less clearly concave posture (seen from behind) by the forward bend, but the lordosis is exacerbated. However, as the natural lordosis generally puts pressure on the back of the intervertebral disc throughout the day if the posture is poor, the forward bend with increased muscle tone is an additional and avoidable risk factor. For this reason, intensive forward bends directly after intensive backbends are avoided at all costs by beginners and less flexible people. However, there is one small exception: such asymmetrical forward bends, in which the spine can also bend sideways, are permitted and are often used to reduce the tone of the back muscles. A typical example of this is parsva uttanasana. Here

the spine is not loaded exactly at the usual point,
part of the forward bending forces is transferred to a lateral tilting movement and
the asymmetrical execution stretches one half of the back extensors much faster than in symmetrical forward bends.

There is also (at least) one path from backbends to forward bends in which the tone of the back muscles is gradually reduced via various inversion postures, most notably sarvangasana.

Cramp in the hip in the dog position

Question:

In some positions in which the hip is flexed and the leg is extended, I tend to cramp in the hip, e.g. in the dog position head down. What is the reason for this?

Answer:

This is probably the cramp in the rectus femoris, one of the four parts of the quadriceps, the group of muscles (three monoarticular and one biarticular) that generally stretches the knee. One of these four, namely the rectus femoris, also runs over the hip and flexes there. The tendency to spasm occurs because this muscle is already maximally contracted in the head-down dog position. It is „at its limit“ in both joints over which it runs, i.e. it cannot stretch any further (in the knee joint, as it is already fully stretched) or flex (in the hip joint, as the (im)mobility of the hamstrings sets a limit to this movement) and is therefore maximally short, anatomically speaking in a very short sarcomere length. What helps is to strengthen this muscle, to further stretch it and its antagonists so that their resting tone decreases.

Tibial crest syndrome

Question:

Whenever I run for a long time or try to jog, my lower legs ache, for example between my inner calf muscles and my shin. This doesn’t seem to get better after more frequent jogging (I’m a beginner), but rather worse. Can yoga help me?

Answer:

This looks like shin splints syndrome, an irritation based on weakness of the inner calf muscles that makes jogging temporarily impossible. After each new attempt, the pain seems to get worse, so that eventually it has to be given up. Here we are faced with the task of enabling the calf muscles to withstand the strong impact-like loads of running. This means: standing postures and again: standing postures (and also: standing postures). You need to practise standing postures frequently, especially those in which pushing down on the balls of the feet is what makes it possible to stand safely in the first place, as this work comes from the calf muscles. These include warrior 2 pose, warrior 1 pose, warrior 3 pose, parsvottanasana, parivrtta trikonasana, eka pada prasatita uttanasana, ardha chandrasana and parivrtta ardha chandrasana and eka pada uttanasana. In these poses, you usually stand too much on the outside foot and therefore become wobbly, so you need to work the inner calf muscles hard to push the inside foot down. Of course, these are mainly asymmetrical standing postures, as

the symmetrical ones pose less of a problem with the inner foot/outer foot and
a one-sided strengthening is usually stronger than a two-sided one (see e.g. caturkonasana versus warrior 2 pose)

because here

more concentration on a single muscle (and possibly its synergists, but only in one limb) is possible and
the other half (here: the other leg) can be used to force the strengthening of the first.

In many cases, however, the mobility of the calf muscles must be improved in addition to all the strengthening, for which the head down dog position is well suited both in the normal version and in the version with the heels on the floor (at least the focus on pressing the heels down). Here, as in the standing postures, care must be taken to ensure that the inner heels are brought into the movement in the same way as the outer heels; it is even recommended to overemphasize the inner heel for a longer period of time.

„Sciatica“

Question:

I „have sciatica“, what now?

Answer:

The „sciatic nerve“ is a common but incorrect term for the common course of the tibial nerve and the common fibular (peroneal) nerve, which arise from the lumbosacral plexus (fed by the ventral spinal nerves of segments L4 S3) and split above the knee. With „sciatica“ or the „irritation of the sciatica“ i.e. the sciatic nerve, can refer to two different things:

the neuralgia (nerve pain) that often accompanies a positive Lasegue test, i.e. bending at the hip with the leg extended causes nerve pain, which usually indicates events such as ischialgia, disc disease, meningitis or subarachnoid hemorrhage. In various cases, a forward or backward bend(extension or flexion) in the lumbar spine is also sufficient to trigger corresponding pain
an irritation of the nerve, usually caused by cold or pressure, which in part (but not only) causes movement-dependent, rather fine, radiating nerve pain
a so-called piriformis syndrome, correctly: „Deep Gluteal Pain Syndrome (DGS)“

The second case is usually based on far less severe events. The cause is often cold exposure of the outer-hind-upper thigh area, such as when sitting on cold surfaces, sitting in or wearing wet clothing, riding a lightly clothed bicycle or motorcycle in the cold or similar. It can also be triggered by prolonged exposure to pressure, e.g. prolonged sitting on poor quality or worn-out chairs or on a hard object, so that the physiology of sitting is violated, which requires that the majority of the partial body weight to be supported is transferred via the ischial tuberosities. With this trigger, ischiadicus irritation can only be differentiated from piriformis syndrome by its behavior and modalities. In a classic cold- or pressure-induced irritation, the pain occurs from time to time under conditions that cannot be precisely clarified: under pressure, during movement, under further exposure to pressure or cold. As a rule, this pain phenomenon heals spontaneously, although not necessarily within a few days. In fact, the pain recurs from time to time for weeks. Avoiding forward bending is often perceived as pleasant, but may not necessarily contribute to healing. Keeping warm, avoiding pressure and cold stimuli, including „inappropriate“ sitting, contribute significantly to healing. If seated postures are practiced, care must be taken to ensure that the surface is not cold, whereby the subjective sensation of cold is often not a sufficient criterion (!) but rather defensive action must be taken. In the case of piriformis syndrome, stretching the gluteal muscles and avoiding efforts that increase tone, such as working in a bent-forward position, usually help.

The first case, on the other hand, requires at least medical clarification, if not immediate (!) intensive medical care, depending on the cause: if it is a cauda equina syndrome, this is a neurological emergency. Unlike a classic emergency, this is not immediately life-threatening, but certain parts of the nervous system can die within a short period of time, which is not curable and is very likely to lead to organ damage, which in turn can become life-threatening! In most cases, cauda equina syndrome becomes apparent through so-called breeches anesthesia, in which both inner thighs become numb, and often also through loss of functions such as micturition, defecation and erection.

If it is (fortunately and probably) not a cauda equina syndrome, a further distinction must be made. Only three of the most common cases will be discussed here for the sake of clarity; a complete discussion would go beyond the scope of this article and the diagnosis is usually made by the orthopaedic surgeon with the help of the radiologist (usually by MRI):

Intervertebral discherniation, also „disc hernia“, herniated disc/protrusion(prolapse/protrusion). In this case, an intervertebral disc is pressed dorsolaterally (backwards and outwards) against one of the spinal nerves emerging from the spinal cord, which causes so-called neuroradicular symptoms (a nerve root compression syndrome), characterized by pain radiating into the area supplied by the affected nerve. The affected spinal segment can be determined on the basis of the area and its dermatome (skin area) and any affected innervations of muscles (the affected muscles are the myotome). Both perception (numbness, tingling, reduced sensation) and restriction or disruption of motor function, such as failure to stand on the heel or ball of the foot, can be affected. If it is a case of „normal“ disc damage without prolonged unmanageable pain, treatment can and should generally be conservative. The proactive patient who is prepared to work for their recovery has a far better long-term prognosis than the consumer-oriented patient who wants a pill for their symptom, or, if this is not available, at least an injection and, if necessary, an operation, as long as it can be done without prolonged personal intervention, behavioral change and relatively quickly, and active cooperation in the recovery is necessary to a limited extent at best. Conservative therapy for proactive patients involves avoiding forward bending of the affected spinal region for a longer period of time. Lifting is done in a back-friendly manner with a straight, powerful back from extension in the hip joints and from powerful extension of the knee joints. It is regularly observed that any kind of convex curvature of the affected spinal region is likely to cause the pain or is associated with its recurrence, which is why it is avoided in sport, therapy and everyday life. On the other hand, back-bending movements generally provide relief and are usually (!) problem-free. Appropriate behavior is taught and practiced during rehabilitation and muscular competence is promoted. The long-term prognosis is quite good with good conscious behavior on the part of the patient. Later on, preventive movements without heavy loads, such as those found in yoga postures, can often be tolerated well again.
Spondylolisthesis(slipped vertebrae): a part of the spine „slides“ forwards/backwards in relation to the part below it, although the spine should actually be adequately secured against this with ligaments and muscles. This is particularly noticeable and worsens when the spine is extended (backbends). Backbends should therefore be avoided, even the dog position head upwards can only be practiced with reservations at best. Forward bends generally provide relief and can be practiced without any problems. Depending on the severity and frequency of the triggering, an arthrodesis (stiffening of the affected spinal segment) can provide permanent relief.
Spinal canal stenosis (narrowing of the spinal canal). This does not only sound unpleasant. Movements usually have a more moderate effect than with the other two, but forward bending and a straight or bent-back posture often have a worse effect. It is therefore more similar in its behavior to spondylolisthesis than to disc hernia. The cause may be, for example, wear of the intervertebral discs or spondylarthrosis with osteophyte formation.
Facet syndrome

By taking a medical history and performing functional tests with different postures, it is possible in most cases to distinguish „sciatica“ clearly enough from stretching pain or pain caused by injury to the hamstrings. If the above remarks refer to intervertebral disc disorders, these can of course also occur in the thoracic spine and cervical spine, but they will not necessarily cause the symptoms of „sciatica“, which is why these cases have been excluded.

Knee pain in postures with lotus leg or baddha konasana-like postures

Question:

I often have pain in my inner knee in lotus-like postures, also in baddha konasana and similar postures. What can I do about this?

Answer:

The pain mentioned is usually associated with the medial meniscus. For a comprehensive and causal discussion, see the question on general knee problems below. The postures addressed by this question are:

baddha konasana and even more its forward bend
supta baddha konasana
adho mukha supta baddha konasana
padmasana and its forward bend
ardha padmasana and its forward bend
supta padmasana
adho mukha supta padmasana
ardha baddha padma pascimottanasana
janu sirsasana
gomukhasana (the full pose with lower half!)

and all inverted postures with corresponding leg positions. The knee pain referred to can, but does not have to, occur when the knee joint is flexed further in a straight line, e.g. in

also occur. All postures that cause this type of knee pain have one thing in common: a large exorotation requirementof the thigh in the hip joint with simultaneous maximum flexion. In most cases, the foot of the affected leg is fixed to the ground. The lower leg is in a slight endorotation in the knee joint and also under slight valgus stress in relation to the thigh due to the hip joint ’s inability to exorotate. This is often sufficient to cause pain in a more or less damaged knee. The pain of this type is usually very easy to control by moving the knee towards the ground and thus also in further exorotation in the hip joint and endorotation in the knee joint and further valgus stress. In contrast, the latter postures (idealized) are pure flexion of the knee joint without rotation of the lower leg in relation to the thigh and without valgus stress. However, there are a few tricks that can be used to make the above-mentioned postures possible again:

Limit the movement of the knee to the floor, e.g. by placing a block under the thigh, possibly in conjunction with a soft, multiple-folded blanket in between
manually rotate the thigh of the affected side, once when assuming the posture
Manual rotation of the thigh of the affected side, continuously during the posture
Pulling a belt on the thigh (close to the knee) with an exorotation moment, i.e. the free end of the belt is at the top and points outwards(laterally), a supporter then pulls on the belt with sufficient force. It is also possible to perform this exercise on a table with the weight hanging down.
Support of the heel of the affected leg so that the endorotation of the lower leg in relation to the thigh is reduced or eliminated.
Reduction of the flexion angle (it is not fully flexed)
Positioning the second thigh too far medially, so that it has to slide past the heel of the first foot and is turned out in the process
Rotation of the leg by placing the thigh on the heel and sliding laterally along it.

With the help of these tricks, we have so far succeeded in almost all cases of this type of knee pain caused by „common“ meniscus wearof various degrees in making the postures feasible again, even if the effort for the person performing the posture or a supporter is not always minimal. Of course, pain phenomena caused by accidents or operations, particularly those involving screws remaining in the body or surgically altered joints (e.g. ligament reconstruction), may be beyond the scope of this stock of workarounds. In these cases, it is necessary to relearn individually how a joint can be used and how it reacts in all cases.

Knee problems in general

Question:

I have knee problems. How do I proceed?

Answer:

{Due to the scope and relevance of this article, it is also available as a PDF}

Knee problems of various kinds are quite common and are often accepted by patients and not even diagnosed. There are a number of different disorders involved:

Traumatic meniscus damage: is usually caused by shock loads in non-physiological movements, sometimes with rotation in the knee joint during flexion, as often occurs during falls and contact with opponents in sport. The menisci themselves are not painful, but if they change, they can press on pressure-sensitive structures such as the capsule and cause pain
Meniscus damage of a degenerative nature: is usually the result of intensive use of the knee in conjunction with advancing age. In principle, a certain amount of physiological, preferably non-impact movements have a protective effect on the menisci, but in many people the damaging influences predominate. Here too, the pain is caused by pressure from the altered meniscus on a neighboring structure
Osteoarthritic changes: degenerative changes in the knee joint that go beyond the menisci and affect the hyaline cartilage of the tibia and fibula or also the patella. The menisci often absorb incorrect loads over many years before they become so thin at the first points that increasingly pronounced contact between the tibia and fibula damages the cartilage covering of the bones, which react by forming fibrous cartilage as a replacement. However, as this is coarser, it accelerates the destruction of the softer menisci. Finally, there may also be (partial) loss of the fibrocartilage with consecutive damage to the bone itself; then the full picture of gonarthrosis is reached.
Arthritis (inflammation of the joints) of various kinds, usually accompanied by swelling and overheating of the knee. Arthritis includes not only infectious arthritis, but also rheumatoid arthritis and rheumatoid arthritis („true“ rheumatism)
Dislocations / subluxations of the knee, i.e. misalignments of the fibula in relation to the tibia, which are made possible by instabilities of the knee joint such as changes in the ligaments or damage to the menisci. They often manifest themselves in that the joint can crack when moving and the condition before or after feels less tense in the muscles covering the joint. In principle, attempts should be made to stabilize the joint, as instability promotes the development of osteoarthritis.
Ligament damage to the cruciate ligaments running in the knee, which in the event of a tear causes the drawer phenomenon or, in the event of tears to one of the outer ligaments, an abnormal outward or inward mobility of the lower leg in relation to the thigh(varus or valgus), which is not physiologically present when the knee joint is extended. The tear should have caused a clearly audible popping or whipping sound and is usually traumatic due to greater external force. If none of the ligaments are torn, they may nevertheless have been overstretched, usually also with a traumatic cause. In all cases, this results in a more or less perceptible instability of the knee joint and it must be diagnosed and treated!
joint trauma, which may cause pain in the joint even after many weeks or months
Baker’s cysts produce a feeling of tension or foreign body sensation, see the corresponding entry in the FAQ.
Plica syndrome is caused by the painful pinching of an excessively pronounced fold of skin created during the development of the knee joint
Further damage to the knee

The therapeutic treatment of knee problems is not always easy and a restitutio ad integrum (complete restoration), i.e. a cure without any symptoms remaining, cannot always be achieved according to the current state of medical care. As explained above, the diagnosis must be made by taking a medical history, clinical examination and MRI and not by arthroscopy, which is fraught with side effects and risks.

In most cases, it is advisable and helpful to raise the conditions for the functioning of the knee joint to the best possible level, i.e. to eliminate all harmful influences that are within the patient’s control. In addition to eliminating any subluxations in the knee joint itself or subluxations or other damage in neighboring joints, this also includes improving the muscular situation. A healthy, balanced muscular system, in which no muscle has an excess of tension or a lack of strength, and all the muscles involved in the joint and the neighboring joints are in a good relationship with each other in terms of these criteria, is a prerequisite for eliminating the symptoms or reducing them to a minimum.

As a rule, this requires a good orthopaedist, a good physiotherapist and a significant degree of personal commitment, especially in the initial period after it has become clear which deficits in the muscular system need to be addressed. In general, harmful influences such as high demands in cold, wet or unheated muscles, impact-type stresses (not necessarily running ), sports known to be harmful to the knees such as sports on indoor floors, especially those involving contact with opponents, tennis, badminton, squash, skiing, snowboarding, unphysiological postures or stresses should be avoided. The to-do list generally includes stretching of all muscles involved and strength (especially strength endurance) increasing exercises, in particular various standing postures, especially those with a bent leg, which strengthen the quadriceps in particular, but not only, such as:

However, there are certainly other postures than standing postures that strengthen the muscles of the legs in the long term, such as:

Many of these postures not only strengthen the quadriceps but also the adduction and abduction apparatus. If the quadriceps, in particular the rectus femoris or other hip flexors, are under too much tension, the position must also be improved here. Presumably not all of the postures mentioned below will work painlessly without adjustment; this is the task of the experienced yoga teacher:

An excessively hollow back in this posture indicates shortened hip flexors. For the risks of a hollow back, see the FAQ here:

If your back is in good health, you can add to this:

as well as further backbends with extension in the hip joint. It is also possible that the pelvic and pomus muscles, as well as the adductors, have too much rotational tension in the hip joint, which could help – for the pomus muscles and exorotators:

If the adductors cause rotational or adduction torques:

for the special case of biarticular gracilis:

if there is too much traction in the direction of knee flexion or hip extension:

uttanasana
prasarita padottanasana very similar to uttanasana
parsvottanasana as a stretch that goes beyond uttanasana
pascimottanasana
janu sirsasana
tryangamukhaikapada pascimottanasana
downface dog also good stretch for the hamstrings
hip opener 5 very effective stretch of the hamstrings that goes beyond uttanasana
Warrior stance 3
trikonasana
parivrtta trikonasana

The directly adjacent joints, in this case the ankle and hip joint, must also be included in the work-up. If there are deformities of the foot or other damage to the foot or ankle, such as instability of the ankle as a result of supination trauma, these factors should also be addressed. Finally, it is important to find out which sport has a supportive and stabilizing effect in the individual case and to what extent. Cycling is generally one of these due to the absence of impact loads on the joints.

However, despite the repeated impact-like strain, this can also include running, especially if it is not a leisurely jog, the muscle-strengthening effects of which are likely to lie primarily in the lower leg apparatus, but rather endurance running at a brisk pace, preferably also as interval training, in order to strengthen the entire musculoskeletal system of the lower extremities up to the pelvis and beyond. Any stiffening effects of sport or running can usually be easily compensated for by yoga. The following simple rules apply to exercise and sports behavior:

Well warmed up and preferably not loaded in cold and wet conditions
It is better to perform movements with force than with momentum
It is better to perform movements slowly, controlled and powerfully than quickly (this does not apply to running, of course, see above)
Perform movements physiologically correctly, avoid rotation of the lower leg during flexion and under load, avoid varus and valgus stress.
Avoid loads that are so heavy that they jeopardize control of the movement
Do not bend the knee joint too deeply under significant load
Exercise regularly, preferably with lighter loads at first and more frequently/longer than heavier ones
„Listen“ to the joint and utilize the experience gained

If you are overweight, this factor should also be addressed in the long term and sustainably. In many cases, all of these measures can achieve a significant – sometimes permanent or even temporary – improvement in symptoms or even freedom from symptoms. However, there are also cases in which surgical intervention is necessary, e.g. when bruised parts of the meniscus cause painful blockages of the joint or in cases of cruciate ligament tears. However, if there is no strict indication for surgery and it is a case of „simple“ meniscus or cartilage wear, the above-mentioned options should be used to postpone the need for surgical intervention until regenerative procedures are available that are capable of regenerating meniscus and cartilage tissue, as they are currently being researched.

Knee: Arthroscopy – YES or NO?

Question:

I have recurring knee pain. My doctor suspects degenerative knee damage and wants to perform an arthroscopy. Should I allow this?

Answer:

In principle, known or unknown pathological changes to the knee joint can always cause pain, even when yoga poses are performed correctly, as we are stretching the entire range of motion of all joints under different types of load. So if there is damage, it is likely that it will be revealed by some posture. If the pain persists during the posture and can be reproduced again and again, if the pain cannot be relieved with all the tricks we know, if the knee joint makes itself felt in other postures, in everyday activities or in sport, this is an invitation to have this clarified by a doctor. The diagnosis is usually made on the basis of the symptoms, the physical examination and, if necessary, three-dimensional imaging using MRI.

Arthroscopy to make a diagnosis is no longer state of the art and should not be accepted by the patient! Superfluous arthroscopies should be avoided at all costs, not least because they represent a risk of infection for an extremely immunocompromised area of the body. In addition, many patients report long-term deterioration after initial improvements if part of the meniscus has been removed. Even the purely diagnostic arthroscopies that were still permitted in the past without intervention often led to deterioration in the patient’s condition. Even if an arthroscopy is much more profitable economically than an MRI plus anamnesis, physical examination including tests and consultation, this should not tempt any doctor, whether in private practice or employed in a clinic, to act against the patient’s best interests!

Very often, conservative therapy is superior in the long term. Furthermore, medicine is progressing and no one should unnecessarily make future superior treatment options such as stem cell therapy for the regrowth of cartilage or menisci inaccessible through hasty or ill-considered intervention. In our view, it is better to try to achieve a stable and resilient improvement in the condition with exercise and sports therapy, yoga, osteopathy and other conservative procedures, even if this means more work and effort of various kinds. As a rule, the body’s own structures are highly optimal and cannot be replaced by any technical good without disadvantages.

Of course, there are also conditions that require intervention, such as a torn meniscus root. This requires arthroscopic treatment in order to reattach the torn or torn meniscus roots, as otherwise there is always a risk of pain and, above all, osteoarthritis of the knee joint. See also in Pathology: Meniscus damage „Simple“ mild to moderate degenerative wear of the meniscus, on the other hand, is usually best treated conservatively with exercise therapy. Torn cruciate ligaments are often better treated surgically, depending on the case, age, occupation and sporting expectations. Other conditions that require surgical intervention are also conceivable. Patients should seek out a competent and conscientious orthopaedic surgeon with a conservative approach and, if in doubt, obtain at least a second opinion before undergoing irreversible surgical changes.

What is a surrogate movement? Is it bad?

Question:

What is a surrogate movement? Is it bad?

Answer:

A surrogate movement is a different movement performed instead of an intended movement that may feel similar in one way, but contradicts the meaning of the posture and disguises the fact that the actual movement to be performed is omitted. Classic examples of surrogate movements are

In the 2nd warrior pose, the pelvis, which is tilted forwards and downwards, is not straightened, but instead, which is much easier, the upper body is bent backwards, i.e. the thoracic spine is moved backwards with the shoulders and head. A lack of body awareness or a lack of understanding of posture often leads to this surrogate movement. This is „bad“ in that, firstly, the correct movement, which promotes mobility, especially in the adductors, is not performed and, secondly, the uncontrolled backward bend of the upper body without extension in the hip joints results in a greater hollow back than without the surrogate movement. However, the purpose of the correct movement is to actually reduce the hollow back compared to the uncorrected posture! In this sense, not only is the incorrect posture not corrected, but a supposed correction actually exacerbates the incorrect posture.
What has been described here for the 2nd warrior position applies all the more to the 1st warrior position. Here it is – presumably both subjectively and objectively – even more difficult to straighten the pelvis, as the opponents that prevent this are not the adductors, which only act moderately in terms of flexion, but the extremely strong hip flexors, which mainly and with great force perform the flexion in the hip joint.
Another classic is the excessive movement of the upper arm backwards in trikonasana. The required movement is the maximum rotation of the upper body away from the leg to the side of which the upper body is moving. This movement is necessarily limited by the core muscles – and also by the adductors via the pelvis. Instead of further rotation – or the attempt to do so – the upper arm is often moved backwards, i.e. retroversion beyond the plane of the back, which is very easy to a certain extent but has nothing to do with the desired constructive movement, unless the arm could be moved so far that its lever causes further rotation. Even then, however, the movement does not come from the muscles intended for this purpose, i.e. primarily the autochthonous back muscles and the oblique abdominal muscles, but is „passive“, i.e. induced by the effect of gravity. This case is therefore less „bad“ because it generally has few side effects compared to the hollow back in the two postures described above.
Another, not „bad“ surrogate movement would be lifting the lower leg while simultaneously bending the knee joint instead of lifting the thigh in the sense of reducing flexion in the hip joint (or even extension in the hip joint) of the lifted leg in the 3rd warrior position.However, there is no beneficial effect when the thigh is lifted in the hip joint, i.e. the strengthening work of the extensors (mainly the hamstrings and gluteus maximus), which have a stretching effect on the hip flexors (only a moderate effect when working against the force of gravity of the leg at the same time).

The surrogate movement is therefore not an evasive movement but an incorrect, useless „substitute movement“ that is performed instead of a correct movement or a corrective movement and may have significant side effects.

In partner exercises: Where to press on the sacrum?

Question:

I can’t remember when to press on which end of the sacrum in postures or partner exercises!

Answer:

Very simple: in forward bends on the „upper“, i.e. cranial or dorsal end of the sacrum – example: right-angled handstand, uttanasana, prasarita padottanasana – and in backbends on the „lower“, caudal, leg-side end!

Assistance more strenuous than the postures?

Question:

I find some of the assistance more strenuous than the postures, is that right?

Answer:

Yes, this is not uncommon. If you can, consider it a welcome boost!

Knee pain in viparita karani

Question:

In viparita karani I have pain in my knee joint, but never in savasana, what can I do?

Answer:

This indicates that the knee joints are hyperextended in viparita karani, see the corresponding entry in the FAQ or the article on hyperextension of the knee and elbow joints as a PDF. The overstretch should be visible from the side. According to the construction of savasana, the ability to hyperextend the knee joints is not important there. In viparita karani it looks quite different. We usually hold the buttocks about 30 cm away from the wall, which usually ensures that the legs can be stretched effortlessly (which may not be the case at a smaller distance, depending on the mobility of the hamstrings ) and that there is still a small pull on the pomus muscles and the hamstrings, which prevents the pelvis from falling into a hollow back, which is usually no longer the case at a greater distance. If the knee joints can hyperextend, they will usually do so in viparita karani with a distance of 30 cm. This can be remedied by reducing the distance so that the tendency to bend in the knee joint just outweighs the tendency tohyperextend or, if the hamstrings has good mobility, by using the following trick: bring your bottom so close to the wall that the tendency to hyperextendstill occurs but you can hold a rolled-up blanket with the back of your knees with the knee joint minimally bent without any strain.

Emerging from an attitude

Question:

Why is it „bad“ if I come out of a posture uncleanly after standing in it for a long time?

Answer:

Assuming a posture often already reveals how you will stand; coming out of it usually shows even more how you have stood. When a posture is assumed, the center of gravity changes and internal and external moments also change. The person must perceive and compensate for this as accurately as possible by making and implementing decisions on (changing or initiating) muscular activity based on their physical experience and perception(proprioception) and their cognitive evaluation. This sounds complicated, and in detail it is; however, when an exercise is performed for the umpteenth hundredth time, many of the necessary actions and reactions have largely taken on a life of their own, i.e. they run „automatically“ without requiring conscious control or concentration. If a less experienced person performs an exercise incorrectly and unsteadily, this indicates that

body perception(proprioception) is insufficiently developed or
cognitive processing is faulty (rarely due to inability of the brain, mostly due to lack of experience/practice) or
the ability to develop large but finely dosed muscular strength is inadequate or the ability of muscles to allow certain angles in joints (stretching) or
citta-vrtti disturb these factors.

These factors are of course not present by chance, but are in a sense a structural flaw that will lead to the position itself not working well. In other words, it may look good to the untrained eye from the outside, but the experienced teacher may still recognize the deficiencies. What’s more, the right things are not happening in the body, or are happening to an insufficient degree. There is nothing to suggest that structural deficiencies can be remedied in 30 seconds to 2 minutes, so the condition described will usually persist throughout the entire exercise and, depending on the type of deficiency, will also affect the next postures.

