Unit 5: The Lower Limbs

Transcription

1 Module # Topic Timestamp Page # 5.1 Somatization: Axial / Appendicular 00:00: Evolution of the Foot 00:06: Geek Out: The Foot 00:13: Walking & Gait 00:27: Feet: What Might Your Students Say? 00:36: Geek Out: The Knee 00:43: The Lotus Dilemna 00:53: Geek Out: Pelvic Halves 01:03: Your Legs are Longer Than You Know 01:12: Lotus: Look Again 01:15: Building an Asana: BOS - COG - ROM 01:21: The Big Questions: Do You Know What You re Doing? 01:27: What is Alignment? 01:49:12 24 Review Unit 5: In Review 01:58:13 26

2 [Timestamp 00:00:00] Narrator: Welcome back to YogaAnatomy.net Fundamentals. This is Unit 5, The Lower Limbs. In this unit we will look at the lower limbs in detail their structures, their functions and how they developed. We will start at the foot, look at the structure and also examine issues like gait, plantar fasciitis, bunions and how to keep the weight transfer healthy. Next we will look at the knee, how it's put together, and what we need to know to keep it safe in practice and in life. Finally, we ll look at the pelvis and the psoas. This unit will close at a look at what we in yoga call alignment. But first we will join Amy for a somatization. Module 5.1 Somatization: Axial / Appendicular [Timestamp 00:00:54] Amy: From a standing position, find your feet underneath you and turn your attention inwards. Bring your attention to your spine. Let all of the things that you may have learned or experienced about your spine settle into the back of your attention, into the back of your awareness, and see what it is that arises as you say hello to your spine today. Then shift your attention to all of the things that are attached to your spine. Consider, for a moment, your organs. The muscles that attach to your spine. Then bring your awareness to your limbs, to your lower limbs and your upper limbs. What comes into your awareness when you hear the word limb? Here's another word to consider. An appendage. What is an appendage? What part of your skeleton do you consider part of the upper limb? What part of your skeleton do you consider part of the lower limb? How is that different than the part of your skeleton that you might consider your axis? So we generally classify the spine as being axial skeleton and the bones of the limbs as being appendicular. But what counts as axial and what counts as appendicular can be fluid in some of the categories of bones. Your ribs might be part of your axis. They might be part of your upper limb. So how is it now to move your arms through space, to lift them up overhead or bring them out to the side or move them however you like. And compare as you do, entertaining the idea of your ribs being part of your limb, part of your appendicular skeleton, to the experience of considering your ribs part of your axis, part of your axial skeleton. You can also, in that movement, entertain the question of what your shoulder blades and your collarbones are. As you move your arms, what do you include in those limbs, in those appendages? Then switch your attention and the movement to your lower body, to your lower legs, and from standing, move your legs and see, where do you feel the pelvis organizing itself? Is your pelvis part of your axial skeleton? Is your pelvis part of your appendicular skeleton? If you want to, you can lift a leg up from where it is or you can leave both feet on the floor and move your legs, but see what you include in that. Then, for just a few moments, bring your attention to your spine. Now move your spine and see how that experience might be different to initiate movement from your axis as compared to your appendages. Is one of the ideas, experiences, more familiar? Is one of the ideas or experiences less familiar? Then find your way back to standing and to relative stillness on the outside. Observe again what your spine says to you in this moment. Add into it, add into the conversation now your upper and lower limbs. Thank you. YogaAnatomy.net Fundamentals Unit 5: The Lower Limbs Page! 1 of! 26

3 Module 5.2 Evolution of the Foot [Timestamp 00:06:57] Amy: In this unit on the lower limbs, we are going to begin at the feet and find our way up to the pelvis. I often begin with the feet because I think that questions we have about knees and hips and back and spine and neck, head, a whole lot of those questions can be sorted out, or at least we can find a starting place in them, when we look at the feet. Leslie: Like Amy, I often start my investigations about what's happening in our bodies with the feet. The feet, after all, are the foundation of our bodies, very much as the foundation of the house supports the rest of the structure. After all, if you were visiting a friend's house and you noticed that the roofline was crooked, I wouldn't recommend going up to the attic to find out what was wrong with the roof. I would go down to the basement and see if the foundation is sinking, and that's what's causing the apparent problem higher up in the system. Same is true of the body. Since we are going to be starting this unit on the lower limb with the foot, I think a good definition is in order. So how would we define the foot? Well, the way I choose to define it, the story I choose to tell about the foot, is this. The foot is the part of your body, which has evolved specifically for the purpose of having a relationship with the earth. Whatever the position you're in in gravity, some part of your body is having a relationship with the earth, with a supporting surface. But the foot is your body part that has evolved specifically to do that. The way it has evolved to do that is to have a particular arrangement of its structural elements that it can most effectively communicate the downward weight-bearing forces of your body to the earth so that it can conduct the upward supporting forces from the earth back into your body. Now, I keep using the word earth in this definition and these descriptions, and therein lies the problem for most of us. When I say most of us, I mean those of us living in the industrialized, civilized parts of the world, where the earth that the foot evolved upon, like the dirt, earth-earth, the earthen earth, is not something we interact with very much with our feet. We don't stand around in bare feet on the earth as our ancestors did for millions of years when this amazing structure evolved to be, essentially, an all-terrain vehicle. The terrain that we interact with mostly looks like this. [Timestamp 00:10:00] It's flat. It's hard. It's paved. It's predictable. It's not all-terrain. It's just flat terrain. If you had an all-terrain vehicle that had a wonderful, sturdy, adaptable suspension system, but never took that vehicle off road, you wouldn't really wonder why, after years of that, the suspension might freeze up a bit. So we yoga people do prefer a little bit more barefoot kind of living. We like to walk in the earth. We walk in the sand. We do yoga barefoot on yoga mats. So we do try to introduce a little bit more of the natural functioning of the foot into our lives through this. So the basic architecture of the foot that allows it to be such an amazingly adaptable all-terrain vehicle is that of a triangle or a tripod. When we look at tripods like the tripod that that camera is sitting on right now, one thing about a tripod is that it will never wobble. It will never wobble. If, however, you have something like this, which is a four legged stool, if the surface it's sitting on is a little uneven, or if the length of these legs is even a slight bit off, you're going to get a wobble. Tripods will never do that. So if we wanted to draw a picture, a simplified picture of the basic architecture of the foot, we can do that by starting with three dots in this sort of arrangement. These dots represent the three places where the bones YogaAnatomy.net Fundamentals Unit 5: The Lower Limbs Page! 2 of! 26

