Originally published in Massage Bodywork magazine, August/September 2000.
Copyright 2003. Associated Bodywork and Massage Professionals. All rights reserved.
Many therapists know first-hand the therapeutic value of yoga and neuromuscular therapy. Consider what might happen if the fundamental laws behind the two disciplines were combined to incorporate their very best principles. The wonderful results of this combination are what many therapists are stumbling upon, a process we've called Balancing the Asymmetric Body.
Using Paul St. John's method of neuromuscular therapy (which works on the interrelatedness between muscles, ligaments, fascia, soft tissue and the nervous system) and Iyengar Yoga (named after the teacher, B.K.S. Iyengar who has a Yoga Institute in Pune, India) a complementary adjunct was realized.
With his brilliant insights into the body, Iyengar's teachings are grounded in a profound understanding and appreciation of alignment and balance in the structure of the human form. The work and teachings of St. John, with his clinic in Seminole, Fla., is equally grounded in a deep understanding of the nature of alignment and symmetry within the body.
Interfacing the work of these pioneers gives us rich insights into how we stand, sit and move in space and time.
The ultimate purpose of both Iyengar Yoga and neuromuscular therapy is to balance the outer body with the more subtle energies of the inner body in order to create an enhanced feeling of harmony, gracefulness and poise. St. John defines this balancing process as "the science by which homeostasis is brought about between the nervous system and the musculoskeletal system." Iyengar describes it as "the dawning of the light of the spirit" within the body and the mind.
The expression, "The Asymmetric Body" grew out of a respect for the body as it is, not as it should be. In order to make progress, we must first accept things as they are. In order to accept things as they are, we must first have the courage to look at things directly -- as though in a mirror and without the mask of illusion.
We developed our approach -- Asymmetric Body Balancing -- through an evolution of our mutual understanding of these two disciplines. One of the goals of our work is to take the mystery out of pain and why we have pain. Using the tools of observation, touch, pressure, movement and exercise, we seek not so much to heal our students and clients as to awaken within them the means by which they can heal themselves. Perception of the problem modifies the problem. Fully understanding the relationship between awareness and internal change is what the great Indian teacher and philosopher Krishnamurti calls "the awakening of intelligence."
Here we will describe how yoga and neuromuscular therapy intertwine in a concrete and practical way. We will limit these concepts to three: gravity and symmetrically diagonal asymmetry, misalignment and imbalance off the coronal plane in relationship to injury, and the pelvis as fulcrum. We will then explain how we go about our work in an effort to unleash the inherent healing energies within the body. Our ultimate goal is to help clients to first diminish and/or alleviate any pain or discomfort they are feeling, and secondly to find and preserve homeostasis and equilibrium in their daily lives.
This is what we call Balancing the Asymmetric Body.Gravity Symmetrically Diagonal Asymmetry
Octavio Paz, the Mexican poet and Noble Laureate, has a beautiful line about gravity in a poem titled "Boy and Top." This exquisite image could be a metaphor for our bodies:
Each time he spins it,
It lands, precisely,
At the center of the world.
The body, like this top, also has a center of gravity and is always attempting to bring itself back toward this center. Our muscles work extremely hard to do this and to make sure that if we were to spin, even very fast, we would never topple.
This occurs with some physical sacrifice to the body -- unless we are perfectly symmetrical, which we're not. Almost all of us have one kind of asymmetry or another. Asymmetry implies a pull of the muscles and the bones in one direction or the other away from the center or median plane. This happens either in a side-to-side direction or a front-back direction.
The side-to-side asymmetry is a misalignment off the midsaggital plane -- the plane comprised of the middle of the eyes, nose, throat, sternum, navel, hara and perineum. The front-back direction is a misalignment off the coronal plane -- the plane comprised of the center of the ears, armpit, head of the femur bone, and the center of the ankle. Any misalignment off either of these planes is known as a misalignment off the median plane, which causes an overstretch in one part of the body and an understretch in another.
