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Yoga Therapy for Knee Problems

by Simon Borg-Olivier and Bianca  Machliss

Bianca and I have just completed presenting our 2015 Yoga Therapy course. It was a really good course and one of the highlights was meeting Matthias St. John, an amazingly talented young man who came to see us to get help with a torn anterior cruciate ligament (ACL). We have developed 17 co-activation exercises that are progressively more challenging for the knee and to be able to practice. An ACL deficient knee is usually very unstable unless can simultaneously tense (co-activate) all of the muscles around the knee joint complex. Matthias St. John is the only person who I have ever in my experience been able to perform all these exercises while keeping stable and continuous co-activation of the opposing muscles around the knee joint complex. The most extreme of these movements is to rotate his weight bearing and flexed knee forwards backwards and sideways around his heel while balances on one leg. This is a testament to his skill as a roller blading expert. Please view the short linked video of Mathias and you will see that although the things his knee has to do are very extreme and although many of these extreme knee movements would potentially dislocate most peoples knees, he has sufficient flexibility, strength and control to co-activate his knee muscles in ways that most people can not. It is a lesson to all therapists that although we sometimes think of certain exercises as being dangerous but as the old adage says “ if it doesn’t kill you it will make you stronger” (but normal people should note that if it does kill you will kind of miss the point! So most people are definitely not qualified to do most of the knee movements (or other extreme movements) that Matthias demonstrates in his video.


Knee problems are amongst the most common physical problems experienced by adults in our western society – many students of yoga, arrive at yoga with a pre-existing knee problem, and some, unfortunately, get knee problems as a result of incorrect yoga practice. Knee problems that occur as a result of yoga are often due to Western yoga practitioners who start yoga late in life with stiff hips and ankles trying to prematurely force themselves into extreme postures of the knee [such as those shown in Figure 1]. Hip stiffness is less common in non-Western cultures partly because of a lifestyle, which includes squatting to go to the toilet and sitting cross-legged since childhood. About 20 years ago, after already teaching yoga for 10 years, our understanding of how to deal with knee problems was greatly improved when we both went back to Sydney University as mature age students to become physiotherapists. After many years of experimentation and research we successfully blended our understanding of traditional hatha yoga with western medical science to develop our synergy-style of yoga. Synergy style is essentially a dynamic and meditative yoga, which applies the basic principles of anatomy and physiology of yoga to the western body.

Figure 1a & 1b: (a) Bianca Machliss in mulabandhasana (downward ankle-twist pose): and (b) Simon Borg-Olivier in kandasana (upward ankle-twist pose): Both of us have had injuries in knee ligaments and cartilage (menisci) but an active approach to yoga with a sound basis in applied anatomy and physiology allows us to now practice postures that would be quite stressful for most people’s knees.

Figure 1a & 1b: (a) Bianca Machliss in mulabandhasana (downward ankle-twist pose): and (b) Simon Borg-Olivier in kandasana (upward ankle-twist pose): Both of us have had injuries in knee ligaments and cartilage (menisci) but an active approach to yoga with a sound basis in applied anatomy and physiology allows us to now practice postures that would be quite stressful for most people’s knees.

 
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Why After Ten Years of Teaching Yoga We Became Physiotherapists

By Simon Borg-Olivier

Fit, healthy and natural people move easily without the heart racing and while hardly breathing and move without sensations of  stretching or tensing muscles as they move easily during their activities. This is what defines them as fit and healthy and also is part of what allows them to feel connected physically and energetically in a state we could call ‘yoga’ (union). However, many people practicing modern yoga do it in a way that could suggest they are trying to mimic an unfit person with lots of injuries. By intentional breathing more and restricting the flow of blood they over-breathe and unnecessarily increase heart rate to compensate for lack of circulation like an unfit person. By intentionally feeling stretch and tension many people mimic the sensations of having an injured region in the body. Imagine if you felt a stretch or felt tension when you want to cross your arms of take a few steps – you would immediately know something was wrong with you. Natural yogis dont feel stretch or tension when they come into postures. Over-tensing, over-stretching, over-breathing all block yoga and lead to injury and illness. Five things block the flow of circulation and the energetic connection within the body that is yoga. These things are

1. Over-tensing

2. Over-stretching

3. Over-breathing

4. Over-thinking

5. Over-eating

Understanding this as the key to good yoga and yoga therapy (which are in a way the same thing). What we should look for in our physical practice is to:

  • improve flexibility without feeling intense stretch
  • improve strength without feeling tense or stressed
  • become more relaxed without needing to be completely passive
  • improve energy levels and circulation without having to breathe more than normal or make the heart beat faster
  • improve the intelligence of my body cells without having to over-think
  • satiate appetite and feel nourished and rejuvenated without having to over-eat

But how can we do this. This involves a deep understanding not just of traditional hatha yoga, but it also needs a deep understanding of applied anatomy and physiology and also a deep understanding of how the modern body differs from the body of person who lives a traditional lifestyle such as that which is still being lived in some parts of the world including some villages in India.