4 of the foot actually come in contact with the surface that it's resting upon. If we were to connect those three dots with lines, we of course get a triangle, and these three lines actually represent arches. Three arches in the foot. Not just one. Whereas the points represent where the weight-bearing energy of our body goes downwards towards the earth, these lines, these arches, represent places where the supporting energy of the earth can come back up into our body in the opposite direction. So to get the rest of the foot, all we need to do is draw the outline here, here, here, here and like that, and that's your footprint. Your footprint actually is reflecting this architectural reality of the underlying structures. We will be going more into this in greater detail as we progress through this unit on the lower limb. So anyone can draw a foot. If I can draw it, you can draw it. Give it a try. Module 5.3 Geek Out: The Foot [Timestamp 00:13:19] Amy: When we look at the bones of the foot in detail, we can divide the foot into two parts that are called the heel foot and the ankle foot, or the tibial foot and the fibular foot. I'm going to use heel foot and ankle foot because those are more familiar to me. On the slide here we have a picture of the bones of the foot with a view from above and with a view from below. Colored in on the slide in the pink color are the bones of the foot that are called the ankle foot. So, from above on the right foot and on the left foot, and from below, we see the heel foot in more tan and the from below we see the heel foot in this tan color on the right foot and on the left foot, and then above it, the ankle foot, left and right. If we look at those bones in that model without the color coding, we can see that there's an organization to the heel foot from the heel bone here into this bone, called the cuboid, and the fourth and fifth toes. Now, a regular person's foot won't do this, but this model shows really nicely, if I pull it apart, how the outer two toes, the fourth and fifth toes, communicate with the cuboid and the heel, the calcaneus. The first three toes, the big toe, second toe, third toe, communicate with these three cuneiform bones with the navicular and what's called the talus. So this organization into heel foot and ankle foot is a really useful way to start looking at how weight travels through the foot. The heel foot is the part of the foot that has the calcaneus in it. It s why it's called the heel foot. The bone of the calcaneus has developed to receive the weight as we bring weight into our foot, as we step forward, or as we receive force from the earth. That weight then travels through the heel foot primarily, because the ankle foot is not, at its back part, in direct contact with the earth. Because the foot does not have four points of contact, as Leslie said, the three points of contact are because the bones of the foot, with their connective tissue ligaments, are organized into what's called an osteoligamentous spiral. What that means is that the back of the foot has one point of contact and is organized perpendicularly, and the front of the foot is organized parallel to the floor. If I were to show this on the yoga mats, if we were to have four points of contact we might have something flat to the floor, like the yoga mat. Instead, the back of the foot has the talus bone right under the ankle, receiving nope. The back of the foot has the talus underneath the tibia receiving the weight of the lower leg and transferring that weight to the calcaneus. In the front of the foot, then, the foot spreads, spirals, distributes the weight into the five toes, and then, from the push of the big toe, all of the toes, the inner part of the foot, we can send force back up into the body through the first three toes, the cuneiforms, the navicular, the talus and back up into the tibia. What this twist does is it gives us the arches of the foot. YogaAnatomy.net Fundamentals Unit 5: The Lower Limbs Page! 3 of! 26