On the other hand, weaknesses when leaving an exercise indicate that a posture is only apparently well executed. By disturbing the balance present in the exercise when leaving it, the above-mentioned factors to be developed, such as body awareness, cognitive processing and the ability to develop finely dosed strength, are once again at work in order to ensure a new state of balance (e.g. tadasana after an exercise) and, above all, an orderly transition to it. That’s why „bad“ here means „caught“.

A good example of this is assuming a posture such as parivrtta trikonasana or parsvottanasana. If the performer bends the pelvis and upper body forward with the attitude „reaching the floor with the hand is my salvation – then I can’t fall over“, it can be said that they will probably not be able to stand stably. In particular, he will not be able to remove his hand from the floor in the short term without falling over or at least wobbling very noticeably. Briefly removing the hand from the floor can therefore be considered a good test.

Exercises that you are not allowed to practise (any more)

Question:

I have heard that you are not allowed to practise the exercises in which „nothing more happens“.

Answer:

The following applies to all yoga poses: if no effect can be felt (anymore) and if no new challenge is in sight or possible, the exercise should not be practiced (anymore), at most from time to time to test the status. The reason is as follows: if no stretching or strengthening (usually the first) is noticeable in an exercise, nothing positive will happen. At most, the joint structure (possibly cartilage, usually ligaments) will wear out, as is the case with hyperextended elbow joints. This should be avoided at all costs. Ligaments stretch much more slowly than muscles. In contrast to muscles, they do not have the ability to contract again after stretching, so that stretching of the ligaments is essentially purely summatory (today a little plus tomorrow a little plus the day after tomorrow plus … ultimately results in an unstable joint), i.e. hardly reversible. Muscles behave differently: after intensive stretching, the stretching of the muscle affected the day before is worse the next day, until the performer has restored the status of the day before after a few minutes of practice.

Muscles shorten through every type of use to a corresponding extent! They shorten more through great exertion and frequent repetitive movement, and relatively little but not at all through intensive stretching (which, according to yoga, is never completely passive, in the sense that the muscle does not have to exert any force during stretching). Another reason is the need to maintain tone balance in the joints. Continued stretching without any perceptible effect would reduce the tone of the muscle almost indefinitely. Continued reduction of the tone leads to unbalanced pressure conditions in the affected joints, even to the point of instability, as manifested, for example, in a patella slipping out to the side.

Do „yoga muscles“ look different

Question:

Is it true that muscles practiced the yoga way look different from other muscles?
Are there any other differences?

Answer:

Yes, in the sense that they have a low resting tone and possibly a greater length at rest and only increase in tone when stressed and precisely to the extent of the stress. In general, a muscle trained in the yoga style will be long and flat at rest, the exact opposite of a muscle trained in the bodybuilding style.
There is an important advantage for yogis: the muscle has a much larger area of contact with neighboring bones, which is crucial for the „nourishment“ of the bones through the pressure of the muscles. Furthermore, the human metabolism is less challenged as less energy is required to maintain the basic tone of the muscles, which – it can be assumed – puts less strain on the body.
The „interpolation theorem“ states that if a monoarticular muscle is able to control a joint at two angles x and y in the three types of contraction(eccentric, isometric and concentric) and thereby exert a moment M in the joint, it is also able to do so at all angles between x and y. Any discomfort occurring between the two angles is generally due to the overstretched joint. Since hatha yoga has the ability to train all muscles even at the most „impossible“ angles, i.e. at minimum and maximum sarcomere lengths (in the angular range of minimum and maximum contraction, by length, not by strength) in the joint or joints involved, everything works all the better at normal angles. Our exercise practice also helps the muscle to „adapt longitudinally“, i.e. intensive work in long sarcomere lengths stimulates it to increase the number of serial (consecutive) sarcomeres (!). This results in a slight increase in muscle performance, i.e. an increase in maximum force development and maximum (unloaded) contraction speed, as well as a reduced risk of injury.

Cramp in the neck / trapezius – FIRST AID BOX NECK TENSION

Question:

I am prone to tension or cramping a) between my neck and shoulders and b) in my neck itself.

Answer:

The situation here is similar to the previous one. However, we can work the trapezius a little more easily here. As these are postural muscles (of the head and the shoulder), they require longer work through asanas, i.e. they need to be held for longer. Furthermore, we cannot necessarily start stretching immediately, depending on how hardened the muscles are. It is better to let the muscles work well first, which increases their willingness to be stretched. The headstand is of course ideal for a longer ‚warm-up‘ as it can be held for a long time. We are able to vary the angular range of the muscle’s work somewhat via the exact point on which we stand. In general, if your neck is tense, you should never stand too far towards the forehead, as this would encourage the neck to spasm, but rather go a little further back from the usual point. After a longer headstand, we can start to stretch the muscle. The shoulder stand with its relatives is suitable for this: supta konasana, halasana, karnapidasana (in order of increasing effectiveness on the neck muscles)
This is most likely the trapezius. This is not exactly easy to „treat“ as there is hardly any effective way of stretching it, especially the middle section. One such option would be to move the shoulder head away from the neck, for example. This is not anatomically possible. Alternatively, you can try to move the neck away from the shoulders, which also works unilaterally, at least for the upper neck area. Nothing can be done in this way for the horizontal areas further down. But then there’s another trick: don’t stretch by moving your body, but – similar to a masseur – by applying physical pressure across the direction of the muscle fibers. In this case, this means pressing on the trapezius from above. This muscle is more of a holding muscle, so it takes much longer to stretch, and hardly anyone would want to press on this muscle from above for that long. For this reason, we simply place the person concerned in karnapidasana on two rolled-up mats that lie on the floor at right angles to the trapezius and therefore parallel to the spine, right next to the neck. This is a somewhat unfamiliar pressure at first, but can generally be held for a long time and usually promises some relief after the first 3-5 minute session.

This is a first aid kit in which you should find something helpful for most cases:

karnapidasana
karnapidasana on diverging rolls
garudasana upper half of the pose with the head tilted forward and, if necessary, slightly to the side
gomukhasana upper half of the pose with the head tilted forward and possibly slightly to the side
Swivel seat with head tilted forward if necessary
maricyasana 1 also here with the head tilted forward and slightly to the side if necessary
maricyasana 3 also here with the head tilted forward and slightly to the side if necessary
Start with a shorter headstand and notice the effect
Shoulder stand with shoulder support if necessary
Head tilting with or without pulling hand
Press your head to the floor
Dumbbell walk with adequate weight until the finger flexors set a limit
Passive sacapula depression with dumbbells
Press your head to the wall
Press your head to the floor
Press the forehead to the floor
Press the forehead to the wall
lying head rotation

Philosophical literature about yoga

Question:

What literature is worth reading if you are interested in what is „behind yoga“?

Answer:

the „Bhagavad Gita“
the „Yoga Sutras (Sutras) of Patanjali“ in various translations and commentaries, e.g. by A. A. Bailey, B.K.S. Iyengar, Deshpande
Furthermore, some more recent works on yoga can provide good information: e.g. „On Yoga“, Mircea Eliade

Suitable and unsuitable forward bends

Question:

I have heard that certain forward bends are not so suitable for beginners.

Answer:

It is true that the original version of e.g. pascimottanasana, ardha baddha padma pascimottanasana, tryangamukhaikapada pascimottanasana and janu sirsasana do not make sense for very immobile beginners, as the gravitational effect of the upper body is completely different to that of more mobile people. People who are immobile in the backs of their legs often do not bring their pelvis into a vertical position, but instead slant backwards and upwards. This causes the upper body to pull backwards. As a result, there is little hope of straightening the pelvis before the weight of the upper body can be used to stretch the legs.

In mobile people, the pelvis tilts forwards effortlessly and the upper body can move forwards (downwards) all the more. The ability to hold the pelvis vertically without the help of the hands can be considered a prerequisite for seated forward bends, but even then there is often still a very long way to go. One way to achieve reasonable work in seated forward bends is to pull on a belt which, running around the soles of the feet, allows you to stretch the back of the legs.

The gravitational effect of the upper body can be used much more favorably in standing forward bends, so with a straight pelvis (and for this consideration: straight back) the weight of the upper body would be 100% usable, with rounding of the back and further or less forward bending correspondingly less. More precisely: the closer the angle of the connecting line between the center of gravity of the upper body and the center of rotation of the flexion in the hip joint is to the horizontal, the more the weight acts as an extension in the back of the leg. Therefore, uttanasana, prasarita padottanasana and parsvottanasana are ideal at the beginning because of the stronger effect on one side. Also suitable: the 3rd warrior pose.

Commutativity (sequence interchangeability) of individual movements

Question:

Could it be that sometimes it doesn’t matter in which order I perform the individual movements that make up a posture?

Answer:

This is quite correctly observed. The movements from which a posture is built up are not commutative (interchangeable in sequence) in several respects:

the result in terms of the posture adopted is not necessarily the same, i.e. the first of two interdependent movements can be performed in full and the second can only be performed to a limited extent. One example is the tilting of the pelvis(flexion in the hip joints) and the lowering of the heels in the head down dog position: if the lowering is performed first, the pelvis cannot be tilted as far as if it were tilted first.
The sequences given in this book for assuming a posture avoid undesirable or pathogenic effects such as „dead“ weight in joints or destructive moments as far as possible. An example of this is the transition from downface dog to upface dog: because the body is already pressed backwards to the maximum before the transition and this is maintained during the transition, there is no moment in which „dead“ weight would occur in the wrists, in contrast to the sequence: first the transition, then the pressing backwards.
the muscular work performed up to the completed posture can vary, or at least vary in intensity, depending on the sequence.

Pain in the knee in uttanasana or other standing postures with one leg extended

Question:

In uttanasana, but also in parsvottanasana, trikonasana and ardha chandrasana, I have pain in my knee.

Answer:

Pain in the knee can be caused primarily by hyperextension of the knee joint, but also by a Baker’s cyst, even when performed correctly; the two cases must be differentiated: Baker ’s cy st pain is localized on the back of the knee, usually quite central; the pain caused by hyperextension can occur on the back as well as on the front, mostly under the patella.

The Baker’s cyst is a phenomenon (not a separate entity) based on internal knee damage such as meniscus damage, in which synovia (joint fluid) escapes from the knee joint into one of the bursae on the back of the knee; the cause is usually increased production of the fluid(synovia) as a reaction to meniscus damage. Pressure is usually felt in the hollow of the knee. Although the Baker’s cyst as a symptom is less serious than the cause, complications can occur in rare cases, particularly thrombosis due to a restriction of venous return flow. For the postures, this is much more of an unpleasant pressure than a risk.
Overextension is defined as an angle of more than 180° in the middle joints of the extremities, i.e. the elbow joint or knee joint, see also the article on joint overextension, which is also available as a PDF due to its scope and relevance. Hyperextension is a common phenomenon in both the elbow and knee joints. It occurs in varying degrees of severity and is much more common in women. Not everyone who can hyperextend the knee joint feels pain and the degree (angle) of hyperextension is no indication of whether pain can be felt or not, even if the probability increases with larger angles. In the knee joint, hyperextension is often the result of a combination of an innate ability to hyperextend the knee joint in conjunction with a tendency to increase this, which controls and changes the position of the pelvis and knee joint due to a weakness of the muscles in the front and back of the thigh, i.e. the hamstrings on the back and the quadriceps on the front. Weakness in one or the other tends to exacerbate an existing hyperextension and to develop a hollow back (hyperlordosis of the lumbar spine). The pain that occurs can affect the back of the knee as well as the front, in which case it is usually located below(caudal) the kneecap. The pain felt during hyperextension is not a muscular stretching pain and does not indicate a physiological phenomenon, which is why it should be avoided. This means that the knee joint should only be stretched so far that this pain does not occur. One possibility is complete muscular control of the joint, so that a balance of forces can be established and maintained in the knee joint at a pain-free angle from a balance of forces in the front and back of the leg muscles. This option is certainly the more difficult one. Even with the analogous phenomenon of hyperextension of the elbow joint, many people are initially unable to use the arm biceps to establish and maintain a balance of forces. The leg is more grossly motorized than the arm and there is generally less body awareness here, which is why another option is often the more successful one, although this cannot be applied equally successfully to all postures: Bend the knee joints wide in uttanasana and press the upper body onto the thighs. Then stretch the knee joints further without losing the pressure of the upper body on the thighs (ideally, it would not even decrease) until the maximum reasonable stretch sensation of the hamstrings is reached. As a rule, the stretching capacity of the hamstrings is not sufficient to achieve painful hyperextension with this procedure.

On the subject of overstretching, see also the FAQ entry on stretching the joints

Inability to perform squats / utkatasana due to stiff calf muscles(soleus)

Question:

I can’t seem to do squats / utkatasana because of stiff calf muscles. From a certain bend in the knee joint I always fall backwards!

Answer:

This actually exists. Depending on how it is performed, the squat / utkatasana is a pose with a reasonably wide but not particularly deep (distance between „front“ and „back“) physical base of support (in mathematical terms, this is the convex hull of the weight-bearing points on the floor). This means that the forward/backward balance is always an issue, especially as there is often a lot of weight on the shoulders (or elsewhere). For a static stance, i.e. one that is held for at least a moment, the center of gravity must lie in the physical support base, and for good stability it must even be halfway in the middle (in terms of length AND width of the physical support base) (further considerations and factors refine this statement!).

So that the squat does not become excessively strenuous for the calf muscles, the center of gravity must be shifted slightly from the front to the back towards the heel, but not too much, as otherwise there is too little room for balancing against tipping over backwards. As the name of the posture „squat“ suggests, the aim is to bend the knee joint (usually relatively far). The load of the upper body and the additional weight must be somewhere vertically above the physical support base. If you now start to bend the knee joints, both the thighs and the lower legs move forward, the angle in the knee joint of originally 180° becomes significantly smaller and the further the knee joint is bent, the further forward it moves. The lower leg must bend further and further towards the ground as the knee bends.

The original approx. 90°, i.e. an approximate vertical, then easily becomes 60° and much less, depending on how far the knee joints are bent. If the knee joints are bent 90°, the lower legs are already at an angle of approx. 45° to the ground. In order for the lower legs to reach such angles, the calf muscles on the back of the lower leg, namely mainly the soleus and gastrocnemius muscles (I will leave out the lower-ranking plantar flexors here for the sake of simplicity), must have the appropriate mobility.

Both muscles can be tested relatively easily: the m. soleus is single-jointed, i.e. it only spans the ankle joints because – attached to the proximal dorsal lower leg – it pulls the foot into plantar flexion via the Achilles tendon on the heel bone (calcaneus). You can test it quite simply with the foot on the ground and the knee joint clearly bent by trying to tilt the lower leg as far forward as possible towards the ground, whereby the heel must not lose weight, let alone lift off.

The gastrocnemius muscle, on the other hand, has two joints; it attaches to the calcaneus from the distal dorsal femur and also via the Achilles tendon. Due to its position and the ability of muscles to only contract, but not actively extend (in length), one can immediately conclude that in addition to plantar flexion in the ankle joint, it also flexes the knee joint. To test his mobility, you need to extend the knee joint and tilt the lower leg forwards towards the ground, again without reducing the weight of the heel. If you then come to the same result – which is not particularly likely – the only possible conclusion is that it is at least as mobile as the soleus muscle when the knee joint is extended.

In all likelihood, however, the lower leg will be able to tilt (significantly) less forward when the knee joint is extended. Whichever of the two sets the greater restriction in squat practice, squats require angles that are incompatible with significantly shortened calf muscles. You could let the heel come up – but this would come at the cost of a blatant lack of stability and an unequal increase in work (not stretching, but effort, i.e. exertion) on the calf muscles – or, to rule out these two factors, you could place the heel on a corresponding elevation, which in turn increases the possibility of cramping of the shin muscles.

Neither has anything to do with real, clean squats. In order to improve the flexibility of the calf muscles, appropriate stretching exercises are required. The following are suitable for the gastrocnemius muscle: uttanasana with the ball of the foot on a block, warrior 1 pose, dog pose head down, especially in the one-legged version and with one leg raised, as well as parivrtta trikonasana. If the soleus is more severely affected, the dog pose headdown, for example, can help: stretch from bent knees, but preferably downface dog in the one-legged version or with one leg lifted, as well as warrior pose 1 with the back leg bent.

To return to the initial question, yes, from a certain angle of flexion in the knee joint, the lower leg cannot tilt any further forwards in the case described. If the knee joint is flexed further anyway, the hip joint describes an arc backwards and downwards and the center of gravity runs backwards beyond the heel out of the physical base of support: you tip over backwards!

Sport makes you stiff?

Question:

I have been doing yoga for some time and have heard/realized that exercise makes you stiff, should I stop and just do yoga?

Answer:

It is true that most sports can and in practice do stiffen the body through countless repetitive movements, especially those with a small range of motion(ROM). In addition, some sports are not exactly good for the joints, especially those involving contact with opponents, which inevitably leads to unphysiological movements and often to injuries to the muscles or joints as a result.

On the other hand, according to current knowledge, endurance sport is the best prevention against diseases such as heart attacks, strokes, arteriosclerosis, vascular dementia, diabetes and other diseases that are less high up in the statistics. It is not necessarily advisable to do without this effect. If you want to improve your flexibility with yoga, you will of course make slower progress if you do sport at the same time and experience some exciting interactions, but the two are basically compatible.

Altered curvature of the spine

Question:

I have a change in the curvature of my spine (observed myself or diagnosed). Is this bad? Do I need to do something about it? And what?

Answer:

The spine is divided into five sections, from top to bottom:

Cervical spine: cervical spine with 7 vertebrae, the head rests on the first cervical vertebra (the „atlas“), physiologically lordotic (convex from the front)
Thoracic spine: thoracic spine with 12 vertebrae to which the ribs are attached, which are connected to the sternum at the front and form the „rib cage“; physiologically kyphotic (convex from behind)
Lumbar spine: lumbar spine with 5 vertebrae, physiologically lordotic
Sacrum: 5 fused (evolutionary) former vertebrae
Coccyx: 3 former vertebrae that have grown together (developmental history)

The number of vertebrae varies slightly; some people have variations, particularly in the area of the sacrum and lumbar spine, and up to two more vertebrae (true or parts of the sacrum). The sacrum and coccyx each have no flexibility in themselves and represent a coherent bone. Apart from and presumably largely independent of the number of vertebrae, many deviations from the physiological shape of the spine can be observed in practice in the sagittal plane alone:

Hyperlordosis of the lumbar spine
Hypolordosis of the lumbar spine (hypolordosis, steep position or kyphosis)
Hyperkyphosis of the thoracic spine
Hypokyphosis of the thoracic spine (hypolordosis, steep position or kyphosis)
Hyperlordosis of the cervical spine
Hypolordosis of the cervical spine (hypolordosis, steep position or kyphosis)

In most cases, spinal deformities do not occur in isolation. During the transition to an upright gait, the spine has adapted from a single C-shape to a double S-shape in order to take account of the changed load conditions, to implement a buffer function for the skull and to provide the lungs with enough space for easy filling and the atria of the heart with sufficiently low ambient pressures for easy filling.

Any deviation from this form is potentially pathogenic, first and foremost for the musculoskeletal system itself, but also for organs and the nervous system. A change often occurs over time and is a reaction to an unhealthy posture or muscular weakness. Other secondary changes often follow with a time delay. As a rule, however, symptoms appear at the onset of the first change, which are an alarm signal and should prompt diagnosis and intervention. For example, weakness of the quadriceps or the hamstrings can be the cause of a chronic hollow back tendency, which consecutively hyperkyphoses the thoracic spine and hyperlordosis of the cervical spine.

After years, this often results in disc disorders, particularly in the lumbar and cervical spine, as well as a possible pronounced tendency to back pain and tension headaches, and after the onset of disc disorders also neurological deficits or neuroradicular pain. If the hyperkyphosis becomes too pronounced, the lungs can no longer expand properly, their vascular resistance increases, and consequently the heart can be affected and become hypertrophied and insufficient over time. In cases where the shape of the spine has changed, the accompanying muscles have adapted to the posture as well as possible in a compensatory manner – but usually not without causing symptoms themselves – and must be retrained over time to enable and even more so to support a healthy posture.

In the case of a hyperlordosis of the lumbar spine, for example, there is usually a significant shortening of the hip flexors, which must be reduced with hip-extending postures ( upface dog, hip openings 1, hip openings 2, hip openings 3, various backbends, warrior position 1). Hyperkyphosis of the cervical spine would require the ability of the spine to straighten up to be restored, which may mean stretching the rectus abdominis (and possibly also the oblique obliqui abdominis) and the intercostal muscles:

and the strengthening of the erector spinae:

The transformation towards a healthy posture will take time and effort and will not necessarily be straightforward and completely free of accompanying symptoms. Both too weak quadriceps and too weak ischiocrurals can ultimately have a detrimental effect on the shape of the spine by leading to hyperlordosis of the lumbar spine, but in different ways:

If the hamstrings is too weak as a hip extensor and the extensors located in/on the pelvis are not used (including the pomus muscles), the pelvis is not straightened sufficiently, resulting in a hollow back. On the other hand, since they exert too little traction on the back of the knee joint, it will tend to hyperextend and the support of the knee joint in the direction of extension will be left to the ligaments and capsules.
If the quadriceps are too weak, the person concerned will try to avoid using them. If a certain degree of hyperextension is possible in the knee joint, the person will try to remain in this position so that the knee ligaments instead of the muscles maintain the position of the knee. The affected person therefore tries to avoid using the quadriceps completely when standing, which would be normal if the center of gravity were behind the knee joint when the knee joint is very slightly bent. In order to achieve a certain stability of the upright stance without using the quadriceps, the pelvis is tilted slightly forward, causing the center of gravity to shift slightly in front of the knee joint and the knee joint to lock into subjectively and objectively stable hyperextension, with the ligaments and capsule bearing the load instead of the quadriceps. The possibility of hyperextension of the knee can become more pronounced as a result of this behavior.

Pathomechanisms are also common in the case of weak or significantly shortened muscles in the hip joint:

Another pathomechanism is found comparatively frequently in young members of the female sex: the attempt to relieve the back muscles of the lumbar spine and the extensors of the hip joint (including the pomus muscles) when standing by engaging the pelvis in maximum extension, resulting in hypolordosis or a steep position of the lumbar spine. As an exceptionally strong muscle group, the hip flexors or the lig. iliofemoral hold the pelvis and upper body slightly in position without being significantly stretched. This change will also propagate towards the head and can lead to a compensatory hyperkyphosis, as the center of gravity of the upper body moves behind the hip joints, so that the center of gravity still remains in the frame. Of course, this is also pathogenic.
Shortening of the hip flexors leads to increased flexion in the hip joints and thus directly to hyperlordosis of the lumbar spine so that the gravity perpendicular does not move too far forward. Consequently, the kyphosis of the thoracic spine and the lordosis of the cervical spine will also become excessively pronounced.

A shortened gastrocnemius can also ultimately cause changes in the WS

In order to achieve an upright posture despite the resulting pointed foot tilt in the ankle, the knee joints are flexed and the pelvis is tilted forward for an appropriate center of gravity. In practice, however, the soleus is much more likely to be the one that causes a pointed foot inclination; this does not react to flexion of the knee joint.

There are various criteria for considering the human muscular system: strength endurance capacity, gravity capacity, speed capacity, flexibility (stretching capacity) and basic tone. When we talk about weak quadriceps above in simplified terms, we are referring to insufficient tone, insufficient strength endurance in relation to the opposing forces. The muscle is therefore often not meaningful in its „built-in“ state without its synergists and antagonists. Some of the altered muscle tensions described above can, if they are only pronounced on one side, lead to pelvic obliquity and thus scoliosis. However, unilateral shortening of the adductors and abductors of the hip joint is also responsible for this

Scoliosis

Question:

I have been diagnosed with / observed to have scoliosis. What can I do?

Answer:

Since the chapter on the treatment of scoliosis is too complex for a presentation in this framework, at least this much at this point: scoliosis can have various causes, which must first be clarified and then remedied, here are just a few examples that exclude the entire range of more serious diseases of the musculoskeletal system, in which secondary scoliosis occurs, such as trauma, rheumatic and chronic degenerative diseases:

Chronic subluxations in a joint of the lower extremity: hip joint, knee joint, (upper) ankle joint
One-sided shortening of the hip flexors, causing a pelvic torsion and possibly also a rocking gait; the Mikulicz lines lean to one side against the vertical
unilateral shortening of the abductors or adductors
Unilateral weakness of the abductors: leads to Trendelenburg’s sign with very low strength (unavoidable tilting of the pelvis to the contralateral side of the weakened side), with only moderately weakened strength to Duchenne’s sign (waddling gait: shifting of the center of gravity to the lateral side when walking to relieve the abductors ipsilaterally of the weakened abductors)
One-sided loads

Scolioses can develop from the bottom up (the first four causes describe scolioses that develop „from the bottom up“, the last often develops in the opposite direction from the top down, including the frequent or prolonged carrying of a load on one arm, such as a school bag, which causes damage to the child’s or adolescent musculoskeletal system, as well as occupational conditions that cause a load to be held or moved countless times with the dominant arm. Scoliosis tends not only to displace vertebrae in the transverse plane but also to twist them (partly due to the muscles between the transverse and spinous processes). This then manifests itself in areas of the body that are displaced forwards or backwards in relation to the contralateral side, usually recognizable in the thorax area. Therefore, scoliosis is often also recognizable from the front instead of only when looking directly at the back or spine from behind. Once the aetiology has been clarified and the underlying causes eliminated as far as possible, yoga postures can be used to intervene accordingly; shortened muscles may need to be stretched and weak ones strengthened, but above all strengthening postures have a positive effect on the autochthonous back muscles, see also the recommendations in the entry on weak backs.

Irritation of the sciatic nerve

Question:

I sometimes have pain in my bottom or outer upper thigh when bending forward, but it doesn’t feel like a stretch.

Answer:

If it does not feel like stretching and is clearly associated with corresponding movements, mainly flexion in the hip joints, it may well be an irritation of the ischial nerve. Exposure to cold, traction, prolonged dampness or even pressure, e.g. when sitting for long periods on seats that are too soft and on which the majority of the body weight does not flow over the ischial tuberosities. Classic triggers in the area of cold and dampness include sitting on cold surfaces (e.g. stones, metal), wearing damp clothing on the legs or buttocks and cycling with thin leg clothing. The susceptibility to this is very individual and depends not least on the amount of protective fatty tissue. The pain is usually subtle, intermittent and triggers are difficult to identify. Cold and pressure worsen, warmth is good.

Predicting when the irritation will heal is difficult and depends very much on avoiding the irritating factors. Of course, a nerve root compression syndrome must also be considered in the differential diagnosis, which would then usually be the result of an intervertebral disc injury, but also, for example, spondylolisthesis (spondylolisthesis), facet syndrome or spinal canal stenosis. In these cases, however, forward bending often improves instead of causing pain.

See the overview article on the topic „I have sciatica…“ with a rough differential diagnosis.

Poor forward tilting of the pelvis (shortening of the back of the leg)

Question:

My tank tilts forward so unspeakably little, why is that? What can I do?

Answer:

If the pelvis cannot tilt far forward in the hip joints in a forward bending posture (in the sense of flexion in the hip joints), the hip extens ors on the back of the leg, which are also knee flexors, are presumably primarily responsible, with the hip extensors in/around the pelvis (e.g. the pomuscles) possibly also having a secondary role. If there is a clear sensation of stretching in the back of the leg, the hamstrings is identified as the limiting factor. It would be corroborating if the stretching subsides significantly when the knee joint is bent slightly. If it does not occur or occurs very moderately, it must be clarified whether the gravitational effect of the upper body and the use of the hip flexors together are not yet able to tilt the pelvis enough or whether – which is less often the case – the hip extensors in/on the pelvis (including the pomus muscles) are actually the limiting factor. The latter can often be easily determined with postures such as half lotus forward bend, as the hamstrings largely plays no role there due to the bent knee joint.

In the case of the former, the lack of strength to tilt the pelvis, the use of a supporter helps to demonstrate this by trying to tilt the pelvis further into flexion at the sacrum with increasing force, which must lead to increased stretching sensations in the back of the leg. Frequent prolonged sitting and sports with vigorous running movements can promote shortening of the hamstrings. The standard approach is then regular standing forward bends; seated bends should generally not be performed, see here. In addition, postures to promote hip extension (upface dog, hip opener 1 and 2, 1st warrior position, various backbends) must be used to ensure that the hip flexors are not shortened by the forward bends!

