Yoga Injuries: Time to Differentiate. ~ Nina Jackson

Via on Feb 15, 2013

Irene_yoga

There’s something missing from the debate on yoga injuries: a distinction between acute and overuse injuries.

People naturally associate acute injuries with a single, traumatic event, but mention overuse injuries and they’re not so sure.

That’s because these injuries are more subtle in nature—the result of micro-trauma to the tendons, bones and joints that occurred over periods of time. Overuse injuries are more common in yoga than acute ones, however they don’t sell books or magazine articles quite like strokes, seizures and crippling disabilities do.

Yoga is neither a performance nor a competitive activity, but we may still learn something from the gymnastics field; we have more in common than meets the eye.

As Mark Singleton explains in his book Yoga Body, modern yoga postures do not originate in ancient texts, but in a range of more recent movements and practices including British gymnastics and military training exercises.

Each year more than 86,000 gymnastics-related injuries are treated by medical professionals.

You’d think the majority would be of the acute variety, given the physical toils that gymnastics requires. In fact, severe injuries are rare—the most common ones occur in the ankles, feet, lower back, knees, wrists and hands due to overuse or simple stress. Matthew Matava, MD explains clearly how this happens:

“The human body has a tremendous capacity to adapt to physical stress. We tend to think of “stress” in the context of its negative effect on our emotional wellbeing, but physical stress, which is simply exercise and activity, is beneficial for our bones, muscles, tendons, and ligaments, making them stronger and more functional. The remodeling process involves both the breakdown and buildup of tissue. There is a fine balance between the two, and if breakdown occurs more rapidly than buildup, an overuse injury occurs.”

Overuse injuries are “creeping” ones because of their habit of sneaking up on you unawares.

Before you know it, you’ve lost that fine balance and crossed a threshold that’s fiendishly hard to recover from.yoga teacher

So think twice before labeling any injury as “minor,” since it can often turn into a major one.

Unfortunately this message has yet to penetrate the yoga community, where disproportionate attention is placed on acute injuries. Meanwhile, more and more yoga practitioners are being affected by overuse injuries, which are harder to diagnose.

I’ve seen a marked rise in such injuries in my own physical therapy practice, usually in connection with advanced asana practice.

The typical patient, who may be a teacher or a student, has self-treated their pain for some time before seeking help.

There are always multiple causes, however most patients have either repeatedly pushed themselves too far in an attempt to achieve the “perfect” posture, or have been repeatedly pushed beyond their limits. It’s the gradual, cumulative effect of many small actions—the straw that breaks the camel’s back.

Yoga offers many great health benefits, including the prevention and treatment of injuries, so it’s ironic that we’re seeing injuries caused or exacerbated by yoga.

Although overuse injuries cannot be prevented 100 percent, we can minimize their occurrence by taking simple precautions.

For example, yoga studios, health clubs and spas can do a better job of explaining the different styles of yoga, which can be confusing, so the overzealous novice does not wander into a class that’s too advanced for them.

yoga offeringsUnder the guidance of teachers, students can learn to listen more attentively (what the Upanishad seers called “shravana”), recognizing the body’s subtle warning signs and risk factors.

Teachers can incorporate more time for stillness and reflection between asanas to give the body a chance to recover before the next series of postures.

The role of the teacher in preventing either type of injury cannot be underestimated.

This includes watching for signs that students are pushing themselves too far, encouraging them to cross-train with other activities at the slightest onset of an overuse injury, and seeking medical help if things don’t improve.

However, to perform our role effectively, we also need to acknowledge and respect the needs of the individual—including the minority in any given class who, for whatever reason, prefer a verbal assist in one or more postures.

The “we assist everyone and if they grumble we say ho-hum and do it anyway because everyone must conform to our idealized version of the pose” philosophy is doing yoga a great disservice.

Since only the student can sense where that threshold may lie, they should have a definite say in the matter.

Communication is everything!

 

Nina JacksonNina Jackson is a practicing physical therapist in Charlottesville, Virginia. She holds an M.S. in Physical Therapy and a B.S. in Exercise Science & Physiology.  She has extensive training in orthopedics, Yoga/Pilates and Yoga therapy, and is passionate about integrating these into her physical therapy practice. Nina has taught yoga for 15 years and is also co-founder of Yogaflipchip.com, whose mission is to promote safer yoga practices by empowering the practitioner.

