It's Physical, and it's More than Physical: Working with Yoga-Related Injuries Part 1

If you’ll indulge me for a couple of paragraphs, I’d like to share a brief history of yoga and my knees. As a flexible body type I was always able to achieve deep hip opening poses in yoga. Then, after about 10 years of practice, my knees started to feel the impact. The first time was pretty dramatic.  I was in an advanced yoga retreat with my teacher and about 30 senior students. We were practicing Mulabandhasana. As you can see in this photo, it’s a pose that takes the knee into full flexion combined with extreme external rotation of the leg, i.e. bent and turned out. As I moved into the pose I felt the dreaded “pop” in my outer right knee. It was the tibia, the shinbone that forms part of the knee joint. It had slid out of place and got stuck there. For a few seconds I couldn’t straighten my leg, until it popped back in and the knee joint started moving again. This was terrifying, to say the least. I can still feel the wave of fear that hit me. But even more disturbing perhaps was that I felt ashamed and embarrassed about it.

I don’t even remember telling my teacher or asking for help. As soon as it went back in, I went back to practice trying to pretend nothing happened. The pain didn’t last, and I continued on working more slowly and carefully. Fortunately, I hadn’t torn a ligament, just really stretched it. For the next few months I was treated by an osteopath and over time I learned (on my own and with teachers) how to stabilize my outer shin, knee and leg to compensate for the laxity there. Yet, for years every time I took my leg into that same position I felt scared.

The other knee had a different story, a dull pain in the inner knee that showed up occasionally at first, and then more often, when the leg was in external rotation like the front leg in Trikonasana or in Upa Vista Konasana. It was diagnosed as a torn meniscus. I was told that it could heal by itself, but it meant not bending that knee past 90 degrees in any pose, that’s a square shape, like the front leg in Warrior 2. I backed off and listened to this advice. For 6 months there was no VirasanaBaddha Konasana, and definitely none of the deep hip openers that I loved. I took it super easy. It healed.

I share the stories of my knees to illustrate a couple of important things about yoga-related injuries – they are physical, and they are more than physical. How we work with them will teach us a tremendous amount about our bodies and our own unique bio-mechanical vulnerabilities. And just as importantly, working with injuries in yoga is a precious opportunity to examine our inner dialogue as well as the larger cultural and psycho-social dynamics at play in our practice environment.

It’s Physical: Common Causes of Yoga-related Injuries

I’ll start by saying that everything in last week’s post on What's The Right Thing To Do? Working With Physical Challenges, Injury And Illness In Yoga is relevant here too, plus more.

The most common musculo-skeletal injuries that occur in yoga happen because of doing too much, too often, too fast or some combination of these:

Too much  - Stretching beyond a healthy range of motion for your joints. Repeatedly moving into deep ranges of motion without creating proper stability can lead to injury. We can also overdo it by simply doing too much intense practice or holding poses longer than we are able to sustain healthy alignment and muscular action.

Too often - Repetitive movements done with misalignment over time create stress on the tendons and ligaments, resulting in overuse injuries like tendonitis, muscle strain and tears.

Too fast - Moving too quickly to hold healthy alignment through moving into, holding and coming out of a pose.

In my experience, injuries in yoga can be of the quick and obvious variety, the muscle pull, or the sharp, burning pain, my tibia moving out of the knee joint. These types of injuries are easy to recognize because they appear suddenly. There’s no mistaking something is wrong.

Other yoga-related injuries are harder to pinpoint. These are the dull aches like my torn meniscus. They can come from vulnerabilities left by old injuries, joint instabilities that gradually start to bug us more over time, or from repeatedly pushing beyond where our body is ready to go. We often may not feel this kind of injury while practicing. The pain might show up later on or the day after. Over time, pain or referred symptoms gradually increase because unknowingly we are making the situation worse by the way we're practicing.

Both types of injuries require us to observe, listen, and come into a deeper relationship with our bodies and our practice.  

What this means for your practice

The good news is that because too much, too often and too fast, with too little awareness and sensitivity are often what leads to injury, there is much we can do to prevent injuries from happening simply by doing the opposite. Slowing down, doing less, and backing off. Of course, increasing sensitivity, awareness, curiosity and a willingness to explore and shift what you are doing are also essential.

Some reminders about avoiding injury in practice:

  • Use your breath to soften effort, calm your nervous system and sustain focus when working deeply.
  • Move slowly and mindfully when going into and especially when coming out of a pose.
  • Always balance stability with flexibility and prioritize stability over flexibility.
  • Choose to maintain the integrity of good alignment over moving deeper into the form of a pose. This includes using props and the appropriate pose modifications for your body.
  • Learn to differentiate between sensation and pain by observing your experience during and especially after practice. Discomfort in postures is not necessarily a sign of injury but it’s important to learn to distinguish between the two. In general, sharp, burning sensation localized in a joint or at a muscle attachment is a red flag to immediately back off. 
  • Sequence your practice to include enough warm up to prepare your body for more challenging poses, and ample warm down, including Savasana.
  • Communicate with your teacher about anything that doesn’t feel good in your body.
  • No matter what style of yoga you love to practice, continue to learn safe and healthy alignment.

Next week: It’s More than Physical - What to do if you get Injured and Cultivating Ahimsa


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