Case Study: Pain in the Metatarsophalangeal Joint

A friend mentioned today that for the last 2 weeks she has been experiencing pain on the inside of one of her feet behind her big toe when her toes are bent forward and bearing weight.

The friend is between 25 and 30, female, and fit. She is moving to a new town, in with a new roommate and new job. She is newly single. She has been doing yoga for 10 years.

She showed me all the moves that cause it the most distress. The action of rolling forward into Cobra or Updog and back to Down Dog and the action of pivoting from sole of the foot on the ground onto the ball of the foot were the primary ones.

1. First Step
I pulled out "Trail Guide to the Body" and looked up the spot. I learned that between the 2nd and 3rd bone of the Big toe side of the foot is called the Metatarsophalangeal Joints. The spot is also known as the "Base of the Phalanges". The Tendon that attaches the Base of the Phalanges to the Metatarsals is called the Abductor Hallucis.

2. A Guess
My guess was that she should stop doing what hurts it and follow the R.I.C.E. protocol. "Rest, Ice, Compress and Elevate." Yet she should continue to move it in gentle circles and keep blood and attention flowing to it.

3. Google
Since my pal thought she had a sprain I typed in "abductor hallucis" with 'injury' and 'sprain' into GOOGLE. These searches revealed that an injury in this spot is super common among football players and is often called "Turf Toe". I also learned that it is the joint that bunyans often grow from and a hot spot for arthritis.

4. Nerve Pathways
One site mentioned the nerve connection to the Sacrum, which inspired me to pick up the Atlas of Human Anatomy by Netter. From this I was able to see the nerve relationship between the S1L5 and that spot in the foot.

5. Conclusion
I was not able to discover any "magical cure" but the increase in the understanding of a 'problem' will often open you up to new insight. And in our research, we began a dialogue that led us up through her whole spine into a much more integrated discussion about how she was put together.

Saturday, April 7; 9:00 Soft Vinyasa

18 Peeps
No major constraints.
Saturday Mornings seem to be my most alive class lately. Everyone is in a good mood and happy to be there. Teaching is easy as all I need to do is reflect that joy.

I arrived with a plan to work on Twists and a new talk that I was trying to work out.
I wanted to further the conversation about our Sympathetic Nervous System Wiring and moving towards a global community. I will be trying to post a blog with threads of the talk.

Opening
Cross Legged.
Forward Fold over the Right Leg.
Roll Up and Easy Spinal Twist to the Right.
Unwind. Switch Legs. Repeat other side.
Fold down through the middle after second side.

Sqaut
Uttanasana
Roll up to Tadasana.

Side Waist Attention and Bow and Arrow Action
Interlace Fingers in front of Body.
Stretch arms overhead. Wiggle and lengthen, bringing attention to the ability to lengthen one side and then the other to find equal length.
Stretch up, out and over to the right. Hold. Come back up and stretch out and over to the Left. Hold. Come back up.
Release hands behind back, interlace fingers and move into a forward fold with shoulders stretching up, out and over.
Release hands and roll back up to standing.

Bow and Arrow Action
Reach arms out in line with the shoulders.
Stretch forward through the right arm as you draw left arm back like you are stretching back a bow. Hold with left hand at chest and notice the hip rotation. Play with rolling the hips forward. Eventually let left arm release behind you and lengthen through both arms. Bringing attention to the small little postural muscle along the spine. To release, bring left arm back to meet the right. Repeat other side.

Repeat the interlocked side waist stretch and the Forward Fold with Shoulder Stretch. Release into a half arch.

Vinyasa 1

Twisting Lunge
Step Right Foot Back into a Lunge.
Bring attention to the Twist starting in the feet with the inner thigh of the back leg rolling up.
Use Bow and Arrow Action to release Left arm up to sky.
To release, bring left hand back to earth.

Parsvakonasana Blueprint
Pivot back foot to bring sole of foot to ground.
Left elbow on Left thigh, Right hand on Right waist.
Lengthen the side waists, roll chest open.

Trikonasana
Catch a hold of the left ankle or shin and slowly draw the left leg towards straight.
Release the right arm towards the sky.
With an emphasis on lengthening both sides of the body.
Reach right arm up and and over the head, towards the center of the room.

Pyramid
Release the right arm towards the floor and shorten the stance.
Inhale, lengthen the spine and exhale fold over.

