The Turning of the Tides: When Yoga Doesn’t Feel Good Anymore
Yoga. The sound of the word makes you think of calmness. Yoga, Sanskrit meaning “to yoke,” or “to join,” draws together the mind-body, spiritual-physical, and sun-moon. One may also begin to visualize people twisted in all sorts of poses or asanas, with such ease and grace, and think… someday. People practice yoga because it feels good, it’s challenging, and allows one to make the holistic connection between their mind and body. However, many fail to adhere to the first yama in Patanjali’s Yoga Sutras, Ahimsa, or non-violence or non-harming. The Western culture tends to be competitive, aggressive, achievement oriented, and when these come into fruition on to our yoga mats, injuries can develop. This article is in no way to intended to scare or to avert anyone from yoga. It is simply to educate some of the possible injuries that can occur with activity. Injuries can occur with just about any activity, sport, or exercise. Some even have a reputation, for example “tennis elbow,” “runner’s knee,” or “weightlifter’s shoulder.” One can even sprain their ankle or knee stepping off a curb, or loosing their footing in four-inch heels. One must learn a few skills while performing the activity of their choice. These include attention, focus, concentration, and memory. One must perform these skills during their yoga practice so they are not haphazardly flinging their bodies in space while failing to listen to what their bodies are trying to tell them. One must also remember what their body feels like as they explore an asana with a sense of containment, so one does not go past their limit.
It is likely that one of the most common factors in injuries during yoga practice is trying too hard to “construct” the asana into what one thinks it should look like, ignoring their unique body and what they are and are not capable of doing. Combining this with another quandary, untrained, unskilled yoga instructors, simply adds to this injury problem. Yoga, becoming more popular with classes springing up in gyms and other local health clubs, left managers scrambling to hire instructors, some with only a weekends worth of training. A newer trend is the fitness-oriented yoga, where these asanas are taught in mirrored gym studios, offering “power yoga” or some other form of kick- butt yoga (Krucoff, 2003). Not that there is anything wrong with these types of classes, on the contrary, classes such as these are essentially Vinyasa-style yoga classes that move quickly, flowing one asana to another. Moving on the breath allows a deeper connection with the body. However, this requires an excessive amount of training and education on behalf of the teacher; certainly much more than a weekend or two of training. This style should only be taught to advanced yoga students who have a strong understanding of the yoga asanas, alignment (especially knowing externally rotated and neutral poses), and their own body’s limitations.
Yoga injuries are unfortunately, far too common in the U.S. According to the U.S. Consumer Products Safety Commission, a government reporting agency, 5,000 people were injured in yoga classes in 2005. Nearly 4,500 people were admitted in the emergency room after yoga injuries in 2006, fewer than the year before but an increase of 18% since 2004 (retrieved November 8, 2008 from http://www.cpsc.gov). An article written by Carol Krucoff (2003) sites Roger Cole, Ph.D., a scientist and Iyengar Yoga teacher stated that the “lower back (lumbar spine), knee, and neck (cervical spine) are the most prone to injury, followed by the sacroiliac (SI) joint, and the origin or attachment of the hamstring muscle where it joins the sitting bone. Lower back and SI injuries are often linked to forward bends,” Cole states, “because they can place strain on the disks and ligaments at the base of the spine (3).” Overuse injuries or repetitive stress injuries occur with repetitive activities, and especially occur when the body is out of alignment. Therefore, performing yoga asanas in proper alignment is crucial in preventing overuse injuries.