If you also have an intervertebral disc disease, you cannot practise postures that cause the lumbar spine to become convex. In this case, deadlifts or the downward dog position with one leg lifted backwards against the wall are very helpful.

I supposedly have a hollow back. Is that bad? Do I need to do something about it?

Question:

I supposedly have a hollow back. Is that bad? Do I need to do something about it?

Answer:

The term „hollow back“ is commonly used to refer to hyperlordosis of the lumbar spine. As explained above, the lumbar spine physiologically has a certain degree of lordosis (convex bend from the front). If this degree is too small or too large, it will damage the musculoskeletal system in the long term and the damage may later extend beyond the musculoskeletal system. The typical causes of a hollow back have already been explained in another topic of this FAQ. In any case, attempts should be made to reduce or eliminate it. The long-term consequence of a chronic hollow back is usually that the muscles of the lumbar spine increase excessively in strength and mass (which would not be bad on its own) but also in tension. This in turn, together with the altered angles in the vertebral joints, leads to chronically increased pressure in the intervertebral discs between the vertebrae. Although the fluid-filled intervertebral discs distribute the pressure on their contact surfaces with the vertebral bodies as evenly as possible according to Pascal’s principle, fluid is squeezed out of the intervertebral discs during the course of each day under the weight of the body, which has to be absorbed again at night.

In general, a regular amount of exercise during the day helps the intervertebral discs to recover and reabsorb fluid and reduces degenerative processes. It is also clear that increasing body weight, particularly in the upper body, increases the pressure on the intervertebral discs and the risk of disc problems. If the intervertebral discs are chronically under increased pressure even at rest and at night, their ability to reabsorb the water pressed out during the day is reduced at night. This leads to a decreasing water content in the intervertebral disc and a decreasing ability to distribute the pressure evenly. In addition, the ability to bind water decreases with age anyway.

When the increased pressure and the loss of the ability to distribute pressure evenly have reached a certain level, the intervertebral disc begins to flatten and expand outwards in any direction beyond its intended shape. This is called protrusion. At this stage, the structural integrity of the disc, which consists of a gel-like core with the ability to bind water and a surrounding fibrous ring, is still preserved.

Nevertheless, the deformed disc can hit one of the spinal nerves emerging from the spinal cord and cause a nerve root compression syndrome by exerting pressure on it. This has the classic pain radiating into the leg and possibly also neurological symptoms such as loss of sensitivity or motor function in the thigh, lower leg or foot, as described as sciatica or lumbalgia. If the strain continues unabated or even increases, the fibrous ring will eventually tear at some point, with core material being pressed outwards to relieve pressure. This is called prolapse. The symptoms of protrusion and prolapse cannot necessarily be distinguished. In both cases, pressure on a nerve can trigger correspondingly pronounced symptoms. Further stages of degeneration and forms such as sequestration with contact between the vertebral bodies and crushing of the protruding part of the disc are possible.

If the intervertebral disc event occurs below(caudal) the end of the spinal cord, cauda equina syndrome may occur. The name comes from the nerves that fan out like a horse’s tail and emerge from the end of the spinal cord. This results in semi-symmetrical neurological deficits on the inner thighs (breeches anesthesia), but also affects nerves that supply organs in the pelvis. This is a neurological emergency that must be treated in hospital as quickly as possible before irreversible pressure atrophy (death of a nerve after too much pressure) occurs and the innervation of organs is destroyed. If necessary, pressure must be relieved surgically.

The other forms of disc damage are generally best treated conservatively (without surgery), whereby a clear interest on the part of the patient in their recovery and corresponding proactive behavior greatly promote prognosis and progression. Patients who are not very proactive, who do not (want to or cannot) reduce the stresses and strains that contribute to their condition and who do not actively participate in their recovery, particularly with exercise therapy measures, may have to undergo surgery if the pain is persistent and unbearable. However, surgery is definitely the worse choice compared to conservative therapy:

No structural improvements in the musculoskeletal system are brought about and, as a rule, the patient’s motivation to proactively take care of his recovery and health is much lower if he can consume a „solution“, this alone significantly worsens the prognosis
During the operation – albeit microinvasive today with the smallest possible incisions – back muscles are severed that are not available later to stabilize the back and protect the intervertebral discs. This further worsens the prognosis.

In practice, it has been shown that the decision for or against proactive conservative therapy is usually a directional decision and the surgical path usually establishes a long disc„career“, as the destabilization of the spine during surgery and the unimproved structural situation are predisposing factors for a further disc event, usually in the adjacent segment. Continuous medication with pain-suppressing drugs cannot be considered the treatment of choice because the drugs damage internal organs in the long term.

In this sense, the hollow back is a very serious risk factor as the start of a „disc career“ and should be tackled without delay, especially if other risk factors such as age, obesity or lack of exercise are also present. The variable risk factors such as obesity and lack of exercise should also be addressed at the same time. With regard to yoga postures, forward bending movements should be practiced to relieve and stretch the overstretched back muscles, and the mobility of the hip flexors must also be improved to a level that no longer poses a risk.

In the case of BACK HEALTH, there are also:

and further backbends with extension in the hip joint.

In the case of an existing intervertebral disc disease, only postures in which the lumbar spine remains stretched or extended may be practiced.

Stretched feet – upright feet

Question:

I know the dog position head up and also other positions from other traditions with outstretched feet, why do you put them up?

Answer:

In fact, there are several reasons for this. We want to design or interpret the postures in such a way that they lead to the greatest possible benefit. There are several reasons when it comes to the feet. First of all, we need to differentiate between whether the feet support body weight or not. Let’s start with the case that they do. This must be discussed separately for postures with extension in the hip joints and flexion in the hip joints. Let’s start with the former using the example of the upface dog. First of all, I need to indicate where the hands are pushing the body:

If I push my hands forward to push my body backwards, there is an unpleasant pull on the skin when my feet are stretched out and a flexion moment in the ankle that wants to get it out of the stretch. I therefore have to work against this moment with the muscles of the calf and sole of the foot, which are already prone to cramps, and this further increases the tendency to cramp. The question also arises as to what benefit the stretched foot should have in the posture: if it is to gain stretch, it would need more body weight acting on it, as is the case in virasana, for example, and better a moment that bends the ankle further plantar instead of reducing the flexion. If, on the other hand, I place the foot on the ball of the foot, the cramping tendencies in the calf and sole of the foot are eliminated, giving me the opportunity to stretch the calf (and a little of the muscles of the sole of the foot) according to the strength of the shoulder and forearms. Instead of constantly having to avoid cramp tendencies and therefore having to limit the use of energy, I have the opportunity to strengthen two weaker muscle groups on a stronger one and, if things go well, to stretch them at the same time. Weighing up the options described below (the better of the two), we choose this intelligent construction as the standard version of the upface dog.
If I push/pull the hands backwards to pull the body forwards, I get flexion moments in the case of the upright feet that bend the toes even further at the base joints and pull the heel forwards, i.e. pull the foot out of dorsal flexion. However, if I place the back of the foot on the ground here, in contrast to above, I get a moment in the ankle joint that stretches the ankle further and the skin on the back of the foot is not uncomfortably compressed. On the other hand, the forces acting on the extension in the hip joints are lower. This is a sensible variation, although it is inferior to the above solution with the feet upright and the body pushed backwards in terms of effectiveness, benefits and possible side effects. This is our inverted feet variation, which we regularly find can be practiced more intensively subjectively, but is regularly perceived as much more uncomfortable in the lumbar spine.
neither: probably the least intelligent solution, i.e. the one that makes the least use of the possibilities

Once the direction of the push is clear, the next step is to indicate where the wrists are.

In our standard upface dog variation, the wrists must be positioned just behind the shoulders. If they were in front of them, part of the ability to work intensively would be ruined because the body’s gravity would (also) push it backwards. In addition, the tendency to hollow backs would be greater. It increases with the distance between the heels and wrists. With the hands just behind the shoulders, the angle of dorsiflexion in the wrists is greater than in the other variation, which requires and develops good stretching with simultaneous use of strength.
in the inverted-feet variation, the wrists must be positioned just in front of the shoulders, again with the argument that the gravity of the upper body should not do any work for us. In addition, with the hands behind the shoulders, the work of the arms would be directed towards further increasing the dorsiflexion, which quickly becomes borderline for many, and with more vigorous work, any discomfort that occurs would intensify.

Another argument in favor of the upright feet is that, in the case of (one or both) halfway horizontal thighs, this enables greater hip extension in purely geometric terms compared to the outstretched feet, as the heels are higher.

Other considerations apply to postures with flexion in the hip joints: In the front of the leg(ventral side), in contrast to the back of the leg, there are no muscles in the lower leg AND thigh that extend the knee at the same time. In the back of the leg, the gastrocnemius muscle of the lower leg as the plantar flexor of the ankle also covers the knee joint as a flexor. This creates the situation in postures with an extended knee joint that flexion in the hip joints can result in a reduction in dorsiflexion in the ankle joint or vice versa. There is no analogy to this on the front of the lower leg; there is no lower leg muscle that dorsiflexes in the ankle joint and simultaneously extends the knee joint. This means that postures with flexion in the hip joints can also have a dorsiflexed ankle joint without losing an interesting or important possibility.

By the way, according to the construction of the human body (in analogy to the above considerations), the combination of extensive flexion in the hips and plantar flexion in the ankles is difficult to realize with a significant gravitational effect(this would be, for example, a toe-to-toe pose in uttanasana or a dog pose head down on the back of the foot or toes) or irrelevant without a significant gravitational effect(stretched feet in halasana or sarvangasana).

If we remember, we are still discussing the case where the feet bear significant weight. If this is not the case, we can choose between maximum dorsal flexion or plantar flexion or a „golden mean“, as no significant effect is to be expected due to a lack of external force. In the case of maximum dorsal flexion, there is a small possibility of stretching the calves with the foot lifts. However, given their strength, a cramp in the foot lifts is far more likely. If we choose plantar flexion, things don’t look much better in terms of the tendency to cramp. In addition to the cramping calves, the muscles of the sole of the foot also tend to cramp. The beneficial effect on the foot lifts is also very low. So the „golden mean“ is the best choice here, a foot as in tadasana, i.e. as in neutral zero. In addition, other poses stretch the foot lifts much better with less tendency to cramp.

Do I have to feel crooked or straight after correction?

Question:

Often, when I have been corrected, I feel more crooked than straight afterwards. Is that normal?

Answer:

Yes, probably! Quite simply, people base their perception of „straight“ on the muscle tension they feel. These sensations are part of what is called proprioception, i.e. the body’s own perception through internal sensory systems. This can result in a crooked posture if the mobility is uneven or the muscle tension is uneven. If I correct the person so that they look straight from the outside, they will feel crooked because they feel unequal tension in their muscles. The existing side discrepancies in the musculature that cause this behavior are often habitual, i.e. acquired through postural habits, including sleeping habits and occupational demands. If, for example, the monitor is positioned slightly to the left or right, this will result in a lateral difference. The neck then only feels „straight“ in a slight rotation. If you pick things up, you will tend to do so with your dominant arm. For most people, this is the right arm, which is why they are called „right-handed“. However, the dominant arm often also leads to a dominant leg, as picking up an object asymmetrically causes much less stretching sensation if the leg on the same side is placed forward and the pelvis is turned away from this leg. In this way, people who frequently pick up objects and do not perform any other asymmetrical activities would inevitably develop a side difference with a dominant leg on the same side as the dominant arm. People who travel a lot by car and frequently move the car backwards, for example out of or into parking boxes or spaces, will tend to turn their upper body backwards in the direction of the free interior space in order to have a good view, i.e. to the right in countries with left-hand drive vehicles. Over time, they will find it much easier to rotate to the right than to the left. Stomach sleepers, for example, will tend to turn their head to one side, with or without a supporting arm. In both cases, the muscles of the cervical spine will adapt to this and develop a sideways shift, so that even for these people the objective central position is not the perceived one. These are just a few examples of the etiology of side differences.

Lumbago (lumbago)

Question:

I have lumbago. Can yoga help me?

Answer:

Yes, lumbago is a pain phenomenon in the area of the lumbar spine, or more precisely the muscles that accompany it. There is an acute form, which is extremely painful, and a chronic form, which can flare up again and again to varying degrees. The acute form feels sharply stabbing and highly painful, is relatively clearly localized with a certain longitudinal (spine-parallel) radiation and is often described by sufferers as feeling like a knife in the back. The smallest movements can trigger maximum pain, especially small turning and tilting movements. It is probably a neuromuscular malreaction that completely cramps a muscle, affecting smaller muscles in particular, which synergistically support larger back muscles under stress (movement or posture) when these are exhausted or overstrained. In the chronic form, the relationship between constitution and strain is so unfavorable from time to time that it flares up. As this is a purely muscular/neuromuscular phenomenon, in contrast to lumbalgia or sciatica, which cause pain due to nerve root compression (usually due to disc damage), it is relatively easy to counteract the cramping and associated pain by stretching the affected muscles, even if the pain is quite noticeable in each case.

As a general rule, bed rest and physical inactivity are not recommended in cases of lumbago. The possible range of movement and – in relation to the individual movements – the extent of movement should always be exhausted. Longer periods of sitting in the same position should be avoided. As a general rule, the back should be in physiological lordosis when sitting, whether sitting freely or – when strength is exhausted – leaning against the back. While sitting, the lumbar spine should be moved in both directions(flexion and extension) from time to time.

Activities such as running(jogging, running) can overstrain the back so that it becomes even more tense afterwards or even during the activity. Walking, on the other hand, is clearly indicated, the more vigorous, the better. The alternating moments in the lumbar spine, which result from the three-dimensional oscillation of the pelvis due to the propulsion from the legs, have a metabolism-promoting and tone-regulating effect on the regional musculature. However, a little stretching training in all directions should always be carried out after major exertion in order to reduce the muscle tone – which is extremely excessive in parts. The rule is: the stronger the step, the better.

If topographically possible, walking uphill at a brisk pace should be part of the rehabilitative training. Stair climbing training is also very helpful. Depending on the severity of the pain and the triggering of the pain, you should first work with one step per stride for a while (see description in the exercise), but as soon as possible you should increase this to a further step – i.e. two per stride – and possibly to three per stride as the lumbago progresses. Please note that a) the movement should not be performed with momentum, b) there should be as little plantar flexion as possible in the ankle joint and c) as much force as possible should be applied to the hip extensors so that their force is converted into corresponding moments in the lumbar spine that act in the regional musculature. The training can be intensive and sweaty, but afterwards you must ensure that the muscles do not cool down, i.e. change into dry clothing or take a warm shower/bath. The physical rest afterwards should always be interrupted by exercise; in the days following the onset of lumbago there is enough need for beneficial exercise anyway. This applies all the more as not only the originally affected muscles are hypertonic, but also other secondary muscles that have been used and strained in an unusually intensive manner to avoid pain.

If one assumes that lumbago does not usually affect the spinal or interspinal areas, but rather the transversospinal system belonging to the medial tract and here, for example, the mulitifidis or parts of the lateral tract such as the caudal area of the longissimus, then the pain phenomenon does not react strictly to flexion of the spine with pronounced stretching pain of cramped muscles or to extension of the spine with the sensation of cramp-like exertion, but even more pronouncedly to flexion with an additional component of rotation or lateral flexion, which is also shown in practice in the form of reports from those affected. These also describe the pain phenomenon not as particularly superficial but moderately profound. It can therefore be assumed that muscles other than the affected muscle perform the extension in isolation and that an additional movement component or a different degree of flexion or extension of the spine responds better to the affected muscle among all its synergists. It will certainly not be possible to completely isolate it. The postures mentioned above have therefore proven to be helpful, including postures that strongly flex the lumbar spine, sometimes with a rotational or lateral flexor component. As beneficial as stretching is, strengthening the local musculature in all movement components should also be included in rehabilitative training for lumbago where possible, especially as structural weakness (in addition to imbalances) is often a contributing cause. Classic strength training such as squats or deadlifts are also indicated here. After all, these exercises involve complete muscle chains and therefore also have a regulating effect on muscles that may be overloaded or tense due to pain avoidance. However, you are also welcome to think beyond the well-known classic exercises.

Helpful are:

janu sirsasana in the „parsva“ variation
parsvottanasana
parivrtta trikonasana, also dynamic entering and exiting
karnapidasana, also variant „Curls“, as soon as possible
parsva upavista konasana
hip opener 1 here, in contrast to the aforementioned poses, the pain is not provoked
malasana Forward bend
parsva uttanasana
parsva karnapidasana
Extend lumbar spine lying down
Press heels to the floor
Roll up the back
Alternate weight-bearing on the lumbar spine in supine position

The postures are adopted in such a way that the pain is induced to a degree that is just about tolerable. Drugs that prevent or reduce the perception of pain (analgesics) are out of place in this therapeutic approach, as the pain must be well perceived and allowed to take effect in doses! If the posture is held for a while, the pain tends to subside slightly. In acute cases, the specified postures are usually difficult to adopt and only to a limited extent and cause the pain typical of lumbago very clearly. It may be necessary to work with aids to enable a stable, longer posture, for example by supporting the patient with the arms. It is usually possible to reduce the pain by 95% within two to three days, although this requires regular practice (several times a day) and enduring the significant pain that occurs. After a few days, hip extensions should definitely be practiced again, as the hip flexors are likely to have contracted during all the forward bends, which may predispose to new back pain. After about half a week (depending on how things go), start to include head-up dog pose in your program again, and if it works relatively well (also in terms of how you feel afterwards!), practice urdhva dhanurasana (back arch) again a day or two later. Basically, the constitution of the back is not optimal or rather far from optimal if there is a predisposition to lumbago. Regular strengthening of the back (not just the extension function of the spine but all three dimensions of movement) while simultaneously maintaining or, better still, increasing the flexibility of the lumbar spine in particular is required for a longer period of time; in particular, the flexibility of the lumbar spine region in the direction of kyphosis should be checked and ensured at regular intervals by rolling up the back segment by segment in the supine position. A certain degree of lateral flexion(lateral trunk flexion) should also be maintained.

Pain / tension in the lower back – FIRST AID BOX LOWER BACK

Question:

I have acute / frequent pain / tension in my lower back. What can I do?

Answer:

{Due to the scope and relevance of this article, it is also available as a PDF}

In most cases, „general“ back pain in the lumbar spine is less pronounced than the lumbago described above, but it is all the more common. Together with complaints in the cervical spine, they represent the vast majority of back complaints. This is presumably not least due to the significantly greater mobility of the cervical and lumbar spine (cervical/lumbar spine) compared to the thoracic spine (thoracic spine), where the rib cage and its functionality result in less flexibility. Despite – or precisely because of – the incomparably greater flexibility in terms of the spine itself, the tension of the muscles in the lumbar and cervical spine is pathologically increased in many people due to many years of incorrect posture or incorrect loading and the mobility is sometimes considerably restricted compared to the physiological state, which can also impair the nucleus structures such as the intervertebral discs in particular over time. Fortunately, a smaller proportion of lumbar spine complaints are actually the result of degenerative processes in the intervertebral discs between the vertebral bodies and are often associated with neurological deficits or pain radiating into the pore region or the leg. This is a special form and requires medical clarification by an orthopaedic surgeon, usually with MRI imaging.

However, even if flexibility is basically maintained, pronounced tension and discomfort or pain can occur. Some movements or postures are usually more painful than others. If it can be assumed that it is purely muscular, an attempt can be made to stretch away this tension, i.e. to find the movements or postures that are causing the pain and hold them with a tolerable intensity, whereby a slow reduction in the discomfort can usually be felt. In quite a few cases, the discomfort can be reduced to a tolerable level or banished from everyday movements and postures with a manageable amount of effort. However, it is not uncommon for this success to be short-lived, as the same postures and strains repeatedly affect the back muscles. Of course, the best thing to do is to improve the postures in everyday life and reduce the strain in conjunction with improving the muscular situation, which also includes strengthening. Here are some postures that are suitable for improving the condition of the back, some of which are symptomatic and some of which are causal:

Lower back first aid kit

This is a first aid kit that should contain something helpful for most cases. Of course, it is not intended to replace medical clarification in cases where it is necessary. Indications of this requirement are, for example

Back pain with pain radiating into one or both legs
Failure or reduction of functions of internal organs, in particular the small pelvis (bowel, bladder, genitals) due to suspected cauda equina syndrome
Loss of sensitivity or innervation of part of one or both legs
Pain-reflective hollow cross formation
Suddenly occurring massive „hard“ restriction of flexion in the hip joints

For pain in the muscles caused by excessive tension/cramping/tension:

parsva uttanasana
parsva upavista konasana
parsvottanasana
parivrtta trikonasana
karnapidasana
halasana preferably alternating with karnapidasana
Shoulder stand, also the right-angled version
half lotus forward bend
janu sirsasana
downface dog
Roll up the back

if shortened hip flexors may be a contributing cause (see hip flexor mobility test):

hip opener 1
Move the upface dog carefully and start with a short duration!
setu bandha sarvangasana

than purely relaxing postures:

After the acute phase is over, but often even during the acute phase, back-strengthening postures often have a very positive effect, especially if they get the muscles to work at a medium sarcomere length:

as well as the right-angled variants of some postures

Partner exercises: I’m afraid to push so hard

Question:

I’m not sure how hard I can or should press during partner exercises. The teacher often asks me to press harder, but I don’t want to hurt the person doing the exercise …

Answer:

Of course we don’t want to hurt anyone, none of the three participants want that, neither the performer, the supporter nor the teacher. In partner exercises, we increase the pressure or pull slowly and sensitively while closely observing the performer’s verbal and non-verbal expressions, including facial expressions and breathing. By slowly increasing the use of force, we give the performer time to closely observe the effects of our increasing use of force and to react. Everyone should have enough self-protection to react appropriately. Some reactions are not even subject to voluntary control, so they could be suppressed out of calculation. When the performer says STOP, this usually means that we should not increase the use of force any further. Only rarely does someone mean that the pressure should be removed completely. What is normally meant is to continue applying force at the current level. It may be necessary to ask. In all cases, regardless of whether the performer wants to get out of the posture directly or the posture is continued and ended normally, the force exerted to assist must be slowly and sensitively reduced to zero at the end of the posture! A very fast or even jerky termination of the assistance, i.e. usually the pressure, pull or rotation contained therein, could lead to reflex-like compensatory tensing and tensing of the performer’s muscles!

In general, we encounter a basic phenomenon of human interaction in the above question. Our own bodily experience and the elementary understanding that arises from it enables us to sense what can happen in the body of the person performing the exercise as a result of our use of force; this often involves an increase in the sensation of stretching or the pain of stretching. Empathy, as the ability to „feel“ things that we have already experienced ourselves that happen in a similar way to another person, and a sense of responsibility or fear of being responsible for harming or causing inappropriate pain to the other person are thus combined here. Depending on our inner disposition, we tend to be rude, insensitive, hasty and tend to demand too much or too quickly from others, or we tend to be overcautious, anxious, hesitant and do not give the other person what is appropriate because we project our own fears and the fear of pain and injury onto the other person.

In general, the phenomenon of projection is one of the greatest difficulties in the field of human interaction. People are very different in many ways and – in this case and in many others – there is hardly any real basis for assessing what the other person likes or dislikes, what hurts or injures them. This implies that the mode and task of assistance must be to find out together with the performer, in a mindful, empathetic and observant way, what corresponds to HIS system, however much this may run counter to or correspond to our expectations or assessments. Neither the contradiction nor the confirmation allows an assessment of how it would behave with another person. It is always an open question, with each new person, which must always be approached anew with the same attentiveness. After all, no one should be harmed because of our carelessness. However, no one deserves to be treated unfairly because of our tendency to project. This is why we approach the partner exercises without a limit to the amount of force we can use, which is generated in our heads, and give our partner the opportunity to explore their reality and show us what it is like.

In turning postures, for example: Place fingers or palm on hand?

Question:

At the school where I first learned yoga, for example, we put our fingers on the floor instead of the whole hand when doing twisting postures. So which is correct?

Answer:

If we ignore the concept of right / wrong and instead ask about the meaningfulness in terms of the forces that can be transferred and the possible side effects, it is as follows: When the fingers are positioned, we need to take a closer look: are they flexed or extended and at what angle are they aligned to the direction of force exertion? Let’s roughly divide them into 4 orientations, which are separated by a 90° rotation. In all cases, we assume that the opposing thumb is used at about 90° to the index finger. We also make a rough estimate of the possible force exerted: assuming that a male performer can bench press at least 40 to 60 kg, this still corresponds to a significant double-digit value in kilograms due to the slightly poorer lever arm for the pectoralis major (the hand is on the floor instead of at chest height). There is no need to impose any restrictions on the exercise of strength if there is no corresponding pathology: the performer may use all the strength of their arms to rotate without restraint. The muscles to be stretched consist primarily of the oblique abdominal muscles (Mm. obliqui abdomini) and parts of the autochthonous back muscles, all of which can be considered to be quite strong and resilient. Furthermore, we assume a seated twisting posture as an example, with one hand pulling on the knee and the relevant hand supporting the fingers on the floor.

the slightly spread fingers point on average in the direction of the force vector (direction and magnitude of the acting force): then, if the 4 fingers are flexed, a massive flexion tendency occurs in the finger joints (proximal joint MCP, proximal joint PIP, distal joint DIP), against which the finger extens ors must work. However, as the finger extensors are significantly weaker than the fingerflexors, they are likely to buckle if more force is applied and ultimately drag the nails across the floor. If the fingers are stretched, there is a strong feeling that the skin is being „pulled away from under the fingernails“. This is not a successful model.
Let’s first rotate the construction by 180° so that the fingers are at the back of the force vector and the thumb is at the front. In this case, the thumb will buckle even when a slight force is applied because its extension force cannot withstand the force applied. The opposing fingers are at a rather unfavorable angle to the floor and would tend to be dragged across the floor. Also not a successful model.
The variation in which the fingers point towards the pelvis and the thumb away from the pelvis is ruled out due to extreme endorotation of the upper arm in the shoulder and the risk of cramping in the rotators. In addition, the load for elbow stabilization is largely transferred to the triceps, the more powerful flexor group consisting mainly of the biceps and brachialis is largely relieved. Due to the strong endorotation, the development of strength in the front shoulder(deltoid) is not particularly favorable. Also not very promising.
The last variant is actually the most favorable: the thumb points towards the pelvis and the fingers away from it. Here the arm flexor group can be used well again and can apply its strength unhindered, and the deltoid muscle can also develop its strength well together with the pectoralis major. Good conditions proximally. Let’s take a look at the hand: the forearm has to defend itself against a force acting in the direction of ulnar abduction in the wrist, which may still be possible, but which can put considerable stress on these rather poorly trained muscles and their tendons. In addition, the 4 fingers in all joints are exposed to significant varus stress, which together with the valgus stress of the thumb can reach a double-digit value in kilograms, depending on the strength of the performer. Even if the fingers are flexed with force and pressed together, this stabilizes them against further flexion (due to friction on the floor) and extension (due to the flexing force), but the varus stress in the fingers cannot be compensated for at all due to the lack of muscles to stabilize against valgus stress and varus stress in the distal (DIP) and proximal (PIP) finger joints! Which is why this option is also ruled out with regard to the health of the finger joints.

