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Ommmm Guard
The Ergonomics of Pilates, Yoga,
Qi Gong, and Tai Chi



By Tamara Mitchell
Edited by Sally Longyear
yoga


In this article we will be discussing several approaches to developing balance, strength, body awareness and flexibility. Integrating any of these practices into your daily life is a good way to improve your general health. They have all proven to benefit young and old alike, and are useful in rehabilitation from injury, specifically repetitive strain injuries. Many physical therapists are incorporating these practices into their rehabilitation programs. As "mellow" as all of these practices seem, there are some aspects that may be harmful to injured body parts, so it is necessary to work with a qualified teacher who is familiar with your condition to avoid further injury.

It is critical that you take responsibility for your own health and do not participate in exercises and poses that stress your injury. All of these methods are designed to promote health and healing, and they all offer alternatives for people who have limitations. They are not "one size fits all" programs, so you should never participate without questioning whether a position is right for you. Before a class or session, make the instructor aware of your limitations so he/she can help you avoid further injury.

Many people in the West believe Yoga, Qi Gong, Tai Chi, and Pilates are similar practices. They all involve non-aerobic, slow body movements and poses. However, there are very major differences in philosophy and goals. Pilates is a Western method of strengthening core musculature and increasing body awareness through concentration on movement and muscle activity. Yoga, Qi Gong, and Tai Chi are ancient methods of creating psychological, physical and spiritual balance that focus on the body, mind, and spirit.

Many Westerners are wary of delving into the spiritual aspects of Yoga, Qi Gong, and Tai Chi. But even if you choose to simply "go through the motions" every day, you will benefit. Your body will become stronger, more flexible and coordinated, and you will feel more calm and peaceful after your session. Of course, if you open your mind to the Eastern philosophies behind these practices, you will increase your understanding of them and probably increase the benefits you will receive spiritually. If you bring a competitive attitude to the session, you will benefit less and be more prone to injury.

Pilates

Joseph and Clara Pilates developed Pilates in the first part of this century. Joseph was a German boxer and performer living in England. He was forced into internment during WWI. During that time, he worked as a nurse/caretaker and developed the equipment and exercises to rehabilitate internees struck with wartime disease and physical injury. The Pilates equipment both challenges and supports the body as it improves. The exercises performed with equipment complement the matwork exercises. Joseph's wife, Clara, was also a nurse who incorporated his concepts and exercises in ways that benefited the more seriously ill or injured. Probably because of her work, Pilates is recognized as a form of exercise that can be tailored to any level of fitness or health.1 Injured dancers and athletes have historically been among the followers of this method of training and rehabilitation.2

Pilates is a set of 500 specific exercises using five major pieces of equipment with the goal of developing body core strength, integrating the mind and body, and providing safe, effective conditioning and rehabilitation of injuries.1,3 Instead of performing many repetitions of each exercise, fewer movements requiring precise control and form are used. Because your mind is required to engage with your body to perform the movements correctly, you experience a new awareness of muscle function and control.3 All of the exercises involve the abdominal muscles in some way. Joseph Pilates believed that muscles don't move alone and shouldn't be isolated during exercise (as they are in weight training). He promoted the concept of proper body alignment and believed in using the body correctly in everything you do, from sports, to walking down the street, to sitting at your desk.2 For best results, Pilates should be practiced 2-3 times per week in one-hour-long sessions with proper instruction and quality equipment. Make sure that the studio or teacher is certified and can accommodate your special needs, injuries, and rehabilitation requirements.

The five basic pieces of equipment are the Reformer, the Cadillac, the Chair, the Barrel, and the Mat with accessories, such as the Circle.

Reformer
Reformer
Cadillac
Cadillac
Chair
Chair
Barrel
Barrel
Circle
Circle

As you can see below, Pilates is not only very physically demanding, but it can put loads on parts of the body that are often injured from repetitive strain, whether you do them on a mat or use the equipment. If you have wrist or neck problems, you should avoid postures that stress your injured body parts.


Strain on wrists

Strain on neck and shoulders

Strain on wrists

Strain on neck and shoulders

To find a qualified instructor, call 1-800-4-PILATE (1-800-474-5283)2 or visit www.pilatesmethodalliance.org/curntmemb.html for a searchable database of instructors.4

The Pilates Institute in the U.K. has a series of books/CD packages tailored to specific problem areas, including one for Repetitive Strain Injury, called "Pilates for Life".5

Yoga

Yoga is a physical and mental practice that involves the body, mind, and spirit. Stone carvings in India dated 5,000-6,000 years old depict yoga positions, so we know that it is an ancient practice.6,7 There are several different types of yoga; the most common type practiced in the U.S. is Hatha Yoga. It combines a series of "Asanas" (i.e., postures) with breathing exercises.7,8 There are over 1,000 postures available. Hatha Yoga is generally practiced without reference to spiritual content, though the breathwork and sense of inner and outer balance that is achieved is often spiritual in itself.

