Injuries in yoga
There is absolutely nothing wrong with talking about injuries in yoga. I have this conversation regularly. I’ve been writing about some of the most common injuries for a number of years now. Many students specifically sign up to practice with me BECAUSE they have an injury and are trying to figure out how to practice appropriately. I’ve been a bodyworker since 1998. As a bodyworker specifically dealing with injuries and/or chronic pain has significantly informed my teaching. No, I’m not a doctor, but I am a damned good investigator with critical thinking skills.
Figuring out injuries and how they came about is not always simple. Knowing what corrective measures to take is also not simple. It’s a series of educated guesses which require a very broad base of information and experience to get it right more often than not.
Why have a conversation about injuries?
This leads us to the “injuries in yoga” conversation. When an injury is presented in an article or post in a general way, I think we have to be very careful about how we frame our thoughts and understanding about what is being posted. We often have extremely limited information about what has happened, much less a realistic amount of history on the student who was injured. Without this, we are simply throwing around our personal biases and opinions based on a small amount of data.
This is a problem because it is unlikely to lead us to the place that these well intended conversations are trying to take us. I’ll just assume that most of these conversations are trying to take us to a place of inquiry about why we practice, how we practice, and/or how to prevent injuries from happening in the future. All of these are great questions to ask ourselves.
The current conversation
“Injuries in yoga” is all abuzz on social media. There is no doubt in my mind that generally raising awareness on this subject is positive. There is a sense in the yoga world that yoga is all healing, and therefore injuries either do not or should not happen. As a yoga community we are slowly but surely getting past this point. Let the conversation and awareness continue.
The “injuries in yoga” conversation was set off globally a few years ago with the William Broad article that came out in the NY Times. Unfortunately, that article angered a lot of people in the community. That was mostly because it seemed like the examples cited in the article were random, or not encompassing enough of the general experience of what asana has to offer. The latest conversations on social media are being initiated by Matthew Remski. I recently got sucked into the conversation myself.
Psychologically and experientially we know that doing asana brings us great benefit. It seems that whenever someone takes a swipe at the totality of the experience with just one aspect of practice (in this case injury), many people shut off to it, rather than look more closely and learn from the discussion.
Why injury in yoga is so complex
The truth is, we are complex beings and I mean that across all levels of our being. The pathology of injuries is also complex. How much do we need to know about a specific injury to be able to come to a respectable level of certainty of why it happened so that we can then make choices that reduce the risk of it happening again?
At some point we have to consider all of the factors that come together around an injury. It doesn’t make sense to isolate the injury. There are at least three things coming together: us, the injury itself, and the pose we’re doing.
Our converging histories
In my book Functional Anatomy of Yoga I refer to what we personally bring to the mat as “Converging Histories”. This is a term that I made up and so I’ll explain below what these “histories” include.
- Evolutionary History
- Being upright and on two legs creates a basic movement pattern.
- Genetic History
- Includes proportions, tendencies toward flexibility, stiffness, and other dispositions.
- Learned Parental History
- Who have we copied when we learned to move initially?
- Activity History
- Prior activities that we have explored deeply create neuromuscular patterns.
- Injury History
- Depending on circumstances, this could set us up for problems down the road.
- Spiritual/Emotional/Psychological Histories
- Covers things like; motivation, drive, approach, response, ability to focus, concentration, and objectivity.
These influences on who we are make us that much more complex as we try to decipher what is going on when someone injures him or herself. These influences make us unique by themselves. We all have different histories. Of course, we are also a lot alike.
Depending on your prior activities, you may or may not have the body awareness to classify sensations in the body. We all have different ways of experiencing sensations and some of us might call it pain. The sensation of stretching tissue to one person might be a good kind of pain, while a beginner might call that a bad pain. Our understanding of and relationship to the sensation seems to change our perception of whether it is good or bad.
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My friend, Mick Lawton created three categories for injury. Mick did the work for me on this one. Although I’m sure there is more to say on this aspect, this is a pretty good start for showing the complexity of injuries.
Types of injuries
1. There is the immediate injury that comes about by simply pushing beyond your limits.
2. Triggering / aggravating a known or unknown weakness.
3. Then there is the injury that comes about from constant, repetitive movements that can potentially lead to chronic issues
Now we could say that practicing with mindfulness will help prevent injury type 1. However, no matter how “mindful” the practice, we could still get injured because of unknown weakness (injury type 2) or hidden long term weakness created by repetitive movements (injury type 3). The whole thing becomes extremely complicated because injury type 3 can have an impact on injury types 1 and 2. Injury type 2 can have an impact on injury type 1. What I deduce from the above is that practicing with ‘mindfulness’ is only going to go part of the way in reducing injuries in yoga practice.
Practicing with mindfulness won’t from my experience, necessarily reduce injury type 3. Since injury type 3 feeds into injury types 2 and 1, I can only make the conclusion that practicing with mindfulness will not have a major impact on reducing injury.
Where do injuries come from?
I will also add that just because an injury shows up in asana, it doesn’t mean that it was initiated by the asana. If your lower back hurts and you go to a doctor and they find a bulge or herniation of your disc, the assumption is often that it happened during the practice. How do they know it wasn’t there already and that the asana practice revealed the existing problem?