5 If we take the twist out of the foot, then, we end up taking the arches out of the foot. Which is only a problem because it diminishes the resilience of the foot to have four points of contact instead of three. The height of the arch, though, is not the point. The height of the arch in the foot is not an indicator of the health of the foot. Instead, the spiraling pathway through heel foot and ankle foot is more important for the presence of the arches. So if the foot is not very highly arched, if the foot is not very highly arched it can still have that spiral pathway. If, however, we consider the foot as having four points of contact in such a way that instead of having one point of contact in the back, we think we're supposed to get the talus or some inner corner down to the floor, we might end up flattening out that spiral. We might end up pouring the weight into both the inner and outer edge of the foot, and taking away the descending and ascending resilience that arises from having the spiral in the foot. So the bones of the foot are organized in this osteoligamentous spiral. Supporting that, we have layers and layers of muscle, which we can see in this drawing. [Timestamp 00:20:00] We have here the deepest layer of muscles that go from the long bones here of the foot into the toes. On top of those muscles are these muscles, also intrinsic to the foot. Which means they begin and end in the foot. Intrinsic muscles begin and end in a body part. Extrinsic muscles begin in one part and end in another. So these intrinsic muscles of the foot and these intrinsic muscles of the foot, and these and these intrinsic muscles of the foot all connect, organize, support, modulate, the relationships between the bones that help that spiral adapt, but stay present through all of the movements of walking. Ah-ah-ah because as we look at all of these layers, which, in these drawings, are organized into four layers you may also hear the muscles of the feet organized into three layers or five layers or two layers. The way we have looked at them is in four layers. When you look at how many different muscles there are, and in light of the idea of muscles all having conversations with each other, this huge number of muscles means we have a tremendous variety of ways that all of the little bones of the foot can move in relationship to each other. So whether our foot has all three points of contact on the floor, has the front toes on the floor, but the heel lifted up, we still have the muscular support to maintain or to continue keeping that spiral pathway through the bones even though we might not keep the exact position of the bones or the height of the arch exactly the same. Could you go to the next drawing, please? Thank you. In this drawing of the side of the foot, we can see the arch of that spiral, the heel as a point of contact. This edge out here is the outer edge of the foot. We're looking through from the medial edge to the lateral edge, or through from the inner edge to the outer edge. So this would be the heel foot edge. This would be the tip of the big toe and the inner edge of the ankle foot. So we can see that the talus bone here does not touch the floor. In the spiral of the foot, then, looking from underneath, we can see all of the layers of the foot, all of the layers of the muscles of the foot, with the most superficial layer of tissue, which is not muscle, but is connective tissue. It's called the plantar fascia, which just means it's the fascia on the bottom of the foot. Here in the side view is the plantar fascia as well, and the layer of fat that cushions the heel and the ball of the foot and the toes. Filling in this space created by the spiraling arch of the foot and the plantar fascia, filling in that space would be all of those layers of muscle that we saw in the previous drawings. When the bones of the foot are not organized in relationship to each other in such a way that that spiral pathway exists, and when all of the layers of muscle that fill in this space are not active in shortening, lengthening and maintaining the relationship between the bones, then it might be that the two points of YogaAnatomy.net Fundamentals Unit 5: The Lower Limbs Page! 4 of! 26

6 attachment for that plantar fascia get pushed away from each other. So if the foot collapses in such a way that the spiral in the foot is not present, and the muscles of the foot here are not active enough to help keep the pathway through the bones clear, then these two end points can get pulled away from each other by the weight landing in the foot. At which point there may be an excessive amount of pull on that plantar fascia, which then leads to it throwing a temper tantrum, which has a fancy name, which is plantar fasciitis. So 'itis' means an irritation, or can be translated to be irritation. So plantar fasciitis is irritation in the plantar fascia. In most of the cases where it arises, it is because we have asked the plantar fascia to support the weight of the body in some way, or to take on the role that the spiral and the bones and the muscles could have been doing. The solution to plantar fasciitis, or one of the things that is often suggested, is to stretch it out. But, in fact, the challenge of it arises because it has been asked to get longer than it can support faster than it knows how to respond to. So clarifying the pathway of weight in the bones of the foot, activating the muscles of the foot enough to support the weight in the bones, can be long term more helpful for the plantar fascia than stretching it out further. [Timestamp 00:27:44] Amy leads a group movement experience: Figure 8 So find a standing position. Find your heels. Shift your weight back and into one heel, and see if you can find that sense of your heel and your heel foot the pathway from your heel to your little toe. Now, if you are accustomed to feeling a lot of weight in the inner edges of your feet, you might feel like you are way, way out. If you go so far on the outside of your heel that you feel like you are stretching the outside of your ankle too much, do less. The point is to go as far out as you possibly can, but to find the place where the weight lands in that heel foot. Having done that on one side, shift your weight forward towards your little toe and then across towards your big toe without dropping to your inner heel. From your big toe, then, shift back and across to the other heel. From that other heel, find your little toe and your big toe and then back and across to your other heel, making a kind of figure eight on the floor that is tracing the pathway through your heel foot and ankle foot through the three points of contact and traveling through the arches of your feet. Module 5.4 Walking & Gait [Timestamp 00:27:44] Leslie: Continuing with our exploration of the lower extremity, we are going to try to put together some of the information you have received and examine it in the context of, well, what we do a lot of with our lower extremities. Walking and gait. So you will recall that we talked about the basic structure of the foot as being a tripod, a three point contact structure. The lines connecting those points are the arches. So, basically, in terms of the physics of the foot, the points, which are located here in the center of the heel, the base of the big toe, the base of the little toe, are the places where the weight of your body is channeled downward towards the earth and the lines connecting those points are the arches, which are basically engineered to create a rebound, or a place where the upward force, what we call support, can be gathered from the earth up into the body. So when we complete the outline of the foot, as we did earlier, we get something that looks like this. What I want to point out now in terms of gait is that when you are moving across a surface with your foot, there's a sequence of events that happens that basically takes this spiraled structure of the foot, stores YogaAnatomy.net Fundamentals Unit 5: The Lower Limbs Page! 5 of! 26