This misalignment off the median plane also causes muscles to contract more in one part of the body than the other, simultaneously establishing a counter-contraction on the opposite side of the body. This counter-contraction occurs in an area of the body that is almost perfectly diagonal to the first contraction. The width and length of these two opposing muscle sets will, by and large, be the same. Although fairly symmetrical, these contractions will nonetheless be the by-product of an initial asymmetry. The body is actually creating the illusion of symmetry at its own cost; pulling or contracting muscles to create a misguided "balance." This is why the phenomenon is referred to as symmetrically diagonal asymmetry.
These pulls and counter-pulls occur in the body so that it can establish its rightful place in the world -- perfectly vertical to the floor. Were we to study the body very closely, however, we would see that it is made up of muscle contractions and muscle releases which zig/zag from top to bottom and cross over each other at various intervals. Some of these patterns are obvious. Many, however, are imperceptible to any but to a highly trained eye.
Take the back, for example, a part of the body where these muscular counterpoints are most apparent. If the upper right thoracic muscles contract due to a slight curvature of the spine, then the lower left lumbar muscles create a counter-pull and would also contract. When someone with this condition first begins to stretch, his back will feel stiff and rigid all over, yet it will be difficult to feel where the tightness is coming from. As his yoga poses improve, however, it will be possible to sense a direction of the pulls.
Lynne Paterson, a student of Iyengar Yoga for more than 20 years, has exactly this type of dual contraction. Paterson's upper right shoulder area is contracted due to a slight scoliosis; her lower left lumbar area is also contracted in order to balance the pull on the upper right side. In addition, her right iliac bone rotates downward more than her left.
As a result of this symmetrically diagonal asymmetry, Paterson has suffered chronic pain in her right buttock and hip for years. When she stands, she experiences the difference in these two sides of her body as only a "subtle" asymmetry. When she moves into her yoga poses, however, she perceives the difference as a "dramatic" asymmetry.Incorporating the Yoga
From a yoga perspective, the pose Janusirsasana -- putting your head to your knee -- is highly recommended to free up this dual contraction in the back.
Since each side of the body is different, Janusirsasana can address these areas of difficulty separately. By straightening the left leg and bending the right, the client protects the tightness of the hamstring being affected by a counter-pull from the upper back. To free up the muscles in the upper right side of the back when you begin to stretch, you can place a 15-pound sandbag over the right inner thigh or press the outer right thigh to the floor (perhaps with a blanket underneath it) and roll the shin bone inward.
In both neuromuscular therapy and yoga it is said: "First you lengthen, then you strengthen." Hence, the initial movement would be to try and lengthen the upper muscles of the thoracic by extending the right arm as far as possible out of the scapula slightly to the inside of the left foot and then eventually to grab the foot as in the picture.
This action can be enhanced if a yoga therapist presses the protruding thoracic area with a forearm or hand. This pressure allows for the spine to extend more and gives the correct direction to the muscles in the back. The left hand holds the ribs in place, lining up the right and left sides of the body in a parallel fashion, thereby pulling the right concave ribs back into place. This helps students develop a body memory of correct alignment when they work on their own.
To help relieve pain in a client's upper right thoracic area using neuromuscular therapy, the focus is primarily on working the levator scapular, the erector spinae, the rhomboids, the trapezius muscles and latissimus dorsi. Before beginning the crux of the work, however, it is important to investigate all the muscles involved in the shoulder girdle and to eliminate those muscles not part of the pain pattern. The muscles that are involved in the pain pattern will be ischemic and will be painful to the touch.
Once the ischemic areas have been determined, and the pain pattern diminished, utilize effleurage to make those areas more responsive and pliable with the intention of creating symmetry. By making the muscles more supple, malleable and permeable, the body can then set about to create symmetry.
In neuromuscular therapy work, the direction of the therapist's hands is largely guided by the feedback of the client. The importance of this feedback system is tantamount. The primary intention is to have clients respond to every touch. This is one of the fundamental differences between neuromuscular therapy and traditional massage where the goal is to encourage the client to become very relaxed, eventually detaching themselves even from the voice of the therapist.