Release from Pyramid into a Lunge.
Step Back into Downward Facing Dog.

Plank
Sphinx
Locust 1 to Cobra
Rocket Cat
Downward Facing Dog

Lift the Left Leg High to step forward into a Lunge.
Rock Forward into Standing Splits.
Standing Split Curls.
Standing Splits
Sqaut
Uttanasana
Half Chair
Utkatasana
Tadasana

Repeat other side. Same.

Eagle Arm Back Runding Stretch
Eagle (Garundasana)

Vinaysa 2
Twisting Lunge
Blueprint Parsvakonasana

Trikonasana
This time play with using the arm to open the chest and maybe even wrapping.
Release towards Pyramid.

Twisting Triangle
From Pyramid, bring hands on waist and slowly come up to standing.
Adjust stance.
Bring arms in front and find Bow and Arrow Action.
Slowly and incrementally, move towards parivrtta trikonasana working on the tiny postural muscles around the spine. Release towards Pyramid Pose.

Pyramid Pose
Lunge
Dog
Plank
Lower Slowly.

Locust Sequence
Hands clasped behind back, lift and lengthen.
Release Arms along shoulders like an Airplane
Arms out in Front like Superman
Arms back along sides.
Release.
Rocket Cat.
Childs.

Half Dog.
Round
Dog.

Jump Forward.
Uttanasana
Half Chair
Chair
Utkatasana
Tadasana.

Repeat with the following exceptions:
Side Plank/ Vasisthasana during Plank
From Childs, lift onto all Fours and take:

Eye of the Needle Shoulder Stretch
Threading the left arm under the right, work spinal twist in the thoracic Spine.
Repeat other side.

Cat/Dog.
Dog.
Childs.

Roll up to sitting.

One One Side
Parivrtta Janu Sirsasana
Marichyasana Variation with Bow and Arrow Arms

Table Top.

Repeat other side.

Twisting Paschimotanasana with Bow and Arrow Arms
Pachimotanasana

Freeform for 5 minutes
Savasana

Sit
Om

Wednesday, April 4; Sweet Vinyasa, 8:30am

12 Peeps
Mixed Level of Familiar and New

Factors
Wanted to share the Wrist Work I had been doing the night before in practice. Decided to prepare for Mayurasana

Opening
Choice of Seated Hip Opener
(Cow, Box or Cross Legged)
Fold Forward (15 breaths or so)
Arch Back (5 breaths or so)
Switch Legs and Switch Sides

Squat
Uttanasna

Clasped hand Shoulder stretch to both sides
Forward Fold with hands clasped behind the back
Uttanasana
Half Chair
Chair/Utkatasana
Tadasana

Repeat, but second time after Uttanasana, find Half Arch.
And from the Half Arch, move into Vinaysa 1.

Vinyasa 1
Lunge
Twisting Lunge
Easy Side Angle Pose to Triangle
Parsva Trikonasana
Parsvakonasana
to Hip Opener with hands on inside of foot
Pyramid Variation with hands on inside of foot.
Lunge
Dog
Plank
Sphinx
Locust to Cobra
Rocket Cat
Dog

[in second set, Widen Legs to be in Prasarita Padottanasana
Play with Hand directions to get different stretches in wrists, ending up with fingers pointing straight back and wrists stretching forward, eventually back to Dog]

Same Leg lifts into Eka Pada Adho Mukha Svanasana
Lunge
Standing Split Curling to Standing Splits
Malasana
(Optional Bakasana to assess arm balancing motivation)
Uttanasana
Half Chair
Chair
Tadasana

Repeat other side.

Eagle Shoulder blade Stretch and Eagle.

Vinyasa 2
Twisting Lunge with arm reaching overhead
(bring attention to back foot as driver)

Easy Side Angle Pose to Triangle
Open Heart Triangle with arm reaching behind you
Half Moon (Ardha Chandrasana)
Standing Splits
Lunge
Pigeon with Twisting Play
Revolved Dog
Plank
Locust Sequence, staying lifted as arm position changes from clasped to sides to out in front and back behind.
Rocket Cat
Dog
Jump forward
Half Arch

Move into second side from here
Instead of lead locusts, we did a little Freeform Vinyasa and eventually met in Childs.