Benefits of Hatha Yoga:6,7

Bikram yoga, a form of Hatha yoga, has been gaining popularity lately. Bikram Choudhury, who still teaches in Beverly Hills, CA, introduced it in 1971. His method involves practicing 26 classic postures in a room heated to 95-105 degrees with 60 percent humidity. Proponents claim that the high heat protects muscles, allowing for deeper stretching, detoxifies the body by opening pores, thins the blood to clear the circulatory system, increases heart rate for a better cardiovascular workout, improves strength and reorganizes fats in the musculature.9,10 While it's true that warmer temperatures facilitate flexibility, the rest of the claims are quite controversial. Exercising in high heat is generally not recommended. If you try Bikram yoga, make sure you drink plenty of water throughout each class to remain hydrated and remain conscious of how you feel during the class. If you become faint, lightheaded, or find the pace or poses too strenuous, stop and rest.9

Another popular form of Hatha yoga is called "Power yoga". It's actually an ancient type of yoga called Ashtanga yoga. All major muscle groups are exercised in a complete range of motion through a series of flowing, challenging postures synchronized with breathing techniques. Ashtanga yoga focuses on building strength, so you will likely work up a sweat and feel invigorated, if not a bit shaky, after a session.10,11

Other forms of yoga include:
  • Bhakti: The Yoga of selfless love, compassion, humility, purity, and the desire and intention to merge with God. It often includes chanting.6,8
  • Karma: The philosophy is that our present experience is the result of our karma - both good and bad - created by our previous actions. Everything we do is a spiritual offering. Results of our work and actions are not hoarded for ourselves, but offered to a higher power.6,8
  • Kundalini: The belief is that dormant spiritual energy in all human beings lies waiting for release at the base of the spine. Awakened by meditation, this force begins a spontaneous and irresistible inner journey through the six energy centers (or Chakras) of the body towards the crown, when the seeker experiences Liberation.
  • Raja: Called the royal road. Through meditation, breathing practice, and study, mental powers are used to obtain control over the mind. Rather than being a victim of the mind, psychological control is used.8
  • Jnana: Called the path of knowledge or wisdom, it involves the study of sacred texts.6
  • Tantra: Believers consciously embrace the whole of life in order to unite with God. Tantra uses the energies of the body, especially sexual, as a means of enlightenment.
  • Injury Prevention during Yoga

    Examples of poses to be avoided by people suffering from wrist pain include:

    Downward facing dog
    Downward-facing dog
    (adho mukha svanasana)
    Upward facing dog

    Upward-facing dog
    (urdhva mukha svanasana)

    Crane
    (bakasana)

    Four-limb staff
    (chaturangasana Dandasana)

    Plank
    Photos courtesy of: www.freespirityoga.com and www.yogacards.com

    People with a great deal of pain should not put any weight on the wrists. For less severe symptoms, modifications of poses can help create the effect of the pose without the wrist involvement. For example, roll up a sticky mat and place it under the heel of the palm to create a less acute angle for the wrist while doing Downward-facing dog. Upward-facing dog may be done with the hands on the edge of a chair seat with the upper thigh on the seat's edge to reduce the weight on the wrist.12

    If you do not already have Repetitive Strain Injuries (RSI), yoga can actually be used to decrease risk of injury by reducing stress and increasing self-awareness. Traditionally the focus has been on the feet and standing poses. Now there is a focus on the shoulders, arms, wrists, and hands as well as the sitting posture. Yoga can be used to incorporate stretching of the fingers, wrists, lower arm and shoulders, which helps prevent RSI. Asana practice can stretch the contracted muscles that are used while sitting for long hours. In addition, a yoga program that stresses breathing, fluid movement, and balanced alignment corrects the contributing factors of RSI (e.g., muscular rigidity, postural imbalance, immobility and restricted breath).12

    To achieve the benefits of yoga, you must integrate it into your daily life. Going to a class once a week is not enough. Because it makes us slow down, breathe, and stretch our muscles where we hold tension, it can prevent RSI and help us heal. We tend to live in our heads and ignore what is happening from the neck down. Yoga improves our body awareness which is necessary in injury prevention and healing.13 If you are gentle and listen to your body, you will not hurt yourself. Don't force yourself to overstretch and do not perform poses incorrectly.14 People get into trouble when they bring a competitive drive to yoga class, pushing themselves beyond their capabilities.