7 energy into it and then releases it in the process of walking. So if we are walking, not going particularly fast, okay, we are going to hit somewhere here in the heel region, okay? The faster we move, the further forward we tend to hit. Now, immediately upon landing on the floor, that impact of that downward weight force needs to be absorbed in what we call the heel foot. Okay? That division of the foot and that arch, [Timestamp 00:30:00] the lateral longitudinal arch, which would be this line here, is really about absorbing and dispersing that initial downward contact. So if we follow the path of the weight in the foot as it lands, or right after it lands this all happens rather quickly, but you'll be able to feel it. It goes to the outer edge of the foot heading right towards that point. Then there's a transition of energy from the heel foot to the ankle foot, and that comes across this arch. This transverse, or sometimes called the metatarsal arch, across the front of the foot. It heads this way. Where is it headed? Well, the final phase, and I'm simplifying this, this can be broken down into a lot more phases if you want it to be. The final phase is, as it goes into what we call the push-off, it passes through the base of the big toe and heads that way. Now, this is a two-dimensional image of a three-dimensional action. But the pay-off you get for allowing that weight to travel through the foot that way is that you have basically wound up a spring if you do that. What's the unwinding? Where does the energy get released from the spring? It gets released up into the body through this medial longitudinal arch. Now, as I said, this is two-dimensional. But you have to imagine this arrow pointing not towards the heel, pointing up along the vertical axis of the body. So this arrow, really, is pointing towards you, the viewer, here. So this is a completely Newtonian picture. The clearer we can get this pathway of weight traveling this way, and remember, this is pointing down into the earth, away from the viewer. The more this pathway spirals up and travels down, the more clearly the support of the earth can come up. So I'd like you just to, without bumping into each other too much, just move around the room and see if you can pay attention to that pathway of weight. Do this at home as well, okay? If you have room. Okay. Now, how many of you are actually looking at your feet when you're doing this? Yes. Okay. That's a perfectly normal response to being asked to pay more attention to what your foot is doing. However, there is something that we have been referring to as proprioception, which is the ability to gather that information from your body's own movements that I'm going to ask you to tune into. Okay? Resist the temptation to reinforce it visually with your eyes. Good. Now, are you noticing that maybe one of your feet is a little smarter at doing this than the other? Yeah. Well, one of your hands will be smarter at doing stuff than the other too. That's quite normal as well. All right? So just go back to where you started and let me just add to this for you a little bit, okay? This is one part of what I like to teach as a three-part method of understanding gait. You can teach these in any order. I just decided to start with the foot. The other is, the other two, actually. I'll teach them together. As you begin moving through space, notice if you can get it to happen with your center of gravity moving first. Most people, when they go to move forward in space, will simply shift the weight off of one leg, swing it forward, let it hit and pull themselves along. If you watch some people carefully as they walk, you might notice that their foot is actually traveling backwards a bit before it actually encounters the floor. Okay? That's not the most efficient way of storing and releasing this energy. In fact, it's a little jarring for the joints when you do that. So if you bring your center up and over your foot a little bit more, let it travel forward and let the leg almost catch up with you. We call that more of a falling step. Notice how you have to actually find your center of gravity in order to do that. For many people, that is quite an accomplishment. But that might change your experience. Can you combine that with that spiral in the foot? YogaAnatomy.net Fundamentals Unit 5: The Lower Limbs Page! 6 of! 26

8 And the third part, where is that leg swinging from? You can experiment with that. See how it feels to swing your leg just from your hip joint. Imagine swinging it from the pelvic half, where it would be articulating at the sacroiliac joints. And my personal favorite, swing it from your psoas crotch up here. I will talk about that a little later. But imagine that your leg actually comes all the way up and your crotch is way up here. Having choices in how we move is very, very important. I have somewhat funky knees. Occasionally they will bug me when I'm walking around. Come back to your mats. See, that was perfect. I caught you at just the right moment. Almost. Sometimes my knees are bugging me when I walk around. You know what I do? I change the timing of these three points just by a fraction of an inch. It creates a little bit more balanced joint space in that moment for those motions. So knowing all these components of gait and movement allows you to have more choices when you need to adapt, or when you need to uncover a pattern you may have that's causing you trouble. Right? So those are the three components. The foot spiral, moving from your center and moving the center first, and then playing with where you're swinging your legs from. You can also play with the timing of how long you spend here or here or here. That can give you all sorts of different effects. So, it's something to play with once you understand the components of gait and walking. Thank you. Module 5.5 Feet: What Might Your Students Say? [Timestamp 00:36:29] Leslie: Let s talk about some of the things that happen in feet that people complain about. Amy: Ah, that people complain about. Besides just generally aching dogs. Leslie: Yeah. Well, you mentioned earlier the plantar fascia as being a kind of going into a resentful state. It's sort of like when you're at work and you end up doing other people's job for them. You get inflamed and resentful. Amy: Yeah. Leslie: It's like when the plantar fascia starts having to do the job that the musculature should be doing, it gets resentful and inflamed. We call that plantar fasciitis. But that actually can progress to another level of problem that happens right around here. Right. That's when the tugging at this attachment becomes so intense it actually starts to pull the attachment point away from the bone, and then the body sort of backfills it with calcium. It will actually show up on an x-ray. That, of course, is what we would call a heel spur. But it's sort of the end product of plantar fasciitis. Amy: Right, though people can have pain from heel spurs without having had plantar fasciitis. Leslie: It just shows up as the heel pain, yeah. Amy: Because we re in that pain question, again, about what people notice and what they don't. So people might not notice the plantar fascia pulling sensation temper tantrum, but they will feel the heel spur. Yeah. YogaAnatomy.net Fundamentals Unit 5: The Lower Limbs Page! 7 of! 26

