Superficial Back Line_Discussion

A Deep Dive into the Superficial Back Myofascial Line

At birth the entire spine is flexed, therefore spinal flexion is considered the primary curve. To counter the flexion of the spine, in order for a baby to lift its head for instance, and for an adult to stand up straight, secondary curves are created. Examples of primary curves are the back of the skull, thoracic area of the spine, the sacrum, the head of the gastrocnemius, and the calcaneus. Examples of secondary curves are the cervical area of the spine, the lumbar, spine, the back of the knee, and the area of the achilles tendon. Notice how the support of the primary curves are stopped by bony structures, while secondary curves rely heavily on myofascia connections for countering and maintain posture. In other words it takes more work and energy to sit up straight and support secondary curves. Therefore the stability of the neck, low back, knee and achilles tendon are contingent on the balance of the myofascia that crosses the area.

Secondary Curves

Yes, the back of the knee is intended to have a slight bend to absorb the forces during play, jumping, landing and running, just like the secondary curves of the cervical and lumbar spine. And these curves are related to each other. For example, hyperextended knees in Anatomy Trains are seen as secondary curve imbalances because the secondary curve in the knee is intend to absorb the force from the floor, into the foot, up the leg. However, in a hyperextended knee the secondary curve now sits in the body as a primary curve, without the bony structure of a primary curve to hold it in place. This causes the load that would have been absorbed in the back of the knee to be distributed to the achilles, lumbar and cervical spine, causing laxity in the front-lower belly. Hence micro bending the knee becomes important within Asanas and stretches. Through awareness and repetitive practice a practitioner can easily strengthen the secondary curve of the knee, which will help strengthen the balance between the Superficial Front and Back Line.

This opens the door for some excellent questions asked by students in the CEU course.

I would love to hear your thoughts on sit bone pain.

The ischial tuberosity is the attachment site for the hamstrings (as well at the adductor magnus, but we are going to focus on the hamstrings). The hamstrings connect to the erector spinae group via the sacrotuberous ligament, along the Superficial Back Line (as well as the Spiral Line but we will focus on the Superficial Back Line connection). The superficial Back Line goes into a "stretch" when placed on an eccentric load during forward flexion. So when someone goes into hip flexion with a tight Superficial Back Line, the first sensation is typically in the areas that is tightest, since the sacral area has the least amount of flexible tissue (muscle) is becomes the weakest links, stretching up into the Lumbodorsal Aponeurosis and the hamstring attachment at the ischial tuberosity. If any kind of ‘trauma’ has been presented in this area (tear, partial tear, sprain {to ligaments}, strain {to tendon and/or muscle}, strong sensation is commonly felt in this area, which can cause a "nervy" sensation. To work with tight Superficial Back Lines or injuries in the weak point of the SBL, bends the knees deeply, support forward folds, and the stretch/pose for significantly longer (starting with at least 2-3 minutes. “Easing into the sensation,” being with it and allowing it to calm down is the restorative process: physically as well as emotionally.

Is it always the hamstrings or do tight glutes and external rotators also play a role?

Yes, tight glutes and external rotators are also a factor. The fascial wrapping around muscle is one continuous thread. So the fascial connection that reaches up into the glutes and down into the hamstrings can tug and pull on each other especially if there is adhesion after an injury to the sit bone area. The adhesion can definitely cause the area to feel "tighter" or "stuck," and can tug on everything that it is “stuck” or adhered to it. In forward flexion, the PSIS (posterior superior iliac spine) moves away from the femur, so tight or adhered gluteals and deep lateral rotators will be place on a stretch (eccentric load) even if they are not being targeted. If placed in hip flexion when balancing on one leg, the eccentric load will be greater (especially since most people stand with slight external rotation and take Savasana with external rotation). Therefore, simply placing the foot in neutral loads the external eccentrically. Then adding weight and hip flexion further loads these tissues eccentrically.

This can easily cause a pull at the hamstring-sacrotuberous connection causing a 'nervy' sensation near, around or at the ischial tuberosity. (Let’s explore this on the anatomy app!)

What are safe ways of working with tight hamstrings?

One of my favorite ways to work with tight hamstrings is Paschimottanasana with bent knees. Sit on a slippery floor with a towel under the butt. Place the feet up on the baseboard. Wrap a strap around the plantar side of the foot. Bend the knees deeply bringing the chest to the thighs. Slowly extend the legs, pushing yourself away from the wall as you slide on the towel. Make sure to keep the lower belly connected to the quadriceps. If the lower belly separates from the quads, or sensation is felt in the ischial tuberosity, you have gone too far. Only extend the legs to a length where the low belly-quadricep connection can be maintained, and there is no sensation in the ischial tuberosity. If there is a nervy sensation, back off until the nervy sensation is gone. Repeat this a few times, adding a little more knee extension each time, holding each phase for 2 to 3 minutes at least. Always keep the low belly-quad connection and stop right before the nervy sensation is felt. After a few times, roll up blankets and place them underneath the knees. Stack bolsters to place the head on, or use a chair. Hold the pose for at least 3 minutes, progressively working up to 5-10-20 minutes. Balance the stretch to both sides if the side of your face is on the bolster or chair. The supported long hold in Paschimottanasana will assist the body by tapping into the parasympathetic nervous turning on the calming effect needed to unravel the fascial adhesions in at, near and around the ischial tuberosity, helping to restorative process. Over time the hamstrings will open, slowly and gradually, as the fascia slowly unravels. On its own time, when it is ready, and as we ease into it with love, kindness and compassion.(Let’s all try this!!!)

