What’s the Best Way to Work With Injured Students as a Yoga Teacher?

As a yoga therapist, I work with a lot of injured students. Many of my private clients come to me initially to see if yoga can help them manage the pain and discomfort of an injury or musculo-skeletal imbalance. Judging from the number of doctor’s referrals these days it seems that yoga is increasingly being seen as a valid and effective tool for helping people to manage their injuries – this is great news!

Yoga teachers are therefore increasingly being called upon to have a thorough understanding of anatomy, physiology and bio-mechanics and this can quickly start to feel a little overwhelming. It’s important to remember that as yoga teachers, we are not physiotherapists/chiropractors/osteopaths etc., and most likely do not have the level of depth and training that these professionals have, nor do we need to. This does not mean we can not be incredibly effective yoga teachers. Our expertise and skill-set is yoga, and yoga has been shown to have some incredibly powerful, unique and yet simple methods for helping us to address imbalance, injury and pain in the body. Below are some of the key things I try to keep in mind when working with an injured client:

 

Treat the cause not the diagnosis
As a yoga therapist it’s not our role to diagnose an injury and I often seek out other health professionals such as doctors or physios to confirm the exact nature of the injury. As yoga therapists this is perfectly fine as we’re not looking to treat the diagnosis, but rather to get to the root of the cause. For it’s in the cause that we can discover why someone got injured and therefore what steps can be taken both to heal the injury, but also ensure that it does’t reoccur. As such, yoga therapy is as much interested in prevention as cure.

 

Understand the role of the Koshas
One of the great advantages of yoga for injury rehab is that it seeks to understand the cause of someone’s injury from a number of different perspectives or levels, rather than just the physical.

In yoga therapy we work with a model called the Koshas, which suggests that we are composed of five layers (or sheaths) that resemble the structure of Russian dolls. These five sheaths are metaphorical rather than literal, and move from the most gross, tangible and outer aspects of who we are such as our physical body, to the ever more subtle, intangible and inner layers of our breath or energy flow, mind state, wisdom and spirit. These five sheaths are interrelated, and so discord or imbalance in one will lead to disharmony across all.

With this in mind, physical injury can be seen not only as discord in the outer physical body (called the Anamaya Kosha or food body) but also as a disruption within other Koshas. For example, injury might suggest a disruption of healthy energy (prana) flow, and certainly injuries can have an impact on our psycho-emotional state.

For this reason, as a yoga therapist, when I take a case history of someone’s injury I’m interested not only in someone’s medical history but also in factors such as their lifestyle, cultural and environmental influences, and even beliefs, thoughts and feelings they might have around their body and its perceived limitations/capabilities. All of these factors can give us a richer and more nuanced insight into the causes and consequences of their injury.

 

Look at the whole body
Yoga therapy is often interested in patterns and the connections between seemingly disparate parts of the body. It recognises that the site of pain or chronic injury is rarely the source of the problem rather we have to look further up and down the kinetic chain. For example, a chronic injury in the wrist may well have its roots in some sort of imbalance further up in the shoulder or neck. For this reason, one of the first things I tend to do with an injured student is review their posture and if appropriate, their gait. I might also get them to mimic for me their preferred way of sitting or standing to get an idea of their postural patterns throughout the day. Postural assessment can be an easy way to see musculo-skeletal imbalances in action, which will then give you a feel for where your focus needs to be during the yoga session.

 

Address imbalances between strength and flexibility
As Patanjali mentioned all those years ago in the Yoga Sutras, the key to a successful and sustainable yoga practice (and a healthy happy body) is by finding a balance between sthira (strength and stability) on the one hand and sukkha (ease and flexibility) on the other. Injury tends to occur when there is an imbalance – too much flexibility/pliability or too much rigidity/tension in the musculo-skeletal system. When an injured student comes to me we’ll often spend a fair amount of time trying to strengthen and stabilise the areas of the body that are weak or inhibited, and stretching out or releasing the areas that are short and tight.
Although this seems like common sense it amazes me how often people don’t seem to realise that yoga is every bit as much about strength as it is about flexibility and increasing range of motion. In fact it requires a lot of strength to safely sustain big ranges of motion – the more flexible you are, the more you’ll need stability work.

