Reader Question: What poses benefit recovery from a sprained ankle?

Dear Dr Armstrong;

I have an ankle that has been sprained a number of times, most
recently this past summer. It's a long-term weakness I'd like to try
and improve while/as I rehab from the last incident.

Just wondered if you saw any particular poses as being of most benefit.

Sincerely
A myyogaonline subscriber from Kelowna

Thanks for your email. Here are a few suggestions to try out.

When we sprain our ankles (an injury to the ligaments surrounding the joints) there are two major problems that result: a decrease in proprioception (the sense of where our ankle is in space), and a decrease in range of motion due to swelling, scar tissue, and pain limitations.

Balance poses standing on one foot are excellent to aid in proprioception that is probably diminished as you recover. In particular, balance poses where you are transitioning from one movement to the next. For example moving from Tree pose / Vrksasana (one foot on opposite shin or thigh, knee out to side) to Warrior III pose / Virabhadrasana III (hinged at waist, leg extended behind you).

Also poses that increase the range of motion will benefit you:

• Downward dog / Adho Mukha Svanasana to lengthen calves
• Fierce pose a.k.a chair pose / Utkatasana to lengthen calves and increase dorsi flexion
• Standing poses such as Triangle / Trikonasana, warrior I, or II to stengthen and lengthen the sides of the ankle (being sure to root down with the outer foot)
• Hero pose / Virasana (sitting in a kneeling position, most people would need one or more blocks under the seat or a folded blanket to give more height) being mindful that your knees are pain free in this pose.
• Lunges with the back toes turned under will also challenge the range of motion and your blance at the same time.

Good luck in your recovery, I hope this helps.

To learn more about Dr. Robin, and her yoga therapy offerings in Vancouver, visit stayactive.ca

Pose Down: Eka Pada Rajakapotasana a.k.a. Pigeon pose

My latest pose for myyogaonline
Eka Pada Rajakapotasana / Pigeon Pose

Benefits

• Opens hip flexor muscles (psoas, rectus femoris), groins
• Opens hip rotator muscles (gluteus medius & minimus)
• May relieves sciatic nerve tension and ease chronic low back pain
• Advanced version opens chest and shoulders
• Traditionally thought to control sexual desire, increase circulation to urinary, digestive, and reproductive systems

Contraindications

• Knee injury --> Meniscus or ligament injury
• Sacroiliac joint injury --> due to the opposing action of the legs in this pose which may increase strain across the joint
• History of shoulder dislocation ->do not progress to holding the top of the foot behind the back (Advanced b below) and use caution reaching behind you for the foot

Step by Step
Eka Pada Rajakapotasana (aa-KAH pah-DAH rah-JAH-cop-poh-TAHS-anna)
eka = one pada = foot raja = king kapota = pigeon

*A progression from intermediate to advanced versions will be given.

1. From your hands and knees, bring your right knee forward to the floor just behind the right hand. Outwardly rotate the right thigh so that the right foot is in front of the left knee, shin on a 45 degree angle on the floor. Strongly flex the right foot to align the ankle and shin bone. (Note: The further away the foot is from the knee, the greater the outward rotation in the hip, the greater the challenge)

2. Curl the left toes under and begin to press the floor away, walking the knee further away behind you until the leg is fully extended with shin, knee and thigh in contact with the floor. The right knee may come slightly outside of the line of the pelvis.

3. Draw your inner thighs towards each other, slightly lifting the pelvis higher. Find the middle point where equal weight is between the left and right sides, and your pelvis is squared to the front of your mat. If your right hip is off the ground, slide your left leg further back first, keeping the hips square. If the right hip continues to be off the ground use a folded blanket, foam block, or bolster under your right hip for support, keeping the hips square and level.

4. Uncurl your left toes, looking back to see that your ankle is in line with your shin, and your leg is running in a straight line behind you.

5. On an inhale, send your tailbone down towards the earth and the crown of your head up towards the sky. Exhale and slowly walk your hands forward in front of you, placing elbows on the floor or arms extended in front of you with torso on the floor.

