Part 1: Talking Yoga with The Sports Physio
I managed to catch up with childhood friend and sometimes controversial physio Adam Meakins recently, to talk about two of my favourite things, yoga and running, from the perspective of a medical professional. As my social media feed and studies fill with more strength & movement based posts and articles and far less photos of extremely flexible instagram-pretty yoga poses and 'correct alignment' articles, I wanted to explore the overlap between yoga and physical activity. Adam too has become aware of this cross-over, he spoke of Jenni Rawlings and of course his NAF podcast partner Greg Lehman's biomechanics expertise has been included in workshops and trainings with Jules Mitchell, Kathryn Bruni-Young and many more. Having not seen Adam for several years we had a lot to catch up on, so I’ve broken our conversation down into 2 separate reads with Part 1 mainly focused on the physical aspect of yoga. Part 2 includes our conversation around running, yoga and pain science. I’ve transcribed our chat with some editing to keep it in a more readable format and if you’re familiar with Adam’s NAF podcasts, you may be surprised to hear that he was remarkably well behaved with only a couple of words needing the *!@ treatment!
Annabel: I wanted to talk about elements of the yoga and physio/ movement science worlds which seem to have more overlap these days as many yoga teachers explore the physical practice with influences from a more modern perspective. I also want to delve into some of the conversations around pain, injury and dare I say, stretching.
Adam: Stretching is very controversial.
Annabel: Absolutely, and we’ll come back to that! Firstly, I have had a number of people come to me who have been recommended they try yoga by their GP or physio, for a bad back, sore shoulder etc. What are your thoughts on this given the myriad styles of yoga out there now?
Adam: When people have pain that’s like a back pain, that’s got nothing serious or sinister behind it, they’ve been screened, they’ve been assessed by a medical professional, the best advice is to go and move, and sometimes moving differently is exactly what somebody needs. So doing something like yoga which they haven’t done before can be beneficial for them. I don’t think there needs to be any one particular type of movement that is more beneficial than others so often people say ‘should I do pilates or should I do yoga’, that’s a common question I get a lot of the time, a lot of comparisons between the two. What’s better? Is pilates better or is yoga better? I’m like, it’s just different ways of moving.
Annabel: Yes, yoga and pilates are so intermingled in terms of the movements nowadays.
Adam: Different philosophies, different theories about what is happening when moving, but I say to people, it’s just movement. It’s just movement in a controlled way and it’s not that one is better than the other, it’s just different. It’s horses for courses. Some people prefer this particular way of moving and some prefer that way of movement. You have to find what suits the individual. My simple approach nowadays is that the more I’ve read, the more I’ve learned, the more I’ve realised that there’s no one particular way of moving that’s better than another. And as much as that kicks me in the biases because my belief is everybody just needs to get stronger, and I very much tried to instil resistance training to most people I see, but I realised it isn’t that simple either.
Annabel: And some people are just not going to do that either, it’s not for them, they’re not going to do it
Adam: And that’s the biggest harm with some of the advice that I think a lot of the healthcare professionals and movement professionals give. They say that somebody has to move in a particular way to get the benefits and that then puts somebody off or it sometimes puts a bit of fear into them and then they don’t move at all.
Annabel: And do you think that in terms of the very specific exercises which people are given by their physios? I’ve been given exercises myself for a calf injury but I just don’t do them much. Sometimes I’m on my yoga mat 3 or 4 times a day, I’m moving, but I’m told I need to also load the muscle with these specific exercises.
Adam: Again that’s a good point because again Greg (Lehman) will talk about this and he’s changed my views on this about how stretching is just another form of mechanical loading. A stretch applies a load to a musculotendinous unit.
Annabel: Absolutely. Stretching and strengthening are not opposites. Something I’ve learned about particularly from both Jules Mitchell and Jenni Rawlings.