Since the discussion of the possible variants of attached fingers was not very productive – in all cases the fingers are the weak point in one way or another – we have to think about attached palms. Here, too, we have several possibilities, which will be divided into 4 rough variants:

Finger pointing towards the pelvis: as already discussed in the analogous case above, a strong endorotation causes a cramping tendency of the endorotators and shifts the load towards the triceps, not very favorable
Finger pointing away from the pelvis: shows a maximally relaxed posture with regard to rotation, but since the hand runs transversely to the force vector and this loads the wrist transversely and not along the axis of its strongest muscles, better possibilities should be found
Fingers pointing backwards, i.e. against the force vector: the wrist is loaded in the axis of its strongest overlying muscles. If the hand is placed far forward, this results in an unphysiological dorsiflexion of 90°+ in the wrist, which is why the hand must be placed further back. However, this reduces friction. It should be possible to find a point at which the hand can be positioned without restriction and with all possible physiological force. However, if too much force is applied, the friction may not be sufficient
Fingers pointing forwards, i.e. in the direction of the force vector: the palmar flexors of the forearm press the metacarpal to the ground through consciously exerted pressure or through their restricted mobility, which increases friction in two ways, namely through the pure amount of pressure and, on the other hand, through the direction in which the wrist tilts. This is reminiscent of the design of the drum brake on vehicles, for example, where the brake shoes are also pressed against the direction of rotation, i.e. against the direction of the force applied. Depending on where the hand is placed on the ground, the angle in the wrist could be borderline in terms of dorsal flexion, but this can be remedied with patches under the wrist if necessary. In addition, exerting force on the arm (with frontal shoulder and pectoralis) leads to relief after construction and not to further strain on the wrist, as the wrist is stretched a little from the wide dorsiflexion. This should therefore be the clearly superior option.

A further positive effect in the determined optimal variant with the palm of the hand placed in the direction of the force vector is that when the hand is pressed forward on the floor with all the force, the flexor group of the elbow joint (biceps and brachialis) works, and this (with a fixed hand) pulls the shoulder blade and the shoulder as a whole towards the ground and thus counteracts the usual tendency to deflect the body laterally towards the contralateral side (lateral flexion), which arises from the fact that the arm flexor group with the powerful latissimus dorsi applies corresponding forces there, which pull the shoulder down as a whole Lateral flexion follows.

In addition to the twisting postures discussed, there are many other postures with one or both hands on the floor in which the question must also be answered. Examples include uttanasana with the fingers on the floor and arms extended, the table variation of uttanasana and ardha chandrasana. The discussion is different here, as only very small forces are exerted on the hands or fingers, pushing them against the friction of the surface. In ardha chandrasana, for example, the arm is used to push the fingertips placed on the outside of the foot, still in front of the toes, diagonally backwards towards the heel with the two vector components

parallel to the foot away from the head: the stretching of the upper body promotes and
forwards (towards the field of vision): the rotation of the upper body promotes

In the twisted postures parivrtta ardha chandrasana and parivrtta trikonasana, the hands are not pushed forwards towards the field of vision but 180° backwards in the opposite direction in order to support the changed direction of rotation of the upper body compared to the postures with the same hand on the side of the floor. The vector component along the outer foot is of course retained in order to promote the extension of the upper body. However, the forces exerted are extremely low compared to the rotational postures because any force exerted that is not axial to the arm would have a direct effect on balance, but even more importantly, in these postures you should work with as little weight as possible on the fingers so as not to impair the balance work from the standing leg!

In addition, in the case of sensitive or previously damaged finger joints (e.g. due to diseases such as rheumatism or other arthritis), they can be positioned in such a way that no varus stress or valgus stress occurs in the finger joints with the fingers on the axis of the force vector, but the flexors and extensors of the fingers can absorb all the forces. In the case of the uttanasana variations and comparable postures, it is recommended that the fingers are also aligned along the axis of the force vector so that the finger flexors bear the load of the push or pull instead of the finger extensors, i.e. the fingers are positioned pointing away from the foot on the same side. The forces transferred here are significantly higher than in the variations of ardha chandrasana and trikonasana, but still lower than in the twisting postures, especially as the lever with the entire length of the arm including the forearm, palm and fingers is extremely unfavorable.

Another case are inversion postures in the variants with the fingers on top, such as the right-angled handstand, the handstand, the staff, vasisthasana or ardha vasisthasana and the dog postures head down and head up. For the inversion postures, there are no static forces in the posture except those that want to bend and hyperextend the fingers, which – as a clear task of the posture – must be balanced with the strength of the finger flexors. In dogs and in the pole, the fingers are usually turned outwards and the thumb inwards, because the dorsal flexion angle in the wrist would otherwise be unbearable, especially in the dog position head downwards, if the hand were to be placed against the force vector, i.e. with the fingers pointing towards the feet, which would be optimal in order to absorb the force exerted with the strength of the finger flexors.

Apart from that, these variations largely dispense with exerting force with the hand in the plane anyway (usually in the direction away from the feet – except for the variations with the feet turned upside down), as the focus is clearly on strengthening the fingers, which can be adjusted continuously from

moderately in the dog position head down over
quite intense in the dog position head up
to very intensive in the staff

can be dosed. The thrust to be generated by the body in the direction of the feet remains the theme of the other variations, with the exception of those with the feet turned upside down, where the direction of the thrust is the opposite: towards the feet. This means that none of these variations could endanger the health of the fingers due to valgus stress or varus stress.

A special position is occupied by vasisthasana and ardha vasisthasana in the corresponding variations on fingertips. Here, the fingers slide in the direction of the foot, which means that there is a certain risk of varus stress and valgus stress with the usual alignment of the fingers backwards, i.e. in the opposite direction to the field of vision. Furthermore, according to the design of the posture, no upper limit can be postulated for the force exerted by the arm to push in the direction of the feet. However, since the force exerted on the fingers is likely to be relativized somewhat at the extreme lever and these variations are unlikely to be accessible to beginners anyway, it can be hoped that the performers will limit the force exerted in the direction of the feet to a finger-compatible level and leave powerful pushing of the hand in the direction of the foot to strengthen the lateral adductor pectoralis major and especially the latissimus dorsi to the standard variations with the hand placed on top.

Furthermore, in postures in which the hand is placed on the floor and should push in a certain direction, the hand is turned in such a way that the tendon of the middle finger on the back of the hand runs parallel to the direction of the force exerted when the fingers are only slightly spread; hip opener 3 serves as an example here.

Fully extend your knees and elbows?

Question:

In gymnastics, I learned that you shouldn’t fully extend the knee and elbow joints. Why do you do it differently?

Answer:

There are actually some different views in Western gymnastics and academic orthopaedics on the one hand and yoga on the other. Part of the reason for certain cautions is that simple rules should be created that are applicable to all people to protect them from joint damage. In part, they take account of people’s everyday movements, and in part of the conditions in gymnastics events in popular sports, which are very different from a good yoga class:

the larger the group being taught,
the less body awareness can be assumed,
the lower the usual and current level of attention,
the less the focus is on precise execution,
the less the execution of the posture is controlled,
The more tired a group or its participants are already, and last but not least,
The lower the motivation of the participants, but also of the trainer,

The more defensive, restrictive instructions make sense, such as: don’t straighten the knee joints all the way, don’t straighten the elbow joints all the way, don’t arch your back!

This avoids not only overstretching (which is discussed here ) but also the destructive effect of forces on the joint in the exact (180°) extension without recognizable overstretching. These instructions then make it possible to teach dozens of participants in mass events even without individual control. Of course, in a yoga class with more or less experienced participants and, above all, an experienced and committed teacher, you can work at a completely different level if the class is not too large, virtually under laboratory conditions. Which, by the way, is the subject of §59 of the yoga regulations.

In the case of the knee joint, for example, stretching the knee joint with work of the quadriceps allows us to dose the stretch sensation as precisely as we like without it suddenly becoming more because the knee joint would continue to stretch uncontrollably. In postures with a narrow physical support base and therefore a balancing character, the fully extended knee joint directly reduces two degrees of freedom (2 dimensions) in which the supporting leg could wobble: Flexion/extension and endo/exorotation. Using the example of warrior stance 3, this means that not only flexion/extension is used for balancing, which is associated with a significant change in the body’s potential energy and therefore with effort in the case of extension, but above all with rotational movements of the thigh in the hip joint and simultaneously in the opposite direction in the knee joint(endorotation in the knee with simultaneous exorotation of the lower leg or vice versa). This is visible as an inward and outward movement of the knee joint in relation to the foot and pelvis. This rotation of the lower leg in relation to the thigh in the knee joint is not available at all when the knee joint is extended, but when it is only slightly bent it enables the knee joint to be moved inwards or outwards with very little effort while the position of the upper body and foot remains largely unchanged, thus creating the possibility of balancing by shifting mass and changing the force ratios. This in turn is an undesirable distortion of the posture, in which the aim is to achieve the necessary balancing with the muscles of the lower legs. The undesirable balancing work performed from endo- and exorotation not only changes the rotation of the lower leg but also the pronation/supination, the precise control of which should actually have been used for balancing.

In the case of the knee joint, the final rotation also comes into play, in which the lower leg is rotated a few degrees in relation to the thigh over the last 5° before 180° extension and the condyles are brought into a more stable position, which can in fact be interpreted as physiological subluxation, in which the femoral condyles are brought into a more stable position where they can no longer slip off the tibial condyles. This additional stability would also be lost without full extension of the knee joint.

In the case of the elbow joint, the situation is slightly different. As already discussed elsewhere, the causes of hyperextension of the knee joint include weakness of the quadriceps or the hamstrings, both of which cause a tendency to hyperextend the knee joint. It is possible that weakness of the flexor group of the elbow joint (especially the biceps and brachialis) also leads to a tendency to hyperextend the elbows, just as a shortened biceps could completely prevent precise extension. However, it must be noted that the causal chain and reasoning is different from that of the knee joint. The center of gravity and – by analogy – the connecting axis of the shoulder joints (in this case, the glenohumeral joint – the shoulder blade-upper arm joint- should be used as an analogy to the hip joint ) do not play a role here. Rather, the analogy to the weakness of the hamstrings is likely to be that weakness of the biceps results in a tendency to effortlessly lock the elbow joint in hyperextension without muscular involvement in the niuscular dorsal structures of the elbow joint.

Despite a possible tendency to overstretch, the exact extension of the elbow joint is the mode or goal of our work. It may take some effort to develop the body awareness to control the joint voluntarily or it may require the appropriate body awareness and development of strength to control the elbow joint from the voluntary use of the flexor group, but this effort is worth it, as it ultimately results in an excellent opportunity to protect the joint in all conceivable situations. In most cases, we think less of the aids used here and there to passively prevent overstretching of the joints, such as a block clamped diagonally under the lower leg in trikonasana, as these circumvent the problem symptomatically and thus prevent the development of the necessary body awareness and strength, see paragraph 37 of the yoga rules.

For those without a tendency to overstretch, the above statement on the exact dosage of stretching naturally also applies. Moreover, the non-exact (reduced extension) is one of the dimensions of evasion in all postures with extensive frontal abduction and it is absolutely necessary to realize an exact degree of extension, if not the exact 180° extension, not only to improve the stretching ability, but also to be able to assess the existing flexibility.

Mouse holes (upcoming finger base joints) – or: An example of fundamental and pseudo solutions

Question:

I learned somewhere else to eliminate the finger base joints of the palm that come up in the dog position head down, which you call mouse holes, by pushing the hands towards each other. Is that wrong?

Answer:

Again, I would like to avoid the terms wrong and right and compare the methods, of course not without discussing the causes of mouse holes and looking for the best possible causal solution. Mouse holes are the basic joints of the palm, especially the index finger and middle finger, which become detached from the ground. In postures such as dog pose head down, upface dog, pole pose, right-angled handstand and handstand, vasisthasana and others, these take on an angle of sometimes significantly less than 180° and often stubbornly resist the performer’s efforts to push them down. The right-angled handstand is considered by many to be the greatest challenge. This inclination increases with the degree of dorsiflexion and the degree of pronation of the forearm. In order to eliminate the mouse holes, more force is needed for palmar flexion, i.e. pushing down the middle hand as a whole, as well as more force for pronation, in particular to push down the palm area.

Apart from the fact that various traditions do not seem to have addressed this issue at all when those trained in them come to teach us, some schools teach how to reduce the mouse holes by pushing the hands towards each other. This transverse adduction in 180° >frontal abduction in the shoulder is mainly performed by the pectoralis major and the pars clavicularis of the deltoideus. Both muscles are not contracted here according to their minimum sarcomere length (i.e. almost maximally). In the case of the pectoralis major, this would also require some frontal adduction.

In any case, it can be concluded that they do not act with full force and in many cases are not far away from or even very close to a cramp tendency, which may not make the method applicable to everyone. Pushing the hands towards each other actually causes a (rather small) tilting moment of the palm in the desired direction or torque of the forearm in the direction of pronation via the friction of the hand on the floor, which actually pushes the palm down a little, but this effect is not very pronounced. The endorotatory effect of the pectoralis major can be used to support this, but it runs counter to the desired exorotation of the arm and must be counterbalanced by the corresponding muscles, so that not much of the effect on pushing the palm down is likely to remain.

However, this solution has nothing to offer in terms of the cause of the mouse holes; it no longer uses either the palmar flexors or the pronators. However, a causal solution would have to start right here and only here. However, building up the necessary strength and any necessary increase in flexibility may be a longer-term project. In addition to the pronators and palmar flexors to be developed, which cause the inner metacarpophalangeal joints to be pressed down directly, in some cases the finger flexors also need to be stretched so that the flexion of the fingers does not provide any additional resistance to the pressing down of the metacarpophalangeal joints. In addition, the more restricted pronation of the forearm is possible, the more exorotation of the upper arm runs counter to pronation of the forearm, so that attention must also be paid to pronationas a flexibility requirement.

If you look beyond the head-down dog position, the picture becomes much clearer: in the head-up dog position, for example, and even more so in the right-angled hand position, the tendency to develop mouse holes is even greater. In addition, compression pain in the dorsal wrist often occurs in the range of around 90° dorsiflexion in the wrist, even under the slightly different rotational conditions of the two postures mentioned, against which there is no remedy apart from the pure reduction of the dorsiflexion angle and the aforementioned use of force by the palmar flexors together with the pronators, provided that the finger flexors are sufficiently mobile. Bear in mind that it is precisely in the right-angled handstand that the entire body weight acts in both wrists and, in accordance with our maxim that the muscles should hold the forces in a joint and not the non-muscular structures that could be damaged in the process, the second method of developing the strength of the palmar flexors and pronators is a must.

There is another serious argument in favor of the superiority of this method: it is independent of the number of hands pressing on the floor and their spatial arrangement! The first-mentioned method of using the pectoralis major must fail as soon as only one hand is on the floor or the hands are no longer shoulder-width apart and perhaps also aligned roughly parallel; this method cannot be used in vasisthasana or ardha vasisthasana, for example. However, the palmar flexors and pronators are available here to reduce the mouse holes, and with them the stress in the dorsal wrist! And all this without destabilizing the angle between the arms and the upper body. And then you would have done well to practise this technique and strength in simpler postures, such as the head down dog position or head up dog position.

There is another argument in favor of this technique: the palmar flexors and their strength are also required for other tasks and in some transitions. Examples include the transition from the downface dog position to the upface dog position and back, where part of the push back into the downface dog position should come from the palmar flexors, just as the palmar flexors should work to ensure that the pelvis does not fall unsteadily into the upface dog position in the opposite transition due to excessive forward deviation of the shoulders, thereby exposing the lumbar spine to stress.

Even in static postures such as dogs, the palmar flexors are not only involved in eliminating the mouse holes, but also contribute to the backward movement of the upper body resulting from the angular reduction ( dorsiflexion) of the wrist, which is useful and important, starting with a slight stretching effect in the triceps surae, through to promoting frontal abduction in the dog’s head downwards and building up pressure (together with the deltoids and muscles of the upper back) of the heels on the wall in the right-angled handstand and thus the ability to remain in the posture at all.

By analogy, using the pectoralis major as the adductor of the arms to reduce the mouse holes would correspond to the adduction of the legs in the hip joints using the strength of the adductors to keep the inner feet sufficiently on the ground. I don’t know anyone who wouldn’t see greater value in learning to control the ankles with the calf muscles, especially with regard to balancing on one leg! Incidentally, here too, the tendency of the adductors, which work close to the maximum concentric contraction, to spasm would make the method absurd for many people.

Thinking one step further in relation to the arm system, pushing the hands towards each other using the strength of the pectoralis major means a reduction in the tendency of the elbow joints to hyperextend, which is highly desirable in itself. Unfortunately, however, this does not result from learned control of the joints that the arm flexors have to exercise here, nor does it serve this or the development of strength and awareness of the muscles concerned; on the contrary, it helps to overlook precisely these opportunities to develop appropriate methods and strength.

And in case anyone now wants to strengthen the pectoralis major and deltoideus pars clavicularis in the described way in downface dog: the upavista konasana with block offers a much more exciting option.

Lumbar spine hump in forward bends

Question:

I have noticed that I have quite a hump in my lumbar spine when I bend forward. Where does it come from, is it bad and can I get rid of it?

Answer:

The „hump“ in the lumbar spine refers to a distinct convex curvature of the lumbar spine (seen from behind) that becomes visible when bending forward and significantly exceeds a uniform gravity-induced curvature. The development of such a hump is often as follows: If the mobility of the hamstrings is significantly restricted, forward bends are practiced in such a way that the muscles at the back of the leg do not report too much stretch sensation. The sacrum will still point more or less clearly forwards and upwards depending on the mobility restrictions on the back of the leg. Instead of using the strength of the hip flexors to tilt the pelvis to the limit of tolerability in the backs of the legs so that the backs of the legs become more flexible over time, they are spared and the back has to bend according to gravity, as the considerable partial body weight of the upper body, head and arms pulls downwards. The place where these forces bend the back the most is, of course, the lumbar spine, which results in its ability to curve kyphotically over time. First and foremost, postural awareness is required here in order to tilt the hip joints into maximum flexion with the help of the hip flexors during forward bends and thus tilt the pelvis forwards – which means creating an intense sensation of stretching. Furthermore, this ability should not be developed further if you already have a „lumbar spine hump“. It is then helpful to perform the forward bends with support, e.g. with a block under the fingertips in uttanasana or to choose variations in which the hip forward bend is combined with a spinal extension or even a backbend. These include, for example:

At the same time, check whether the lumbar spine assumes its physiological lordosis when standing straight upright, e.g. in tadasana, or whether it remains steep or even kyphotic. If this is the case, backbends should be practiced more frequently in order to pull the lumbar spine towards lordosis via the pull of the hip flexors in order to restore its ability to lordosis, for example:

Backbends also increase the tone of the lumbar spine muscles, which counteracts kyphosis. It also makes sense to strengthen the autochthonous back muscles in general and in the lumbar spine area in particular. Suitable exercises for this include

If there is too little postural awareness to tilt the pelvis forward in everyday movements with bending as well as in yoga poses without significant kyphosis of the lumbar spine, this ability must be specifically trained by practicing the two possible pelvic movements (reducing and increasing flexion in the hip joints) at different angles of flexion, starting with tadasana or neutral zero and increasing flexionby a further 20° in each case upto uttanasana. Physiotherapeutic tape in the lumbar spine area to increase postural awareness can also be helpful, as this makes it noticeable when forward bends are made from the lumbar spine instead of from flexion in the hip joints or when loads are lifted from the muscles of the lumbar spine instead of from the hip extensors and thigh muscles when stretching the knee joints

I have a hump! How do I get rid of it?

Question:

I have a hump in my middle/upper back. It doesn’t look nice and I tend to have stress in my back and neck. What can I do to improve the situation and maybe even get rid of the hump?

Answer:

The described „hump“ is probably a hyperkyphosis of the thoracic spine. A certain degree of kyphosis (convex backward curvature) of the thoracic spine is not only statistically but also physiologically normal and desirable. As our evolutionary predecessors became accustomed to walking upright, their spine adapted to the upright gait and the completely different statics and kinetics: an original (and at that time optimal) C-shaped, i.e. totally convex spine eventually became a double-S-shaped spine with a lordosis (concave when viewed from behind) in the lumbar spine and cervical spine and a kyphosis in the intermediate thoracic spine. On the one hand, this enables optimum shock absorption of the much higher kinetic load when walking upright due to the significantly greater partial body weight and the changed leverage ratios, which was very important for our brain but also for the intervertebral discs between the vertebral bodies; on the other hand, there is still enough space in the spinal kyphosis for the lungs and the heart to expand and contract again according to their task and function.

The thoracic spine kyphosis can increase for various reasons. On the one hand, these include pathological events that are associated with changes in the intervertebral discs or the vertebral bodies themselves, so that, for example, so-called wedge vertebrae form that are flatter at the front(ventrally) than at the back(dorsally), such as in ankylosing spondylitis and Scheuermann’s disease, or the qualitative degenerative change in the bones and vertebrae in osteoporosis. However, it can also simply be the result of prolonged poor posture. It is not uncommon for hyperkyphosis of the thoracic spine to be a compensation for previously developed hyperlordosis of the lumbar spine (see corresponding article). However, it should be clarified that the spine is not pathologically altered apart from the hyperkyphosis so that exercises can be performed against it without hesitation. Depending on whether hyperlordosis of the lumbar spine exists, something must also be done about it (see there). The procedure used to tackle a hyperkyphosis of the thoracic spine itself consists of three important components:

Training in posture awareness and supportive measures in everyday life, including optimization of everyday working life
Promoting the ability to extendthe (thoracic) spine
Promotion of the strength endurance of the autochthonous back muscles

Training postural awareness and continuously striving for good posture and supporting good posture are certainly often neglected factors, but this alone can easily fail due to the available possibilities, which is why the other two factors are also extremely important: if the ability of the thoracic spine to straighten up is lacking, all strength or strength endurance would be lost due to the resistance and nothing would be achieved in the end apart from effort and giving up the effort. On the other hand, if the thoracic spine is reasonably able to straighten up, but lacks the strength endurance to do so over hours of sitting quietly, overexertion and tension in the muscles will quickly set in.

To promote the ability to extendthe thoracic spine, backbends of the upper body are practiced in particular, such as

but also „shoulder openings“ that straighten the thoracic spine in the direction of extension on the long lever of the arms, such as

Suitable exercises to promote the strength and endurance of the autochthonous back muscles include

Sore muscles

Question:

I often get very sore muscles from practicing. What exactly is that? Is it bad and how do I deal with it?

Answer:

The muscles of the musculoskeletal system generally consist of one or more heads, for example the biceps of the arm has two heads and the triceps three heads, which gave them their names. The heads consist of muscle fiber bundles, which in turn consist of individual muscle fibers, which are actually cells up to a good 15 cm long. In the case of the striated muscles of the musculoskeletal system, these in turn often contain many thousands of sections, called sarcomeres, which are separated by the so-called Z-discs. Actin filaments are attached to the Z-discs in both longitudinal directions of the muscle, into which myosin filaments engage, which in turn are attached to an M-disc arranged in the middle of each filament. The actual muscle work in the sense of concentric contraction, i.e. the contraction of the muscle, consists of the two heads of the myosin shimmying along the actin filaments. The further along, the more the muscle contracts. This happens with all myosin filaments in all sarcomeres of a muscle cell and in many muscle cells simultaneously. During concentric contraction (the active contraction of the muscle), only one myosin head is always on the actin filament, whereas during eccentric contraction, i.e. the counter-movement under load, both myosin heads are on the actin filament, which is why there is approx. 40% more force available eccentrically. Roughly speaking, the muscle contraction is geometrically nothing more than an approximation of the Z-disks (caused by the further interlocking of the myosin in the actin), whereby the muscle contracts in length and correspondingly thickens in cross-section so that its total volume remains the same.

Under high loads, if the pull of the myosin on the actin becomes too great, the Z-discs can be damaged and tear. These small tears often occur during eccentric movement, especially when movements are stopped under great force (more than could be achieved concentrically ). The body naturally tries to repair these tears, which causes inflammation. As there is no pain receptor in the muscle cell, this process remains pain-free until the first substances involved in the inflammation leave the muscle cell and encounter pain receptors. This usually takes around 12 – 24 hours. Normally, sore muscles heal within a few days without any consequential damage, which is also referred to as restitutio ad integrum, i.e. restoration to the original wholeness. If this were not possible, the opposite would be called „defect healing“; functional tissue would generally be replaced by non-functional connective tissue.

In principle, it is of course a good idea not to push the muscle hard again during muscle soreness so that, on the one hand, the existing damage can heal undisturbed and, on the other, there is no immediate need for further repair. This requirement may be a little at odds with the desired training efficiency and effectiveness: if a muscle is significantly challenged, its performance naturally collapses and it becomes fatigued. At the end of the challenge, it begins to recover and at some point (usually not within the same day) has regained its original performance capacity. Beginners with lighter training may be able to do the same type of exercise the next day or the day after at the latest, while professionals with very hard training will only be able to do it after at least 2-3 days, possibly a little longer. Once the muscle has returned to its pre-training performance after the recovery phase, its performance increases slightly above the original level, this is known as supercompensation. In other words, it tries to arm itself a little against the type of demand or overload. The supercompensation phase begins immediately after full recovery, the performance level slowly increases by a small amount up to a maximum increase, only to drop again and finally fall back to the original performance level.

Now, of course, you would want to place the next workout directly into the maximum of the supercompensation in order to exploit this effect again at a slightly higher level. And again and again. However, the increase in performance does not increase proportionally without end, but presumably follows a logarithmic curve, so that the achievable increase decreases further and further towards the end or disproportionately more effort is required to achieve the same increase.

For optimal training, the muscle soreness curve and the supercompensation curve must therefore be taken into account, although both are difficult to predict or calculate in general. They are very individual and depend on the type and intensity of training. Even if sports scientists claim that muscle soreness does not affect actual performance, but only the subjective feeling during (not too exaggerated) performance development, it seems wise to let the Z-discs heal largely unhindered, at the risk of the supercompensation phase being caught towards the end and therefore not at its maximum at the start of a new discipline. As the tendency to get sore muscles again due to the same type of requirement decreases a little with each similar training session, the trade-off becomes increasingly easier and the loss of training time due to the voluntary break caused by the sore muscles becomes increasingly smaller.

In general, warmth and gentle massages seem to help heal sore muscles due to their circulation-promoting effect, whereas hard massages would mechanically irritate the muscles too much and delay healing. Both before and after intense physical exertion or training, higher oral protein doses are helpful, especially if they contain significant amounts of BCAA (branched-chain amino acids).

Incidentally, even if the „hangover“ seems to be the natural enemy of the muscle in its etymological sense as a Latin „little mouse“, „hangover“ is actually a popular corruption of the Greek „katarrh“, which actually means „flowing down“, i.e. the effect that occurs when the mucous membranes of the nose and throat become inflamed.

„Deep muscles“

Question:

Does yoga train the „deep muscles“ just as well as method XY?

Answer:

Yes, of course, because there are no deep muscles! Various providers of exercise programs advertise that their method is particularly good at training the „deep muscles“. It seems that providers who at best have only half-knowledge of anatomy have an easy time with laypeople who have even less knowledge by inventing and promising good-sounding things that simply do not exist. Probably the only way to reconcile the terms „deep“ and „musculature“ in our musculoskeletal system is the fact that some muscles lie more superficially, i.e. are visible in trained people with not too much body fat, and other muscles lie closer to the bones (in the case of the extremities) or the internal organs (in the case of the torso). The anatomy speaks of more profound (deeper) and superficial (more superficial) muscles. For example, the m. transversus abdominis (the muscle that causes the abdominal press) lies deeper (i.e. closer to the abdominal organs) than the other abdominal muscles rectus abdominis (the long abdominal muscle that runs parallel to the spine and flexes the spine ) and the two mm. obliqui abdomini (interni and externi: the oblique abdominal muscles that primarily cause lateral trunk flexion and rotation of the spine ). There are several other examples in which one muscle lies over – i.e. more superficially – than another. The next example is not particularly far-reaching: the pectoralis minor lies more deeply than the pectoralis major, but these also differ in function, as the former lies between the ribs and shoulder blade and depresses the shoulder blade, whereas the latter mainly (but not only) pulls from the sternum and clavicle to the upper arm. Of course, there are many other examples, especially in the muscularly complex back. However, one and the same muscle does not have a „deep“ layer; it could therefore be argued that anyone who advertises that their method is particularly good at addressing the „deep muscles“ is simply making a statement about their seriousness and anatomical knowledge rather than offering a benefit.

Why should I not use my toes in standing postures?

Question:

I keep being told not to use my toes in standing postures. Why is this so important?