6. Breathe slowly for at least 5 deep breaths.

7. Slowly walk your hands back up towards your body, placing the hands slightly wider than shoulder width. Send the head of the arm bones back, allowing the upper chest to lift slightly so that the collar bones are broad. Inhale sending the tail down and the crown up, walking the hands closer and closer to the body on an exhale so that the torso is moving towards an upright posture. Breathe here for 5 breaths or continue with the advanced pose below.

8. Advanced a): If you are able to painlessly and evenly stay in this posture while removing your right hand from the earth, you may reach your right arm behind you with the palm up. Draw your lower belly in to stabilize the spine, inner thighs moving towards each other. Bend your right knee and grasp the flexed foot with your hand. You may stay here and breathe or progress to the next stage.

9. Advanced b): Point the foot and slowly shift your hand to the toes of the foot by outwardly rotating the arm deeper, slowly lifting the elbow forward, upwards, and eventually backwards so that the palm is facing down. Press the left support hand into the floor to lengthen the waistline, keeping even weight in the left and right sides of the body. Breathe here or progress to the next stage.

10. Advanced c): If you are able to maintain your balance and stability draw the lower belly in, move the inner thighs towards each other, lift the left arm up and back, grasping the foot with both hands. Send the head of the arm bone back into the socket, keep the action of the lower belly and legs, and breathe.

11. Slowly, release the foot, place both palms on the floor and step back to Adho Mukha Svanasana / Downward Facing Dog. Return to your hands and knees and repeat on the other side.

Modifications / Cautions

• Low back pain in the pose – if at any point you feel low back pain in the pose, back off, draw the low belly in and lengthen through the spine to avoid compression. A folded blanket, foam block, or bolster under the bent leg thigh will add support and may relieve the pain. Do not continue in pain.
• Knee position – the knee is a hinge joint (open-close) and therefore should not be challenged from side to side. In pigeon pose the weight of the body and the pressure of the floor challenge the knee joint on either side. It is important to keep the ankle in dorsi flexion (toes up) to align the shin bone. If you are feeling any tension or pain around the front knee, back off, place the foot closer to the opposite groin, and consider a supportive blanket, block, or bolster under the thigh. Do not continue in pain.
• Progressing to advanced versions – a belt may be used around the foot rather than holding with the hand. Before entering the pose, make a small loop in a strap and place it around the back foot at the ball of the foot. Set up the length of the strap on the floor beside you. Enter the first phase of the pose, during the second phase, bend the knee and grasp the strap a) arm behind you palm up, b) turn the palm down, externally rotating the shoulder sending the elbow forward, up, and back, or c) with both hands behind you. In each stage slowly walk the hand(s) back so that the tension increases on the strap.

To learn more about Dr. Robin visit stayactive.ca

Pose Down: Upavishta Konasana / Wide Angled Seated Forward Bend

My latest pose for myyogaonline

Upavistha Konasana (Wide Angled Seated Forward Bend)

Benefits

• Stretches Adductor muscles of the groin
• Stretches Hamstring muscles
• Strengthens the supportive musculature of the spine
• Encourages activation of the core
• Traditionally thought to increase blood flow to the pelvis, keeping it healthy

Contraindications

• Low Back Pain: Sit up on a block or blanket, high enough that you can maintain the natural curve of your low back. When you are folding forward, use your hands for support on the floor. If you cannot safely enter and exit the pose without pain, it is not appropriate for you.
• Sacroiliac Joint Pain: If you have been diagnosed with Sacroiliac Joint pain, avoid wide legged poses until the pain subsides. Return with caution, using your core to support you.
• Pregnancy: The hormone Relaxin causes the bones of the pelvis to be more mobile that usual. Take your legs slightly less than 90 degrees, and gently lift and support the pelvic floor muscles (a Kiegel) to prevent unnecessary shearing in the pubic symphis. Do not allow your stomach to be compressed against the floor.

Step by Step
(oo-pah-VEESH-tah cone-AHS-anna)
upavistha = seated, sitting
kona = angle
1. Sit with your legs open to a 90 degree angle (with your pelvis in the centre). Flex your feet to align the knees, toes pointing up to the sky. If you feel your pelvis rocking back, or a loss of the curve in the low back, sit up on some height, allowing the pelvis to tilt forward.

2. Place the finger tips on the floor behind your hips. Inhale, drawing the sides of the body long, creating space in the spine. Stay here if you are feeling a stretch in the legs.