I have seen this many times outside of the yoga world. Clients who started to exhibit pain in their back went for an MRI. The MRI revealed a disc issue. The assumption was then that the disc was the problem, and sometimes it was. But the only way to know for sure that it was the problem would be to have had an MRI from some time before the pain started to show itself. Injury and pain evolution is not as simple as we would like to think.
Then, there is the pose, or asana itself, which is a complex series of movements done at varying speeds and/or intensities. The asanas themselves come with a potential for bringing about positive changes to tissue and neuromuscular patterning. They also have the possibility of solidifying or compounding existing imbalances.
I believe there are a number of questions that we could ask about yoga asana in general that point out the complexity of injuries in yoga.
- Is it the method?
- Is it the repetitive nature?
- How long have you have been practicing for?
- How many days per week do you practice?
- What is your age?
- Is it your approach?
- What is it your drive and motivation?
- Is it bad teaching?
- Is it no teaching at all?
- Are you listening to yourself?
- Is it your anatomy?
When you mix all of these questions and factors together, your mind could start to go numb. How do we whittle this down into something graspable, measurable, systematized, organized, and reproducible?
When is it too many postures too soon?
One clear problem I have seen over the years is students moving too quickly through the process of asanas. Too much too quickly can be a significant problem. This is partly to do with a student’s mentality about achieving an asana and pushing too fast or too hard. It is also partly to do with the model of teaching that we have set up. We need/want students to come back so we may fall into the trap of giving them more than they can handle so that they feel like they are progressing. This is an article in and of itself. In this lies the problem with the current conversations. It seems almost impossible to factor in all of the subtle aspects of “us”, “injuries”, and “asana” and the varying ways they can converge.
The over-simplification of injuries in yoga
Because we are talking about injuries in yoga we have to factor in what we are really talking about, which is a movement based approach to developing concentration, awareness, physical fitness, energetic stimulation and many other things. This approach absolutely has great potential to lead us further down the path of being more of who we are. There is a difference between Yoga and asana. Asana is perhaps a technique of yoga practices, but asana itself is not necessarily Yoga.
We are doing asana in the West. Of course we should use what we know about the body, about injuries, about movement in both our practice and our teaching, especially if we are trying to avoid injuries in yoga practice. But that’s not the goal of asana, is it?
Asana as a physical therapy tries to bring balance to the person and their physicality. Working with students in a therapeutic way is different than those who are intentionally using the asana as a tool of personal development. Of course, there is overlap between the two. But what if you don’t have any physical injuries that you’re trying to rehabilitate?
Education in anatomy and/or biomechanics is certainly a starting place. However, knowing anatomy by itself isn’t really enough. What I’m getting at is that in this phase of the “yoga experiment”, it’s more important for us to be REALLY honest about what we know, and what we don’t know.
What are we learning from the yoga experiment?
I purposely refer to what is currently going on in the yoga world as a big experiment. I refer to it as an experiment because there is a proliferation of people doing yoga asana and yet we do NOT know what the outcome of that will truly be. It’s easy to say that we should simply apply western ideas of alignment or a western understanding of human movement.
Why is there resistance to this? Maybe it’s me, I sense the resistance in myself and I love anatomy. How do we use what we know, without destroying the part that has attracted us to practicing asana in the first place?
Why have we chosen yoga as a means to working with our body? I mean, at some point if we’re really talking about functional movement and fine tuning movements for the purpose of sculpting or balancing our body why even choose to do yoga? Why not go to a physical therapist or other movement therapist and work on balancing our body? At what point have we taken the Yoga out of a yoga asana practice?
Finding nuance in the yoga and injuries conversation
My biggest issue with the current discussions going on is the desire to make things measurable and compartmentalized. I know, there is no way around this. We have to talk about the parts and pieces to some degree so that we can understand it all. The place where this happens regularly is in the mixing of yoga and asana as if they are the same thing. In other words, just because you can put your leg behind your head or do more advanced asana doesn’t mean you are a more advanced yogi.
Mixing the two is often where people get upset, as if an injury is an affront to the yoga practice or as if by recognizing injuries in asana we are downplaying the larger idea of what yoga is.
However, I do believe that this is where William Broad went off the rails with the yoga community. It’s not fair, nor realistic to take some type of rare injury and hold it up as an example of injuries in yoga without creating a context. Whether intentional or not, and I believe it is NOT intentional, it leads to the belief that people are injured like this all the time, when they’re not.
But what are the actual numbers? While everyone is focused on the injury aspect of asana practice, what percentage of the practicing population is this? What classification of injury are we talking about? Are these minor strains and pulls? Do these injuries need surgery?
Are we going to frame these conversations in a way that proves our point and leans toward our existing bias? Likewise, are we going to pull the injury out of context and parade it around as if everyone is about to have the same injury? Are we going to live in denial of injuries in yoga all together?
Where are we going with this? What do we want from these conversations? I think as a community, we’d better figure this out. Regardless of your answer to the many questions raised, don’t shut down to the conversation as a whole. Remember that injuries don’t live in a vacuum and drawing conclusions from limited information is probably not helpful.