Answer:

The background to this is the anatomy: the muscles that move the toes are much weaker but also somewhat more fine-motorized than the majority of the muscles that move the whole foot in the ankle joint. Strictly speaking, there are actually three „ankles“:

the OSG (upper ankle joint), articulatio talocruralis between the malleolar fork of the tibia/calf bone and the talus(ankle bone)
the anterior USG (lower ankle joint), articulatio talocalcaneonavicularis, ventral joint between the talus on the one hand and the calcaneus and scaphoid on the other
the posterior USG (lower ankle joint), articulatio subtalaris, dorsal joint between the talus on the one hand and the calcaneus on the other

which, however, is of secondary importance in this context. The typical reason for using the toes, especially in postures with a balancing character, would be a lack of stability. If the performer realizes that he or she cannot balance well due to the strength of the muscles that move in the ankle joints, he or she uses the more fine-motor toes. Unfortunately, however, the strength and endurance of the muscles that move the toes is quite limited, so that their ability to provide support is restricted to a very short period of time, far shorter than the posture should be maintained. If the toes or their muscles give up, firstly, this does not happen in a completely steady manner, but rather in an uncontrolled and restless way. Secondly, due to the support of the toes, which consisted of plantarflexion in the toe joints, the area of the ball of the foot is no longer as evenly supported on the ground as before the toes were used, so that the situation is now doubly difficult:

Firstly, the switch is made from the fine motor muscles of the toes back to the muscles that move in the ankle joints; secondly, their main point of contact with the ground, namely the balls of the feet, is no longer evenly distributed on the ground, but the use of the toes has usually resulted in a transverse curvature of the ball of the foot, so that this also has to be reduced. It therefore seems wiser to only work with the muscles that move the whole foot in the ankle joints from the outset and to leave the toes still. This means not pressing them to the ground, but also not lifting them, as this would also lead to temporary deformation of the bunion area.

Now the question naturally arises as to why the same maxim does not apply to the upper limb, i.e. the hand, as to the lower limb – namely not to press the fingers against the floor. Well, if we take the dog position head down as a posture without any balancing character, the question of which muscles are used in the extremities is obviously irrelevant for balance. So we can safely strengthen the flexors of the fingers a little here if this does not create any „mouse holes“, i.e. the pressure in the metacarpophalangeal joints is not impaired. In postures with a balancing character such as free handstand, tolasana and bakasana, we also demand that the fingers are not used primarily for balance work, in particular that pressing down on some parts of some fingers does not make others lighter, but that an even distribution of pressure is created and maintained between all finger joints.

Should I only sleep on my back? And how do I do that?

Question:

I have heard that the best sleeping position is on your back, as in savasana. Is that really the case? I can’t fall asleep on my back …

Answer:

Let’s take a combinatorial approach: roughly speaking, a person could sleep on their back, on their stomach, on one side, standing up or on their head and in many angles and contortions in between. Why should there be a „best“ position? Let’s take a look at a few positions, starting with the popular stomach sleeping position: if we look at the breathing mechanics, it generally consists of two parts: Chest breathing and abdominal breathing. Chest breathing means that the ribcage rises and expands forwards(ventrally) and slightly upwards. If I sleep on my stomach, the “ ventral“ component is massively hindered by the body’s own weight. The inspiratory muscles have to work much harder to overcome the gravitational force of a significant part of the body weight. This costs much more energy than necessary and does not necessarily create more rest. The component “ cranial“, i.e. towards the head, would be equivalent to a displacement of the spine in relation to the part of the ribcage resting on the base and, depending on the elasticity of the body, also of the remaining structures – or else would cause a periodic elastic deformation of the transitions between the resting ribcage and the cranial and caudal rest of the body. This is certainly also a rather energy-intensive and restless process.

In addition, there is a serious factor: if the head is straight in relation to the upper body, i.e. in a prone position as in Anatomical Zero, there is a risk of suffocation! So we come up with something to survive the night’s sleep and turn our head. In order to mitigate the requirement of a 90° rotation of the cervical spine resulting from the shape of the head and the usually semi-horizontal base, which most people are likely to feel would cause them to wake up the next day with massive tension in the muscles accompanying the cervical spine, the head is supported laterally with an arm raised upwards towards the head and usually bent. A glance at the shoulder blade and cervical spine area makes it clear that this must be a field for endless asymmetries, imbalances and tension in the musculature. The younger the person, the greater the ability to compensate for unphysiological behavior. With increasing age, however, the side effects of this behavior become less and less able to be compensated for and are felt more and more clearly. If the behavior is not changed, chronic pathological conditions occur, such as chronic tension in the trapezius and other muscles or scoliosis. This joint can also take the position on a widely bent elbow very badly, but this belongs more in the „side sleeping“ category.

Side sleeping produces a large number of curvatures of the spine compared to standard anatomical position with an evenly elastic base. This gives an entire industry room to offer seemingly interesting products to avoid the side effects. The uneven load on the hips, the high pressure on the shoulder on which the patient is lying, the possibly unphysiological position of the arm and the question of the position of the legs, which can hardly be solved sensibly, clearly prohibit side sleeping, especially as the lateral flexions of the spine give room for the development of muscular asymmetries and corresponding scolioses.

Those who are inclined to minimize the effects that occur should be told that the body remains in the position in which it falls asleep for hours. The fact that the human body moves unpredictably after about three hours with the onset of the dream phases and frequently changes its position does not in the least invalidate the demand for an optimal position for falling asleep; after all, a person either lies well, relaxed, restful and restorative for three hours or does the opposite for three hours!

Positions such as standing on your head or sleeping on your feet are hardly an alternative (even if other species are able to do so) and are out of the question due to the small physical support base and the resulting lack of stability, which can hardly be maintained under the temporary „loss of consciousness“ of sleep.

So what remains, how do I achieve it and why do some people find it so difficult? Naturally and unsurprisingly, sleeping on the back is the position of choice with its design that best accommodates breathing mechanics, especially as it comes closest to standard anatomical position or neutral zero and therefore represents the best approximation of a posture with minimal muscle tension and minimal opportunities to tense or shorten muscles during sleep. To illustrate the latter, just think of the effect that a supta virasana lasting just five minutes has on the hamstrings in people who are not very experienced: afterwards, it feels so shortened that it is no longer possible to stretch the knees in the subsequent head-down dog pose until the hamstrings has been relaxed again by applying the appropriate force to stretch it.

Why is it so difficult to fall asleep on your back? The simplest and most common answer is a purely emotional one: it’s much cozier on your stomach or on your side. There is not much to counter this, except that you really have to weigh up whether the cozier feeling when falling asleep justifies the possible or expected long-term disturbances to the musculoskeletal system. Let us now turn to the objective: the supine position is a completely stress-free and comfortable position and yet many people who are not used to it have difficulty falling asleep on their backs. A physiological explanation does not initially appear to be found, assuming that the room is dark enough, unless it is the case that the light entering the (closed) eyes is less in the prone position or the side position facing away from the light than in the supine position. However, there remains a very plausible explanation that refers to the constitution of the subtle nature of the human being: The receptive (absorbing) chakras of the human being lie (in the cases of chakras 2-6) on the front of the body and are turned towards the earth in prone sleep, so that less of them is absorbed than in the supine position! In the prone position, the active aspects of the chakras are turned upwards, but this does not deprive us of sleep.

There is still the question of how to learn to sleep on your back (or more precisely, how to fall asleep on your back) and the general answer is all too banal: Practice. Nevertheless, an important hint can be given: in the supine position, people tend to have considerably more thought activity – not least because of the receptive aspects of the chakras that are open to the world. This needs to be stopped by not pursuing any thoughts that arise. This may require an attitude that regards the past day as completed and can leave its remaining tasks and questions in the room. Today has had its day and perhaps I have done my best, nobody – not even myself! – and tomorrow will have its own; and perhaps some of the questions and tasks can be brought forward. The night with its sleep is there for peaceful rest and not for the sake of suffering under the unresolved. We regularly hear that once we manage to let go of thought activity, sleep will soon follow. And with a little mental discipline, sleeping on your back can soon become the norm.

Foot center lines parallel or knees parallel? It’s not the same thing – the question of the final rotation.

Question:

I always hear in class that in tadasana or forward bends like uttanasana, the midlines of the feet should be parallel and the knees or, more precisely, the patella should point exactly forwards or upwards. That doesn’t work at all! Have you never heard of final rotation?

Answer:

The questioner is right, of course. For the sake of simplicity, many teachers equate this, assuming that they are aware of the final rotation of the lower leg in the knee joint. Briefly explained: in the last 20-30 degrees of extension of the knee joint, the lower leg performs an exorotation of around 5-10 degrees, which stabilizes the knee joint in the extended state and secures it against unintentional movement. It is more pronounced in knock-knees (genu valgum) and reduced to absent in bow-legs (genu varum). It is caused by the iliotibial tract or the tensor fasciae latae, which supports extension (otherwise flexion) together with the anterior cruciate ligament in the last 20-30° before the knee joint is extended. At the beginning of flexion of the knee joint, the popliteus pulls the lower leg out of the final rotation to ensure normal movement in the mid-range of angles. In principle, it therefore belongs in the list of flexors of the knee joint, but the force it exerts in this direction is negligible, which is why it is not usually mentioned as a flexor. Whether it is visibly an exorotation of the lower leg or an endorotation of the thigh is a question of the situation: if the foot (e.g. on the ground) is fixed (in sports science and anatomy this is also referred to as the „standing leg„), the thigh endorotates, whereas if the lower leg can move freely („free leg„), it exorotates.

When the knee joint is extended, there is therefore an angle of 5-10° between the midline of the foot and the „longitudinal axis“ (from dorsal to frontal) of the knee in the transverse plane. Which of the two lines should we use for orientation and is this differentiation necessary? In general, it is sufficient to use the midline of the foot as a reference. In postures such as tadasana and all postures that can be derived from it and are identical in the leg position, e.g. uttanasana, urdhva hastasana, this means that the thigh has a slight end rotation. However, this does not detract from the postures. On the contrary, in forward bends it facilitates the movement of the ischial tuberosities away from each other and thus tends to improve the ability to flexthe hips.

The imaginary midline of the foot is much better suited as a reference than an axis of the knee, as it is easier to estimate due to the length of the foot. In addition, the kneecap, as the most prominent structure of the knee that can be seen from the front, is far less easy to assess in terms of its exact alignment, and in some people it is also in an abnormal position (e.g. lateralized) and often covered by clothing. The foot, on the other hand, is often uncovered during exercise and, if it is, then at best covered with rather tight-fitting socks. In the case of pronounced knock-knees, the experienced teacher may have to assess the situation differently and define a new reference and new behaviors. For the time being, we do not refer to the final rotation in our lessons in order not to complicate the explanations and instructions unnecessarily – unless it seems necessary to us.

Weak back

Question:

I have a weak back and need to do something to strengthen it. What postures can I do to do this, and do I really need to do deadlifts, isn’t that more „gym stuff“?

Answer:

Of course, there are many good yoga poses that strengthen the back, but the deadlift definitely has its place and its benefits, let’s take a closer look. When we talk about the „weak back“, we first need to look at the structure of the back and try to find out what is meant and where there is a need. First of all, the back muscles are divided into the autochthonous back muscles, also known as the „erector spinae“ or „back extensors“, which are the oldest muscles of the back in evolutionary terms and are found in slightly modified form in many species of vertebrates. All other back muscles are ultimately muscles that have migrated from the extremities. This is why the autochthonous back muscles (even today) have their own nervous control system. These muscles perform three functions:

Extension of the spine, i.e. stretching as opposed to (forward) bending
Rotation of the spine, i.e. a torsion of the spinal column structure in itself, a twisting of one part in relation to another
Lateral flexion of the spine, i.e. lateral bending of the spine or part of it

These movements cannot be performed for each spinal segment (i.e. two adjacent vertebral bodies and the intervertebral space between them with its intervertebral disc), but only for large sections of the spine as a whole. For example, the cervical spine can be rotated to the right(rotation) and the head tilted to the left(lateral flexion), but the thoracic spine with the lumbar spine can be rotated to the left and bent to the right. This can also be combined with flexion or extension in the areas mentioned. If you take a closer look at the musculature, there are many different muscles that connect more or less adjacent vertebral bodies or areas that are further apart in various combinations. The spinous processes and the transverse processes of the vertebral bodies are the main points of origin and attachment. If we imagine that a muscle attaches to the spinous process Th3 and the right transverse process Th4, then its contraction obviously causes a left rotation of Th4 in relation to Th3 or a right rotation of Th3 in relation to Th4. It also contributes a little to extension. If muscles only span spinous processes, they have a pure extension function; if they only span transverse processes, they only perform lateral flexion to the side on which they lie or pull out of lateral flexion to the opposite side. In some cases, the autochthonous back muscles also attach to the ribs (halfway close to the spine). all other back musclesHere we find, for example the muscles for depression, elevation, rotation or retraction of the shoulder blades, other muscles that pull from the shoulder blade in the direction of the arm, for example to tilt or rotate it, a few that are involved in inspiration or expiration (serratus posterior inferior and serratus posterior superior), or connect the iliac crest with the ribs(quadratus lumborum). The largest of these is the latissimus dorsi. Almost all of these muscles move the shoulder blade or the arm. Most of these muscles are not directly and significantly involved in upright posture, but their tone or flexibility can have a certain effect on posture. In most cases, however, „weak back“ primarily refers to weakness of the erector spinae. If we do postures to strengthen it that also involve the arms, we usually also strengthen some of the muscles outside the erector spinae. The most important postures that significantly strengthen the erector spinae include the extension function of the spine:

Warrior stance 3, especially in the „backwards against the wall“ variant
right-angled uttanasana
Shoulder stand, especially at right angles
Headstand (not particularly strong, but strong in the right-angled version)
halasana
urdhva dhanurasana
salabhasana
upavista konasana with block
maricyasana 1
maricyasana 3
purvottanasana
Most postures that combine hip flexion with thoracic spine extension

With regard to extension, it must be said that postures or exercises should not only be assessed in terms of the usual criteria of strength and duration, but also in terms of the angular range in which the muscle work takes place, i.e. the sarcomere length:

We strengthen the rotation aspect with, among other things

although this is a very rough and incomplete list and it must be borne in mind that even intensively performed stretching postures can have a powerful effect.

Unlike the yoga poses, the deadlift is an exercise in which any external weight is deliberately used to achieve scalable strengthening effects that could not be achieved using only your own body weight – and in a comparatively simple way. In return, it rewards you with rich and effective strengthening:

the calves(triceps surae) and various other stabilizing lower leg muscles, which stabilize against the gravity-induced dorsiflexion inclination in the direction of plantar flexion and pronation or supination
of the hamstrings, which (apart from the m. biceps femoris caput breve) plays a key role in extension in the hip joint when lifting the upper body. Strengthening it can serve many purposes, e.g. as part of the treatment of a hollow back by supporting the strengthening of the hip extensors. The hamstrings is very important here because it generally straightens the pelvis in areas of moderate force application before the gluteus maximus is acquired as a force extender of the hip joint. Strengthening the hamstrings is also important in the treatment of various disorders of the knee joint. In both of the latter cases, moderate to higher weights are used. In the case of irritation of the area of origin of the hamstrings at the ischial tuberosities, a very light weight is used to start with. The weight should only be increased to such an extent that the pain associated with the disorder is not triggered.
of the gluteal muscles, specifically all monoarticular hip extensors involved in lifting the pelvis out of flexion. Strengthening them requires significantly heavier weights than for the therapeutic applications described above, especially when treating irritation of the origin of the hamstrings at the ischial tuberosity. From a therapeutic point of view, the main focus here is on imbalances in the leg/pelvic muscles and the resulting disorders such as bow legs.
„the back muscles“. A distinction must be made here between the autochthonous back muscles, which extend the back and thus counteract the large lever that the upper body represents with the head and arms, and which is now additionally increased by an external weight on a relatively long lever arm. This explains the outstanding effect of the deadlift in strengthening the back, although it should be noted that it is mainly the parts of the erector spinae that perform the extension of the spine. The parts that are primarily rotationally or laterally flexorally active are only affected to a lesser extent. Instead, there are a number of yoga postures that serve this purpose, e.g. all twisting postures relating to rotation, some of which also work with clear internal moments, such as in the case of jathara parivartanasana, which usually do not need to be enlarged further externally – at least not for therapeutic purposes – as well as the lateral flexors, which serve postures such as trikonasana, ardha chandrasana or vasisthasana and ardha vasisthasana excellently. There is generally no need to work with external weights here either. In both cases, the usual upright posture places little demand on these muscles. The second area of the back muscles are all the muscles involved in stabilizing the position of the arms and shoulder blades, i.e. primarily the retractors and depressors of the shoulder blade. The shoulder blade, which moves freely on the back and is only fixed by muscles, is the bony anatomical structure on which the external weight hangs via the arm, so it must be held with appropriate muscle strength, which in turn is able to strengthen these muscles very well. Shoulder blade depression exercises are likely to benefit people who tend to habitually raise their shoulder blades and thus tense their trapezius. Those who tend to pull their shoulder blades forward or have a shortened pectoralis major will benefit from shoulder blade retraction exercises. Both of these bad habits often go hand in hand and often reflect internal tension.
of the neck muscles. Even if only the head needs to be held, this is done with a good gravitational effect on average; if the upper body is horizontal with the head, it is at its maximum.

Due to its scalability, simplicity and multiple effects, the deadlift is therefore an outstanding exercise that we like to use. However, we still need to differentiate a little: When it comes to the muscles of the lower and lower to middle back, the deadlift is often the first choice. However, if the already smaller paravertebral musculature between the shoulder blade and spine is affected, which is rather weak in many people and therefore sometimes shows weakness after just a few hours when holding the trunk upright every day, which manifests itself in an annoying persistent longitudinal (spine-parallel) pulling of this area, which can only be dealt with by changing position, but which very quickly returns when the upright posture is resumed, then a different tool is needed: the „therapeutic front lift“. The „trick“ that makes this effective is that the force is applied almost from the other end of the spine. On a long lever arm, the human arm, a weight is moved up and down in alternating frontal abduction. This creates significant bending moments in the vertebral segments, especially in the thoracic spine (naturally, the spinal segments above the maximum of the thoracic spine kyphosis are most affected) and forces the paravertebral autochthonous muscles there to work intensively. Even if this posture was presumably invented primarily to strengthen the shoulders, it can be modified in such a way that it results in sustained strengthening of the back muscles in question by shifting the total duration of action as far upwards as possible using an adapted low weight. The focus here is therefore on the maximum time that can be spent with the arm more or less raised and the effective moments in the thoracic spine, not on the number of repetitions or the amount of weight.

Pressing down the metatarsophalangeal joint of the big toe

Question:

Why do the instructions for the asanas always insist on the sometimes really difficult pressing down of the metatarsophalangeal joint?

Answer:

To understand this, we need to briefly visualize the anatomy of the foot. Apart from the bony anatomy with the tarsal bones (the tarsus) in the so-called hindfoot, whose support on the ground is the heel bone (the calcaneus), the midfoot with the metatarsal bones (their entirety is also called the metatarsus), there is also the forefoot with the toes. As a general rule, we leave these soft in our postures, so we don’t press them onto the floor or lift them, but leave them completely soft on the floor. The reason for this is that the toes can transfer much less force than the ball of the foot and no matter how you use the toes, using them would always lead to less than optimal support for the ball of the foot, which would impair the transfer of force to the floor. In postures with a balancing character, especially those on only one leg, the position and use of the foot is obviously extremely important for stability. As the heel bone (calcaneus) lies under the ankle bone (talus) and this in turn lies in a line of force under the shin bone (tibia) and thigh bone (femur), the heel bone is the one that naturally transfers most of the weight force to the ground. However, this alone does not enable usable balancing due to the very small contact surface, and the muscles that move the heel bone in the ankle joints are comparatively coarse.

In order to balance properly, we must therefore include other parts of the foot: the midfoot and the ball of the foot. In physiological terms, the midfoot only consists of the outer edge of the foot as far as possible contact with the ground is concerned, as the inner foot is hollow. Although there are many muscles here, except in the case of pathologically altered feet, e.g. flat feet, these have no support and cannot transmit any force. In particular, there is no bone structure in the inner foot that could transfer force to the ground (much better than muscles pressed to the ground). Only the metatarsophalangeal joint, which is still part of the midfoot, can transfer force to the ground and is intended to do so as a preliminary result of the evolution of the human body. When walking and running, a significant part of the force is transmitted in particular via the metatarsophalangeal joint area of the big toe. The main muscle involved is the very powerful triceps surae. Taking into account the leverage ratios, it can transfer loads of up to over a tonne via the Achilles tendon. This sounds very much as if the structure of the metatarsophalangeal joint area and the executing muscles are strong enough to carry out balancing.

However, this approach has a small „flaw“: the gastrocnemius part of the triceps surae not only causes plantar flexion, i.e. pushing down the forefoot in the upper ankle joint, but also supination (lifting the inner edge of the foot) in the lower ankle joint. This means that the pronators of the ankle joint in the lower leg must also be included in the balancing process, i.e. ultimately a dynamic, constantly changing balance of forces must be created and maintained from the entirety of the relevant lower leg muscles, which perform pronation, supination, plantar flexion (and possibly also dorsiflexion), in which the majority of the relevant movements and forces are transmitted via the metatarsophalangeal joint area. What applies to balancing postures on one leg also applies to a lesser extent to postures such as parivrtta trikonasana and parsvottanasana and it is generally advisable to use all standing postures to train the lower leg muscles for the task of balancing postures

In practice, it can be seen that the toes are often used in between, namely when the posture feels quite unstable. The reason for this is that the muscles that operate the toes are more sensitive than those that operate the balls of the feet. This means that they only last a small fraction of the time when comparable force is applied (if this is possible at all), which is often only a few seconds with sufficient intensity. Of course, the use of the toes must lead to a change in pressure on the associated balls of the foot. If the muscles that move the toes are then exhausted, you are thrown back onto the balls of the feet and have to continue the balancing work with their help, but this has two disadvantages: Firstly, by using the toes, the balls of the feet are no longer lying full, steady and evenly on the floor and secondly, the switch from fine motor (toes) to gross motor (balls of the feet) work is difficult – and particularly difficult in this situation, as the balls of the feet are lying deformed on the floor anyway and the actual reason for using the toes was a perceived instability, i.e. some of the prerequisites for calm, good balancing are not in place. We therefore recommend categorically not using the toes for balancing work.

Cracking joints

Question:

My kneejoint/elbow joint/foot joint/hip joint cracks from time to time. Is that bad? How do I deal with it?

Answer:

We have to differentiate here: if it is a noise that can be repeated with every similar movement, whether it is a cracking or crunching sound, with or without the associated sensation, this is a different case from a clearly defined joint that cracks once and can no longer produce this cracking sound for the next few minutes/hours. We should not deal with the first case here, we will leave it to the orthopaedist for clarification. In the second case, it appears to be the elimination of a small misalignment (dislocation or subluxation) associated with noise or sensation, which many people are more or less aware of. In almost 100% of cases, those affected say that the condition after cracking is no more unpleasant than before. A similar number say that the condition is more pleasant afterwards, and a large proportion of them say that they previously felt a slight feeling of tension in at least some of the muscles covering the affected joint, which can no longer be felt after cracking. If we therefore assume that this is a spontaneous repositioning (bringing the joint back into the correct position), it must be clear that the joint may only be loaded in the state after cracking, which should be the physiological state. This applies in particular to heavy and repetitive moderate demands! Exertion in a dislocated state not only stresses the joint and could change the capsular tension or ligament lengths in the long term, but also places increased demands on the affected muscles and is all the more likely to lead to premature fatigue, cramps and strains! While muscular disorders such as a condition after a cramp and even a pulled muscle usually heal spontaneously within weeks, acquired changes to capsules or ligaments often take several years and only heal spontaneously if the conditions for this are (re)created, i.e. in particular if misalignments are repeatedly corrected before strain is applied. Anyone who knows how to reposition the dislocation with a simple movement is therefore well advised to do this before any demands are made. This naturally applies to all types of activities and exertion, be it sport, professional or hobby activities or yoga.

Intervertebral disc problems and poor forward flexion (stiff hamstrings)

Question:

I have been doing sport for a long time and have super stiff backs of my legs. At the same time, I was diagnosed with a herniated/bulging disc after an examination for back pain radiating into my leg and I realize that forward bends, which would make the backs of my legs flexible, are not good for me.

Answer:

This could be described as an „unhappy couple“. All forward bends that practise hip flexion and round the back in line with gravity can lead to increased symptoms in the case of disc problems and are actually contraindicated. On the other hand, it is precisely the mobility of the back of the legs that is lacking in order to perform certain movements in a back-friendly manner, i.e. with a straight back, for example when I pick something up from the floor. Is there even a solution for this?

Fortunately, exercises that promote the flexibility of the hamstrings (or hamstrings, i.e. the muscles at the back of the leg that perform hip extension as well as knee flexion ) can also be performed with a straight back; deadlifts are an excellent example, as is the table variation of uttanasana. A properly executed 3rd warrior pose or back extension are of course also included. Similar to the weakened 3rd warrior pose, the deadlift has the advantage of strengthening the back. Often – but not always – an intervertebral disc problem is associated with weak back muscles. The deadlift is therefore the right thing to do in two ways, and the stretching effect on the hamstrings can be as strong as you like – depending on subjective and individual tolerance – thanks to the external weight. When deadlifting, the back is kept in the physiological lordotic position and the hip joints are flexed as far as the back can be kept straight or – if this can be considered safe – the sensation of stretching in the back of the legs is tolerable.

You can also use another trick to prevent the back from curving when exercising flexion in the hip joint, namely extension in the contralateral hip joint, which has a lordotic effect on the lumbar spine. Rarely is the back so sensitive that this trick does not work, even in the case of disc problems. This includes postures with „scissor movements“ of the legs, a good example of which is the dog pose head down with one leg lifted backwards against the wall, also known as the „favorite winter warm-up pose“, which implements precisely this principle. At the same time, it also has a stretching effect – albeit not very strong – on the hip flexors, the shortening of which is often part of the etiology of disc damage.

Of course, it takes sustained practice over time to make the backs of very stiff legs flexible again. Back-friendly behavior is of course a MUST, especially during the period in which the back tends to cause discomfort when rounded – particularly with pain radiating into the leg. Pain that flares up again and again is a sign that the intervertebral disc is still very close to the affected nerve. However, there is a good chance of leading a normal life through sustained practice, in which movement habits practiced later, such as lifting with a straight back using the strength of the hip extensors, become second nature and the system figuratively and literally moves further and further away from the pain threshold and even an occasional „misbehavior“ with regard to the back does not immediately lead to the pain flaring up again.

Static and dynamic practicing

Question:

Dynamic practicing is more fun for me!

Answer:

– yes, but

It is not uncommon for students to come to us who have already spent several years practicing dynamic yoga disciplines, whether they are called flow, power yoga or vinyasa. They usually report that they have not really progressed in their dynamic discipline, but have injured themselves more often or have not been able to get rid of an acquired injury. It almost always becomes clear very quickly that ultimately deficits in strength, flexibility or body awareness are the presumed causes of their complaints. Deficits are not meant in terms of an average statistical normal state, but in terms of the demands of their dynamic discipline. Sometimes all it takes to cause an injury is a little carelessness in execution, a movement that is executed a little too imprecisely, too much willpower in view of the given conditions. It is well known that some of these injuries can be very persistent, e.g. if they affect the gracilis or the shoulder area.

Intensive use of the anatomical structures that were not originally intended to bear the entire body weight or a large part of it, namely the hands, forearms, elbows and shoulder area, can cause a wide variety of disorders ranging from dorsal pain or palmar tearing in the wrist/forearm during supporting exercises with approx. 90° dorsiflexion of the wrist, overloading of the elbow joint at large flexion angles or a golfer’s elbow if the palmar flexors of the wrist and finger flexors are repeatedly used very intensively, through to the many disorders that can occur in the complex shoulder area. Rapid straddling movements can cause strains of the gracilis that are difficult to heal, just as unheated swinging movements in the direction of hip extension can cause strains in the hamstrings or irritation of the origin of the hamstrings on the ischiadic tuber.