In this section, some of the overuse injuries and where they sometimes present themselves will be discussed. Bursitis is the inflammation of the bursa, small fluid-filled sacs that cushion and lubricate a joint. Bursitis can be caused from overuse or trauma (e.g. a fall). This type of injury can occur in the shoulder, elbow, and knee. Tendinitis is the inflammation or small tears in the tendons. Tendons are at the end of a muscle and attach to the bone. Some of the joints where this can occur are the shoulder, elbow, spine, hip, and knee. Strains are tears of the muscles, sometimes called pulled muscles, and are caused by over stretching or trauma. This obviously, can occur in almost every skeletal muscle in the body. In yoga, this can occur more commonly in the muscles of the rotator cuff, four muscles that help the shoulder form a socket around the head of the humerus bone, and in the hamstring where attaches at the sitting bone (ischial tuberosities). A sprain occurs in the joint and is more serious than a strain. The technical definition of a sprain is when the ligaments or tendons that secure a joint are stretched or torn. This is more common among the rotator cuff tendons that attaches at the shoulder, and the tendon that attaches the hamstring to the sit bone. Because of their limited blood supply, tendons and ligaments heal very slowly. Serious ligament sprains often have to be surgically repaired as soon as possible, as the ligament can soften. Some surgical procedures include replacing the ligament with an artificial one or one donated by a cadaver.
Spinal injuries can also occur, most commonly a herniated or bulging disc. This most often occur in the cervical or lumbar spine. Discs are gel-like cushions between vertebrae holding them in place, and avoid the painful “rubbing” of the two bones. Sometimes the herniated disc can touch a nerve, leading to extreme pain. In the lumbar spine, it can push on the sciatic nerve, leading to sciatica. Wrist problems tend to develop slowly, unlike many other yoga injuries in the knee or back. Compression of the median nerve is the principal cause of carpal tunnel syndrome (CTS). Wrist injuries can express themselves as a dull ache, and eventually sharper pain, as well as numbness and tingling in the hands, wrists, and/or forearms.
This section will illustrate some of the various injuries, along with listing some of the asanas that could lead to these injuries. These are just a few of the injuries and how they may present themselves. The alignment points mentioned below are only suggestions that can reduce the risk of an injury, and should not assumed that they will prevent an injury. There is no substitute for a trained and attentive yoga teacher, in addition to being attentive to one’s own body. The shoulder joint is a common point of injury due to its instability. Impingement syndrome (weightlifter’s shoulder) is when tendons become trapped under the acromion. The tendons become compressed, damaged, and inflamed leading to rotator cuff tendonitis.
The different rotator cuff muscles than can be strained or torn. Chaturanga is probably one of the most dangerous poses for the shoulder if constantly preformed incorrectly. This is also commonly performed many times during a session with repeated cycles of surya namaskar (sun salutations), especially when they are done quickly, which makes correct alignment more difficult to achieve. Allowing to elbows to bow out to the sides can place additional stress on the shoulder joint. Elbows must track in line with the wrists during chaturanga. In downward-facing dog (adho mukha svanasana) there must be external rotation in the arms, securing the humerus bone in the socket. The inside of the upper arm is facing slightly forward, while the wrist crease is parallel to the front edge of the mat. This same external rotation in addition to the elbow wrist alignment must also be present during chaturanga, adho muka vrksasana (hand stand), urdhva mukha svanasana (upward-facing dog), and urdhva dhanurasana/chakrasana (upward bow/wheel).
The knee is also a delicate joint, as being a hinge joint, it can only flex and extend. However, when the knee is bent, it can move slightly from side to side. The knee is equipped with medial and lateral menisci to cushion the knee if it bows inward or outward. Allowing the knee to bow inward or outward in standing asanas such as utthita parsvakonasana (extended side angle), parivrtta parsvakonasana (revolved side angle) virabhadrasana I or 2 (warrior poses), or utkatasana (chair pose). The knee must always track over the ankle and be centered (inline with middle toe) to avoid this injury. Correct alignment of the knee if the above standing asanas and transitioning to other asanas will also help prevent ligament tears. Also, pressing opposite foot on the knee joint or shin during Vrksasana (tree pose) can strain the menisci. A torn ACL, a common injury if the knee is torqued or consistently allowed to come forward of the ankle or toes in standing poses. Knee injuries are also common in Padmasana (lotus), when one pulls on the foot to force the pose, before there is enough opening in the hips to allow for the asana.
