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Working with Students Who Have Yoga Injuries, Part 1

Students who injure themselves practicing yoga may need to modify their usual practice in order to get better.

By Timothy McCall, M.D.

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Ahimsa, Sanskrit for "nonharming" or "nonviolence," is the first yama or moral injunction in Patanjali's Yoga Sutra. It's also the foundation of yoga and yoga therapy. The practice is designed to improve health and well-being, and a growing body of scientific evidence suggests it works. Even so, yoga injuries—particularly with the more vigorous asana styles popular today—are increasingly common. A recent government report revealed that almost 4,500 people in the U.S. visited an emergency room in 2006, the most recent year for which statistics are available, due to a yoga injury. In this and my next three columns, we'll discuss some ideas about how to handle a few common injuries including of the back, knees, shoulders, wrists, and hamstrings.

Students who come to you seeking therapy for yoga injuries need careful evaluation, both to treat the current problem and to prevent future ones. The first thing you'll want to do is try to analyze what happened, since that can guide your treatment, give you clues about which poses may be contraindicated, and help you help the student prevent similar injuries in the future. Often students will be able to pinpoint a specific pose that led to the problem, though sometimes they'll only know that something hurts. If you observe them practice, you may be able to figure out what's likely to have occurred.

Common Causes of Yoga Injuries

Probably the most common factor in yoga injuries is trying too hard. We are an achievement-oriented society, impatient for results, and yoga students aren't immune from this. The peer pressure of a class may spur some students to attempt poses they aren't ready for, or to push their bodies to reach a certain alignment, overriding signs from the body and breath that they've gone past their "edge." This type of injury is most likely to happen to students whose ayurveda">Ayurvedic constitutions include strong elements of vata, pitta, or both (Hands-on adjustments are another common cause of yoga injuries, though I won't address them specifically in this column.)

Knowledge of your student's constitutional tendencies and current imbalances, from an Ayurvedic perspective, can guide your treatment, not just of yoga injuries but of a wide variety of health conditions. Ayurveda also speaks to which yogic tools may be most helpful for particular students. And as a powerful "sister science" that evolved thousands of years ago alongside yoga, Ayurveda is a natural complement to it.

Vata types tend to be more flexible and have greater laxity in the ligaments surrounding joints, putting them at heightened risk of injuries. Vatas can also have a harder time remaining mindful, and it is often during periods of inattention when an injury occurs. All students, but particularly those with vata tendencies, need to be especially mindful of the transitions in and out of poses where attention may flag and many injuries occur.

Pittas, Ayurveda teaches, tend to be especially driven. Of course, pushing to "achieve" a certain alignment or attempting a pose that your body isn't ready for can be missing the larger point of yoga, which is not about such external markers of proficiency but much more about one's internal state. Happiness, equanimity, cheerfulness, and reduced suffering—far more than flexible hamstrings or a fabulous Urdhva Dhanurasana (Upward Bow Pose)—are the markers of a skillful practice.

Another major cause of injuries is biomechanical. Poor bony alignment, often due to tightness of specific muscles (or other soft tissue such as fascia) or ignorance of proper form, can lead to compression of joints or tearing of tissue. It takes a trained eye to diagnose misalignments and figure out what's causing them, which is one reason why there is no substitute in yoga for working directly with an experienced teacher who can give you personal attention. In order to heal the injury and prevent future ones, such alignment problems need to be addressed. That said, in the acute phase after an injury, you may need to wait a while before focusing on improving your student's alignment.

Working with Acute Injuries

Although you are trying to help your students heal, your primary responsibility as a yoga therapist, following the principle of ahimsa, is to not make them worse. When an area is acutely inflamed, you'll want to give it time to recover and for the inflammation to subside. Signs of inflammation include redness, swelling, pain, and warmth to the touch. (Significant inflammation should prompt you to encourage the student to get a medical evaluation to be sure that you're not dealing with something that yoga alone won't be enough to heal.) If you try to work such tissue strongly, you may make matters worse. Similarly, if there's significant swelling or inflammation, it's best to have the student avoid practicing in a hot environment, as heat fuels inflammation and, especially in the first couple of days after an injury, can increase swelling.

The routine you recommend to an injured student is likely to be radically different from, and usually much gentler than, what they may be used to. Less can definitely be more. Rather than prescribing long therapeutic sequences, in the early stages it's often better to have them do a few poses carefully and well. With acute injuries, it's also often best to work around the troubled area, focusing more on other parts of the body while letting the injured area rest. You may also need to avoid the poses (or category of poses) that got the student in trouble. Restorative poses can be very useful since props can be used to support injured tissues, allowing good alignment with minimal exertion.

Restoratives also help calm the nervous system, which may be agitated in response to the injury. When the body's stress system is turned on, it fans the flames of inflammation and exacerbates muscle tension, contributing to both pain and misalignment. Other practices, such as chanting, meditation, guided imagery, and simple breathwork, can also foster relaxation.

In Part 2, we'll begin a discussion about how to work with a few specific injuries, focusing on knee problems and aching backs.

Dr. Timothy McCall is a board-certified specialist in internal medicine, Yoga Journal's medical editor, and the author of book Yoga as Medicine: The Yogic Prescription for Health and Healing (Bantam). He can be found on the Web at www.DrMcCall.com.
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Reader Comments

Kate

I would temporarily eliminate surya namaskar for a person with "severe back pain". Practice supine poses with the back supported until the severity of the pain decreases.

Alida

Thanks for a useful article. I am looking forward to the ones that follow. Could you explain 'restorative' asanas, please. It may just be a difference between UK and US English!
I've recently overdone it with the upper back - not through Yoga but over-enthusuastic Butterfly! I have been to my osteopath and am now going back to exercise. Any ideas to help getting back to normal, and later on for safe butterfly welcome!
Om - Alida

Bonnie Berk, RN, MS, ERYT

While injuries may cramp your style, this is a great opportunity to learn how to really listen to your body. When I broke my wrist many years ago, I continued doing yoga and rather than focusing on what I couldn't do, I focused on what I could. And I believe my healing was quciker because I continued to practice. In fact, my surgeon told me I might never be able to put weight on the affected arm. However, I am stronger today than ever.
So, encourage your injured students to do what they can and honor their body by really "paying attention." Pain is a great modifier" and remember when a door closes, a window opens.

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