Adam: Again that’s something that’s changed my perspective over the years, listening to Greg and listening to what he’s had to say, reading a few papers that he’s pointed me to and I’ve actually changed my view on that, that actually stretching is just a form of loading. But often for chronic types of injuries I think the stimulus is too low. I mean it’s not that you can’t get a high stimulus with stretching in some ways and means, but you don’t get the same stimulus into the muscle with a stretch as you would with a loaded exercise. Again I think for something to try and adapt where it’s been having problems because of deconditioning or previous injury, stretching it, we’re probably going to find, is not going to create the stimulus needed to create the adaption to get it more robust and resilient, whereas a loaded exercise is easier to create that stimulus. But again one of the biggest problems I see is people under-loading, particularly physios. They will give an exercise trying to strengthen something up but it’s just nowhere close and they’re still having the problem later on, and say ‘well I’ve tried the strengthening exercises, they didn’t work’ and I’m like ‘well nah, they’re not really strengthening exercises’.
Annabel: Teachers are beginning to introduce external loads into their yoga classes, but a lot of the loading is traditionally our own bodyweight. Is that ever going to be enough when I describe my classes as ‘strengthening’? Is this strengthening if we’re just using our own bodyweight, or is it just movement?
Adam: Absolutely, so again that’s something that’s changed over the years in my views on the heavier the load the more strength and hypertrophy you’re going to get, but again it’s not that simple. So we know that if you create the stimulus to be strong enough it doesn’t matter what type of load you use, you’ll get something stronger, or somebody stronger and you can even get hypertrophy effects as well, just as equivalent as heavy loads. So whereas you see the body builders, the power athletes lifting extremely heavy loads for very small repetitions, 5 reps, 8 reps and they get really big and bulky and strengthened up, a number of studies have shown that you can get the same bulking of a muscle and hypertrophy of a muscle by using a lot lighter loads but the key point is the stimulus is the same. To get the same stimulus as these people using the heavy loads the people using the lighter loads have got to be doing 30, 40, 50 repetitions. So although bodyweight exercises will be unloaded, they will be lighter, I mean it depends on what type of exercise you’re talking about I guess, but yeah, the simple answer is as long as you go close to fatigue with the exercise, you will create a sufficient stimulus for the body to adapt. I don’t think it needs to go to complete fatigue, but you can’t be too far away from it. It’s a small ‘sweet spot’ to create stimulus for adaptation so it has to be pushed hard but if you push to failure to fatigue every time you could end up overloading and causing problems, but if you’re 3, 4, 5 repetitions away from failure, you’re probably not getting into the zone or ‘sweet spot’ to create adaptation.
Annabel: You did a podcast recently with Greg (Lehman) where you said something like we define fitness almost as how flexible you are and if you’re not seen to be flexible you’re not seen to be fit, which is clearly not the case. Someone who is not able to touch their toes, does not signify that they’re not fit, that they’re not strong, that they’re not completely capable of movement. I also see the opposite, very naturally bendy people who are drawn to yoga because of their flexibility and you read articles that say these people have no control over their muscles etc because they’re hypermobile, that they’re over-stretching and are going to damage their joints. I know you talk a lot about the language that’s used and I think in yoga a lot of the language has been quite negative, like ‘protect your knee, don’t put your knee past your ankle’. It is beginning to change and a lot of teachers are realising that we don’t need to make people feel at risk all the time, that their bodies are stable and robust to do what we do in an average yoga class.
Adam: It’s like anything. It’s fine in the middle ground when it comes to advice and guidance about what could potentially be injurious and what is not injurious. Again we haven’t got much robust evidence to say one way or another but just because your knee goes over your toes it’s not going to cause a significant problem immediately. If it was to happen all the time at high intensities or extreme frequencies then I’d probably say yeah there could be a possible risk there, but that could happen regardless if your knee didn’t go over your toes. But it’s normally not the exercise, it’s the other parameters around it; it’s not how it’s performed, it’s the intensity, it’s the frequency, the duration. They’re the things that tend to lead to people becoming injured, not the actual technique so much. Now that’s not to say that technique doesn’t have any role, there are times I think some coaching to do something in a more comfortable, efficient way is definitely advantageous. You get some individuals who have no clue over their body, somebody who has been sedentary for years, they’ve got poor motor skills, that really don’t know their own bodies, they need some coaching or guidance to help them get started and find those normal motor programmes so that they can start to explore and find themselves.
