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.