Due to the similar lordotic curve in both the cervical and lumbar spine, injuries to these areas are common with yoga. Forward bends in the cervical spine, asanas such as halasana (plow), salamba sarvangasana (shoulder stand), can lead to herniated discs in the neck. Once must try to maintain alignment in the cervical spine by supporting the shoulders with props if holding the pose for long periods of time. Similar injuries can also occur in the lumbar spine. Deep forward bends such as paschimottanasana (seated forward bend), uttanasana (standing forward bend), halasana (plow), or janu sirsasana (head-to-knee forward bend) can lead to disc herniations. One should never attempt the full versions of these poses until they have the openness and flexibility in the hamstrings.
Deep forward bends are also common causes of hamstring injuries. To avoid the common injury at the hip attachment of a complete hamstring tendon tear, sometimes call “yoga butt,” the hands or arms should never be used to force or pull the torso more deeply into the pose. Also, excessively arching the lower back (anterior pelvic tilt) in standing poses and during adho mukha svanasana (downward-facing dog) can also pull on the hamstring attachment.
The wrist, a small and delicate joint, is a common area for injury. Here, the medial nerve is compressed, which is the principal culprit of carpal tunnel syndrome (CTS). Those with small wrists and those who are overweight are at most risk of developing CTS. The poses most likely to bring on symptoms include adho mukha vrksasana (handstand), chaturanga, and urdhva dhanurasana/charkasana (upward bow/wheel); as all are weight-bearing with the wrist angled back. This injury can possibly be avoided with the external rotation of the humerus bone and placing the weight on the fingers and less on the base of the palm.
Some body types are more at risk of developing certain injuries. People with a great deal of openness and flexibility have greater elasticity in the ligaments surrounding joints, putting them at heightened risk of sprain injuries. These body types can also have more difficult remaining mindful and focused, as inattention to ones body is when an injury is more like to occur, especially transitioning to other asanas. It also feels good to “hang out” in your joints and enjoy the stretch. However, what they are doing is slowing increasing their risk of an injury. This also takes the work out of the pose as one is not using their muscles to contain the pose and maintain alignment.
Some people, due to muscle tightness, especially if they are driven to “create” an asana, or ignorance about alignment, can force themselves into asana that their body’s are not prepared for. Tightness of specific muscles (or other soft tissue such as fascia) can lead to compression of joints or tearing of muscle and other connective tissues. It takes a trained eye to identify misalignments and figure out what is causing them. This is why it is so important to work with a skilled and experienced teacher who watches and corrects one’s form. One concept I personally try to stress to my students is that a competitive and aggressive spirit is adverse to the true purpose of yoga and they must accept the body as it is in the present, and not allow the ego to prevent one from taking care of one’s body. In other words, the ego wants the body to do things they are not physically prepared to do, compromising the spine and other joints. Therefore, advanced poses such as adho mukha vrksasana (handstand) or urdhva dhanurasana/chakrasana (upward bow/wheel) should only be taught to advanced students who are skilled in their practice, and should be first taught with a strap above the elbows until students are confident they can perform the pose in proper alignment. Proper alignment is key to improving one’s practice, preventing injuries, and preventing re-injury. If entering a yoga class with an injury, or recovering from one, the student is 100% responsible in keeping oneself safe. Be sure to notify the teacher of any problem areas, while being mindful in the practice. Yoga is meant to bring happiness, allowing for the clearing of the mind, contentment, and love for your body, not pain and destruction.
- Namasté
Melanie Clark Mogavero, CSCS, RYT
References
Krucoff, C. (2003). Insight from Injury: If the practice of hatha yoga was meant to heal, why are so many yogis getting hurt? , retrieved November 8, 2008 from www.yogajournal.com.
http://health.allrefer.com/health, retrieved November 8, 2008.
www.eorthopod.com/public/patient_education, retrieved November 8, 2008.
www.cpsc.gov, retrieved November 8, 2008.
www.webmd.com/pain-management, retrieved November 8, 2008.