 

Check in with the breath
Exploring and working with the breath is fertile ground for the yoga therapist because breath is a mirror for both the state of our nervous system and our mental and emotional landscape. Getting injured and being in pain is often a stressful event, particularly if the injury is preventing someone from doing their normal daily activities or from playing their favourite sports. There may be all sorts of related fears associated with being injured, such as worries that the injury won’t go away or concerns about the financial costs of getting it fixed. All of these factors can exacerbate our feelings of stress, which typically leads to dysfunctional breathing patterns that further ignites the sympathetic nervous system, commonly known as the body’s fight-or-flight response.
This is one of the reasons that I often start a yoga therapy session with teaching students how to breathe using the diaphragm. The diaphragm muscle that spreads across the bottom of the rib-cage innervates with the vagus nerve, which in turn stimulates the parasympathetic or rest-and-digest part of our nervous system. This is not only essential for helping our body to restore and repair itself, but can be a great gateway to soothing and settling the mind and emotions.

 

Befriending the body
When we get injured it can sometimes feel like our bodies are working against us. Feelings of inadequacy, fragility, frustration and hopelessness can lead to a fractured and dysfunctional body image. One of the key things I hope to offer students is an opportunity to befriend their bodies, and to see themselves as so much bigger than their injury. The model of the Koshas reminds us that we are so much more than just the muscles, bones and connective tissue of our physical body. Learning to view our injuries with a greater level of friendliness, compassionate curiosity and kindness is like a healing balm that can go a long way on our journey back towards health and wellbeing.

The Art of a Safe Sustainable Yoga Practice – Part 2

In the previous post I discussed some of the key factors that I believe can predispose a student to getting injured during practice. These included conditions such as practicing with speed and momentum, not paying attention and allowing Type A personality traits such as competitiveness and striving to remain unchecked on the mat.In this post I want to dive a little deeper into some of the qualities and conditions we need to cultivate in order to keep our practice safe. In short, how do we create a safe sustainable yoga practice?

 

Learn and honour your body’s biomechanics

There are important ‘best practices’ when it comes to elements of postural alignment which we would do well to honour when it comes to maintaining a safe yoga practice. For example, the knee joint is a synovial hinge joint – its main function is to flex (bend) and extend (straighten) the leg. There is a small amount of lateral (side-to-side) range of motion but it is limited, and generally to keep the knee joint and surrounding tissues healthy it’s wise to avoid too much of this side-to-side movement. You may be familiar with this idea in poses such as Warrior 2, where the teacher tells you to keep your bent knee pointing in the same direction as your 2nd/3rd toes. If you allow the bent knee to drift inwards as it often wants to do, you risk damaging ligamentous tissue and the inner meniscus of the knee.

 

Another important alignment principle you might be familiar with is to ensure that the front heads of the shoulders don’t droop towards the floor in poses like chaturanga. If allowed to do so this can put excessive strain on the front capsule of the shoulder leading to strain and injury.

 

Whilst I appreciate not everyone is an anatomy geek, knowledge is power and it’s a good idea to educate yourself and become familiar with your body’s natural biomechanics in order to keep yourself safe and injury-free.  If you do feel pain in any yoga poses this should not be a case of ‘no pain no gain’.  Instead it is a likely result of increased load on certain structures or muscles, which should not be taking the brunt of the pose.  If you are feeling pain within your practice, ensure that you address this with your teacher or health professional with an understanding of injury and biomechanics.

 

Cultivate a ‘flow’ state

It’s all too easy to get stuck in a rut with yoga practice, to find yourself going through the motions and slipping into autoilot. In many ways from an evolutionary perspective, autopilot allows us to get a lot of amazing things done with relatively little effort or brain capacity. Think about driving your car – when you first learn to drive, you have to think about every action, but as you become more familiar with driving the whole process becomes more seamless and fluid. In fact this sense of effortlessness is often something we’re told to seek in our yoga practice and is often considered a marker of a more ‘advanced’ practice. To me however there’s a troubling link between autopilot and injury.

