Asana Analysis: Standing Forward Fold/Uttanasana: Incorporating this Pose into Physical Therapy Practice

Standing Forward Fold can be wonderful way to release physical and mental tension. It is an intense stretch for hamstrings but is also a good posture for quieting the chatter of the mind and sharpening an inward focus. But Uttanasana is not for everyone. See ‘PT Notes’ below for a discussion of the risks and contraindications for this pose.

Muscles Stretched: Hamstrings, gluteals, piriformis, other small external rotators, errector spinae,

Points of Body Awareness:
*Notice how the weight is distributed in the feet. Have you shifted back onto your heels? Are you carrying more weight on one side than the other? Have the arches of your feet collapsed?
*Distribute the weight evenly and maintain neutral foot posture (arches slightly lifted with good contact in the four ‘corners’ of the feet: inner and outer heel bone, ball of the big toe and of the pinky toe).
*Maintain muscular support in the legs and belly. The quadriceps lift the kneecaps up and the navel draws in toward the spine.
*Relax the upper body. Let the head hang down. Let gravity provide traction to the neck.
*You may feel some discomfort in the back of the legs however it should not feel like a sharp or shooting pain. If you notice sharp pain or numbness that increases as you hold Uttanasana, stop or modify the pose.
*Breathe into the connective tissue and muscles of the lower back. Hold for 3 to 6 slow, steady breaths.
*Do you notice a subtle rising and lowering of the torso that is in sync with the breath?
*Inhale as you rise back up with a long, strait spine.

To Modify: Take pressure off the hamstring muscles and sciatic nerves by bending the knees slightly. Or bend the knees a lot and rest the belly on the thighs in order to feel a deep release of the lower back.

For an intense stretch of the hamstrings with less spinal flexion, use blocks under the hands and keep the head and shoulders lifted. Try to tip the pelvis forward (move hip points/ASIS closer to the thighs) and maintain length in the spine.

To Challenge: Keep the feet together, rather than hip-distance apart. This is more difficult because the hamstrings and sciatic nerve are under more tension. This is also true for a another standing forward fold, Padahastasana/Hands under Feet Pose.

PT Notes:
This posture is one that may feel like a cardinal sin from the perspective of a PT. How often have we taught people to ‘bend with you legs, not your back!” Who doesn’t remember that chart of how much pressure is placed on the discs when the spine is flexed? But in our zeal to teach ‘correct’ posture and body mechanics, we may inadvertently cause rigidity in minds and bodies. Teaching a patient that it is never okay to let the spine flex may lead to a pattern of stiffness and hypertonicity of the superficial erector spinae muscles.

Years ago I realized that people can not and should not stop flexing their spines. However they should have a spine that is able to flex in a healthy and efficient manner. Repetitive and prolonged spinal flexion is harmful. Lifting, pulling and twisting with spinal flexion is risky. But allowing the spine to bend with good muscular support, with adequate segmental motion, and with a conscious intent to relax tense, overworked muscles can be very therapeutic for many people.

Observing a patient in a standing forward fold posture can reveal a lot. How much do they flex in the lumbar spine or in the hips? Is all their motion occurring in the thoracic spine? Do they weight shift to one side? Does the torso sidebend? Do they have scoliosis? Equally important is how they move into and out of the posture. Is it smooth or is there a juddering quality? Do they have a hitch to one side? All of this information can be useful in selecting appropriate variations of Uttanasana and other poses for your patient.

Uttanasana is obviously contraindicated for anyone with a symptomatic disc herniation or with acute neurological signs elicited by lumbar flexion. It is also contraindicated for those with glaucoma, detached retina, high blood pressure or any other condition that is exacerbated by a head-below-the-heart posture. For those patients, Down Dog on a Wall is a good alternative pose for stretching hamstrings. Anyone with a history of a low back injury or with osteoporosis should proceed cautiously.

Tips to Minimize Stress in the Low Back:
*Do not attempt Uttanasana unless you have good mobility in the hips. Practice anterior pelvic tilts, cow pose, and child’s pose to improve the mobility of the lumbo-pelvic-hip complex.
*Know how to engage transverse abdominis properly and do so as you move in and out of the pose and while you hold it.
*Keep the knees bent.
*Let the spine lengthen. If the spine (including thoracic region) feels rounded, try a modification that will allow for greater length of the torso.
*Do not hold the pose longer than 30 seconds.

See Roger Cole’s article in Yoga Journal for more information about protecting the lower back.

Photo credit: Yoga Journal