    It is important to make sure that a yoga instructor is qualified and is both willing and able to tailor the poses to your specific restrictions. Take responsibility for yourself and do not participate in poses that strain body parts that you have injured. Sit out those poses and ask the instructor to help you with an alternate pose during or after the class. Many classes are specifically tailored to people with arthritis, multiple sclerosis, fibromyalgia, or other medical conditions such as pregnancy. High blood pressure, glaucoma, a history of retinal detachment, or heart disease will also limit the poses you should participate in.6

    For online RSI-prevention yoga exercises you can do at your desk, please refer to: http://www.mydailyyoga.com/yoga/rsi.html

    A yoga video specifically designed for RSI called "RSI? Rx: Yoga!" is available for ordering online from: http://www.rxyoga.com/video.html

    Qi Gong (Chi Kung) and Tai Chi

    Qi Gong and one of its forms, Tai Chi, are the softest of the martial arts. They date back 2,000 to 3,000 years ago in China.15,16,17 Chi or Qi is the essential energy of life. The goal of Qi Gong is to cultivate and increase the circulation of chi in the body.18 Qi Gong is generally practiced outdoors at dawn because it's believed that chi is best at the moment the sun first comes up and hits the dew still on the ground.15 Chi nourishes and heals the body as food does. Excess or lack of chi in any area of the body causes diseases and ailments, so improving the flow of chi throughout the body prevents blockages and facilitates health and healing.19

    Qi Gong and Tai Chi have been used to treat a variety of illnesses in China including heart disease, cancer and multiple sclerosis. Today in the U.S., Tai Chi is being used in cardiac rehabilitation and for treatment of fibromyalgia, arthritis, and multiple sclerosis.16 A study funded by the National Institute of Health is researching the ability of Qi Gong to help treat reflex sympathetic dystrophy (RSD), a disabling disease of the nervous system which is often resistant to the methods of Western medicine.15 Another study conducted at Johns Hopkins University found that Tai Chi was almost as effective as aerobic exercise in reducing blood pressure over a 12 week period.16 The researchers studied 62 sedentary men and women, aged 60 and older with high normal to mild hypertension. Qi Gong and Tai Chi are still awaiting more scientific study to determine the effectiveness and the existence of the "life force", but it is widely recognized as a great way to relax, reduce stress, harmonize the muscoloskeletal and nervous systems, and develop concentration, better balance, and coordination.18

    Yon Lee with the Department of Athletics at Harvard University has been studying the effectiveness of Tai Chi movements in treating Repetitive Strain Injury.19 After watching people type and use the keyboard, he concluded that the hand, fingers, and wrist don't move much at all. He believes that after hours of such restricted, repetitious movement, grooves are developed. Once the wrist and fingers get accustomed to this limited use and narrow range of movements, attempts to leave or deviate from this range will not only cause pain, but will become difficult.

    Through Lee's work, he recommends three methods of intervention for RSI. First, he recommends a selected group of Tai Chi movements. The combination of these movements exercises the entire hand, every joint and every combination of joints. Second, he recommends a routine using beans in a box. And third, he recommends employing the use of a herbal compound and manipulation of the injured area using Qi Gong techniques.

    Tai Chi movements for RSI:

    Grasping Sparrow's Tail
    Grasping Sparrow's Tail
    Old Man Moving the Mountains
    Old Man Moving the Mountains
    Crane's Wings
    Crane's Wings

    The second set of exercises is a routine using beans derived from the training of Iron Palm. Iron Palm is the conditioning of the hand to strike and break a brick or cinder block with an open palm. The method is to simply run your hand through the beans using five movements: stabbing, twisting, squeezing, turning, and raking. The theory is that if this method can condition a person's hand to withstand intense pressure within a very short time, then your hand can be trained to handle the pressure of repetitive strain. Note that this methodology has not been tested with controlled studies, but has been used by Lee in his treatment of RSI.

    Iron Palm bean routines:
    Stabbing
    Stabbing
    Twisting
    Twisting
    Squeezing
    Squeezing
    Turning
    Turning
    Raking
    Raking

    The third part of Lee's treatment involves using a warm herbal compress on the affected area. This method works on hands/wrists, back, and knees. Apply the compress to the area and let it sit, moving it around to avoid burning the skin, until all of the heat is gone. Then manipulate the "chi" by massage, which, unfortunately, Lee does not describe. Do this two more times, re-heating the compress.

    Recipe for compress:
    1 part fresh Ginger root, crushed
    1 part green scallion, white part only
    Rice wine (15%), enough to cover ginger and scallions

    Bring to a boil. Squeeze out the fluid through cheesecloth. Apply solids to injured area.