Played with Moving towards Peacock/Mayurasana
Stages:
1. On Knees, play with Turning Fingers Back and get used to stretching wrists like this.
2. Create Cleavage and snuggle belly down onto elbows. Hang here and get comfortable, head is on floor.
3. As ready, move legs back to be straight behind you.
4. Lift head
5. Use toes and feet to drive weight forward and find balance, reaching through toes.

Met on backs, knees to chest.
Bridge
Urdhva Dhanurasana
Freeform for 10 minutes
(Some went into Shoulderstand, some rolled forward into forward folds, everyone did a twist of some sort).

Savasana
Sit
Oms

Tuesday, April 3, Practice 5pm

At Erich's with Eric and Casey

Hung upside down on Inversion Contraption Erich has
While hanging, stretched shoulders with hands clasped behind back, cow face, and down dog shoulder opener. Twisted this way and that. And abdominals. For like 20 minutes. So yummy.

Squat.
A few rounds of Rocket Cat to Ustrasana.

Pasarita Padotanasa with different hand and arm positions.
Hands forward, hands to the side, fingers turned back with wrists forward, forearms, etc.
Squat with arm and mudra play.
Allowed Mudras to pull the lines of energy through.

Pasarita Padotanasa with Inverted Arm Positions and Mudras

Wide Legged Mayurasana

Uppavista Konasana Twisting Variations

Malasana

(Started to be lead more and more to investigate the compressed area in the right side of my sacrum)

Reverse Pigeon
Supta Padangusthasana Variations with Abdominals and Twists
Standing Splits
Pyramid Stretch
into unfamiliar arm balances with new wrist and hand positions

Pidgeon with Twisting
Fallen Warrior Play into new arm balances

Realized that, with my sacrum, I have been asking "who can help me." Instead of noticing how I can help myself. And that led to new postures and positions that started to reveal new spots.

Hug knees into chest
Happy Baby and Supine Baddha Konasana Play
Rolling into Bridge and sliding Forward towards Saddle, but up on toes and really working the inner lines of the leg.
Super fun play here rolling from plow into bridge and then up into Navasana and back into abdominals. A variation on the classic Iyengar rolling back and forth sequence.

Parivritta Paschimotanasa Play with resistance and Mudra and slow deep accessing of the muscles around the spinal column. Rounding and arching.

Lay on the Korean Massage Bed for savasana.

Monday, April 2, Practice 6:30am

Huge Yellow Full Moon Setting
Sun just starting to come up

Constraints:
Woke up thinking about the Bikram sequence.
Wanted to maintain at least a 6:9 breath
And focus on the play using hip rotation and tailbone action to create length on the inside and outside lines of my body.
So resulted in a slow deep investigative practice with pedestrian postures.

Tadasana
Breath
1/4 Suns
1/2 Suns

Lunge Salute Pattern 1
Low Lunge with Arch
Pyramid Variation
Twisting Lunge

Dog
Plank
Several Chaturangas
Sphinx
Rocket Cat
Dog

Opposite Leg Forward and Repeat Lunge Pattern
Step Forward

Bikram Half Moon Sequence
(Long time in the forward fold)

Repeat Lunge Pattern 1
(with some variation in foot placement and Locust Pose instead of Sphinx)

Repeat Half Moon Sequence

Bikram Awkward Series

Lunge Salute Pattern 2
Step back to Warrior 1
Warrior 2
Side Angle
Twisting Lunge
Pyramid Variation

Dog
Plank
Several Chaturangas
Upward Facing Dog
Dog

Step Forward with Opposite Leg and Repeat Pattern.
Stepping Forward and Rolling up to Standing.

Bikram Standing Head to Knee Pose
Dancer's Pose
Warrior 3

Bikram Style Pasarita Padotanasana
Bikram Style Parsvotanasana

Squat
Lie on Back
Knees to Chest

Navasana
Lolasana Practice

Ana Forest and Jill Miller Style Abdominals

Bridge
Spinal Twist

Coffee instead of Savasana

Saturday, March 31, Stiff White Guys 10:45am

12 Peeps
Regulars

This class is usually packed with injuries and new people, so I was able to take advantage of the intimate familiar group and offer a few new ideas. One of the students had been bitten by a DOg, so we agreed to do downdog. This surprisingly led us to work on headstand preparation.

Starting on the backs
1) Hip Rotation Awareness.
2) Eye of the Needle to Half Happy Baby. Repeat other side.
3) Supta Padangustasana with Straps.