9 Leslie: So that s definitely again, the long-term solution is to get those muscles in the foot doing their job so the plantar fascia doesn't have to. Amy: To get the muscles in the foot to do their job and to get the bones knowing what their relationship is to each other, and I think also knowing the spiral through the bones, that the bones can bring their own consciousness to it as well. Leslie: That goes back to the definition of what the muscles job is in relation to the bones. It's to put the bones in the position so they can do their job of channeling the weight-bearing forces in a healthy way. Amy: Yes. Leslie: Speaking of bones and weight bearing forces, tell us about 'cause your feet are kind of interesting. Amy: Thank you, Leslie. That was very diplomatic. One of the things that we also like to talk about looking at foot issues, and my foot is able to demonstrate, is what happens in a bunion, which goes back to rather than being a plantar fascia issue, though it may also go along with that. One way to explain what happens in it is the lack of clarity in the pathway of weight. So if I bring my foot to the floor and instead of finding my heel foot, I pour the weight into the inner part of my foot, can you see how the weight pours into this joint right here? I did this for many, many years. My mother did it too and my sister does it. I don't think my dad did it. But high heels exacerbate it, and for me, training as a dancer exacerbated it in looking for turnout. So a bunion is an expression of too much weight combined with a predisposition towards it. But too much weight pouring into that ankle foot. What's interesting about, I think, that kind of expression of what happens in the foot is to go back to that idea that it doesn't necessarily have to do with the height of the arch because I can lift my arch up here, but keep that bunion pattern. So because of whatever muscle, flexibility, blah, blah question I have in my foot, the arch can lift up, [Timestamp 00:40:00] but the pathway of weight can still be unclear. The toes, in fact, get even more distorted. So the height of the arch will not necessarily clarify the pathway of weight in the foot. But the pathway of the weight in the foot can help sort out some of these issues that arise. Leslie: Now, is this the same thing as what usually ends up getting described as excessive pronation? Amy: I don't know what they mean by excessive pronation. Leslie: You hear that a lot, though. Amy: Yeah. I know. But a lot of what I hear is people coming in to me saying, "I have been told I do this. I'm, like, Yeah." Supination and pronation, they are actions in the foot that happen as part of walking. They are part of our natural gait. So excessive pronation might be that being stuck in it and not having available the supination aspect of it. Leslie: So excessive pronation could actually be deficient supination? Amy: Yeah. Well, I think it's one of those things that s about stuff being in balance. YogaAnatomy.net Fundamentals Unit 5: The Lower Limbs Page! 8 of! 26

10 Leslie: Yeah. Amy: So we need supination in our foot. We need pronation in our foot. We need a clear pathway of weight. Having all supination and no pronation is no good. Having all pronation and no supination is no good. We need to be able to do the action when we need it, not do it when we don't need it, so that we can be responsive to whatever the terrain is offering. Leslie: Yeah. it's sort of like inhaling and exhaling. It's not like one is good and the other is bad. Amy: Right. Exactly. Leslie: You kind of want to have the ability to do both freely when it's appropriate and whatever pattern is supporting what you're doing. Amy: Exactly. It's all about being able to respond and to change to whatever comes up, right? Leslie: So, for example, unlike you, who went directly from the heel to the big toe and had to work to bring this pathway in, some people might have the opposite problem where they go from the heel to here and they are leaving out their big toe. Amy: Some people might have the opposite problem, yeah. I see that less often, except for as an overcompensation to having been told, "Lift your arch," that we get stuck in this pattern. Leslie: Right. Amy: But, yes, that can also happen. Leslie: One last little thing. Some people have been taught that, to lift their little toes up like this when they are practicing is a good way to ground the foot and create the support through the arch. As a strategy, it seems to make a certain amount of sense. When you create this lifting energy on the top of their foot you are driving energy down into the bottom of the foot. So as a way of finding it, maybe. Amy: Maybe. And when you lift the toes, you also end up when you lift the toes, you end up pulling this taut. You pull it forward a little bit. So it might help lift the arch up. But lifting the toes comes from the muscles on the top of the foot. And it doesn't cultivate an understanding of what's going on on the bottom of the foot in a way that, when I let go of my toes, I will still be able to do the action. Leslie: Right. Amy: So. Leslie: So there. Amy: Yeah. Spiral your feet. Leslie: Okay. Module 5.6 Geek Out: The Knee YogaAnatomy.net Fundamentals Unit 5: The Lower Limbs Page! 9 of! 26