 

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Ed: Brianna Bemel
Assistant Ed:  Terri Tremblett

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21 Responses to “Yoga Injuries: Time to Differentiate. ~ Nina Jackson”

  1. Joe Sparks says:

    Excellent article! We need to get away from performimg poses and realize that some poses are actually harmful to the body, and our number one responsibility is to teach poses that are safe and will not injure our students"

    The yoga sutras teach us to use discernment and practice meditation to help remove the filters and obstacles that prevent us from seeing the truth. I do not think human bodies need to be stretched into right angle positions and many people do. A lot of people think the world used to be flat. There are no straight lines in nature; the human body is made of curving spiraling forces that are being undermined from sitting in chairs, hunching over lap tops and doing forced abdominal exercises that flex our spine. Many yoga poses like straight leg forward bending, and positions like staff over ride natural function. This is the big reason why people are being injured and why some of the long time practitioners need hip and knee replacements. The body does not lie." Michealle Edwards–Yoga Teacher and author of YogAlign

  2. fragginfraggin says:

    I love how you actually have advice for teachers in this article and I hope elephant journal posts more sage wisdom like yours in the future. Thank you so much for sharing your expertise.

  3. Thanks for this article! Overuse and repetitive stress are probably the biggest causes of injury, but people are so determined to have a "daily" practice that they don't recognize that they're hurting themselves in the process. What's that saying? The simplest answer is usually correct?

  4. Thanks for the great article. I've been teaching yoga for going on 15 years, have been a licensed massage therapist for the past 8 years, and am the creator of "Anatomy Studies for Yoga Teachers." I've seen so many different kinds of injuries that have been caused directly or indirectly from yoga. High on that list on meniscal tears, shoulder impingement syndrome and lumbar disc herniation. One of the things that I tell my massage clients who come to me with yoga-related injuries is that even if their alignment is spot on injuries can manifest slowly over time if they are not doing a balanced practice. For example, are they doing as much posterior shoulder strengthening as they are anterior shoulder strengthening? If they do 100 chaturangas in a one-week period, all of which strengthen the front deltoids and triceps, did they do a comparable number of posterior deltoid and bicep strengthening exercises? Probably not, unless they are also going to the gym and doing seated rowing exercises or they are doing loads of table-tops and bridges and the like. If the front deltoids have higher resting tone than the rear deltoids, the humerus will be pulled forward in the socket and there will be greater risk of shoulder impingement. I think it would be great if teachers were taught about this kind of thing, the way that personal trainers are, as it would go a long way toward helping to prevent repetitive strain injuries.

  5. Lisa says:

    Thanks Nina, Jason & Joe most helpful

  6. Scott Miller says:

    In the last thirty years, all of the "overuse" injuries I've seen can all be traced back to a more aggressive body pounding than yoga. People don't come into yoga and suddenly turn aggressive. They've been aggressive their whole life. The men have played football, or something almost as damaging, and the women have been running hours a day, biking, doing gymnastics, or something. So the overuse has already been going on for years. Then yoga replaces the real culprit, doesn't "fix" whatever has been building up for years, and things don't go well. Then people write blog posts about overuse injuries in yoga. The truth is only those of us who started practicing thirty years ago have been doing yoga long enough to cause any overuse damage and we don't care. We never thought yoga was a hygiene anyway.

  7. Rogelio Nunez says:

    One of The great things of Iyengar Yoga is that when practiced as recommended or taught we don't do the same thing every time. if we do repeat poses one can emphasize different aspects of the asana so as not to create repetitive stress on the body. Also it focuses on proper alignment, done over long period of time, one can learn not to force the body but allow the asana to penetrate without injury….yes there are injuries, but i truly believe and have experienced the benefits of Yoga over 17 years and my body has remained healthy with minimal stress injuries….this includes headstand and shoulder stand…

  8. Christina Cudrigh says:

    Nina, I would really like to do some yoga with you. Tini

  9. [...] Yoga Injuries: Time to Differentiate. ~ Nina Jackson [...]

  10. [...] Yoga Injuries: Time to Differentiate. ~ Nina Jackson [...]

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  12. Yoga Roadkill says:

    I am happy to see the issue of repetitive stress/strain injuries entering the yoga injury conversation more and more. It is pretty widespread and prevalent and it needs to be discussed openly. I think the article is good but falls into some of the same tired talking points that get tossed around when the yoga injury discussion is raised (again and again).

    Once again, there is the tendency to "lay blame" for the injury on the shoulders of the student with suggestions of doing too much or pushing too far even though early on in the article it clearly states these injuries can sneak up on you unawares and cross some unknown threshold before you even sense that something might be wrong. If you spend 1-2-3-etc years doing the same practice with no problems, indeed with benefits, but then some unbeknownst wear and tear catches up with you (that pesky non-detectible threshold) how on earth is that "doing too much" or "pushing too far"? It's not, it's simply repetitive strain on muscles and joints following an expected trajectory (injury). Yoga teachers don't talk about repetitive stress/strain in classes, they don't address this in teacher trainings or workshops, it is completely left out of the conversation as far as I can tell.