In neuromuscular therapy, the process of staying in contact with the movement and direction of the therapist's hands is what makes this technique interactive. This work requires equally as much from the client as from the therapist. Misalignment Imbalance off the Coronal Plane
Kevin, a 39-year-old triathlete, came to find this work in an attempt to eliminate pain lingering from three knee surgeries. When knee problems are involved in injury, it is important to first look at the client's posture pattern in relationship to the coronal plane. What was apparent in Kevin's case was that his right pelvis rotated forward, meaning his right sacroiliac joint was misaligned. When the right ilium is rotated forward even more, it causes hyperextension in the knee joint, a lengthening of the quadriceps and further pressure on the knee joint. This additional pressure on the joint is what created the pain pattern in Kevin's knee.
In order to allow the knee joint to heal, it is essential to stabilize the pelvis by creating symmetry in the sacroiliac joints. In neuromuscular therapy treatments, the initial focus, however, is to eliminate or diminish the pain in the knee joint. The work that focuses on diminishing the pain pattern precedes the work that focuses on bringing about alignment to the pelvis and the rest of the body.
Work on this client's knee included palpating the quadriceps and the tissue surrounding the hip to determine any build-up of lactic acid or nodules that caused the muscles to contract. This involved palpating the tendon of the gracilis, the sartorius and semitendinosus muscles, each of which have the same common tendon. With knee problems, injuries tend to happen more often on the inside of the knee, partially because of this common tendon. The therapist should begin by working on the attachment of these three muscles, then move to the outside of the knee, including the iliotibial band and the connective tissue which surrounds the lateral portion of the knee.
Once the pain pattern has diminished, the focus returns to creating alignment in the pelvis. Here the work begins in the abdominal area, on the rectus abdominis and the psoas muscles, and the iliacus and the inguinal ligaments.
When there is pressure on the sacroiliac joints, added pressure is felt on all the other joints in the body and more specifically on the side of the body where the sacroiliac joint is misaligned. Releasing these muscles takes pressure off the ilium, allowing the sacroiliac joints to become realigned, returning the pelvis to stabilization which will lessen pressure on the knee.Incorporating the Yoga
Many yoga poses, particularly the standing poses, help to stabilize the pelvic area and bring the body back to the center of the coronal plane. Virabadhrasana I, or Warrior I, is a perfect example. This pose teaches the body to learn to bring the sacroliliac joints down, lift the iliac bones up, release contraction in the quadriceps which pull on the knee caps, and lengthen both the right and left sides of the flanks, notably in the area which Iyengar calls the "armpit chest."
The client's feet should be approximately 4 1/2 feet apart, the right foot turned in and the left foot out. Keeping the back leg only slightly bent in order to pull the sacrum down, the client bends the left knee into a 90-degree angle. This causes the pelvic bones to pull up and away from the groin, while the sacroiliac joints descend.
The yoga therapist, using her hands to press against the triceps, pulls the arms up, encouraging an upward direction in the latissimus dorsi, while the ischium bone of the left buttock descends and the inner right leg stretches back into the heel. This creates an equal and symmetrical lengthening of the sides of the trunk. This has the effect of drawing the rib cage in and freeing the arms. Little by little the pelvis begins to stabilize as the quadriceps loosen and the sacroiliac joints descend. This in turn brings the pelvis into a parallel position.
This same yoga move can also be done while lying on the floor. The therapist should hold the client's ribs down while the client stretches the heels out and the arms over the head.
As a result of his work with the therapy, Kevin is able to stand straighter, and realize a greater connection down through the medial part of his knee all the way to the right big toe. Even his swimming stroke has improved. "I have a greater ability to finish my stroke and recover my arm in the crawl by using shoulder and mid-back flexibility vs. turning my whole body with each stroke," Kevin said.
"What we are trying to do, I believe, is to look at cause and effect and do it all in reverse order. It's like dropping a pebble into a pool of water and the disturbance radiates out from that pebble. We've got this dispersed energy, like those ripples in the water, in all these various parts of our bodies and we have to address each ripple before we can come back to the center." The Pelvis as Fulcrum
In French, the word for pelvis is "bassin," meaning basin. According to Webster's Dictionary, a basin is either a bowl, or any wide, shallow container for liquid. As a receptacle, it has holding power and its circumference is always parallel to the ground.