11 [Timestamp 00:43:02] Amy: We're going to look next at the knee joint and some of the major structures in it. The knee joint is made up of three bones. The top of the tibia, the bottom of the femur and a third bone, the patella, which is embedded in the connective tissue at the front of the joint. So the patella is embedded in to the joint capsule and the connective tissue that connects the quadriceps to the tibia. When we look at the top of the tibia, it's a relatively flat surface. The depth of the socket doesn't match up very much with the roundness of the condyles at the end of the femur. So if you look at the bottom of the femur from the side, we can see that the condyles are very rounded. They don't actually match very closely to the top of the tibia. So we have an additional soft tissue structure that is attached to the top of the tibia that creates more of a socket for the condyles of the femur. This is called the meniscus. We can see part of the meniscus here, this wedge-shaped structure. We can also see part of it here. What the drawing doesn't quite show is the continuity of it as a ring all the way around. So if we look at the top of this model, you can see the lateral meniscus here and the medial meniscus here. So the lateral meniscus would be on this side of the tibia and the medial meniscus would be on this side of the tibia. The menisci together are attached to the top of the tibia. Unlike in the model, where it's a really separate piece of plastic that has been attached to the top of the bone, the meniscus arise from the same tissue that the tibia does. So they are not a separate thing that has been imported in, but they are an outgrowth, or a part of the top of the tibia, that is developed into these specialized structures. When we look at the movement of the femur on the top of the tibia, then, we see that it is a combination of rolling and gliding. So if we only rolled the femur and did not glide, the femur would end up falling off the back of the top of the tibia. Or, if the knee were in flexion already and we were to roll but not glide, we would end up with this kind of organization between the bones. So instead we need to do, we do do, luckily, a combination of rolling and gliding for the condyles of the femur to roll and glide on top of the tibia. Or, if we were to do it the other direction, for the tibia to move around the femur. That rolling and gliding action is facilitated by the meniscus. So the meniscus, in their attachments, have very strong attachments close to the center of the top of the tibia, and the outer part of the meniscus is much more loosely attached so that, as the femur moves, the meniscus can shift forward and back in relationship to the movement of the femur. Either in flexion and extension, or in the rotation of the tibia underneath the femur. So those movements are flexion and extension. Or, if we do that movement moving the tibia, it would be flexion and extension. The rotation of the knee is then that the tibia and the femur can rotate separately from each other. An important point to make here is that, if we are talking about rotating the knee but the two bones move the same direction, then that's not an articulation within the joint, but is a movement of the joint through space. If the knee moves in such a way that both bones do the same thing, that it's moving through space, then chances are good that the movement is happening, actually, in an articulation of the hip joint. Or, if not there, somewhere else higher up. But if we are looking at the movement at the knee that is possible, we have flexion, extension. We have medial rotation, describing the movement of the tibia, and lateral rotation and very, very little movement side to side. Inside of the knee joint, then, along with the meniscus, we have two ligaments between the meniscus and between the condyles of the femur that are called the cruciate ligaments. If we were to look at the knee joint from the side, one of them runs on an angle this way and one of them runs on an angle this way. They cross each other, which is why they are called cruciate ligaments. One of the jobs of the cruciate ligaments is to keep the femur and the tibia in relationship to each other so that as we roll and slide that ligament that might be connecting from the front of the tibia back to the femur keeps it from sliding back. The posterior cruciate ligament that connects YogaAnatomy.net Fundamentals Unit 5: The Lower Limbs Page! 10 of! 26

12 from the back of the tibia forward to the femur helps to keep the femur from sliding off the top of the tibial plateau. [Timestamp 00:50:00] So the cruciate ligaments support the knee joint in the side to side relationship with each other that goes forward and back, anterior to posterior or posterior to anterior. The meniscus support the knee joint in this horizontal plane on the top of the tibia, and we have two more ligaments that support the knee joint, then, on either side. These are called the collateral ligaments. They help resist too much movement in this plane of motion. So the movements that the knee can functionally do and needs to be able to do are flexion and extension, medial and lateral rotation, but only a little bit of this medial and lateral kind of deviation. We often hear that rotation in the knee is a bad thing and is not supposed to happen. But, in fact, there's a little piece of rotation that's necessary to have in the knee. It's called a physiological lock. When we look at the condyles on the base of the femur, the medial condyle is angled out to the side and is a little bit longer than the lateral condyle. What that means, then, is that when the femur is rolling on top of the tibia, or when the tibia is excursioning on the femur, more movement needs to happen on the medial edge than on the lateral edge to keep a clear pathway of weight from femur to tibia and to keep the center of each condyle oriented over the top of the tibia. What that means, then, in terms of movement, is that when the knee extends, if I'm very precise about centering the condyles of the femur over the top of the tibia, at the end of extending the femur, a little extra rotation needs to happen through the media condyle of the femur. That extra rotation of the medial condyle of the femur to center both condyles of the femur over the top of the tibia is called the physiological lock. It's often described as being a lateral rotation of the knee, which would mean that the tibia rotates laterally. But it might show up as a rotation of the femur medially. Whether it's the femur moving or the tibia moving, that little bit of rotation, which is not huge, but is doable and necessary in the knee. It might be just this much rotation of the tibia under the femur, is part of a healthy rotation, a healthy spiral through the tissues of the knee that helps keep the femur in relationship to the tibia when the knee is extended, and then, to varying degrees, participates in the femur staying in relationship to the knee, whatever other position the knee is in. Module 5.7 The Lotus Dilemma [Timestamp 00:53:43] Leslie: So having covered the structure of the knee and its movements and the idea that we have these labrum structures in the knee called the meniscus, I want to go into a little more detail on the movements of the meniscus and, in particular, this problem that I have come to call the Lotus Dilemma that afflicts certain people in our yoga teaching and practicing community. So, first of all, the movements of the meniscus. This is a graphic that we have created. Just to orient you, the top of the graphic represents the anterior front part of the knee. So if you were looking at this particular knee from this same angle, you would be looking into it this way, with the top being anterior, the back being posterior. This would be the lateral side and this would be the medial side. In general, just so you know, in most illustrations that show anatomy, if it's not specified otherwise, the body part you're looking at is going to be a right side body part. There's a strong preference for right sided things in anatomy books. As it happens, there's also a strong preference for right sided things in yoga practice, but we will get to that. YogaAnatomy.net Fundamentals Unit 5: The Lower Limbs Page! 11 of 26!