 

Research done into the ‘flow state’ – that wonderful place of presence where we are wholly absorbed and immersed in what we are doing – shows that optimal performance occurs in the meeting point between our abilities and difficulty level. This correlates with Patanjali’s words of advice ‘sthiram sukkham asanam’ – the practice of asana should consist of the perfect balance between both effort and ease. If the yoga practice is too effortless, it’s all too easy for the mind to sink into lethargy and distraction. Too difficult and we tend to get frustrated and lose enthusiasm. Needless to say both ends of the spectrum leave us wide open and vulnerable to injury.

 

Therefore to stay present in your practice and out of autopilot find just the right level of challenge to keep your body and mind engaged. Introduce an element of novelty into your practice – try new transitions, explore different postures, add some other elements such as breathwork or meditation, practice with a different teacher and investigate another style of yoga. Not only will this keep your practice fresh and interesting but it will also make you less vulnerable to the kind of mistakes and injuries that mindless autopilot makes more likely.

 

Using breath as a barometer

There’s a reason yoga teachers keep harping on about the breath. Your breath is an incredible guide to the state of your nervous system, your mental and emotional realm, and to the level of physical intensity you’re experiencing.

 

One of the things that I think it’s helpful to clear up is that your breath will and should change during your yoga practice, depending on the physical demands you place on your body. I don’t believe it’s a particularly realistic or worthwhile endeavour to try to keep the breath the exact same pace, rate and depth throughout the entire practice. For example, your breathing will speed up most likely in backbends and high demand poses like arm balances, and your breath will probably slow down during forward bends and restorative postures. This is entirely normal, natural and to be explored and celebrated.

 

That said we are looking for a fluidity to the breathing experience, and any obvious strain in the breath can serve as a useful signal that we are straining and at risk of losing our equilibrium. One of the most common and potentially risky things I see in practice is when students hold their breath. This introduces an element of tension and stress in the body-mind as well as a reduction in sensitivity that makes it more likely we’ll overdo it in practice.  So if you’re ever in doubt as to whether you need to back off, check in with your breath it will tell everything you need to know.

 

Another cause of increased tension on the body is a prolonged and ‘forced exhale’.  Occasionally if your teacher is cuing breathing, their rhythm may not match your requirements, and you may end up straining to try and match the cues.  Try and ensure instead that you alter the breathing rate to one which does not feel forced or strained and instead use your teacher’s cuing as a guide of how to sync the movements and breath up.

 

Become your own teacher and practice alone sometimes

As a yoga teacher, I am so happy when a student says that they feel confident and equipped with enough knowledge and information to start supplementing their teacher-guided practice with practice at home.

 

If we’re always following somebody’s else’s instruction and guidance, we stunt our growth and capacity for tuning into our own needs.  The lack of verbal instruction in a self-guided home practice provides an experience of space and silence that opens up the possibility for hearing the voice of intuition more readily.  In this way our practice becomes a more honest and authentic representation of who we are, with none of the practice-as-performance mentality that can sometimes creep into a group class if left unchecked.

 

Ideally students are encouraged in class to develop their own level of discernment and inner listening skills so that they feel able to take what they learn in a group context into the privacy of their own practice to further explore and experiment with. From that place students become their own best teachers and to me not only is that a sign of an advanced and maturing practice, from an injury prevention perspective, its probably one of the most powerful practices you can do.

The Art of a Safe Sustainable Yoga Practice – Part 1

Yoga is well documented as being one of the safest forms of movement out there. Many students, like me, come to yoga looking for a way to help them manage and rehabilitate a pre-existing injury. Others of us use yoga to help prevent injury occurring in the first place – its no coincidence that many top athletes rave about yoga. That said, injuries sadly do occur in yoga and I’ve become fascinated with how and why injuries happen on the mat. More importantly, how does one cultivate a safe sustainable yoga practice?