    The best piece of advice contained in this article is to not ignore what may seem like small or inconsequential injuries. And I would add, even moreso if you have a number of different little injuries showing up over time (wrist pain one month, then 6 months later some knee pain, etc.). These are the true early warning signs that the practice is causing damage to your body and setting you up for injury. I recall hearing reports of minor injuries or problems almost consistently among the regular yoga crowd when I frequented the studio scene – lots of "I've been doing this for years but now I am getting pains in my wrists/shoulder/lower back/knee". These are the folks who have been practicing for years, some even teachers, going to classes multiple times a week, most have been through a teacher training or heading toward that. Some of these folks ended up with more serious issues including muscle and ligament tears.

    I absolutely love the suggestion that teachers encourage students to cross-train. I would also add, teachers should be very upfront about telling students that practicing more than once or twice a week over an extended period of time can increase your risk of getting overuse injuries. The thing is, I don't think yoga teachers understand what repetitive strain/overuse looks like save for a very small minority who happen to be well informed in this area. I also think there is a strange cultural acceptance of these ongoing smaller injuries as a generally accepted side effect of the practice, par for the course, albeit one no one really talks about except in side conversations. If one of these smaller injuries tips over into a serious injury, well, it must have been because of your ego or your inexperienced teacher or pushing too hard or not paying attention or (my fave) "not for you". The last one kills me, fifteen years of the same practice no problem, you get injured in year sixteen and suddenly realize "oh, hey, it's not for me!"

    I'm happy this article was written and I would like to see more ongoing discussion on this important issue. I'm guessing there will be a certain amount of blowback (there always is with yoga for some reason) but please keep the conversation going. The more it is brought up the more folks will be willing to engage the conversation in a non-reactive way.

  13. I registered the domain yogainjuries.com about seven years ago because as a bodyworker, postural therapist and yoga teacher, I noticed how many yogis I knew how aches and pains and I could see that yoga injuries would some day be a prevalent issue. If you have suffered any kind of yoga injury at all, whether it be a severe trauma or overuse, please log in and take the injury survey. The results will be published and shared with all who are interested in knowing the statistical details of yoga injuries.
    I began to invent YogAlign about 20 years ago when I realized that my vinyasa yoga practice was causing my neck to go out, my knee to ache and also sharp pains in my hip and groin when I did poses like revolved triangle. At this time I feel that the big blindspot in why we are getting the 'overuse traumas' from yoga is from the right angle body positions that are ironically shown in the photos posted with this article. Humans are made of curves and spirals. Why are we trying to stretch out our curves? It is just part of the linear thinking that we should be moving away from especially in yoga asana !
    The work of Rolfer Thomas Myers ( anatomy trains fascia tensegrity) has proven that our body is not made of parts and is strung together with connective tissue that is the true determinant of our structure. We are global; and any movement reverberates through our whole body. Poses like Paschimottanasana or seated or standing straight leg forward bending creates extreme spinal flexion undermining the integrity of our spine and sacral ligaments. The sacroiliac ligament tension is necessary to create the curve and nutation needed for shock absorption between our trunk and hips. Twisting the lumbar spine should never happen when the lumbar is in flexion. The picture on the top of the article shows a woman sitting with lumbar flexed and she is twisting. This pose does a lot of damage to the ligament balance of the sacroiliac joint. What needs to happen in yoga is to do poses that simulate how we use our joints in real life. Nobody that has graceful efficient posture walks around with the lumbar spine in flexion! what is the use of this pose?
    For the shoulders, we can do poses that balance the forward tension of the anterior deltoid and pectoral muscles with strength of the rotator cuff and rhomboid muscles to be contracted and strong enough to pull the head of the arm bone back. These movements should happen simultaneously the same way we use our arm with good alignment in real life. If we lift a heavy box without stabilizing our scapula, we can strain or tear our rotator so the best way to teach asana is to teach full body movements that engage the whole body in balanced tensegrity. We have to stop training the 'parts' because there are none. Unfortunately the quest to touch our toes with the knees straight dominates yoga when in reality, the anatomical truth is that we are not designed to touch our toes. I have been working on YogAlign for twenty years if anyone is interested. The focus is on attaining graceful aligned natural posture not performing poses that are based on trying to engage 'parts'. http://www.yogalign.com

    • Debra Hennesy says:

      I love the work of Thomas Myers as well, and it has changed my own practice, as well as that of my students/clients (I have taught yoga since 1995 & am a yoga therapist). THANK YOU for raising these points about tensegrity & the global aspect of practice within our bodies!