    If you would like to explore Qi Gong further, Self-Healing video tapes are available online from: http://www.qi-healing.com/Qigong_Self-Healing_Video_Clas/qigong_self-healing_video_clas.html

    If you would like to find a class in Tai Chi, refer to the following website: http://212.73.32.211/hosting/fjvelasco/usa.html (via: http://www.scheele.org/lee/taichi.html)


    ***********************************

    This article and all of our articles are intended for your information and education. We are not experts in the diagnosis and treatment of specific medical or mental problems. When dealing with a severe problem, please consult with a healthcare or mental health professional and research the alternatives available for your particular diagnosis prior to embarking on a treatment plan. You are ultimately responsible for your own health and treatment!

    ***********************************
    REFERENCES:
    1. "What is Pilates?", ©2003, Pilates Method Alliance, Inc., a not-for-profit organization. http://www.pilatesmethodalliance.org/whatis.html
    2. "Today's Question" on DrWeil.com, 6/23/1998, ©2003 Polaris Health, LLC, http://www.drweil.com/app/cda/drw_cda.html-command=TodayQA-questionId=3294-pt=Question
    3. "What's Different about the Pilates Method?", ©2000, Pilates, Inc., http://www.pilates-studio.com/docs/method/methdiff.htm
    4. "Looking for a Pilates Instructor?", ©2003, Pilates Method Alliance, Inc., a not-for-profit organization. http://www.pilatesmethodalliance.org/pilatinstructor.html
    5. "Pilates for Life: Pilates for Repetitive Strain Injury", book/CD, http://www.pilates-institute.co.uk/acatalog/Online_Catalogue_CD_Books_4.html
    6. "Yoga", ©2000, National Women's Health Resource Centers, Inc., http://www.ivillagehealth.com/library/nwh?arrivalSA=1&arrival_freqCap=2
    7. "Today's Question" on DrWeil.com, 2/24/1998, ©2003 Polaris Health, LLC, http://www.drweil.com/app/cda/drw_cda.html-command=TodayQA-questionId=288107-pt=Question
    8. "Paths of Yoga", ©1997-2003, Bikram's Yoga College of India, http://www.bikramyoga.com/yoga2.htm
    9. "Today's Question" on DrWeil.com, 11/30/2001, ©2003 Polaris Health, LLC, http://www.drweil.com/app/cda/drw_cda.html-command=TodayQA-questionId=16686-pt=Question
    10. "Styles of Hatha Yoga", by Yoga Expo, Executive Producer, Bikram Choudhury, ©2002, Yoga Expo. http://www.yogaexpo.com/yoga/more_about_hatha_yoga.html
    11. "Today's Question" on DrWeil.com, 8/4/1999, ©2003 Polaris Health, LLC, http://www.drweil.com/app/cda/drw_cda.html-command=TodayQA-questionId=3614-pt=Question
    12. "Carpal Tunnel Syndrome, Repetitive Strain Injury, and Yoga", by Ellen Serber, © 2002, Ellen Serber & Daniel Will-Harris, http://www.mydailyyoga.com/yoga/yoga_and_carpal_tunnel
    13. "Yoga in Modern Medicine" by Carol Krucoff, © 2000, Carol Krucoff, http://www.ivillagehealth.com/interests/healthy/articles/0,,165588_186345,00.html
    14. "Bent Out of Shape", by Alanna Fincke, Body & Soul Magazine, ©March/April 2003.
    15. "Qi Gong: The Healing Dance of Dawn", by Carol Krucoff, © 2000, Carol Krucoff, http://www.ivillagehealth.com/interests/altmed/articles/0,,242964_125434,00.html
    16. "Tai Chi For Health", by Carol Krucoff, © 2000, Carol Krucoff, http://www.ivillagehealth.com/interests/senior/articles/0,,242972_125425,00.html
    17. "Why Learn Chinese Qigong & Qi Healing", by Tianyou Hao, © 1999, Tian Enterprises, University Hts., Ohio, http://www.qi-healing.com/Learning_Qigong_and_Qi_Healing/learning_qigong_and_qi_healing.html
    18. "Today's Question" on DrWeil.com, 6/7/2000, ©2003 Polaris Health, LLC, http://www.drweil.com/app/cda/drw_cda.html-command=TodayQA-questionId=3860-pt=Question
    19. "RSI and What We Can Do About It", by Yon Lee, Department of Athletics, Harvard University. Presentation at the Harvard Tai Chi Conference on Tai Chi and Health, Science Center, April 17, 1999. http://hcs.harvard.edu/~htctc/lecture_rsi.html




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