So is dynamic practicing actually poison? Not necessarily, but the conditions must be right. It can by no means be treated as a beginner’s discipline and anyone who feels the desire to do so can safely be admitted and start their yoga career with it. Due to the high requirements, years of intensive training in flexibility, strength, body awareness and ideally also endurance should have preceded this if you want to practise dynamically without harm and successfully. As is so often the case, you have to do your duty first before you can do the freestyle.

We have repeatedly held dynamic classes with more advanced athletes, even at high intensity, without any injuries that I can remember. However, beginners were always excluded from these so that they could not come to any harm. After all, years of intensive, predominantly static asana practice not only bring with them the characteristics listed above, but also an increased resilience to fundamentally high but physiological demands and often also to a certain extent to a moderate (!) degree of deviation from purely physiological behavior.

Our recommendation would therefore be to practise static asanas intensively for a few years, preferably also doing strength and endurance-enhancing sports at the same time, before starting dynamic practice. The anticipation will then be rewarded by the fact that the subsequent joy of dynamic practice can be enjoyed unclouded, without setbacks and for a long time, instead of collapsing because of them.

Pain in the knee in upavista konasana

Question:

I have knee pain in upavista konasana, but it is also a problem knee.

Answer:

This problem is relatively rare and only occurs with previously damaged knees, whether the previous damage is known or not; nevertheless, there is a solution: Upavista konasana is performed alone free, alone against the wall, alone in a supine position against the wall or as a partner exercise. A distinction must be made between these cases:

free alone: if the pelvis is pushed forward, the heels must move outwards a little to increase the angle. It is undesirable, but not always entirely avoidable, that the heels also slide forward a little. When the pelvis moves forwards, the heels provide significant resistance with good friction on the floor. This results from the weight of the legs, but also from the tension of the hip extensors, especially the hamstrings. Moving the pelvis forwards therefore creates valgus stress in the knee joint, which can cause pain in an already damaged knee joint that has nothing to do with constructive processes such as stretching or exertion and should therefore be avoided
against the wall alone: in analogy to the first case, the greater the resistance (of the wall), the greater the quasi-infinite friction, which may cause the above pain to occur with even less movement of the pelvis
alone in supine position against the wall: Here we assume that the posture is not only performed very gently, whereby the friction of the heels on the wall would cause the knees to sink into a varus stress according to gravity, but so intensively that the friction of the heels on the wall outweighs the effect of the pull of the adductors in such a way that, as in the first two cases, a valgus stress occurs. Then it behaves as shown there
as a partner exercise: This variation behaves in the same way as the first two.

In all cases – assuming sufficient intensity – valgus stress is generated, which can cause pain in the knee. How can this be avoided? The simplest solution is the most complex: a supporter presses with his feet not against the feet of the performer but against the thighs near the knees. This reverses the force effect on the knee joints and the valgus stress tends to become varus stress, at least as long as the feet are pressing against the floor with sufficient friction. If they are now deprived of sufficient friction, be it through socks that slide on a wooden floor or through a blanket on which the heels can slide, this varus stress is also almost completely eliminated and the posture can be performed without pain.

Pain in the forearm/hand(golfer’s elbow, tennis elbow, tendinitis, RSI syndrome, carpal tunnel syndrome)

Question:

I work a lot with my hands/on the computer/manually and have persistent or recurring pain in my forearm/hand. What could this be and what can I do?

Answer:

Regular high stress or overloading of the structures of the forearm due to heavy, but also frequently repeated light activities such as typing or operating the mouse can generally cause several disorders:

Tendovaginitis (inflammation of the tendon sheath): In addition to VDU workers, musicians, masseurs, physiotherapists or other professionals and hobbyists who work intensively with their hands can also be affected. Working with greater hand forces, vibrating tools or repetitive movements with a repetition time of less than 10 seconds predispose to the disease. The tendons and sometimes muscles can be painful on pressure, movement and possibly also at rest. The pain quality during movement tends to be pulling to stabbing. Rest at night brings little recovery. Redness or overheating may be recognizable as further signs of inflammation. The tendon sheath may produce more collagen and constrict the tendon, which can lead to the phenomenon of the „fast moving finger“, which initially hardly moves at all and then continues to move quickly and jerkily when further force is applied. The Finkelstein test (if the thumb is affected) shows pain when the tendon is passively stretched; active tension against resistance is also painful. It is usually a non-infectious inflammation of the tendon sheaths. Nodules of collagen can form in the tendon she aths, which can lead to palpable and audible rubbing or crunching. Therapeutically, it is advisable to protect the tendon sheaths from the triggering stresses, stretch them carefully and strengthen them therapeutically as soon as tolerated. If the tendon sheath inflammation is not cured, an RSI can develop, see below.
RSI (repetitive strain injury syndrome): pain syndrome, also known as mouse arm or secretary’s disease, which is caused by very frequent, rather light movements, such as typing on a keyboard (computer or virtual smartphone keyboard) or clicking the mouse. Contrary to previous assumptions, RSI is a non-inflammatory, chronic degenerative change in the tendon tissue( tendinosis, tendinopathy). The cause is probably that the frequently repeated movement is no longer in a healthy relationship to the ability to regenerate, so that only inferior collagen is formed. In the USA, RSI is the number one occupational disease, with ergonomic deficiencies in the workplace favoring its development. Initially, there is tingling and discomfort and the symptoms subside after the strain has ceased. Later on, strength may decrease, coordination disorders may occur and chronic pain may flare up again after even the slightest trigger. Stiffening of the joints is possible. In the late stages, there is constant pain regardless of exertion, which only begins to subside after weeks of rest. RSI is a possible complication of unhealed tenosynovitis. Ergonomic deficiencies in the workplace predispose to the development of RSI, and sport can have a preventive effect. Many therapeutic approaches have been tried, but rest without immobilization is mandatory in any case.
Golfer’s elbow: This is an insertional tendinopathy of muscles that originate at the medial humeral epicondyle of the elbow joint, including the pronator teres and flexors of the forearm. It is caused mechanically by pressure on the epicondyle, which can cause microlesions, or more commonly by overloading the palmar flexors of the wrist or finger flexors. Inadequate stretching or strengthening in relation to the strain, ergonomic or technical deficiencies (in sports and other activities), frequent firm gripping with the hands, especially with simultaneous supination of the forearm, all kindsof racket sports, climbing, various manual activities or activities such as road construction (scooping), or mechanical activities (e.g. with frequent tightening of screws) predispose to the development of the golfer’s elbow. A suitable medical history in conjunction with the typical tenderness and functional diagnostics is generally sufficient to make a reliable diagnosis. Pain at rest may be present, but pain on exertion is particularly characteristic. In addition to the epicondylitis brace, reducing the strain, possibly brief immobilization, but never longer, adequate stretching training, cooling if necessary in the active stage and warming later on are important pillars of therapy. Therapeutic strengthening training with a very high number of repetitions using such light weights that the pain is not triggered is also promising, even if healing may take several months under favorable conditions. There are also many other approaches. After healing, it is important to maintain a good level of stretching and strength in the affected muscles to prevent recurrence. A distinction can be made depending on the affected muscle and the resulting painful movement restrictions:
- Forearm pronation golfer’s elbow: the pronator teres muscle is affected
- Wristpalmarflexion golfer’s elbow: flexor carpi ulnaris, flexor carpi radialis or palmaris longus muscles are affected
- Finger flexor golfer’s elbow: the flexor digitorum superficialis muscle is affected
Tennis elbow: the sibling disease of golfer’s elbow, similar symptoms, similar causes, similar therapy, only in this case it is not the palmar flexors and finger flexors that are affected but in both cases the extensors or dorsiflexors. The causes are overloading, e.g. through tennis, mechanical work (assembly line production), intensive playing of a musical instrument, housework, previously also often found in typists. Sensitivity to pressure, pain on movement and especially pain on exertion are found here in a similar way. With the Thomson and chair tests and an appropriate medical history, these are usually sufficient for a diagnosis. Treatment is also very similar to that for golfer’s elbow: rest or immobilization of the wrist, but not the elbow. A few months must also be set aside for treatment here. Depending on the affected muscle and the resulting painful movement restrictions, a distinction can be made:
- Forearm supination tennis elbow: : the supinator muscle is affected
- Wristdorsiflexion tennis elbow: extensor carpi radialis brevis, extensor carpi radialis longus or extensor carpi ulnaris are affected
- Finger extensor tennis elbow: the extensor communis or extensor digiti minimi are affected
Carpal tunnel syndrome: the tendency to carpal tunnel syndrome is quite individual with the same or similar movement behavior. The dominant hand is usually affected. Injuries, pre-existing tendon sheath inflammation or a troublesome ganglion can cause this condition, sometimes it also occurs secondarily. The main causes are frequently repeated and preferably heavier use of the finger flexors: with the 4 tendons of the flexor digitorum profundus muscle (in the ulnar sac) and the 4 of the flexor digitorum superficialis muscle and (in the radial sac) the flexor pollicis longus muscle, a total of 9 finger flexor tendons run through the carpal tunnel. Symptoms include paraesthesia of fingers 1-3 (swearing hand), attacks of pain at night, feeling of fingers falling asleep, initially pain on exertion, later also pain during the day and at rest. The pain can radiate into the arm, weakness of grip first occurs in the morning, later persistent, the muscles in the ball of the thumb can atrophy. Initially, immobilization is sufficient for treatment, possibly with anti-inflammatory and analgesic drugs; if this is not successful or worsening strain cannot be avoided, the constricting ring ligament must be surgically severed.

These are probably the five most important disorders of the hand and forearm that can be triggered by stress. Anamnestically, the disorder can often be quickly identified by location and possible triggering activities; in case of doubt, functional diagnostics can help. Ergonomic deficiencies at the workplace and frequently repetitive activities such as typing on keyboards and smartphones and clicking the mouse are common triggers for tendonitis and RSI in particular. Yet these images in particular are often easily avoidable by making small changes. A correct sitting or desk height, a wrist rest for the keyboard and a vertical mouse often help to prevent the development or heal an existing disorder. The other disorders are often caused by too intensive use of the finger muscles in the forearm in relation to training and stretching status as well as regeneration time.

Where do you turn your head? You do it differently than …

Question:

I’m a little confused: in various postures you don’t turn your head the way I’ve learned. Why is that?

Answer:

Well, we try to match the anatomy and movement physiology of the human body as closely as possible, or sometimes contradict it in a certain way, in order to achieve a specific maximum learning effect. Some examples:

ardha chandrasana: Depending on how securely the participant is standing, we don’t have them look upwards as in the original pose, but first enable them to stand better by having them look down towards the foot. The reason for this results from anatomy: the visual feedback from the stance to the brain by looking down at the foot and the ground is two times faster than the feedback from the foot’s pressoreceptors. This accelerates the reaction processes and provides a much safer stance. The advanced participant, who no longer needs this, can then turn their head upwards as soon as they no longer require this assistance.
parivrtta trikonasana: The same argument applies here as for ardha chandrasana, except that it has even more of a balancing character. Nevertheless, beginners in particular benefit from looking towards the foot and therefore also having the floor in their field of vision
2. warrior pose: in the original pose, the head looks along the arm on the side of the bent leg. However, it is already impossible for most participants to keep the pelvis and upper body parallel to the long edge of the mat in the desired position. As the pelvis and upper body as well as the upper body and head are closely and diversely connected muscularly, a rotation of one inevitably has an effect on the other. As a result, the original head position would prevent the upper body and – not unlikely with it – the pelvis from getting into the correct position even less than it already is. It therefore makes more sense, albeit unconventionally, to point the head in the exact opposite direction: in the direction of the outstretched leg!
1. warrior position: many people consider the original position to be tilting the head back (maximum reclination). However, the movement of the head inevitably has an effect on the thoracic spine and the sections of the spine (cervical spine, thoracic spine, lumbar spine) can only be specifically controlled as a whole and not in individual segments. With the reclination of the head, an extension of the thoracic spine and in all likelihood – except with really good body awareness – also an excessive extension of the lumbar spine must be accepted and this is exactly what we are fighting against with all the strength of the hip extensors! This can therefore only be recommended for practice purposes for really advanced participants, for the first few years the reclination of the head is simply counterproductive, especially as there are more suitable postures for practicing this in a dedicated way, such as purvottanasana. In other interpretations of the first warrior postures, as can be seen frequently in various media, in which no maximum extension is practiced in the hip joints but the curvature is distributed evenly or seemingly randomly and without any recognizable measure to hip extension and spine, our argument is of course invalid.

Can you recommend a good school in XY?

Question:

I am moving away and then it will be too far to come to you for yoga. Can you recommend a good school in XY?

Answer:

Usually not. I would strongly recommend pre-selecting the schools there according to the information available online and then trying them out, if in doubt several times or with different teachers. If you are used to and appreciate a style, you often approach something new with the idea that it has to be the same or similar to the old one. Sometimes you are not open to something good that is simply different, but also valuable. On the other hand, I often hear from students who come to us for the first time and have previously tried a few other schools that they have never experienced such precise and well-founded work and such helpful ways of dealing with difficulties or health problems of any kind. We are then pleased that they feel they are in good hands with us.

Conversely, people who have moved away often report that they were unable to find anything similar in their home town. At this point, there is not much more we can do than refer to our ever-expanding www.yogabook.org, offer the opportunity to drop in at any time if the opportunity arises and continue to provide remote advice on specific questions or uncertainties. In individual cases, we also encourage people to start teaching to our standard themselves and complete our training.

Irrespective of the fact that we try to set standards in the understanding and execution of the asanas and to do justice to every person with almost every condition, I must nevertheless express a fundamental thought: A path generally consists of many sections and all the more steps. It is anything but inappropriate to be here or there for a while in order to take in as much as you need or can grasp. Then the path continues somewhere else and you try again to take what you need or can grasp.

What can be said for sure is that anyone who teaches asanas and has little interest in and knowledge of anatomy, physiology and pathology cannot be a good teacher. It may be that if he is a lucky one, he will rarely notice it or he will notice it late so that it does not affect his business too much, but it will be noticeable. Anyone who teaches yoga and does not have a corresponding mindset and therefore treats the students with respect, attention, benevolence and interest in the deviating behavior of their body in the asanas cannot be a good teacher either.

To give an example: I was recently made aware of posts on social media in which a yoga school from a neighboring town advertised its own events with completely false arguments. It was about simple anatomical questions and the opposite of what was written was always true, which could easily have been found in any anatomy book on the planet. What’s more, it would definitely have been part of a yoga teacher’s basic knowledge. In addition, there was a freely invented mobility of a joint that certainly does not exist and cannot even exist pathologically to the extent claimed. Anyone who disqualifies themselves professionally at the lowest level in this way is certainly not worth experimenting with.

If this kind of doubt arises with regard to the teacher’s technical equipment or attitude, you won’t be able to stay there for long if you were used to better things before. If there is no previous experience, at some point you will begin to wonder whether this is the state of the art and start looking for better.

side discrepancies, especially in mobility and imbalances in legs/hips

Question:

I have noticed that in some postures that require mobility of the legs or hips, the two sides work differently and there are obvious differences in mobility. Is that bad? What can I do?

Answer:

{Due to its scope and relevance, this article is also available as a PDF}

Apart from congenital anomalies and differences, these are mostly acquired differences caused by professional or hobby activities and one-sided or unilaterally trained sports. One-sided sleeping habits can also play a role. For example, sleeping regularly on your stomach with one arm bent under your head will result in unequal mobility of the shoulders and a specific tendency to tension. If one leg is bent to the side in a supine or prone position, this would also result in a tendency to tension in the hip and pomus muscles and a sideways difference in the mobility of the adductors.

In the same way, repeated asymmetrical sporting activities are suitable for developing asymmetries in the musculature. The soccer player will develop his kicking leg differently from his standing leg, the volleyball player will develop the arm with which he serves from above differently from the other, the tennis or squash player will develop the leg with which he goes forward to receive the ball. Often the dominant leg and arm will be stronger, or the joints with which they are attached to the trunk, i.e. the hip joint and shoulder joint, will be somewhat more „movement-conscious“ but often also less flexible. „More aware of movement“ here means above all better proprioception. In the case of the leg or hip, depending on the extent and type, this imbalance may have an effect on the entire body statics and lead to a hollow back with or without thoracic spine hyperkyphosis, pelvic obliquity or pelvic torsion and scoliosis and often to chronic complaints. The most important correlations are presented below.

The center of gravity of the upper body, head and arms meets the connecting line of the acetabuli (hip joint sockets) at anatomically zero, which theoretically results in an unstable balance with only minimal muscular work required to maintain orthostasis (standing). Muscular imbalances in the muscles pulling on the pelvis towards the legs therefore all too easily cause a change in orthostasis and, as a chronic picture, various incorrect postures or deformities of the trunk. There are various muscular causes for disorders. The most important ones are listed below. Weak extensors of the hip (ischiocrurals and gluteals)the relatively stronger flexors tilt the pelvis forward, resulting in a tendency to shift the center of gravity forward, which is usually responded to by shifting the upper body backwards and (following the minimal muscle tension) by tilting the pelvis into slight extension, where it remains due to the lig. iliofemoralia and the hip flexors. The effort to keep the head upright leads to hyperkyphosis in view of a posteriorly tilted lumbar spine and lower thoracic spine. Diagnosis/therapy with the following postures:

right-angled uttanasana the hamstrings, together with the glutes, holds the body weight minus the legs
Warrior stance 3 the hamstrings together with the glutes hold the body weight minus the standing leg, but also lift the raised leg together with the glutes. However, the lifting is limited by the hip flexors!
Warrior stance 3 backwards against the wall the hamstrings accelerates and together with the gluteals holds the body weight minus the standing leg
two-legged lift to headstand the hamstrings holds and accelerates the weight of the legs together with the glutes
Shoulder stand the hamstrings pulls the legs away from the head together with the glutes against the resistance of the hip flexors
parsvottanasana the hamstrings of the front leg together with the lateral glutes holds the body weight minus the legs
setu bandha sarvangasana The height of the pelvis (the higher, the better) is limited by the mobility of the hip flexors, but the extensors lift the pelvis
Bridge The height of the pelvis (the higher, the better) is limited on the leg side by the mobility of the hip flexors, but the extensors lift the pelvis

Shortening of the flexors of the hip(hip flexors)the pelvis tends to tilt forward into flexion, the center of gravity of the upper body would then be in front of the acetabuli, which is why the lumbar spine is hyperlordosed as compensation in order to keep the center of gravity of the upper body in a position favorable to the legs and the knees are slightly flexed in order to relieve the hip flexors, which are under tension; the OSG are in slight dorsiflexion, which favors shortening of the foot lifts. Hyperlordosis of the lumbar spine often results in hyperkyphosis of the thoracic spine and possibly also hyperlordosis of the cervical spine. If the shortening is unilateral, a pelvic torsion follows, the shortened side tilts forward and is lower on average. This is followed by scoliosis, affecting the SI joint, the vertebral joints of the lumbar spine and possibly also the thoracic spine and cervical spine, as well as an apparent (functional) difference in leg length. A further consequence may be a rocking gait with alternating lateral tilt and relative straightening of the upper body. Diagnosis/therapy with the following postures:

Head up dog position shows the flexibility of the hip flexors due to the height of the pelvis (the lower, the better) above the floor
hip opener 1 shows and exercises the mobility of the hip flexors well, but is dependent on the mobility of the hamstrings and gluteals (front leg)
hip opener 2 shows and exercises the mobility of the hip flexors well, but is dependent on the mobility of the hamstrings and gluteals (front leg)
hip opener 3 shows well the mobility of the hip flexors on the side of the extended leg, but is dependent on the mobility of the hamstrings (biceps of the flexed leg) and gluteals (side of the flexed leg)
ustrasana
Bridge
dhanurasana is more diagnostically relevant, the force applied is rather low for a significant stretching of the hip flexors
Hip flexor mobility test only diagnostically relevant, shows mobility well and side discrepancies if necessary
warrior 1 pose is the posture with the greatest extension requirement(!) of all postures that are reasonably suitable for beginners and has a good effect on the hip flexors if the appropriate force is used
setu bandha sarvangasana The height of the pelvis (the higher, the better) is a good indication of the flexibility of the hip flexors; the gluteus and quadriceps can be used well for stretching
supta virasana shows good mobility of the rectus femoris and side discrepancies if necessary, good effectiveness
Quadriceps stretch 1 on the wall
Quadriceps stretch 2 on the wall

Unilateral shortening of the abductors or adductorsDisplacement ofthe pelvis in the frontal plane, uneven and thus unilateral overloading of the SI joints, depending on the severity, functional leg length discrepancies (shortening of the abductors: ipsilaterally lengthened leg, shortening of the adductors: ipsilaterally shortened leg), compensating for this by flexing one knee joint and slightly abducting the leg contralaterally. The result is a consecutive scoliosis, often in a double-S shape with asymmetrical development of the muscles of the trunk and cervical spine and corresponding one-sided symptoms. Diagnosis/therapy with the following postures:

half lotus forward bend shows and exercises the mobility of the gluteus maximus in particular very well
hip opener at the edge of the mat shows and exercises the mobility of the gluteus medius in particular very well
hip opener 3 shows and exercises the mobility of the gluteus maximus in particular very well and in a knee-friendly manner
parsvottanasana demonstrates and exercises the mobility of the gluteal muscles, albeit strongly dependent on the hamstrings
parivrtta trikonasana demonstrates and exercises the mobility of the gluteal muscles, albeit clearly dependent on the hamstrings
Warrior position 3 shows and exercises the mobility of the gluteal muscles, albeit clearly dependent on the hamstrings

Weakness of the abductorsStaticallywhen standing on one leg and kinetically, for example during walking, only the abductors stabilize the pelvis in the frontal plane against lateral sinking. Slight weakness of the abductors leads to the unsupported side of the pelvis sinking(Trendelenburg sign); bilateral weakness therefore leads to the manequinus. If the weakness is more pronounced, the partial body weight (body weight minus supporting leg) is shifted over the hip joint to relieve the abductors, resulting in a waddling gait(Duchenne’s sign). One-sided development leads to corresponding scoliosis diagnosis/therapywith the following postures:

Tree may show a weakness of the abductors of the standing leg due to a sinking pelvis on the side of the bent leg
Warrior stance 3, with good mobility of the hamstrings, may show weakness of the abductors due to the inability to raise the hip of the lifted leg from a lowered position. Good for strengthening
ardha chandrasana may show a weakness of the abductors due to an insurmountable adduction of the lifted leg. Strengthens well
vasisthasana demonstrates and exercises the strength of the abductors against large partial body weight
ardha vasisthasana demonstrates and exercises the strength of the abductors against large partial body weight

Weakness of the quadricepsWithonly slight flexion of the knees, the center of gravity of the upper body is already behind the axis of movement of the knees and the quadriceps must work to hold the partial body weight. In the case of hyperextension, the centre of gravity would be in front of the axis of movement and the dorsal ligaments and capsule would stabilize the joint without muscular involvement. To relieve the quadriceps in the event of weakness, the pelvis is therefore often tilted forward with the upper body to relieve the rectus femoris from stretching. Statically, the knee can then be effortlessly extended and locked in hyperextension limited only by the posterior structures of the knee; dynamically, walking is facilitated and the hyperextension tendency of the knee joint is increased. Diagnosis/therapy with the following postures:

utkatasana
Warrior position 2
caturkonasana
hip opener 1 shows the strength of the quadriceps and exercises them to work against gravity of the leg and mobility restrictions of the hip flexors
hip opener 2 shows the strength of the quadriceps and exercises them to work against gravity of the leg and mobility restrictions of the hip flexors
Hip opening shows the strength of the quadriceps and exercises them to work against gravity of the leg and mobility restrictions of the hip flexors
parivrtta_parsvakonasana shows the strength of the quadriceps and exercises them to work against gravity and restricted mobility of the hip flexors
Warrior stance 1 shows and exercises quadriceps strength in both legs – in the back leg to work against gravity and hip flexors

Weakness of the hamstringsWiththe exception of the biceps femoris caput breve, the hamstrings is biarticular: knee-selecting and hip-extending. In standing and moderate walking, the ischiocrural group is the main extensor of the hip joint; the glutes only become active under greater flexion and load. A weakness of the hamstrings causes the pelvis to tilt forward into flexion when standing and the knee to fall too easily into hyperextension. Although these are the antagonists, the clinical picture here is similar to that of weakness of the quadriceps, except that in the latter case the pelvis is actively tilted forward to relieve the quadriceps; in the case of weakness of the hamstrings, it tilts forward from the (relatively speaking stronger) pull of the hip flexors. Here too, the gait is characterized by increased hyperextension. Diagnosis/therapy with the following postures: see above under Weak extensors of the hip. In many everyday movements, the hamstrings is involved both in extension or in preventing increased flexion in the hip joints, but to a large extent these muscles also bend the knees. Shortening of the triceps surae results in increased plantar flexion in the OSG and increased supination in the USG (pointed foot) with apparent lengthening of the leg, which is compensated for by slight flexion in the knee. When walking, the forefoot is placed on the ground first and flexion in the knee remains greater than normal. If the affected leg is pulled forward from behind, more flexion is required in the hip joint to prevent the forefoot from hitting the ground. Lifting the leg, in turn, is facilitated by a slightly forward tilted pelvis, which shortens the hip flexors and can lead to hyperlordosis of the lumbar spine. As the hamstrings is involved in holding the pelvis in slight flexion and has to perform greater flexion of the knee joint than normal during walking, it is also likely to be shortened. Diagnosis/therapy with the following postures: A distinction must be made here between the three parts of the triceps surae:

Gastrocnemius very powerful plantar flexor of the ankle and simultaneous supinator in the USG; at the same time knee flexor, very important with plantar flexion when walking/running
Soleus powerful plantar flexor of the ankle and simultaneous supinator
Plantaris largely negligible knee flexor and endorotator of the lower leg for plantar flexion

The two important muscles are therefore the soleus and the gastrocnemius, the first of which is stretched with every significant plantar flexion of the ankle and the second only in very strong dependence on the extension of the knee joint. In postures with the knee joint not extended, therefore, only the soleus should be stretched; when the knee joint is fully extended, successively more stretching of the gastrocnemius occurs and when the knee joint is fully extended, this stretching should clearly outweigh that of the soleus. The relevant postures are

Postures with straight leg and 30°-45° angle between the feet

Warrior position 1 also affects the gastrocnemius
parsvottanasana also works on the gastrocnemius
parivrtta trikonasana also works on the gastrocnemius

Postures with straight leg and 30°-45° angle between the feet and some others:

downface dog also acts on the gastrocnemius
utkatasana Restrictions in the mobility of the soleus limit the tilting of the lower leg forward towards the floor, thus having a significant influence on the center of gravity and increasing the need to tilt the upper body forward
Squat 1 shows and exercises the mobility of the soleus
Squat 2 shows and exercises the mobility of the soleus
malasana shows and exercises the mobility of the soleus

Weakness of the foot liftsWhen walking, the rear forefoot, which is to be pulled forward, would drag briefly on the ground, which is why more flexion is required in the hip. If the foot is placed in front, the forefoot reaches the ground first, resulting in a stepper or stork gait. The increased flexion in the hip joints in turn results in hyperlordosis of the lumbar spine and shortening of the hip flexors, which is further promoted by their increased work. Diagnosis/therapy With regard to the kinetics of human gait, the dorsiflexors are of no greater relevance than their involvement in pronation and supination, i.e. in the lateral tilting movements of the foot, firstly because they lift the forefoot so that it does not strike the ground when the foot is pulled forward from behind during walking and secondly because they prepare the foot for renewed plantar flexion, which is part of propulsion. Consequently, the plantar flexors could also be called „pushers“ or „pushers away“ in analogy to the term „dorsiflexors“ of their antagonists, because they contribute to propulsion with a significant amount of force. Furthermore, the plantar flexors support the forward leaning upper body supported by one leg, as they do in the case of the symmetrical two-legged stance in Anatomical Zero.