If we think of our own pelvis, however, most of the time our chest is either sinking into it, or the pelvis itself is pouring out over the tops of the thighs, like a tipped-over bowl. It is rarely, if ever, parallel with the ground -- the way a hula-hoop would be as it swirled around our hips.
When combining yoga and neuromuscular therapy, the work begins and ends with the pelvis. This is because the pelvis is our fulcrum. The word fulcrum comes from the Latin "fulcire," meaning to prop, to support. The fulcrum is not only a support, but also, according to Webster, "a means of exerting influence." This influence, as evident in Kevin's case, can be either positive or negative, depending upon how stable our pelvis is.
When the pelvis is rotated forward, it compresses the sacroiliac joints -- the joints between the sacrum and the ilium bone. When we walk, these bones articulate in such a way that they allow movement to occur. When our pelvis rotates forward, the joints get too much pressure on them. When there is too much pressure on a joint, the proprioceptors, or nerve receptors inside the joint, start firing in reaction to the pressure. To protect the joint, the muscles tighten. If the pressure is not relieved, the muscles begin to spasm, diminishing the blood flow to that area. That is a signal to the body. If we don't hear that signal, the muscles spasm and lock in order to protect the joint. That's when people's backs go out, or give way.
In neuromuscular therapy, there are certain movements to be practiced as part of the treatment and which serve to prevent all of this from happening. These movements are known as pelvic stabilization exercises.Pelvic Stabilization
Before beginning these exercises, it is important to determine which leg is longer as that indicates where movement begins. Clasp your hands around the tibia bone below the knee, then bring the knee back toward your chest and hold for two seconds. This stretches the hamstring muscles. Next, fully extend your arms and press the knee into the palm of the hand and hold that pressure for eight seconds. This process tightens your hamstring muscles which attach to the ischium bone and create a pelvic tuck. This realigns your sacroiliac joints. Then release the leg and do the same procedure on the opposite leg.
Alternate five times starting with the longer leg and ending with the longer leg. By doing this first thing in the morning before you get out of bed, it allows you to start your day with your joints even. Do it again before going to bed, allowing you to end your day with your joints even. Do this procedure at least three or four times a day especially before and after any exercise.
Noa Hall, a student of Iyengar Yoga, incorporated pelvic stabilization exercises into her yoga practice after taking a workshop on The Asymmetric Body. The results were telling: "I begin my practice every day with these exercises. I feel as though they get me started in an alignment I didn't have before. It's as though these exercises ground me for the day because I get started in the right place."
With yoga, establishing horizontal planes in the shoulders or pelvis by stabilizing the pelvis allows the asymmetrical vertical planes to have a reference point. One can establish horizontal planes by sitting on one's heels with the knees and inner thighs against each other or by sitting cross-legged or in lotus position.
The simplest way to assess whether or not the hips and shoulders are parallel is to either sit in front of a mirror or sit across from someone else with the middle of the bodies lined up with one another. Seated positions such as this make it easy to create horizontal planes in the body because gravity doesn't compromise the horizontal plane as it does when standing. The therapist can also put a folded blanket underneath the ischism bone of the lower side of the pelvis in order to raise it to the level of the other side.
Establishing the horizontal plane this way allows the muscles in the front and back of the trunk to perceive more accurately which areas are tight and contracted, and to detect which are weak and non-supportive. If you sit this way for two or three minutes, you will see that the tighter areas of the back become uncomfortable and the weaker areas quickly begin to tire.
When there is asymmetry in the back, the muscles will take the path of least resistance; like flowing water, they travel around the area of difficulty. In ways often hidden to us, the muscles of the back and abdomen shorten in certain areas, and lengthen in others to alleviate discomfort. When we stabilize the pelvis and shoulders in this manner, we can observe these tendencies in our bodies. We can learn how to soften the tight areas and strengthen the weak. Clients can bring this understanding directly into their yoga poses.
Poses to strengthen the pelvis include the Utthitha Trikonasana (which means to stretch the body intensively in three triangles). Here, the therapist holds a short stick against the iliac bones of the student practicing the standing pose. Because the pelvis is stabilized, the left iliac bone being on a horizontal plane with the right, the client can stretch the muscles of her back and her abdomen on either side of the spine evenly in the direction of her head and away from her sacroiliac joints.
