Working with Students Who Have Yoga Injuries, Part 2
Back injuries come in so many varieties that it's difficult to come up with useful rules of thumb that will apply to all of them. People differ in their postural habits and patterns of muscle tightness and weakness, as well as the precise location of their injuries. Dozens of different muscles can go into spasm, numerous ligaments can be strained, and a variety of joints can be inflamed, and from a yogic perspective each may require a different response. Even what's contraindicated may vary based on the mechanism of injury. Most cases of what doctors lump into the categories of low back strain and sciatica respond to gentle backbends, including Bhujangasana (Cobra Pose), while many forward bends may exacerbate the problem and are generally contraindicated in the early stages after the injury. Seated and standing forward bends, in particular, can compress the front of the lumbar spine, causing the spinal discs in between the vertebrae to budge backward and to the side, potentially pushing on nerves exiting the spinal cord. On the other hand, yoga injuries caused by overarching the lumbar spine may benefit from forward bends such as Uttanasana (Standing Forward Bend), whereas even gentle backbends may make matters worse.
One thing doctors have learned in the last couple of decades is that babying a sore back is not the best way to go. When I was in med school, we were taught to put people with acute back pain on strict bed rest for several days at least. We now know that's ill-advised. Studies show that people do better when they resume gentle exercise soon after injury. First try to find poses in which the student is pain free, such as Pavanmuktasana (Supine Knee-to-Chest Pose), and then gradually work up from there over the coming days and weeks, always being guided by what you observe and what the student reports.
As always, try to personalize your approach based on the specific pattern of tight muscles, underworking muscles, and postural misalignments you observe—as well as your student's response to the therapeutic measures you try. One-size-fits-all back exercises, such as the kinds doctors often recommend to strengthen the abs, don't work well, and recent evidence suggests they may actually be counterproductive. This should come as no surprise to the yogi, since we know that some people get back pain from an unhealthy flattening of the normal inward curve of the lumbar spine. Stomach crunches, which can tighten the hip flexors, may only make matters worse. Luckily in yoga, particularly with students who've developed good body awareness, pain (or the relief of pain) as they do the poses you suggest—as well as their breathing and the balance of effort and ease—will indicate whether the poses are likely to be harming or helping.
In Part 3, we'll look at wrist, hamstring, and shoulder injuries.
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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