Working with Students Who Have Yoga Injuries, Part 3

Practicing contraindicated poses or returning to a strong practice too soon can exacerbate hamstring muscle tears and shoulder injuries.

By Timothy McCall, M.D.

Hamstring Tears

Hamstring tears in yoga typically occur near the sitting bone (ischial tuberosities) and often happen during forward bends such as Uttanasana (Standing Forward Bend) or Upavistha Konasona (Wide-Angle Seated Forward Bend). During rehab, you need to be careful with these poses, perhaps asking your students to practice them with the knees slightly bent or avoiding them entirely. The arms should never be used to crank the torso more deeply into the pose. Also be careful of standing poses that have an element of forward bending in them, such as Trikonasana (Triangle Pose) and Parsvottanasana (Intense Side Stretch Pose). Down Dog and Uttanasana may also be safer with slightly bent knees, which takes some of the pressure off the hamstrings while facilitating the stretch of the spine.

The biggest risk in rehabilitating hamstrings is doing too much too soon, leading to re-injury. Months of progress can be lost in seconds. Slower, more mindful practice is less risky than fast-paced vinyasa. Beyond resting the hamstrings to let the tissue repair itself, work on strengthening these muscles, as their relative weakness compared with the quadriceps may contribute to the vulnerability to tears. Backbends like supported Bridge Pose (Setu Bandha Sarvangasana), with the hips on a block, strengthen the hamstrings. In this pose, ask your students to visualize the sitting bone moving toward the backs of the knees, and the quadriceps lengthening.

Shoulder Injuries

Shoulder strains and injuries to the rotator cuff—the sleeve made up of the tendons of four muscles that help the shoulder form a socket around the head of the humerus bone—are nearly ubiquitous as people get older. They typically result not just from the precipitating event but from the cumulative effect of years of wear and tear. Since these injuries can make it difficult and painful to lift the hand over the head, you may need to avoid poses such as Adho Mukha Svanasana and Adho Mukha Vrksasana. In more severe cases, students may have difficulty even bringing their arms parallel to the floor as they prepare to move into standing poses. Some poses can be modified, however. For example, Virabhadrasana I (Warrior I) can be done with the hands on the hips rather than stretched overhead.

Shoulder problems, such as rotator cuff injuries and bursitis, often involve a significant degree of inflammation, so follow the recommendations on dealing with inflammation from Part 1[link] of this article. You may want to tell your students to avoid such poses as Chaturanga Dandasana entirely, and be very careful of those such as Gomukhasana (Cow Face Pose) and Reverse Namaste, in which many students poke the head of the humerus bone too far forward to be safe. Indeed, due to the weight bearing involved, Chaturanga may be one of the most dangerous poses for the shoulder if your student has this common postural habit. For these students, repeated cycles of Surya Namaskar (Sun Salutation) that include full Chaturanga, especially when they are done quickly (which makes correct alignment more difficult to achieve), cause many shoulder problems and may be contraindicated during their rehabilitation.

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