13 So just to orient you, again, this is the three-dimensional version of what we're seeing in two dimensions. This shaded area, which is below, three-dimensionally, in all of the drawings, is the tibial plateau. That's the top of the tibia, which is slightly dish shaped. But it's deepened into more of a socket by these structures here, the meniscus. So medial meniscus would be on the left side. The lateral meniscus would be on the right side. As Amy mentioned earlier, they are anchored very firmly in the center of the tibial plateau. We have actually represented that with little circles here just to drive that home. It's as if they were tacked down on pivoting attachments, okay. So these attachments don't go anywhere. But the cartilage can wander around and change its shape from that firm attachment point at the center of the knee, depending on what the femoral condyles are doing. So the job of the meniscus, really, is to follow the movements of the femoral condyles on the tibial plateau. So what does that mean in terms of the basic movements of the knee? We're gonna look at extension, we're gonna look at flexion and we're gonna look at both medial and lateral rotation. So up here in the upper left we see where the cartilage goes, the meniscus goes, during extension. That's compared to a neutral position, which is here in the center, where it's neither being pushed forward, nor pulled back on the tibial plateau. So extension of the knee, straightening of the knee, moves the cartilage, the meniscus, towards the front of the knee. Both sides towards the front of the knee. Flexion does the opposite. It draws the meniscus towards the back of the knee. Now, as you might imagine, rotation is going to do one on one side and one on the other. So medial rotation describes the way that the tibia is going. If there were a foot at the end of this, the toe would be also moving medially toward the midline of the body, right? So medial rotation, which is being pictured here, and you can see three dimensionally what does that do? It moves the medial condyle anteriorly and the lateral condyle posteriorly, and that, of course, is going to be reflected in the movements of the corresponding meniscus. Does that make sense so far? Well, then lateral rotation is going to be the opposite. Okay? It's going to be this. The medial meniscus moves to the back. The lateral meniscus moves to the front of the joint. So, to review, extension moves the cartilage to the front of the knee. Flexion moves it to the back of the knee. Medial rotation moves the medial meniscus forward, lateral meniscus backward. The opposite happens for lateral rotation. This is where the Lotus Dilemma comes in. In my practice of therapeutic yoga education over many years of doing that, I began to see an interesting pattern emerge in people who showed up with knee injuries, injuries to the meniscus. There was a rash of them for awhile. It was mostly in the left knee. I was wondering, "What is it about the left knee in yoga practice that could be making so many of these cartilage injuries? By the way, it was medial meniscus. It was not the lateral one. It was the medial meniscus that was getting torn in people doing yoga, and most of the ones I saw were in the left knee. So, again, looking into what people are practicing and how they were practicing it. I think we've all heard this at one point or another about folding the legs into lotus or half lotus or whatever. It's much safer to bring your knee into full flexion first before you begin doing any kind of rotational movement. [Timestamp 01:00:00] The idea, of course, is to have that rotational movement coming from your hip joint, not from the knee. Because rotation of the knee is deemed dangerous. Well, in reality, the knee is able to rotate much more freely when it's in this half bent, half straight position. When it's fully straight it's got less rotational movement available to it, and when it's fully bent it has less rotational movement available. But when it's in between it's got a lot of rotational movement available to it. So the thing that we're told to avoid to make this safe is this, grabbing the foot and cranking like that. Why is that unsafe? Well, it's right there in YogaAnatomy.net Fundamentals Unit 5: The Lower Limbs Page! 12 of! 26