In Part 1 of this article we’ll explore some of the factors that I believe may predispose you to injury during practice. In Part 2 we’ll then identify and explore the essential ingredients necessary for creating a safe and sustainable yoga practice.

 

Yoga and Injury Risk Factors

 

Type A personality

It’s sometimes said that whatever you bring on to the yoga mat is what you feed. Many of the traits typical to a Type A personality such as ambition, striving, perfectionism and competitiveness can get us into very hot water when bought into the yoga practice. These qualities create an underlying tone of aggression and pushiness that when left unchecked leave us vulnerable to injury because we are unwilling or unable to heed the body’s feedback and respect its boundaries.

 

I believe if we are honest about many of the injuries that we incur in yoga, we will see that a certain amount of egoism lies at their root. We were trying too hard and were too busy trying to get somewhere.

 

The antidote to this is we need to keep asking ourselves what is it we are ultimately seeking from this practice? What qualities are we looking to foster and grow? Is it really about getting into the splits or is this pose trying to teach us the greater lessons of humility, honesty and self-respect?

 

Speed and momentum

Movements done with momentum are some of the more risky manoeuvres because they lack the fine motor control and finesse that more controlled movements possess. Momentum usually implies speed which in turn means less control, again increasing the risk factor. Kicking into handstand therefore is always going to have a higher element of risk than pressing into handstand, particularly if the kick uses a large amount of momentum and swing.

 

When we move slowly on the other hand, we develop greater strength and we can identify more easily where strength may be lacking. This is one of the main reasons that I encourage students to learn to move slowly and steadily in their practice particularly during transitions. It’s no coincidence that injuries are more likely to occur when going into or out of a pose. Often we are so intent on getting from a to b, from trying to get somewhere, that we simply rush through the transition rather than regarding it as an intrinsic and meaningful part of the experience.

 

Inattentiveness

What makes yoga yoga and not simply Eastern calisthenics? I would argue that the whole foundation of yoga depends upon our ability to be present. Attention is a skill and a birthright – we’re all born with the ability to be present but we need to practice it regularly in order to maintain the habit. It is this awareness that transforms and elevates yoga from a simple stretch class to something more akin to a moving meditation. In terms of injury prevention, attentiveness is critical because it’s usually when we’re on autopilot and not paying attention that mistakes happen and injuries occur. When our minds are drifting off we often miss important cues from the teacher, and we’re much less tuned in to the feedback from our bodies and breath. Our ability to discern what we need in any given moment is compromised and we may not realise we’ve overdone it until it’s too late.

 

Ignorance

In this context ignorance has more to do with a lack of self-awareness than insufficient knowledge. In Patanjali’s Yoga Sutras ignorance is considered one of the key obstacles, or Kleshas, that lead to suffering along the yogic path. When it comes to injury prevention, the key to a safe and fulfilling yoga practice is to be honest about your current strengths and limitations and tailor the practice accordingly.

 

The physical yoga practice is really a lesson in finding and maintaining equilibrium. In each asana we practice to strike the perfect balance between strength and stability on the one hand, and softness, and flexibility on the other. If you have too much stability you can become rigid, tense and your joints lack appropriate range of motion. If you have too much flexibility and softness, then you lack the necessary support to maintain joint integrity and alignment.

 

We also commonly see a combination of these two presentations, where certain joints display increased movement, whilst those above and/or below remain stiff and unmoving.  This places the hypermobile joints at more risk of injury and the stiffer joints are predisposed to becoming pain generators due to the lack of movement.  We need to remain aware during practice to try and counterbalance between these extremes and allow for more even movement throughout the body.

 

Students therefore need to develop a certain level of self-awareness so that they can adapt the practice to their needs. Some practitioners need more strengthening; others need more lengthening and stretching. Often it’s more complex than that – one part of your body will need more stability, whilst another area will need more work to open up and create space. The important thing here is to know yourself. From that place of deeper understanding and humility, only then can you create a practice that will truly serve you.

 

 

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