  14. yogajanet says:

    Thanks for the thoughtful article and advice to teachers. As a 43 year old practitioner, I have become more sensitive to over using different parts of my body and have become more focussed on alignment, not over-doing it, and being kind to myself. I encourage the same in my students. Thanks for adding intelligence to the yoga injury discussion.

  15. sarah says:

    Wow! I was thinking about this today and I really think it's so true. A few years back I was an avid Ashtangi. I stopped the constant practice feeling something was not quite right. I was getting rotator cuff discomfort, lower back discomfort. Not serious but not good either. I try to vary my practice alot these days and also take in some other strengthening and cardio activties so some days are mixed up, some days a quiet practice, some days dynamic. Mostly it works. I really think overuse injuries are key and that yoga practitioners and teachers are yet to reach a point of helping people balance their bodies to achieve their individual best. Thank you kindly for the article It is timely.

  16. MG1 says:

    Thank you so much, this is a great and important piece and I feel it's bringing light on the big shadow of our western yoga community. I'm enrolled in a yoga teacher training in the tradition of T. Krishnamacharya and the people who teach his approach (he used to be the teacher of Iyengar and P.B.Jois) really really insist and teach us to design all practices based on adapting to each individual and to the class. There is a counter-pose for every pose, there is attention to the pace of guiding the practice so people do not rush, there is always dynamic before static practice of an asana, there is a progression – preparation towards goal, goal, then coming back – in each session, and over the long term (e.g. quarter or year); each asana preparing the next, etc. My teacher says that yoga must adapt itself to the student rather than the opposite, and Krishnamacharya and other great yogis at the time, lived in very different conditions (healthier than now in many respects), started practicing yoga at a very young age, and practiced a lot – the impressive postures they were able to do, the impressive practices they had, were suitable and beneficial for them. They're not for most of us today and can do more harm than good. In our classes we will never give a headstand or other very demanding postures unless we're dealing with people who have outstanding physical condition, but are also able to from a perspective of breathe and mind as well. Our teacher tells us it's very unlikely that in an adult beginner class we'll ever give them such postures, – unless for a taste, to bring in some sense of challenge, but with adaptations etc. And it's okay to try in one class but you don't want them doing this every day at home then. So this gives back a lot of importance and responsibility to the teacher – it's a complex thing to learn when to give what to someone and how, and how you can build someone's capacity in a way that their suffering (in body, heart, and mind) will be alleviated and their well-being enhanced. And so you must observe your students. Which cannot happen when you yourself are busy practicing as on a 'stage', boasting your tight little lululemon butt to the envious classroom. Or learning to become a yoga teacher in a couple of week-ends somewhere. The training I do is 4 years long and now, almost at the end of it, I feel I'm only beginning on a very long path…This all goes against lots of our cultural programming in the West (faster,better, harder, stronger etc). Which results in many people I know not interested to join the classes that I go to, or give, because they feel we don't suffer enough there. Not enough sweat and tears. They look for more 'hardcore' classes and as long as they don't hurt themselves in one shot, they do not realize whether the practice actually serves them and their health in the longer term.

  17. Jakar says:

    Too much theory and not enough practice going on here for me. Don't practice with ego, practice with awareness. I teach Ashtanga and I don't see that it has too much in common with gymnastics. A gymnast runs like hell at a vault then spins and flips and lands perfectly still. I don't do that, ever. My back bend has taken 12 years of careful and consistent practice, never pushing it beyond what feels right. I listen to the teachers I've had and haven't yet decided I know more than the lineage. In fact it is the one area of life that I can surrender to an authority. I can trust the teachers, who in Ashtanga have all paid their dues. I'm 50 and I get aches and pains of course. Today my shoulder aches a bit after full Primary last night but I know it will be fine tomorrow. 99% of the time I feel fantastic. People who don't have a regular yoga practice have no idea what I mean when I say that. 86,000 gymnastics injuries don't strike me as in any way surprising. A few people will get injured in yoga but in the vast majority of cases it will be because they aren't paying attention.

    • yogajanet says:

      You seem to be the example of someone who practices mindfully and with awareness. Not everyone does. It seems that the advice in the article is advice you have already incorporated into your practice. :)

  18. [...] published in Elephant Journal Feb 15, [...]

  19. wyatt says:

    thoughtful article. balance between steadiness and ease. regular (daily), dedicated, logical practice. and above all else, cultivate more than just asana, so that asana does not consume (and damage) you. shanti~

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