Bianca Machliss & Simon Borg-Olivier (Yoga Synergy) practicing together on Bondi Beach (photo courtesy Newspix)

Figure 1: Bianca Machliss & Simon Borg-Olivier (Yoga Synergy) practicing together on Bondi Beach (photo courtesy Newspix)

Why we became physiotherapist after ten years of teaching yoga:

People often ask us why after ten years of ‘successfully’ teaching yoga and managing to get 60-80 people in most of my classes in the early 1990’s why did we bother to go back to university and spend another four intense years of studying to become physiotherapists. The truth was that even most of our classes were packed we were simply not happy with the results we was getting from all the people in our classes. I had been teaching since 1982, like most teachers’ classes, my classes were small to begin with but within ten years they had increased significantly, and by all reckonings I was a successful yoga teacher. However, I was repeatedly noticing that not everyone was happy with the yoga I was offering. I was not alone. Every yoga teacher I knew was saying the same story then (and many say the same thing today). The statistics then were about the same as they are today. About 50%  of people who tried their first yoga class never came back to yoga, another 45% of people never continued past about one year and only 5% continued practicing more than one year. I was so passionate about my practice, but I had to ask why was it that only one person in twenty (5%)  finds yoga worth continuing after one year and and ten out of twenty people are not interested enough to come back after the first class. After many years of interviewing students and ex students I came to the following conclusions.

  • Most people who don’t  come back after their first physical yoga class or leave before the end of one year either because it did not feel good (or even felt painful or caused injury) or that it was ineffective.
  • Many  people who remain after their first class but leave before the end of their first year actually sustained injuries from practicing physical yoga.

There was something missing in the yoga that we were practicing and teaching. Why was it that not everyone was getting the benefits, why many people were getting injured and why not everyone had the same passion for yoga that we had.

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When it is Good to Hunch Your Shoulders Up

by Simon Borg-Olivier

When you should lift your shoulder blades up as high as possible

As I travel around the world I see many people in the world of exercise and yoga teach and practice that when you lift your arms up in the air you should pull the shoulder blades down (scapula depression). While there are times when you should not lift your shoulders or shoulder blades (such as if it causes pain), there are a lot of really good reasons to lift your shoulder blades up (elevate the scapulo-thoracic joint) when your arms are raised above your head (glenohumeral joint flexion) (Figure 1). This is not new information. It is precisely what Sri BKS Iyengar taught and you can see him practice in his classic book ‘Light on Yoga’ (Figure 2), but for reasons, (some of which I’ll also explain below) many teachers around the world of modern yoga today teach and practice that when your arms are above your head you should pull the shoulders down.

Figure 1: Here we are all lengthening our spine and facilitating calm breathing into the chest by elevating our shoulder blades with our arms above our heads. Photo of my workshop in Moscow by Mikhail Lisov

Figure 1: Here we are all lengthening our spine and facilitating calm breathing into the chest by elevating our shoulder blades with our arms above our heads. Photo of my workshop in Moscow by Mikhail Lisov

 
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The Risks and Benefits of Chest Breathing

Simon Breathing around the spine in unsupported headstand, and here doing exhalation retention with isolation of the rectus abdominis (nail)

Simon Borg-Olivier breathing around the spine in unsupported headstand, and here doing exhalation retention with isolation of the rectus abdominis (nauli)

Chest breathing can be extremely beneficially if done correctly but can also cause problems if done in a way that overstimulates the nervous system.

Many people teach and practice to inhale into the chest, and to exhale from the lower abdomen, but clinical research using Real Time Ultrasound (RTU) has shown that about 90% of the average adult population cannot really breathe into the chest without first inhibiting the functioning of the diaphragm by activating either the muscles of forced abdominal exhalation which firm the abdomen and draw the navel to the spine (co-activation of the internal and external abdominal oblique muscles, or ha-mula bandha), or by activating the anal constrictor muscles (ashvini mudra). Similarly, most people cannot exhale from the lower abdomen (and draw the lower abdominal muscles inwards) without inhibiting the diaphragm and immobilising the lumbar spine.

In this two minute video, Yoga Synergy Director and physiotherapist, Simon Borg-Olivier demonstrates breathing around the spine in such a way that the expansion due to inhalation is first seen and felt in the lower back, then the upper back, then the chest, and finally the abdomen. Then the contraction due to exhalation begins in the lower back, then the upper back, then the chest and finally the abdomen. In this type of the breathing, which is best learnt from a seated or normal standing position, the inhalation up the back starting from the tailbone up the spine is quite subtle, so it appears that the chest is being inflated first and the abdomen second. Similarly, on exhalation up the back starting from the tailbone up the spine is quite subtle so it appears that the chest is being compressed first and the abdomen draws inwards second. In the final part of the video Simon holds his breath out and performs an expansive uddiyana bandha, which is an expansion of the chest and upper back like an attempt at inhaling into the chest with a relaxed abdomen but without actually inhaling. This is followed by an isolation of the rectus abdominis (nauli).

 
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Ten things to do that can improve your life

Here are ten great reminders for the day that have been shown to have a positive effect on your life. This is inspired by an article by Eric Barker but I have adapted it to be more inclusive of Yoga practitioners.

1. Get out in nature – bare feet on the earth if best and in the water if you can
2. Exercise – do some yoga – move your spine
3. Spend time with friends and family
4. Express gratitude
5. Meditate – be happy with yourself
6. Get enough sleep – and relax more in the day
7. Challenge yourself – physically, mentally and emotionally
8. Laugh – kids laugh 300 times per day – adults often not more than twice!
9. Touch someone – hugs are even better!
10. Be optimistic – its free!

 

One of the first Yoga Synergy Workshops by Simon Borg-Olivier and Bianca Machliss at the Poland Rainbow Festival in 1991

One of the first Yoga Synergy Workshops by Simon Borg-Olivier and Bianca Machliss at the Poland Rainbow Festival in 1991

 

Read our detailed information about what to do get the most of these ten reminders by clicking on the rest of the article below.

 

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