Here too, there is no analogy with the dorsiflexors. If they were to support the body against tilting backwards, the forefoot would already have to be fixed to the floor, and even then they would lack any significant strength to do so. It should be clear from these explanations of the physiology of movement that both in everyday life and in yoga, foot lifts can be given little training or even the opportunity to do so. Apart from rather exotic examples such as walking in heavy shoes or athletic cycling with a click fastener or stirrup over the forefoot, there is not much use beyond lifting the forefoot when walking. In asanas, their main purpose as dorsiflexors is to balance the tension of the plantar flexors of the triceps surae when the foot is not pressed onto a support and therefore the tension is not nullified by gravity or other effects. Inverted postures are an example of this:

The dorsiflexors are used here, but do not have to exert any significant force apart from the resting tension of their antagonists. If you were to construct postures in which they work powerfully in the anatomically zero position of the ankle joint, they would certainly also have a clear tendency to cramp, as they are close to the maximum of their concentric contraction and therefore close to it. The only postures in which you could train them a little and make statements about their strength would therefore be those with a more stretched(plantarflexed) ankle. And the variations of the dog position head down and dog position head up with the foot turned over are ideal for this:

downface dog with feet upside down, bending the feet out of plantar flexion against gravity
upface dog with feet upside down, bending the feet out of plantar flexion against gravity

In the above list, diagnosis and therapy are combined because this is typical for yoga postures: they show the difficulties or limitations in their execution and are usually precisely the therapeutic agent to remedy or expand them. In individual cases, we also use pure tests such as the hip flexor mobility test, which theoretically fulfill the criterion of effectiveness as a therapeutic agent due to their very low effectiveness, but fundamentally lack efficiency. However, a number of common tests, such as assessing the mobility of the shoulders in the direction of frontal abduction by raising the arms as high as possible with the back pressed against the wall, are too imprecise for us, as are some stretching exercises that are frequently seen in sport, such as stretching the quadriceps by holding an ankle with the same hand on the side with the knee joint bent; Although a certain, not particularly large stretching effect is exerted on the monoarticular parts of the quadriceps (the muscles of the arm are rather at a disadvantage against those of the leg), the particularly important biarticular rectus femoris can happily utilize all dimensions of evasion in the hip joint. Here, the precisely described asanas with their indications of possible or probable evasions in different directions, their interdependencies and the possibilities of recognizing and avoiding them, offer much more.

A distinction must be made between symmetrical postures, some of which show very direct side differences, such as baddha konasana, in which the knees are at different distances from the floor, upavista konasana with a block, in which the arms move differently upwards and backwards, or simply a back stretch, in which the shoulders are at different heights despite the hands being placed at exactly the same height on the wall, and on the other hand asymmetrical postures such as hip openings 1, 2, 3, 4, 5, warrior postures 1, 2, 3, parsvottanasana or gomukhasana, which only reveal the side differences in a remembered or recorded comparison, but offer a very good opportunity to practise the more restricted side for longer or more often.

Of course, in all the cases described above, an attempt should be made to eliminate the imbalance, as this is an essential prerequisite for good body statics and freedom from complaints, as well as the best prerequisite for long-term health of the musculoskeletal system. An analysis followed by a regular program tailored to the deficits is very helpful. Success should be monitored. In principle, not only the (more) shortened side should be practiced, but the (more) shortened side should be given more attention and time.

In asymmetrical postures, it may therefore be advisable to practise the affected side first and then practise the affected side again after the other side. On the one hand, it benefits from the marginal effect that the side practiced first is often practiced more intensively, more attentively or for longer, and on the other hand it has a greater overall effect due to the more frequent execution compared to the other side.

However, it is not advisable to specifically stiffen the other side, for example through one-sided sports training. It is much better to raise mobility to a uniformly higher level. Of course, these processes require time and repeated attention. As in many other cases, attempts to force quick results are likely to have side effects, not least because the body has adapted to the imbalance over a period of time and now has to make this „readaptation“ gradually.

There are tricks for some symmetrical poses, such as the use of a dumbbell in the lying variation of upavista konasana, in which a belt is placed around the foot of the more difficult side with an appropriate dumbbell hanging from it, or the dumbbell placed on the thigh of the more difficult side in the „against the wall“ variation of baddha konasana. Note the increasing effectiveness with the lever arm: the further away the dumbbell is from the pelvis (towards the knee), the greater the lever and the more intense the stretching effect.

In over 90% of cases, diagnosed leg length discre pancies are functional and not anatomical, i.e. they are due to uneven muscle tension and give the impression of a length discrepancy or are due to subluxations of the affected joints: ankle joint (especially the ankle joint), knee joint and especially the hip joint. Of course, it is important to clarify what type of length discrepancy is involved, as incorrect treatment may cause more damage than no treatment at all. Even in the case of pronounced anatomical length differences in the legs, 15 or 20 mm should not be compensated for immediately, as the body has adapted to the difference over a long period of time and a change in adaptation takes time or too rapid compensation generally has significant side effects.

At this point, some typical behaviors should be pointed out that can cause side differences (and other disorders), not all of which relate to the leg and pelvic area and thus necessarily characterize a pelvic obliquity or pelvic torsion. It should be noted that dominance of the extremities is often and not without reason expressed laterally and that disorders of the upper body can affect the leg/pelvic area and vice versa. Disorders in the leg/pelvic area therefore do not necessarily originate in the lower extremity; they can also be based on the behavior of the upper extremity or the trunk, i.e. have an effect from top to bottom:

Sitting with one leg crossed: changes the tension of the adductor and pomus muscles, tilts the pelvis slightly sideways, causing the lower lumbar spine to tilt slightly sideways
Standing with uneven load distribution between the feet
Frequent bending to one side or diagonally forwards and sideways: a person usually develops a dominant hand early on, which makes them right- or left-handed. In the same way, we develop a dominant leg, which is often the same side as the dominant hand. If we use the right hand to lift something because it is stronger and has more fine motor skills than the left, it is easier to support ourselves with the right leg than with the left. As a result, many muscles develop differently: the right calf muscles become stronger, the right hamstrings becomes stronger, the right glutes also become stronger and the autochthonous back muscles on the right side become more pronounced than those on the left. Furthermore, the latissimus dorsi, shoulder blade retractors and arm flexors as well as the finger flexors become stronger on the right. This side-unequal behavior is reinforced, as the attempt to use the other side, in this example the left side, is perceived as weaker, more strenuous and perhaps also less fine motor skills, so that from then on the right side is used all the more.
Prone sleep implies the need to protect yourself against suffocation, which would be likely if your head was pressed straight onto the pillow. The head is therefore turned to the side. If the head were not supported by an arm, the cervical spine would have to rotate around 90°, which would almost certainly lead to such tension for an untrained adult that a sick note would be necessary for at least a day. So you use a bent arm to support your head, which results in significantly reduced but still significant rotation of the cervical spine. However, the shoulder girdle is completely asymmetrical, which often leads to the development of chronic tension in the trapezius on the side of the arm bent overhead.
Abdominal sleep with the leg pulled to the side improves the mobility of the adductors at the same time as the antagonists tend to tense up. The tucked leg usually leads to a slightly rotated pelvis and different tensions at least in the lateral flexors. The spine is often slightly bent in one direction, so that the cervical spine is also involved.
Depending on the pillows, mattresses and other factors used, side sleeping predisposes to various shapes of the spine that deviate from standard anatomical position, which often involve an interplay of lateral flexion to the left and right. Accordingly, the muscles and their fasciae change with a tendency to develop a scoliosis. As a rule, the legs are not placed on top of each other, but one is at least slightly shifted forward against the other, which leads to differences in the hip joints and pelvic position, and possibly also to an effect on the knee of the upper leg due to the persistent slight varus stress.
VDU work with the monitor not positioned exactly frontally in front of the head naturally leads to an imbalance in the shoulder/neck area due to the necessary continuous rotation of the head. The upper body is also often rotated by degrees, which also makes it uneven.
Various „cozy“ positions on the couch in the evening in different inclined positions can lead to tension immediately afterwards or the next day as a one-time cause, but as a frequently adopted posture they can also have a lasting effect on the musculoskeletal system.
Carrying bags or briefcases from school age, which was common in past decades, naturally led to lasting disorders in the musculoskeletal system, this time acting from top to bottom, i.e. from the upper extremity that carried the load, via the shoulders and trunk muscles to the pelvis, leg and foot.

Can’t you create a program for me that I can practice regularly on my own?

Question:

I don’t know what to practise at home. Can’t you create a program for me?

Answer:

A question that is often asked and I always give the same answer: just don’t! I would commit you to a few things and create a one-sidedness. Even if it may be exactly what you need most urgently at the moment, its potential as a corrective will be exhausted at some point, and from then on it will drive you into another one-sided state. And there may also be second and third most important things that I would withhold from you – apart from the fact that you would not conquer everything else that I do not advise you to conquer so that it becomes part of your state of being.

As a matter of principle, we are not giving homework until further notice, as this would encourage a one-sided approach and the exclusion of many other important aspects. Nevertheless, we can be sure that our students will recognize their homework, or rather their to-do, with clear indications of difficulties and connections.

In principle, we also test where necessary and give advice on deficits and how to work through them, but we consider one-sided determinations from a superior position to be questionable. The best thing that can happen to a teacher – in this case of the asanas – is that his student will eventually lose the negative polarity towards his teacher, who presents him with his own, and can then say: now it is unreservedly mine!

The teacher should probably not say anything more than go a little more to the right here to drink from the spring in front or avoid the abyss in front on the left, the path is that of the STUDENT.

Inability to straighten the knees even when the hips are extended / feeling of tension in the back of the leg when extending the knees after sitting cross-legged or supta virasana

Question:

Two questions arise in connection with the outer back of the knee:

A) I can’t straighten my knees, but this doesn’t seem to be the typical problem of stiff backs of legs because it is independent of the angle in the hip joint, what is it?
B) After postures such as virasana, supta virasana, lotus and similar postures I have a feeling of tension in the outer back of my knee, what is that?

Answer:

These are two rather rare cases, both of which need to be approached slightly differently. In the case of

A) If the knee is generally noticeable even when the hip joint is extended by 20°-30° (slightly flexed so that the hip flexors are not restricted), this is probably due to a shortening of the caput breve of the biceps femoris, i.e. the single-jointed biceps partthat only flexes the knee joint and does not extend the hip joint. Simple, slow, ever-increasing extension of the leg with quadriceps strength, with a weight or with a supporter is then the method of choice, to be performed repeatedly until the knee’s ability to extend is restored. This phenomenon is caused, for example, by running or sports with a high proportion of running in combination with sedentary activities, whether in a chair or sitting cross-legged.
B) if the knee can normally be fully extended without any stretching sensation, this is a different case. In the postures mentioned, the muscles in the back of the leg contract, the longer the posture is maintained, the more they contract. However, there is no real restriction of mobility here; stretching the biceps femoris caput breve by fully extending the knee joint is possible with almost no resistance and is therefore not a successful solution. Therefore, an attempt must be made to influence the muscle in another way, namely through intensive work in the area of large sarcomere lengths, which in this case means shortly before the knee joint is extended. One useful way to do this is to support yourself backwards on the floor on your forearms and place your heels on a chair in front of you. The pelvis should not touch the floor and then small bending and stretching movements are performed in the knee joint, lifting the partial body weight of the legs, pelvis and upper body. Of course, the pomus muscles are involved in this movement, but the actual work is done by the hamstrings of both legs, which are strengthened on the one hand and, in the best case, even show longitudinal muscle adaptation during intensive training, i.e. increase the number of serial sarcomeres, which gives the muscle greater flexibility and a lower resting tone in addition to other positive effects. Both together should lead to the effect described above no longer becoming apparent after some exercise.

The shortenings can be differentiated and divided into degrees of severity, here in descending order:

the leg has an extension deficit in the hip joints regardless of the angle of flexion, then it is the monoarticular head of the biceps (caput breve). Then practise extending the knee joint repeatedly, using a sandbag if necessary, see above.
After virasana, supta virasana, lotus or similar, the leg shows tension in the biceps / its tendon, which slowly decreases. Then practise hip opening at the edge of the mat and 3rd hip opening, in each case with less flexion (i.e. greater angle) in the affected leg.
the leg shows noticeably high tension in the biceps in the postures just mentioned. Even then: practice!
the leg shows excessive tension in the biceps in some postures with the leg extended to stretch the hamstrings. Here too, see the recipe above!

If I turn my upper body sharply, I lose the extension of the spine.

Question:

I’ve noticed that when we practise twisting postures and I’m told to keep my back straight, the harder I twist, the more difficult it is. Is that normal?

Answer:

Yes, the rotation of the spine results in a slightly increased tendency of the upper body to bend. This is due to the fact that the tension of the abdominal muscles, especially the oblique muscles, less so the rectus abdominis, pulls the ribs or sternum caudally. On the dorsal side of the body, the innervation of the transversospinal and sacrospinal parts of the autochthonous back muscles, i.e. the so-called oblique system, which also has a rotational effect, also generates extending moments that have a stretching effect on the spine, but the pull of the abdominal muscles outweighs the latter effect. So the more vigorously we twist, the more the back wants to arch. Or to put it another way: the more intensively we twist, the more we can strengthen our autochthonous back muscles.

Tension in the groin area (pectineus)

Question:

I have a more or less constant feeling of tension / pulling in the groin area, which does not improve noticeably even with most standard exercises. What could this be? And what can I do about it?

Answer:

If the phenomenon is perceived to be muscular and not pain as in a hernia or inflammation in the abdomen or pelvis, and if it also does not respond positively to backbends or hip-extending postures such as upface dog, bridge, setu bandha sarvangasana, hip opener 1 and the like, it may be the effects of a shortened pectineus. The discomfort can then be localized by testing as

caudal all abdominal muscles
further medial than sartorius and rectus femoris
more superficial than the deep insertion of the iliopsoas on the lesser trochanter
cranial/lateral of the remaining adductor group
caudal and lateral to the pubic tuberosity

The pectineus is the shortest of all adductor muscles and originates cranial to the other adductor muscles above the origin of the adductor brevis on the pubic bone. Its insertion is also far cranial on the femur. As it is not a long or large muscle, its muscular competence is rather limited. Its functions in terms of effectiveness are Adduction, slight exorotation and slight flexion in the hip joint. In principle, therefore,hip extensions such as all backbends would be helpful for a tense pectineus , but the hip flexors may not be flexible enough to allow such a wide extension that the pectineus is significantly stretched. In principle, statistically speaking, this tension/shortening is more likely to occur in less flexible people than in very flexible people. To counteract this phenomenon, abductions in the hip joint are more effective than extensions. As it has a slightly hip-flexing effect from standard anatomical position and extensions of the hip joint bring it into greater sarcomere lengths than flexions, abductions in hip extension (which generally do not occur as yoga poses because abduction is deliberately avoided as an evasive movement when extension is required) or at least without flexion in an extended or, if possible, extended hip joint are recommended. This includes, for example

supta padmasana without and with weight, also as an ardha padmasana variation
adho mukha supta padmasana
prasarita savasana
supta baddha konasana
adho mukha supta baddha konasana

but not the standard variations of lotus and baddha konasana, as the approximately 90° hip flexion excludes any stretching effect. On the other hand, in postures with extremely wide hip flexion that is not restricted by the biarticular hip extensors (the hamstrings), i.e. with the knee joint clearly flexed, stretching effects on the pectineus can occur again due to the abduction forced by the joint structure. It is therefore worth trying with

As the lowest possible flexion in the hip joint is important for the effect of the postures and almost all of them have an adductor hip flexor effect, which increases in abduction, it is helpful to warm these up in advance, as well as the hip flexors, especially if one of the groups has significant mobility restrictions.

Dealing with leg length discrepancies in the postures

Question:

I have legs of different lengths. do I have to take this into account in the asanas?

Answer:

This is very inconsistent. In some postures it doesn’t matter at all because the legs are not on the floor, see e.g. Inverted postures such as handstand, headstand, right-angled headstand, shoulderstand, right-angled shoulderstand, elbowstand, or other postures in which the legs have no contact with the floor such as supta dandasana, jathara parivartanasana, or there is no great weight on the legs such as right-angled handstand, right-angled elbow stand, pascimottanasana, in others it doesn’t matter because they are asymmetrical, such as the asymmetrical standing postures trikonasana, parsvakonasa, 2. Warrior pose. The different length of a leg results in minimally altered levers and forces, but these are within the range of what is already caused by the asymmetrical movement and posture behavior of humans in work, sport and leisure.

If there are large differences in symmetrical postures with outstretched legs on which the body weight or a significant part of it rests, the difference would be compensated for, e.g. with a suitable flat wood or some adapted patches. These mainly include uttanasana, tadasana, urdhva hastasana, free backbend with most variations.

In utkatasana, you would try to keep the pelvis straight without having to use an elevation. This is possible here as the legs are bent and results in a slightly lower bend in one of the two knee joints, but the difference in angle is likely to be well below one degree, so that the physiological effects, such as the altered sarcomere length in which the muscles work, are marginal and within the usual side discrepancies that people develop anyway due to their generally not exactly symmetrical movement and posture behavior in work, sport and leisure. The same applies to caturkonasana. If one thigh were longer than the other, the load distribution between the two legs would not be exactly equal, but there would be no undesirable pelvic obliquity when the thighs are horizontal. If one lower leg were longer than the other, one knee would have a slightly greater bend for an optimally straight pelvic posture, i.e. 90° + x, which is perfectly tolerable in the same way as in utkatasana. In ustrasana, the knee of the shorter leg would be raised accordingly so that the pelvis can stand straight. Here, too, there is a minimal difference in the length of the sarcomere, which, however, as already argued above, is more in the range of common side differences that result from the asymmetrical use of the body anyway. The same applies to urdhva dhanurasana, except that here you can choose between raising the leg, which would be the method of choice if it is known that the difference in leg length is due to unequal lower leg lengths. If the difference is due to the thighs, the feet would be moved in a longitudinal direction instead.

In downface dog, the feet can also be offset longitudinally, which has the advantage that this adaptation also works in upface dog and Staff pose. Similarly, in setu bandha sarvangasana, you would also choose a longitudinal offset of the feet if it is not known that the difference in length is due to the lower legs, because here too the feet are in danger of slipping away due to the great force exerted. Alternatively, you can choose the variant against the wall, in which both variants are available. In this case, one of the feet must be pressed against a spacer on the wall if the difference in leg length is due to the thighs and placed on an elevation if the lower legs are the cause. This type of fitting is also preferable because the alternative of using patches under one foot, for example, may not prove to be durable enough if changed frequently; sooner or later they will slip away. In the upface dog position, the ratio between the force that causes the patches to shift between each other or on the support and the force of gravity that causes friction is much less favorable than in the downface dog position: the support force is reduced due to the center of gravity being shifted away from the feet and the pressure exerted backwards (away from the hands) should be significantly higher. The back extension also leaves the choice between raising one foot or longitudinally offsetting the feet. Since the posture is about warming up and stretching the hamstrings, the offset of the feet would not be the method of choice because it shifts the working range of the hamstrings, whereas the alternative does not have this disadvantage.

Using the above criteria, the postures can be categorized as follows.

symmetrical poses without weight or with only little weight on the feethandstand, headstand, right-angled headstand, shoulderstand, right-angled shoulderstand, elbowstand, supta dandasana, jathara parivartanasana, rectangular handstand, rectangular elbowstand, pascimottanasana, ardha chandrasana, parivrtta ardha chandrasana, halasana, parsva halasana, karnapidasana, parsva karnapidasana, supta konasana, hyperbola, samakonasana, upavista konasana, tolasana, dandasana, supta dandasana, navasana, bhujangasana, salabhasana, savasana, reclining on bolster, reclining on block, viparita karani,
symmetrical poses with significant weight on the feet and bent knees: uttanasana, prasarita padottanasana, tadasana, urdhva hastasana, hasta padangusthasana, virasana, supta virasana
symmetrical poses with significant weight on the feet but bent knees: utkatasana, caturkonasana
asymmetrical poses: trikonasana, parivrtta trikonasana, parsvakonasana, parivrtta parsvakonasana, warrior 1 pose, warrior 2 pose, warrior 3 pose, counter, vrksasana, garudasana, hip opener 1, hip opener 2, hip opener 3, hip opener 4, hip opener 5, padmasana, ardha padmasana, hip opener at the edge of the mat, janu sirsasana, ardha baddha padma pascimottanasana, tryangamukhaikapada pascimottanasana, supta padmasana, adho mukha supta padmasana, parsva upavista konasana, parivrtta parsva upavista konasana, hanumanasana, gomukhasana, krouncasana, supta krouncasana, ardha supta krouncasana, vasisthasana, quad stretching 1 at the wall, quad stretching 2 at the wall, eka pada viparita dandasana, eka pada variant of urdhva dhanurasana, sitting twist, supta padangusthasana, roll up the back, John’s sequence
Special cases: shoulder opening on the chair, purvottanasana, downface dog, upface dog, staff pose, deadlift

Which postures can I do with damaged intervertebral discs and which should I avoid?

Question:

Which postures can I do with damaged intervertebral discs and which should I avoid?

Answer:

I have been diagnosed with disc damage in my lumbar spine. I now don’t know which postures I can and can’t do?

The lumbar spine is the place where most disc damage in the spine manifests itself, followed by the cervical spine and finally the thoracic spine. If the „classic“ is present, as in your case, all postures that flex the lumbar spine, i.e. bending in a convex direction (viewed from behind), must be avoided for an indefinite period of time. In most cases, disc damage is also caused by chronic strain or overloading in a convex position of the lumbar spine. This starts with people who sit for a long time every day with their pelvis tilted backwards and their back usually leaning backwards. In this pose, the pelvis can tilt backwards and will do so if the person does not force themselves to adopt a more active posture. However, this puts increased pressure on the intervertebral discs, which is quite intolerable for them, especially in the absence of a change of posture and a general lack of movement. As explained above, we must assume that people with a shortening of the hip flexors are at increased risk, as their back muscles are under increased tension. However, there are a number of other predisposing factors such as heavy lifting or frequent bending at work, sedentary work, poor seating, lack of exercise and weak back muscles. So what can you do with this problem and what should you avoid and for how long?

Before we look at this in relation to individual postures, a brief digression: it is essential to avoid postures that flex the lumbar spine for a longer period of time, as on the one hand they can re-trigger pain that has disappeared for a short or longer period of time, and on the other hand they contribute to maintaining the structural problem due to the unfavorable load. A fundamental distinction must be made between seated and standing forward bends. The less mobile a person is, the less effective seated forward bends are in terms of stretching the hamstrings (back of the thigh) and the worse the effect on the intervertebral discs. Standing forward bends are generally much more suitable. However, this also often leads to the familiar pain, especially in people who are not very flexible. Only when the hip flexion is very good does the effect change and instead of compressing the intervertebral discs in the intervertebral spaces, the force of gravity from the weight of the partial body tends to pull the spine apart. It is difficult to specify an exact angle for this, but it is likely to be well beyond 120° hip flexion.

For the time being, hip flexions must therefore be performed with a strong, straight back. Not performing them as a matter of principle leads to a worsening of the situation, as people are generally unable to completely avoid forward bending movements in everyday life. Even tying shoelaces or picking up objects from the floor usually involves bending the back, except in cases of very good mobility, and the less mobile the hamstrings is, the more so. Although people could in principle try to perform all movements that require them to reach down to the floor with their hands by bending their knees deeply, there are often factors that make this difficult or prevent it: the first reason is shyness about the effort or discomfort involved. Forgetfulness, which then allows the movement to be performed as usual, is another important reason. In some cases, the dorsiflexion abilityof the ankle or significant restrictions in the mobility of the buttocks and hip muscles may also make a deep squat impossible, just as constricting clothing or high shoes may prevent this.

This results in the recommendation to perform the forward bend with a consciously straight back, possibly with slightly bent knees depending on the situation. If this is to be possible without or with only slight bending of the knee joints, the hamstrings must be very flexible, and the back muscles and hamstrings must have a certain amount of strength – also due to the large lever arm – so that the upper body can be lowered and raised again with confidence in an extended position. If a forward bend is to be held for a longer period of time, for example for the purpose of a short handgrip in the course of some activity, this places additional demands on these two muscle areas. In addition to these two, the calf muscles (the triceps surae), as a group that supports the lever of the upper body with the head over the foot, must also have the appropriate skills. If there is a willingness to use the squat in everyday activities, the strength of the quadriceps should be good enough to make this appear easy. If heavier objects are being lifted, the squat is usually the method of choice, but sufficient strength should be available. Performing the lifting movement as a deadlift with the knee joint more or less extended should be reserved for those with sufficient body awareness and strength.

Now to the postures. When we say below that the back must remain straight, we mean that the physiological lordosis should be maintained as far as possible; under no circumstances, however, should the steep position in the direction of convex be exceeded. Depending on the load and any flexion angle in the hip joints, this can place great demands on strength and body awareness. The DOs and DON’Ts, i.e. the to-do list and the not-to-do list (contraindicated postures), can be presented simply as follows:

DO: Back-strengthening poses such as deadlift, warrior 3 pose, right-angled uttanasana, headstand, sarvangasana (although holding the pose is very critical here! The most favorable option is probably setu bandha sarvangasana ) urdhva dhanurasana, salabhasana, utkatasana, trikonasana, ardha chandrasana, parsvakonasana (possibly with a block so that the back can remain straight), upavista konasana with a block (possibly on elevation so that the lumbar spine can remain straight) Postures that promote flexibility in the hamstrings. Caution: the back in the lumbar spine area must remain straight despite hip flexion: uttanasana with an extended back, preferably as a right-angled uttanasana and also as a table-top variation of uttanasana, the same applies to prasarita padottanasana: with an extended back, right-angled or as a table-top variation, downface dog backwards against the wall with one leg (favorite winter warm-up pose), deadlift performed deep enough, 3rd warrior pose.
DON’T: standing forward bends unless they are performed with a completely straight back: uttanasana, prasarita padottanasana, parsvottanasana; seated forward bends unless they are performed with a completely straight back: janu sirsasana, pascimottanasana, tryangamukhaikapada pascimottanasana, ardha baddha padma pascimottanasana, handstand and elbowstand (it’s not the postures but the holding of them that is critical), ardha padmasana forward bend, hip opening at the edge of the mat, maricyasana 1 and maricyasana 3 unless you have very good flexibility that allows you to keep your back completely straight in the lumbar spine area, seated torso side bend. This list should give you a good overview of how to proceed in most cases of lumbar disc problems. It is generally irrelevant whether it is a protrusion or aprolapse, the symptoms can be identical in both cases, as can the causes and approach. However, there are also cases that react even more sensitively, so that rotational postures are also contraindicated. This cannot necessarily be deduced from radiology and can be tested carefully. In the case of acute symptomatic intervertebral disc disease, the affected person can often tell within seconds whether the posture or movement is tolerable. Lateral trunk bends should also be avoided.

Associated movements

Question:

In class, we often talk about associated movements. What does that actually mean?

Answer:

Associated movements are those that take place or are undertaken in addition to an intended movement. The two cases „take place“ and „are undertaken“ must be distinguished. The former also includes movements that result from physical laws, such as the well-known „wobbling“ of the arm, which means that the inertia of the involuntarily controlled lower arm may cause it to perform a more sweeping movement than desired when the upper arm is accelerated by the frontal abductors or retroverters. Effects (see below) that are also caused by used muscles are also included under „take place“. On the other hand, the other case „being undertaken“ includes acquired misunderstandings in movement behavior and deficiencies in body awareness.

In general, this does not refer to physical effects, but to voluntary movements that are not within the spectrum of what is intended. There are plenty of examples: many people, when asked to stretch their chest, also slightly recline their head. This is sometimes already the case when standing, but much more so in more unfamiliar postures, especially if the intended movement is more difficult, such as stretching the chest in a right-angled uttanasana.

Another common associated movement is, for example, to tilt the head sideways in the corresponding direction when asked to release the upper body from its lateral curve in trikonasana, i.e. to undertake a lateral flex ion of the cervical spine instead of just lifting the ipsilateral lateral flexion of the thoracic spine. On the other hand, the upper body in trikonasana is often turned sideways when further rotation is requested.

It is also sometimes observed that the request to move the arms as far back as possible in urdhva hastasana, for example, i.e. to maximize the frontal abduction, is answered with an additional reduction in the kyphosis of the thoracic spine or even a real extension of it and sometimes also with an additional hyperlordosis of the lumbar spine(hollow back). This of course touches on the fundamental topic of body awareness in its aspect of the ability to differentiate and the ability to take an analytical approach to completely separate individual movements from one another and, conversely, to assemble movement sequences specifically from individual building blocks.