3. To move deeper, first support your low back using your core musculature. Draw the muscles of the pelvic floor gently upward (the same muscles you use to stop and start the flow of urine). Draw the lower abdomen gently in.

4. Start to walk the hands out in front of you, slowly, using your breath as a guide. Keep the spine long and lead with the heart. Stop when you feel you have reached a challenging but sustainable position. Rather than trying to get closer to the earth, imagine growing longer through the spine.

5. Advanced: If you are able to bring your chest to the earth, you may wish to reach for your ankles or feet. Keep your core muscles drawing in. If you are hovering above the floor, use a supportive prop to avoid straining the Sacroiliac Joints and the lumbar spine.

6. Breathe comfortably.

7. To exit the pose, reconnect with your core, and slowly walk the hands back towards your body. Use your hands to gently bend the knees, and bring the legs back together.

Modifications / Cautions

• Knee Discomfort / Inability to straighten legs: Place a rolled up blanket or towel under the bend in each knee for support.
• If you are in between the stage of supporting your self with your hands, and allowing your torso to meet the floor, use a bolster to rest your torso on, or a block for your forehead but ensure you are supporting your low back by gently contracting your lower belly.
• Avoid rounding the lumbar spine to avoid stress on the discs between the vertebrae.

To learn more about Dr. Robin visit stayactive.ca

Sivasana: Even Blogs Need One

Oh my it has been a while. But as the title of this post reads, even blogs need a sivasana once in a while.

To make it up to you I will post below a wonderful script for 61 points relaxation. This is a powerful way to shift from our sympathetic nervous system (fight or flight response) to our parasympathetic nervous system (rest and digest). The wonderful and surprising thing about our bodies is that we can trick them into a parasympathetic state. Simply by recreating some of the actions that occur during that state, our body will start to shift. Deep, slow breaths, which in turn cause our heart rate to decrease, which allow us to slow down and notice the tension in our body - and voila we are in a parasympathetic state of being.

Enjoy a deeper, calmer state of being.
61 Points Relaxation
Lie in sivasana.
Begin to slow down your breathing – taking deeper inhales and longer exhales.
Become aware of your right thumb and mentally say ‘right thumb’ without moving. Bring your awareness to:

Right hand thumb, first finger, second finger, third finger, pinky finger, palm of the hand, back of the hand, wrist, lower arm, elbow, upper arm, shoulder, armpit, waist, hip, thigh, knee, calf muscle ankle, heel, top of the foot, sole of the foot, right big toe, second toe, third toe, fourth toe, fifth toe.

Now go to the left side. Become aware of the left hand thumb, first finger, second finger, third finger, pinky finger, palm of the hand, back of the hand, wrist, lower arm, elbow, upper arm, shoulder, armpit, waist, hip, thigh, knee, calf muscle ankle, heel, top of the foot, sole of the foot, left big toe, second toe, third toe, fourth toe, fifth toe.

Next move to the back of the body. Back of the head, back of the neck, right shoulder blade, left shoulder blade, right buttock, left buttock, right heel, left heel.

Now the front of the body. Top of the head, forehead, right temple, left temple, right ear, left ear, right eyebrow, left eyebrow, middle of the eyebrows, right eye, left eye, right nostril, left nostril, whole nose, right cheek, left cheek, upper lip, lower lip, both lips together, chin, neck ,right collarbone, left collarbone, right side of the chest ,left side of the chest, middle of the chest, navel, upper abdomen, lower abdomen, right leg, left leg, right arm, left arm, the whole of the head. The whole body, the whole body, the whole body.

Become aware of the body lying on the floor. Bring your awareness to the points of contact between your body and the floor. Both heels are on the floor and there is a point where they touch the floor. Now, from the top of the body. The head and the floor, the back and floor, the right hand and the floor, the left hand and the floor, the right elbow and the floor, the left elbow and the floor, the buttocks and the floor, the hamstrings and the floor, the heels and the floor. Imagine the meeting points of the body and the floor, the whole body and the floor. The body is on the floor. Become aware of the whole body, the whole body, the whole body.

Slowly bring your attention back to the room, making small movements with the body. Roll to your side and come back to sitting.

To learn more about Dr. Robin visit stayactive.ca