Another yoga pose which serves to strengthen the muscles around the pelvis is Ustrasana, meaning camel. In this pose, the hips thrust forward, yet not beyond the quadriceps, and the spine arches up so that the upper clavicular area and sternum are parallel with the ceiling. This position causes the gluteus maximus muscles to tighten and become much stronger, thereby enabling the pelvis to remain in place more easily. It also serves to lengthen the quadriceps.Conclusion
Making use of the art and science of yoga and neuromuscular therapy creates subtle shifts within the body which gradually begin to permeate the conscious mind. These shifts often have a great deal to do with a newly perceived sense of direction in how the body moves, how the muscles feel and how the bones and joints line up. For some, this sense of direction can be felt even after the first neuromuscular session. A remark made by a long-time student of Iyengar Yoga who had neuromuscular work incorporated into his therapy, spoke volumes: "Afterwards my body felt very supple. There was a direction to this work which I haven't normally felt when I've been massaged before. [With massage], my body often felt loose, but this felt different...it was as though it had given me a new direction to move in."
This client was able to sense this new direction partly by how well he stayed with the movement and direction of the neuromuscular therapist's hands. "If you're quiet inside, while still responding to his touch, you begin to follow what he's doing. You begin to observe how he goes about -- from the very start -- turning the pain pattern around. He's very skillful."
This same sense of direction manifests in the yoga work as well when one enters so deeply into the body that he learns to "see" asymmetries kinesthetically. That "seeing" alone brings about an imperceptible adjustment. This can even occur during deep relaxation, for example, simply by symmetrically spreading the intelligence of the mind equally to the right palm of the hand and the left palm of the hand, observing a similar sensation of warmth in both palms simultaneously. That infusion of the awakened mind begins to align the body as well. This is what is known as the internalization of symmetry. Hall describes the heightened awareness this way: "I now know what Karin meant when she said in the beginning of her class that 'your mind's awareness is almost getting you half-way there' in any part of your yoga poses. I understood that deeply when she said that just the mere perception of the asymmetry changes the asymmetry automatically."
As Rumi, the 15th century mystic and poet said, '"I am pain and what heals pain." Clients and students of this work could say, "I am imbalance and what heals imbalance."
When working with the asymmetric body, this inner work on the part of the student or client is as important as the outer work on the part of the teacher or therapist. This is what is known as the vital and lively exchange between the healer and the person being healed.
Healing is a result of this constant conversation between the two -- what Krishnamurti calls the observer and the observed, the teacher and the taught, the seer and the seen. Balance occurs at the center of gravity of this rich exchange. Like a top spinning, like dancers dancing, like two lovers whispering, the truth lies in what occurs in the middle.
This is what is called "Asymmetric Body Balancing." Randy Payne is a certified neuromuscular therapist, St. John method, and the father of two boys, Julian and Arion. He has been a student of Paul St. John's for more than 15 years and considers himself a continuing student of St John's work. Payne has been in private practice since 1985. His massage therapy focuses on the healing of pain and discomfort due to injuries and/ or misalignments, and he draws on a vast clientele from all over New England, and in particular Boston and the surrounding area. Payne lives and practices in Cambridge, Mass. and can be reached at 617/441-9667 or by e-mail at RPayne5150@aol.com. Karin Stephan has been studying and practicing yoga since 1969 and has been teaching Iyengar Yoga since 1973. She offers group classes at the B.K.S. Iyengar Yoga Center of Greater Boston and at her loft in Cambridge, Mass. She also has a bed and breakfast where people come from all over the United States to have private yoga therapy sessions with her and neuromuscular therapy treatments with Payne. Stephan can be reached at 617/497-0218 or e-mail to firstname.lastname@example.org.Karin and Randy offer seminars and workshops together on "Alignment and the Asymmetric Body." To arrange a workshop in your area, or for more information regarding Asymmetric Body Balancing, call 617/497-0218 or e-mail email@example.com.