Annabel: Traditional yoga poses are based on alignment, and whilst there has been a bit of a backlash against alignment, there is still often the sense of the ‘shape’ of the pose.
Adam: You have to remember genetic differences, so we’re unable to get into the same shapes.
Annabel: So, have you ever practiced yoga?
Adam: A couple of classes but nothing for an extended period of time. I sort of dipped my toe in it to see what it’s about, to experience it so I could tell people what to expect if I was recommending it for them. I wouldn’t say I didn’t enjoy it, but it was probably not for me.
Annabel: What are your thoughts on Yin Yoga, of holding poses for an extended period of time? This has had good press and bad, some people saying it helps improve flexibility, others saying it weakens the joints.
Adam: I actually think the longer you hold the stretch the more chance you have to create a mechanical change in the actual musculotendinous units. Again, the research tells us the longer you hold the stretch and the more intense it is the more likely you are to actually create a mechanical effect, so you will probably see, for those extended periods of time, if they do it frequently enough, you will see a lengthening effect in the actual tissues. You get this sarcomerogenesis effect, you start to get little individual units added in series to the muscle length which actually increases the length of it. I think the minimum I’ve found is you have to hold a stretch for 8 minutes to get this lengthening effect. Anything under 8 minutes in a static stretch doesn’t change the tissue. People get more range of movement but that’s because of the neurological factors around it so they become more tolerant to the stretching sensation and so they can utilise the range of movement that they’ve already had. The neurological brakes are slowly taken off but the actual tissue hasn’t adapted, hasn’t changed, because it hasn’t had a strong enough or intense enough or a long enough stimulus. But with those (yin) types of poses, if they’re there for 10 minutes and it’s end of range and high intensity, they will create a mechanical change in the structure with that. Will it be dangerous? No, I think the trouble with that type of stretching though is they still need to strengthen in those ranges. So just because you’ve now encouraged the length of the tissue to increase, have you got sufficient control of movement of that end of range and sufficient capacity and resilience of that tissue at that end of range? Which is why I don’t really think that type of stretching, it’s not that it’s dangerous or harmful, I just don’t think it’s good. You’ve done it, you've increased the length but now you’ve got to go and do some strengthening exercises in that end zone to try and make sure you’ve got control and strength and resilience.
Annabel: Have you ever come across any yoga related injuries in your clinic?
Adam: No, I don’t see yoga as a high danger activity. Scott @ifphysio is my yoga physio. He's an awesome yogi and a lovely guy. I'm amazed at what he can do. He shows photos of his progress from 10 years ago. The dedication, the mindfulness, he does it every day religiously and what he can do with his body is incredible.
Annabel: Do you think that is part genetics, the fact he practices every day, the fact he’s doing other movement too, as well as the poses? I’ve practiced yoga for 20 years but I know for me it was never about doing the advanced poses. I’m not naturally flexible unlike many yoga teachers and for me it was about keeping my body moving well, and keeping me running. So I’ve never gone down the ‘I want to balance on one arm with my legs behind my head’ path but could I have got there if I’d done what he has?
Adam: It’s a very difficult question to answer but he’s clearly got genetic factors on his side, but he is extremely dedicated and he works his arse off as well. So I think you need the best of both. You look at any elite level athlete, they’ve got the combination of the dedication, the hard work but also the luck of the genetic draw. You really need that winning combination to be at the top of your game with anything.
So after sharing his man crush with me, Adam and I went on to talk about running, flexibility and pain science, which I’ll be sharing with you in Part 2 of this conversation very soon.
Thank you for reading and please get in touch with any questions or comments.