Roll to Sitting

4) Squat
5) Utanasana
6) Tadasana

7) Side Waist Stretch with Fingers interlaced and Palms Facing Up
8) Forward Fold with Fingers interlaced behind back
9) Half Chair to Utkatasana
10) Tadasana

Repeat with emphasis on working the underside of the stretch.

11) Breath Awareness with Tailbone movement
12) 1/4 Suns
13) Half Suns

14) Splat at Wall
15) Half Wall Dog
16) Wall Lunge
17) Splat
18) Half Wall Lunge with Leg Lift
19) Utanasana

20) Down Dog with Hands at wall (2x) (Childs Pose in between)
21) Down Dog without wall
22) Sphinx

23) Seated Shoulder Awareness Exercise
Lift right elbow to be in line with right shoulder, creating a 90 degree angle. Roll shoulder back and down. Use left hand to press into right forearm and press right forearm into left elbow creating awareness of the strength under the shoulder blade. Repeat other side. Finish by holding both arms in front of you and working like you are trying to squeeze the elbows together but resist and don't.

24) Dolphin
25) Sirsasana (headstand) Preparation

26) Sirsasana Preparation with 3 blocks at the Wall
Played with lifting legs. Some people went up!

27) Childs Pose
28) Bridge Pose 2x
29) Spinal Twist
30) Savasana
31) Sit an OM

Saturday, March 31, Soft Vinyasa 9:00am

Everyone shows up in a good mood on Saturday and everybody seems to know each other so there is a instant friendly connection in the studio. This makes it super easy to teach cuz all I have to do is reflect back what is already happening.

20 peeps
Mixed Levels

I am still on the tailbone kick. And I am trying to work out a discussion on Competition and unraveling our stories about survival. For more detailed instructions, see earlier posts.

1) Establishing Tailbone awareness and movement
a) Baddha Konasana with Tailbone Movement Awareness
Forward Fold and Backwards Arch
b) Squat
c) Uttanasana

2) Opening Side Waist and shoulders and continuing tailbone awareness
a) Side Stretch with Fingers interlaced overhead
b) Forward Fold with Fingers interlaced behind back
c) Half Arm
d) Half Chair to Utkatasana
e) Tadasana

Repeat. During second round, emphasize the underside of the the side stretch. Use different grip and after half arch, move into Vinyasa 1.

3. Vinyasa 1
Step back for
a) Lunge with Tailbone Awareness
b) Twisting Lunge
c) Low Lunge with Tailbone Awareness and 1/2 cow face stretch
d) Pyramid Variation
e) Dog (TA)
f) Plank (TA)
g) Sphinx to get traction sensation, Locust with hands under shoulders to Cobra
h) Rocket Cat
i) Dog
j) One legged Dog (TA)
k) Lunge
l) Standing Split Rolling to Standing Splits
m) Squat
n) Forward Fold
o)Half Chair
p) Utkatasana
q) Tadasana

Enter second side with forward fold and hands interlaced behind back, releasing into a half arch and then stepping back. Repeat, but roll into Cobra second time. Yesterday we rolled into Updog after cobra.

In between Vinyasa Sequences: Eagle Arm Stretch and Eagle Pose (Garundasana)
2) Vinyasa 2
a) Forward Fold with hands clasped behind back
b) Half Arch
c) Forward fold
d) Twisting Lunge with arm extending into Center of Room instead of Overhead
e) Warrior 1
f) Parsvottanasana
g) Warrior 3
h) Standing Splits
i) Pigeon with back thigh Stretch (modified eka pada raja kapotanasana)
j) Pigeon
k) One legged Dog to Revolved Dog
l) Roll into Upward Facing Dog and back to Down Dog
m) Jump to Hands
n) Forward Fold
o) Half Chair
p) Utkatasana
q) Tadasana

Repeat, but after rolling into upward Facing Dog and Downward Facing Dog, lower onto Belly

3) Main Event
a) Dhanurasana 2 x
b) Rocket Cat to Childs
c) Rocket Cat to Ustrasana (3x)
Some peeps found kapotanasana

4) Counter Sequences
a) Childs
b) On backs
On one side
c) Eye of the needle/reverse pigeon
d) Half Happy Baby
e) Abdominal curls with Leg Straight towards sky and other leg reaching into center of room
f) Knees to Chest

Repeat other side
Eagle Lying Spinal Twist

Freefrom
Savasana
Sit
OM