In some cases, but by no means always, associated movements result from using muscles that perform both the intended movement and an unintended movement elsewhere where they also act. After all, muscles can only contract – or relax – along their entire length, so all joints between origin and insertion are affected. If you want to limit the effect to one joint, partial antagonists in the other joints in which no movement is to take place must work against it. There are countless examples of this „co-movement“ in the human musculoskeletal system, such as the additional flexion of the knee joint when the hip extension of a free leg is required, caused by the hamstrings used for this purpose.

In general, however, a „co-movement“ in another joint can also occur for a reason other than the contraction of a muscle covering both joints, namely when the action of a muscle elsewhere increases the tension of a (different) muscle in such a way that the joints covered by it assume a different position. In these cases, we are dealing with questions of individual, acquired understanding of movement and individual limitations in body awareness; the effects are partly based on the known physiology of movement.

The term associated movement is related to the term surrogate movement. In this case, other movements are undertaken as a complete or incomplete substitute for an intended movement or a movement requested by the teacher, which have a comparable effect (usually on distal parts of the body), but lead to essential differences in the relevant areas in between. Complete or incomplete substitution means that the actual movement to be performed is not performed at all or only partially.

Why do my arms bend in all kinds of positions, even when I try to avoid it?

Question:

In many postures in which the arms should be stretched overhead, I am unable to achieve or at least maintain the stretch, regardless of whether the hands are firmly on the floor or free in the air. What is the reason for this and what can I do about it?

Answer:

There can be several reasons for this, the simplest of which is, of course, attention. A lack of attention means that the arms are quickly forgotten, especially when they are – literally – out of sight, as in urdhva hastasana. However, muscular – and only very rarely capsular or ligamentous – reasons also come into question. A distinction must be made between cases.

If the hands are fixed at about shoulder width, whether on the floor as in the head-down dog position or in a handstand, the bending follows a simple logic: limited mobility of the shoulder joints in the direction of frontal abduction causes the upper arms to move outwards. For a given amount of strength and mobility, the overall degree of evasion will always be the same in relation to a suitable standard; we can only choose where the evasion takes place. If the hands are fixed, the elbow joints are forced to bend. Several agonists can be used to improve the extension of the elbow joints: the lateral adductors of the shoulder joint such as the pars clavicularis of the deltoideus, the pectoralis or the (only) extensor of the elbow joint, the triceps and the short head of the biceps, to name a few of the most important. Working together, it should be possible to noticeably improve the extension, even if the given strength endurance will limit this over time.

The less plausible case at first glance is when the arms are not shoulder-width apart or otherwise fixed. Then, for example in urdhva hastasana, a bending of the elbow joints is nevertheless often recognizable, and more frequently than would be justified by a lack of attention if muscular reasons were not also involved. The tendency to bend is naturally greater when the upper arms are prevented from moving outwards than when they can do so largely unhindered. The reason for this behavior lies in the short head of the biceps, which is also used as an adductor to prevent the upper arms from moving outwards and to keep them shoulder-width apart. As it is also the flexor of the elbow joint, this is where the described flexion tendency results. Finally, it can only pull the origin (at the coracoid process) and the insertion (at the radius) towards each other. The contraction force exerted always affects all (here: two) intervening joints. If the movement is to be limited to one joint, the partial antagonists acting in the other joints must be used. Keeping the elbow joint extended therefore requires the use of the triceps as the only extensor in the elbow joint.

Behavior with endoprostheses

Question:

I have an artificial joint replacement, i.e. an endoprosthesis. What do I have to consider?

Answer:

In an artificial joint replacement, the materials used represent a harder osseous mobility limit than the cartilaginous joint coverings in the natural case. Even if the collision of two such joint partners in terminal movements is usually not a problem for the material itself in the short term, the „hard“ osseous limit has become a „very hard“ artificial limit. After all, only particularly hard and abrasion-resistant materials are used so that as little abrasion as possible is released. Abrasion and its effects on the body are still an issue today; metallic particles and dissolved metals in particular find their way into the bone or bone marrow. In principle, the above applies even more to a TEP(total endoprosthesis), in which both articulating joint partners are replaced, than to HEP (hemi-endoprosthesis). The limited compressibility of the cartilage coverings of the bones is partially or completely eliminated, so that any force applied is transmitted rigidly to the rigid structure of the joint partner and thus ultimately also to the other bone. Depending on the intensity and frequency of the impact, this can certainly lead to loosening of the joint replacement, which usually results in a further operation in which the kmoplet endoprosthesis often has to be replaced with the loss of further bone material. The mobility restrictions of the various prostheses vary depending on the type and joint. Different types of prosthesis are also often used in different joints. They are usually made of ceramic, steel, titanium or various ultra-high molecular weight polyethylenes. To avoid abrasion, damage and loosening, the limits of the range of motion should therefore not be reached. The doctors providing treatment inform patients of the restrictions they will face in the patient consultation before the operation. It is advisable to keep a small safety distance from the limits, even if it is only one degree. As joint replacement is usually only carried out on one side of the body and this side will therefore have more limited mobility than the side that has not been treated, the question of how to deal with asymmetrical postures arises. As a rule, the „very hard“ limits of the artificial joints are well ahead of the hard, osseous limits of the natural side. For this reason, both sides of any posture involving this issue should only be practiced until just before the artificial limit in order to avoid encouraging the development of muscular imbalances. These are often already present when the indication for a joint replacement is given, as the affected side has already been painful for a long time, which has led to avoidance behavior and thus the development of imbalances. Of course, these should not be exacerbated or new ones added. In the case of the knee joint, for example, both the biarticular part of the hamstrings can be kept sufficiently mobile through wide hip flexion and the rectus femoris through wide hip extension with a usually clearly flexion-restricted artificial knee joint. In the case of the hamstrings, only one knee-flexing muscle is monoarticular anyway, namely the caput breve of the biceps femoris, which can easily be stretched by extending the knee joint alone. As far as the front of the thigh is concerned, the situation is a little more complex. The tension of the monoarticular quadriceps parts is increased in many people, which occurs as a risk factor in many diseases of the knee joint. However, these three vastii can only be effectively stretched by wide flexion of the knee joint, so that there are hardly any possibilities here. The biarticular rectus femoris, on the other hand, is particularly responsible for incorrect posture and movement, not only because of its hip-flexing effect and, if it is contracted, the resulting hollow back, but also because of its central lateral attachment to the patella and its guidance in the femoropatellar joint(femoropatellar sliding bearing). In any case, the retropatellar cartilage is often replaced with an artificial cover during knee TEP, which changes the situation as it is no longer exposed to an increased risk of arthrosis.

See also in the pathology section under „Condition after arthroplasty“

Stiff shoulders

Question:

I have such stiff shoulders. I find it difficult to hold my arms overhead and my elbow joints bend quickly in asanas with overhead postures. What can I do?

Answer:

To understand this in more detail, it is helpful to outline the underlying physiology of movement. The perceived stiffness of the shoulders is usually mainly due to the limited ability to perform frontal abduction in the shoulder joint, i.e. the difficulty in raising the arm far upwards over the front into the „overhead position“. There are also limitations to the arm’s ability to rotate in the shoulder joint, i.e. when turning the arm inor out. Furthermore, some movements of the arm are only made possible by corresponding movements of the shoulder blade to which the arm is attached. External rotation is particularly important here: if the arm is to be raised far outwards, it must rotate far outwards, otherwise the humerus will touch the acromion. From an angle of approx. 90° of the arm to the spine, the shoulder blade must begin to rotate outwards for further lifting of the arm.

From an anatomical point of view, raising the arm represents lateral abduction (sideways) or frontal abduction (forwards and upwards), both of which no longer differ at the 180° limit, as lateral abduction over approximately 110° requires a certain degree of rotation of the arm, which brings it into a degree of rotation that is also required when raising the arm forwards(frontal abduction). The arm’s ability to rotate decreases with each degree of lifting, and hardly any rotation is possible in the overhead position of the arm.

In practice, a mobility restriction in the shoulder joint that is perceived as significant is almost never caused by anything other than the muscles of the adductors of the shoulder joint, i.e. mainly the pectoralis, teres minor, teres major and latissimus dorsi. Muscularly, the adductors of the shoulder joint therefore represent the greatest restriction. Of the four muscles mentioned, all but the teres minor are endorotators, which oppose the minimum (exo)rotation to be performed.

The three-dimensional mobility of the shoulder joint is the reason for the regularly observed evasive behavior: if maximum frontal abduction is required, the exorotation is lost at least to some extent and the arm begins to evade laterally, which corresponds to lateral adduction from the position. Depending on whether the hands are punctum fixum or punctum mobile, the adduction is manifested in the first case as flexion of the elbow joints or in the second case as outward deviation of the extended arm.

This also makes it clear how the task must be approached. When practicing the desired frontal abduction, care must be taken to ensure that the arms do not twist in an evasive manner, as this would reduce the stretching effect of the important muscles. Exercises in which the arm is turned out towards the construction and no muscle strength is required are therefore particularly effective, such as the elbow stand and all related postures or the shoulder opening on the chair. In exercises without wide exorotation, care must be taken to rotate the arms as far as possible, which may limit the exact degree of frontal abduction to some extent.

When selecting exercises or designing exercises for frontal abduction, it must be taken into account that the muscles performing the exercise, such as the deltoids, biceps and coracobrachialis, are not able to produce a significant stretching effect in their antagonists due to their sarcomere length and in consideration of the force-length function, so that muscles of the other extremity (leg) or the effect of a greater partial body weight must be used as agonists to achieve a useful effect. If the upper body is moved as a punctum mobile relative to the hands as a punctum fixum, the length of the arms is added as a favorable lever arm. This results in postures such as the raised back extension and the hyperbola on the one hand, and postures in which the strength of the legs acts on the muscles to be stretched, such as in urdhva dhanurasana (back arch), on the other. Since the muscles to be stretched are certainly among the stronger ones (after all, these muscles are involved in lifting almost 100% of the body weight in pull-ups), a longer, more powerful action is required. If there is not enough strength endurance available, the comparatively passive stretches of increased back extension and the hyperbola prove to be very useful. A type of „held pullover“ is also good, i.e. a supine position on a support such as a weight bench, in which an adequate weight is held as low as possible above the floor with the arms turned out (i.e. elbows held rather close together). With a fixed weight, the effect can be scaled via the bending angle in the elbow joints.

One difficulty that sometimes occurs in these postures is a cramping sensation in the original area of the deltoid pars clavicularis. Experience has shown that this will decrease with increasing exorotation of the arm. Depending on the posture, the hand of one arm may be able to rotate the other on the upper arm for a while, which should provide noticeable relief.

Stretching before or after sport

Question:

Should I stretch or do intensive stretching yoga exercises before sport? Or afterwards? Or even independently?

Answer:

Opinions differ here, even among experts, and the subject has not yet been sufficiently researched. The only thing that is widely accepted is that intensive stretching should not be carried out before muscular performance requirements, such as those typical of ambitious sporting activities. Stretching reduces muscle tone, which makes performance more difficult. As the functions of the megamolecule titin in the sarcomere, the smallest contractile unit in the muscle, have not yet been sufficiently researched, no conclusive and comprehensive causal statement can be made. If one only refers to actin and myosin, stretching may reduce the length of the engagement or overlap of the myosin with the actin and thus reduce the number of possible active myosin heads. Professional athletes, but not uninformed amateurs, are sometimes recommended dynamic stretching, which, however, if performed carelessly or incorrectly parameterized, carries the risk of strains due to and in the eccentric loads.

Some people say that intensive stretching is also contraindicated after sport in the sense that it makes regeneration more difficult, e.g. by reducing the blood flow to the muscle excessively and delaying the removal of its metabolic debt. The extent to which this is true is still the subject of debate. What is clear is that correctly performed, calm stretching after physical exertion brings the entire system from a sympathetic to a parasympathetic state and thus faster regeneration. It can also be taken for granted that stretching should not be done so intensively after exercise that, in addition to the micro-tears in the Z-discs caused by the exercise, the repair of which later leads to muscle soreness, the stretching also causes tears, which can delay healing in terms of the extent of the inflammatory reaction required to repair the Z-discs.
inflammatory reaction required to repair the Z-discs.

It is probably a good idea to stretch regularly at least a few hours, or perhaps even better a day, after significant sporting activity, for example the morning after. In many cases, performance-oriented athletes dislike any additional day on which they cannot carry out sport-specific training or suitable basic training because they feel that they are not getting the most out of their training, i.e. not achieving the maximum possible increase in performance. After all, well-educated trainers now clearly point out the need for regeneration phases, which not only serve to regenerate the muscles, but also take into account the fact that muscles are among the fast-metabolizing(tachytrophic) tissues that excel with a short regeneration time. However, the passive parts of the musculoskeletal system, such as ligaments, cartilage and capsules, have a short regeneration time,
cartilage, capsule, etc., sometimes have far greater to extremely long turnovers, so that too rapid a sequence of sport-specific training or intensive basic training would very probably overtax these structures in the long term. The theoretical turn over of the cartilage is even well beyond the human lifespan, so that regeneration times are very important, especially in sports that place a higher load on (at least some) cartilage. Here, as in a chain, the weakest link counts; the cartilage under the most stress will define the extent of the necessary regeneration time in the long term, even if it is a physiologically thick cartilage, such as the 6-7 mm thick retropatellar cartilage.

In practice, neglecting these principles regularly leads to corresponding disorders which, depending on the length of the
turn over of the corresponding tissue, a correspondingly long training break or reduction or even a temporary switch to suitable alternative sports is required. Depending on the type and extent of the necessary disruption, this can lead to a complete loss of training time or only to a less than optimal training phase (when switching to a suitable alternative sport). As the ambitious athlete, and even more so the competitive athlete, always has an eye on the time available until they reach their maximum physical performance capacity after about the age of 30, but hardly after the age of 35, they often tend to neglect regeneration as well as stretching.

In the case of regeneration, the above considerations show that this will not lead to optimal and sustainable training success and ultimately sporting success. In the case of stretching, the situation is similar, but for different reasons. An insufficiently stretched muscle is more susceptible to various injuries, starting with an increased tendency to strains, increased pressure in joints under static loads and, above all, the usually much higher kinetic loads, through to the increased susceptibility of tendons and their insertions, i.e. the risk of insertional tendinopathies or, in adolescents, the disruption of healthy bone growth such as Osgood-Schlatter disease. It is quite common to see athletes who have developed unspeakably stiff and correspondingly injury-prone muscles as a result of the exclusive practice of their sport, as well as restrictions in their natural expression of life.

In both cases, regeneration as well as stretching, performance (possibly!) increases somewhat (!) faster if stretching is omitted as a „one-day“ training unit, but in the case of regeneration even this is not true, but the effect of overtraining occurs: a drop in performance with additional increased susceptibility to injury due to insufficient
regeneration. For the time being, it can be said that a sport-specific stretching ability that is at least adequate must be developed, but that stretching should not take place immediately before or intensively after training, but regularly enough so that existing and risky restrictions in mobility are worked through and no permanent reduction in mobility occurs as a result of the training. Apart from this, the asanas of yoga often offer a very attractive combination of stretching and strengthening when they intensively challenge muscles over a long sarcomere length, as is clearly the case with various postures in relation to the hamstrings.

The duck walk – wasn’t it harmful?

Question

I keep seeing, for example on social media, how the duck walk is praised as a good
good training for the quadriceps. Wasn’t it harmful?

Answer

Before I come to a technical answer, it should be said that experience has shown that not everything that is claimed in so-called social media is true simply because it is modern media. Equally, not all of the actors there are a priori experts in a field other than self-presentation. From a professional point of view, the duck walk has been a thing of the past for decades. The basic idea behind the duck walk was probably, even if its inventors were perhaps not even aware of the physiological background to movement, that the quadriceps has very little strength in the large flexion angles of the knee joint due to the long sarcomere length according to the force-length function and can therefore produce a very low extension moment in the knee joint. If you still manage to achieve a certain stroke (extension in the knee joint) through training, this strengthens the quadriceps in an interesting way. In principle, strengthening in longer sarcomere lengths is more valuable than in shorter ones, because the mobility of the muscle is potentially maintained, if not improved by longitudinal muscle adaptation. However, there is more than one catch here. Firstly, stretching the knee joint in its wide flexion occurs in the range of sliding friction, not rolling friction, which significantly increases the tendency to wear. Secondly, the achievable stroke is small due to the quadriceps force – if not due to perceived discomfort in the knee joint – so that only a very small area of the joint cartilage is used during the exercise. On the one hand, this dramatically increases the tendency to wear and tear; on the other hand, only a small part of the joint cart ilage and menisci is nourished by the change in pressure, which in turn bears no healthy relationship to the tendency to wear and tear. Thirdly, and this is by no means less serious, there are always rotations in the knee joint during an extension or flexion movement when moving forward, i.e. when switching between the standing leg and the free leg. These are already unphysiological in the area of rolling friction of the knee joint (i.e. below about 90° flexion) and quite risky in terms of wear and tear, but in the area of sliding friction they are completely out of the question for those with expert knowledge without further thought. In addition to all this, the supported partial body weight on the long lever arm of the thigh presses approximately vertically downwards, i.e. generates an essentially maximum gravitational effect.

It can therefore be argued that the duck walk is one of the not uncommon possibilities of unphysiological movement with which one can purposefully damage one’s menisci – and later articular cartilage. Due to its delicate construction, the duck gait has become an orthopaedic test for meniscus lesions, as described in
in the TESTS section at yogabook.org/tests/#duck_walk. In this test, the duck walk is performed for a few steps forwards, sideways, to the left and to the right and attention is paid to any discomfort in the knee joint.
knee joint. These are highly likely in the case of a previously damaged knee, particularly in the case of meniscus damage or further arthrotic damage.

CAVE ! Before anyone carries out this test, it should be noted that it is contraindicated in the case of known significant previous damage. There are more harmless tests available to determine this, these are described in the TESTS section. Depending on age and existing pre-existing damage, these can be detected by carrying out the above-mentioned
Duck-Walk/Childres test mentioned above.

uttanasana: with bent knees ?

Question

Why do you do uttanasana with your knees straight? I keep seeing references in various media to the fact that this is or can be harmful to the back.

Answer

Of course, what we are doing is well-founded, and we are happy to explain it: etymologically, uttanasana means „intense stretching“. The first question is of course: whose? Only dorsal areas of the body come into question here, such as the calves(triceps surae), the hamstrings (hamstrings), the glutes and large parts of the back muscles, especially the autochthonous ones. The effect of stretching the back becomes increasingly exhausted with increasing mobility, so that it is questionable whether the back is meant to be the target site of action of the posture. In addition, especially in the initial phases, when the posture is performed by people with little mobility and the pelvis is still far removed from the 90° angle to the thighs, there is an excessively strong curvature of the back in the area of the lumbar spine, as the lumbar spine is closest to the center of rotation for tilting the pelvis, i.e. flexion in the hip joint, and therefore holds the most body weight. Because of this imbalance in the effect on stiff beginners and flexibility, it can probably be ruled out that uttanasana is meant to stretch the back.

Furthermore, a distinction must be made here between people with healthy backs and those with lumbar disc disease who must avoid a convex curvature of the lumbar spine, who may only perform this posture anyway with a straight or, even better, physiologically lordotic lumbar spine. The existence of this contraindication naturally has no influence on the basic understanding of the posture, just as the fracture of an arm cannot call into question the basic concept of the head-down dog position.

At this point, a word must be said about the recurring disorders of the lower back in
uttanasana, which are clearly on the other side of disc problems and are purely functional in nature. Excessive tension or muscular imbalances can certainly trigger unpleasant sensations in the lower back in uttanasana, which in a high percentage of cases are significantly reduced or even eliminated in the parsva variation. This is not a feature or design flaw of the posture itself, but rather an indicator that (as a rule) the muscular structure of the lumbar spine area is in need of significant improvement, which should be addressed before it also has a negative effect in other situations.

So if the back cannot be the target site of action of the posture, it must be assumed to be further inferior, i.e. in the glutes, the hamstrings or the calves. Let us deal with the latter first, so that the other two, which together with a few pelvitrochanteric muscles that are to be regarded as subordinate form the hip extensors, can be treated together later.

For physical reasons, the ankles in uttanasana are at best in a neutral position (zero degrees of plantar flexion or dorsiflexion) if the hamstrings is very mobile, but usually in slight plantar flexion if the mobility is less good, because the pelvis has to be moved backwards a little to compensate so that the center of gravity of the supported partial body weight is still in the physical base of support. This applies all the more if the toes are not to be used for support, which is an important prerequisite for standing balance postures if you want to learn them solidly. However, the slight plantar flex ion that is usually adopted does not represent a useful stretching of the calf muscles, not even for the biarticular gastrocnemius, much less for the monoarticular soleus. If the slight plantar flexion were already a significant stretch, this would inevitably result in a pointed foot, which would impair or make it impossible to stand upright, and even more: completely rule out a rolling movement of the foot as a movement in the OSG. These are obviously only pathological cases that should have been diagnosed long ago.

Back to the rest of the people who are normal in this respect. If the gastrocnemius were to be stretched in uttanasana, a significant dorsiflexion would have to be created and thus body mass would have to be shifted so far forward that the center of gravity would be outside the physical base of support, meaning that support with the hands or another aid would be necessary. To address the soleus as part of the triceps surae, a minimum degree of flexion in the knee joints of 20° – 30° would be required to relieve the gastrocnemius and allow the soleus to be stretched. However, the distribution of the body mass above the gastrocnemius would only produce a moderate force to stretch the soleus, much less than would be the case in utkatasana. This means that both calf muscles of the triceps surae can be excluded as the target site of action of the posture and the hip extensors remain: on the one hand the biarticular parts of the hamstrings, i.e. all except the biceps femoris, caput breve and on the other hand the glutes, clearly primarily the gluteus maximus.

It is now known from movement physiology that biarticular muscles are almost always more likely than monoarticular muscles to set a soft-elastic movement limit if the position in the second joint they cover is only unfavorable enough, so that a clear effect on the glutes can almost regularly be ruled out, with the exception of pathological cases and those with extremely altered proportions due to occupation or sports training, the prevalence of which is more likely to be in the per mill range. This clearly relates to the hamstrings, i.e. the hamstrings. As previously mentioned, the biceps femoris, caput breve is no longer a monoarticular flexor of the knee joint and the semimembranosus, semitendinosus and biceps femoris, caput longum muscles remain. These are stretched when they are forced to a great sarcomere length under sufficient load, which is subjectively perceived as a stretching sensation. The sufficient load can be interpreted as tendon strength and depends largely on the gravity-induced torques in the covered joints. If the knee joint is flexed to allow the hip joint to flex further, the distribution of the body mass of the upper body around the horizontal (maximum gravitational effect) becomes less favorable. If, on the other hand, the knee joints are extended, the distribution – with the exception of a few extremely stiff people – is more favorable for stretching. In addition, the extension of the knee joints causes the sarcomere length of the gluteus maximus to be shortened, which brings it into a range in which it no longer contributes to the soft-elastic movement limit and the partial body weight acts purely on the hamstrings to stretch it.

For inexperienced beginners, the resulting intensity quickly reaches a 7 or 8 on the NRS of 0 to 10, which leads to a de facto good stretching effect of the muscles and, in all likelihood, to longitudinal muscle adaptation, which causes a significant increase in mobility over time via the iteration of the execution. If you were to practise with bent knee joints, not only would the achievable stretching effect be worse, but the muscles would also work at a shorter sarcomere length for geometric reasons, which in any case extremely reduces the possible stretching effect. However, with regard to the two factors of everyday behavior and the yoga practice itself, an appropriately rapid increase in flexibility is absolutely desirable. After all, in many people’s everyday lives, preventive movements (in the hip joint and upper body) cannot be avoided, for example when picking up objects from the floor or tying shoes, not to mention corresponding professional activities, so that any increase in mobility in the hamstrings results in a better tilting of the pelvis in relation to the thighs and in space, a reduced convex curvature of the lumbar spine and ideally even a reduced gravitational effect and therefore reduced bending moments and thus a reduced risk for the intervertebral discs of the lumbar spine.

In addition, good mobility of the hamstrings opens up the possibility of performing deadlifts with a stretched back in the sense of a physiological lordosis, which brings the riciso for the intervertebral discs close to zero. If intensive work is done on the mobility of the hamstrings, the cumulative potentially damaging effect on the intervertebral discs of the lumbar spine is certainly less than if endless practice with little stretching effect and only marginal progress is used.

One result of practicing uttanasana and similar forward bends while protecting the hamstrings should be mentioned here: the lumbar spine hump. This is the ability to bring the lumbar spine into a considerable convex curvature in forward bends; in practice we have already seen over 60°. This is often induced by incorrect posture and an incorrect understanding of forward bends and the corresponding execution. The excessive mobility of the lumbar spine in the conxev direction in relation to other factors in the musculoskeletal system usually also means instability in the sense of reduced muscle tone, which can be pathogenic in combination with other factors. It must therefore be taught that forward bending is always practiced with a minimum intensity of stretching in the hamstrings of about NRS 6 – 7, so that this effect does not occur, but the effect of the partial body weight causes a stretching of the hamstrings, which over time brings about a lower convex curvature in the lumbar spine in accordance with gravity.

In addition to the etymological approach, it is also essential to consider the physiology of movement:

What maximum benefits can be achieved from the basic geometric design of the posture and how?
When and how should this be deviated from?

Against this background, the same result can be easily and ultimately only with the arguments already offered above: uttanasana must be interpreted and performed as a stretching of the hamstrings. Any special dispositions and pathologies naturally require appropriate adaptation.

In this context, it should be noted that the intensity of the stretch sensation achieved in uttanasana in the hamstrings should ideally be somewhere between NRS 7 and 8.5. If this cannot be achieved with the gravitational effect of the supported partial body weight (upper body, head, arms), it should be varied, for example by pulling on the ankles or sufficient use of the hip flexor iliopsoas, the active use of which must first be learned in this pose in some cases.

If a lumbar disc disease has been diagnosed or is suspected on the basis of the symptoms (e.g. pain radiating into the leg with convex curvature of the lumbar spine, especially under load), postures such as uttanasana should of course not be performed with a convex lumbar spine, not only in uttanasana, but in all comparable and many other less comparable postures, care should be taken to ensure that the physiological lordosis of the lumbar spine is maintained.

Another aspect also deserves attention in this context: the possibility of developing a PHT (Proximal Hamstring Tendinopathy), an insertional tendinopathy of the origin of the hamstrings at the ischial tuberosity.) This is generally associated with intensive exercise of hip-preventing movements and in fact increases with the sarcomere length of the hamstrings, i.e. the extension in the knee joint, and with the load. As with any type of training, the factors of overcompensation (to avoid the term supercompensation, which refers purely to the muscles) and potentially damaging demands are opposed to each other, and long-term, side-effect-free, restorative training results from a positive balance of restorative factors over the longest distances, which must not be broken for too long at a time and not too often. The equation naturally contains many variables, perhaps all of which can hardly be quantified. These include metabolic factors, regeneration, other stresses and, last but not least, disposition. The disposition factor in particular is difficult to assess and can mean that a reasonable amount of training, which is tolerated by most people without any side effects, can also lead to side effects. However, a PHT is not the end of all training, but rather an opportunity to try to work through weaknesses in the disposition through adapted training so that they cannot be triggered by other factors. As a rule, this process results in normal weight-bearing work, and the work done in the process, for example with deadlifts, produces further positive effects.

Finally, the issue of hyperextension of the knee joints, which has been discussed elsewhere, must be addressed. As a rule of thumb: knee-dorsal abnormal sensations almost always turn out to be muscular(medial: semimenbranosus or semitendinosus; lateral biceps femoris; in between: gastrocnemius). Ventral discomfort is usually non-muscular in nature and is best avoided, otherwise only tolerated up to NRS 1.

And to come back to the initial question: not everything is qualified and valid information just because it appears in a currently popular medium. The content must be scrutinized in the same way as that of a classic book, for which it is just as true that not everything that is available to read in print is only true because it has been printed. The more expertise, perceptiveness and alert evaluation there is, the clearer the distinction between what is true and what is not