14 front of us, okay? It's right there in front of us. Flexion, the bending of the knee, is trying to pull the medial meniscus backwards. But the medial rotation is trying to pull the medial meniscus forwards. It places a contradictory mechanical strain on the medial meniscus to combine, simultaneously, flexion and medial rotation. So all you need to do to avoid it, really, is make sure the knee is fully flexed, it means the cartilage has been drawn to the back of the knee and there it will stay, where rotational force are minimized and you're trying to get this to come from here, not from here. Well, that's all well and good when you put your right leg into lotus. Remember when I said there's a strong preference for right handed things in yoga? Well, usually lotus is taught, do the right leg first. Then, how do you protect the left knee in the same way you protected the right knee? Okay? I've got it fully flexed here and it's up in position. Now, how do I I m kind of stiff. Maybe a more flexible person could do it. Actually, it doesn't matter how flexible you are. At a certain point this leg is going to have to come out of its full flexion just enough to clear this shin to bring it over here. It's at that moment, that moment, when it's not fully flexed, and you are pulling it in that you run the risk of tearing that medial meniscus. Now, you may be able to do this your entire life and never have a problem. In fact, most people do. Some people are flexible enough to do it without their hands. They just flop their legs into lotus. It's never even an issue that they would consider. But, for certain people at certain times, all it takes is just that one moment where the cartilage just doesn't want to respond to that contradictory demand by stretching in both directions at once, and it will tear by being stretched in both directions at once. So that, in short, is the Lotus Dilemma. How do we solve it? Well, I've solved it. Pretty easy solution. I don't do it and I really don't teach it. In my book, if you're flexible enough to do it easily then you probably don't really need to be doing it. It might be fun, but if you are too tight and you struggle with it, it's probably not worth the risk. I know Amy has her own take on this as well that she's going to share with you very shortly. So that's the Lotus Dilemma. Module 5.8 Geek Out: Pelvic Halves [Timestamp 01:03:43] Amy: When we go to the next joint up from the knee joint, we come to the hip joint. The hip joint is where the femur articulates with the pelvic half. The pelvic half is one of the bones that makes up the pelvic basin, or the pelvic bowl. The pelvic bowl, or the pelvis in general, is made up of the two pelvic halves, which are also called innominate bones, and the sacrum. The pelvic halves articulate with each other through a disc at the front called the pubic disc or the pubic symphysis. They articulate in the back with the sacrum on either side. Each pelvic half has a socket in it, or a hollow, called the acetabulum. The acetabulum and the head of the femur articulate with each other to create the iliofemoral joint, or the hip joint. Like in the knee, we have an additional soft tissue structure to help the head of the femur stay in relationship with the acetabulum, which is called the labrum. Labrum means lip, and it is additional connective tissue that develops around the edge of the acetabulum to help cover and articulate with the head of the femur. Because the head of the femur is so rounded and the acetabulum, relatively speaking, is so deep, and with the addition of the labrum, is deeper, when the head of the femur and the acetabulum are in relationship to each other, we have a lot of choices about joint movement. Those joint movements are described as being in the sagittal plane or in the vertical plane or in the horizontal plane, but we really have an infinite number of combinations of those movements to do in the hip joint. The hip joint is often described as being the very top of the leg, but in fact the top joint of the leg is where the pelvic halves meet the sacrum. The sacroiliac joints. When we look at the sacrum and the pelvis in YogaAnatomy.net Fundamentals Unit 5: The Lower Limbs Page! 13 of! 26

15 relationship to each other, when we open up that sacroiliac joint and separate the bones from each other, we can see, colored in on the sacrum here, is the articular surface where the sacrum and the pelvic half move in relationship to each other. On the pelvic half, we can see colored in here, where the sacrum articulates with the pelvic half. What I think is interesting about this, or one of the many things I think is interesting about this, is how far forward this articular surface is. If we look at it in the full model, that this is where that articular surface is, not in the back here. So many of us describe our sensation back here as being sensation in the SI joint where we might actually have a lot of sensation here. But where the joint is, is not here, but more accurately in the front. So the pelvic half, which is made of three bones that fuse together, they come from the same tissue that the leg develops from. The sacrum comes from the tissue that becomes the spine. So when we look embryologically at where the leg develops and where the spine develops and where those two meet, the SI joint, the sacroiliac joint, is actually the top of the leg. The movements that we can do at this SI joint are called nutation and counter-nutation. It used to be said, I hear less and less, but I still hear sometimes that we are not supposed to move at our SI joints. That movement at the SI joints is bad or pathological, or should only happen in certain situations. In fact, the movement at the SI joint is also part of this need, part of the whole body relationship of having a little bit of movement at a lot of places. A little bit of movement at the SI joint on either side is part of how we don't ask too much of our spine and we don't ask too much of our hip joints. So when we look at what that movement of nutation is, the movement of nutation in the SI joint, which is the place where it happens, is the nodding of the sacrum forward. So when the top of the sacrum tips forward, like it's nodding, that's called nutation. If the top of the sacrum comes forward and the whole pelvis goes with it, that's not articulation at the SI joint. That would be a pelvic tilt, perhaps, and it might move the sacrum. But it is not articulating in the SI joint. So the movement of nutation is the top of the sacrum tipping forward [Timestamp 01:10:02] and the movement of counter-nutation is the top of the sacrum tipping back in relationship to the pelvic halves. Now, that doesn't have to happen because the sacrum moves. It might also be that we nutate and the pelvic halves change their position in relationship to the sacrum, or counter-nutate and the pelvic halves change their relationship to the sacrum. Either way, nutation and counter-nutation are movements at the SI joint and are expressing or participating in the conversation between movements at the hip joints and movements in the spine. When we walk, then, if each pelvic half is considered part of the leg instead of part of the pelvis, then the movement of the pelvic halves around the sacrum will be one of one joint counter-nutating while the other joint nutates. For example, when I do that. Then, as soon as the other leg swings forward, we have nutated and counter-nutated in the opposite joints. So if I switch to the big skeleton here, which doesn't have quite as much movement in the SI joints, but has a little bit. When the right leg swings forward to walk, rather than it being that it's all movement at the hip joint, if we let the pelvic half be part of the leg, then less will be asked of our lumbosacral joints and lumbar joints, and we might ask less of our hip joints as well. A little bit of movement in each SI joint won't necessarily be very apparent at the top, but the repercussions of it are significant in how the leg travels through space and bears weight, and in how the weight, and in how the force of the stride travels into the spine. So the top of the leg on a skeletal level, instead of being the hip joints, could be brought all the way up to where the lower limb meets the axis by coming all the way up to the sacroiliac joints. YogaAnatomy.net Fundamentals Unit 5: The Lower Limbs Page! 14 of! 26