What is your approach to working with hamstring insertion injuries?

Always go slow and easy. It’s really important to be very aware and mindful. Hamstring insertion injuries take time to restore and can re-injure fairly easily.

What if people experience a "nervy" pain in poses such as ardha matsyendrasana (top leg)?

The hip flexion is too deep for them, and placing to much eccentric load on the hamstring-sacrotuberous connection. Have them take the twist without a cross (this is how I teach it anyways, keep thighs from crossing over the midline). This will help maintain balance in the pelvis homeostasis within the hip joint (head of femur inside the acetabulum). It also helps reduce the bend of the top knee so the hip is not in such a deep hip flexion (taking out some of the eccentric load on the hamstring-sacrotuberous ligament-lumbodorsal aponeurosis connection). Additionally placing a rolled up blanket underneath the straight knee will support the secondary curve. Finally take the twist without so much reach. In other words less twist. Basically, you are backing off to the point where there is no pain/sensation, but holding the poses significantly longer. This will trigger the myofascial unraveling and the calming parasympathetic effect needed for restoration of this delicate fascial connection.

How about standing split or any standing balance involving hip flexion of the standing leg?

Same thing. Back off until you don't have sensation. And I would probably stay away from these demanding poses for a while until the sensation was significantly reduced and the area was able to absorb the eccentric load. There are more accessible poses that can be held for much longer and provide greater benefits for this myofascial injury. Starting with 2-3 minutes, and easing into increased holding times is important for myofascial “release.” The longer the hold the more potential for unraveling.

How about poses such as pigeon or lizard, what do you recommend?

I would also stay away from pigeon and lizard for a little while until the sensation was significantly reduced and the areas was able to take on a greater eccentric load to support these poses. Supported Paschimottanasana is my go to.

 

**But keep in mind that the front of the hip needs as much attention if not more. When the pain is it ain't, and with sensation the body is telling us there is a facial imbalance in the hip area. Hip extensor asanas are going to be key for the restoration of the hamstring - sacrotuberous ligament - lumbodorsal aponeurosis connection.**

Biceps Femoris Short Head and Knee Extension Restriction

The express muscles associated to the Superficial Front and Back Line are made for power, gross motor movement and quick transmission of energy. While local muscles are accountable for posture and support the skeletal system. Local muscles work all the time and are responsible for posture. Therefore when the sensation is posture related, targeting deeper, smaller, uniarticular muscles will become important. Even if it feels like it is superficial. Therefore, in a chronically flexed knee, we might think hamstrings as since they are the main knee flexor, which is accurate, but because we are dealing with a postural hold, we need to think deep, small and local. Hence we move deep to the us Biceps Femoris Longus into the Biceps Femoris Brevis has two heads. Use the towel and supported examples of Paschimottanasana to address this myofascial item. Alternatively you can have your back to the wall and place your heels on the towel. (Let’s try this variation!) Biceps Femoris Short Head, Posterior Pelvic Tilt

When you observe someone with significant posterior pelvic tilt, think biceps femoris short head. The concentrically loaded biceps femoris is most likely pulling down at the adductor magnus, linked to the biceps femoris short head via the linea aspera of the femur, causing an inferior pull at the ischial ramus. In the Paschimottanasana variations from above, place the focus on the anterior tilt to shift the load from a downward pull on the adductor magnus to an upward pull on the adductor magnus.

When Do We Lengthen the Stretch? Shorten it?

In most cases, a shortening of a yoga asana initiates a deeper stretch into the locals. On the other hand, a lengthening of an asana will distribute the force of pull along the remainder of the myofascial line. Therefore, when targeting a local muscle we want to bring a bend to the stretch. In the instance of Knee Extension Restriction, bending the knee will help target the Biceps Femoris Short Head. Straightening the needs, will draw the stretch superficially and distribute the load along the entire Superficial Back Line.

Paschimottanasana and Pelvic Tilt

It is very beneficial to have practitioners bend their knees in forward folds because it gives the pelvis the slack it needs to move it into anterior pelvic tilt, which is the action we want performed in Paschimottanasana in most bodies (even though the pose might want to push us into posterior pelvic tilt). Bend knees, exaggerated dorsiflexion and anterior pelvic tilt will maximize the eccentric load on the Superficial Back Line while keep the weak point of the line stable. Slowly extending the knees from this position will help us and our practitioners open the areas of the SBL that actually need opening.

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